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HomeMy WebLinkAboutApplication for Landmark Designation HISTORIC PRESERVATION COMMISSION SOUTHOLD TOWN APPLICATION FOR LISTING ON THE SO[ITHOLD TOWN RFGISTFR OF DESIGNATED LANDMARKS BUILDING-STRUCTURE INVENTORY FORM DATE: OWNER'S/SPONSOR'S NAME: ADDRESS: CITY/STATE/ZIP: PHONE: ORGANIZATION (If any): IDENTIFICATION 1. Building Name (How commonly identified): 2. Address: 3. County: Town: Village: 4. County Tax Map Number: Section: Block Lot ( 5. Ownership: a. Public b. Private 6. Present Occupant: 7. Use: Original: Present: 8. -Accessibility to Public: Exterior visible from public road: _Yes _No Interior accessible: (Explain, i.e. By appointment) DESCRIPTION 1. Building Materials: a. —Shingles b. _Clapboards c. _Stone d. _Bricks e._Stucco f._Board and Batten 2. Structural System: a.—Wood frame b. _Masonry load bearing walls C. _Metal d. _Other 3. Condition: a._ Excellent b. _Good c. _Fair d. _Deteriorated 4. Integrity: a._On original site b. _Moved If so, when? c. List major alterations and dates, if known: . RELATED OUTBUILDINGS AND PROPERTY a. _Barn b. —Carriage House c. _Garage d. _Privy e. _Shed f. _ Greenhouse g. _Shop h. —Gardens i. _Fence j. _Landscape Features k. _Other (Explain): THREATS TO BUILDING a. —None Known b. _Zoning c. _Roads d. _Developers e. —Deterioration f. _Other (Explain) . a✓ ` 2 OTHER NOTABLE FEATURES OF BUILDING AND SITE(including interior features, if known; indicate if building or structure is in an historic district): SIGNIFICANCE 1. Date(s) of Initial Construction and Major Alterations, if any: 2. Architect: 3. Builder: 4. Historical and Architectural Importance, i.e. famous residents, special events took place, etc. 5. Is structure, place or site presently on any historic register that you know of? If so, which one(s) and on what date (s)? MISCELLANEOUS DATA In your estimation, why should this property be designated a Southold Town Landmark? SOURCES OF INFORMATION(Individuals other than owner/applicant, maps, etc.): Attach photos of facades of building/structure/site visible from a public street as well as of significant interior features, i.e. fireplaces, mantles, stairs, etc. as appropriate. Attach Survey Map or Sketch of Location. AGREEMENT It is understood that by the riling of this application,and following the inspection and evaluation of the property recommended for landmark status, that you are requesting the services of the Southold Town Historic Preservation Commission to help you conserve,protect and preserve your historic property. Neither the Commission nor the Town has fiduciary responsibilities for any recommendations it might make to you to accomplish these conservation goals. The Commission's recommendations to you are not binding, but non-conformance with these recommendations could result in denial or revocation of Southold Town landmark status. Signature (s) of Applicant(s): Date: Forward completed application with required attachments to Southold Town Historic Preservation Commission, Town Hall, P.O. Box 1179, Southold, NY 11971 APPLICATION FOR LISTING ON THE SOUTHOLD TOWN REGISTER OF DESIGNATED LANDMARKS TRANSMITTAL/ROUTING SHEET FOR BUILDING-STRUCTURE IAIVENTORY FORM (For Office Use Only) 1. Date Received: 2. Date Initially Reviewed by Commission: 3. Date Scheduled for Inspection: 4. Date Inspected: 5. Inspection Team: 6. Comments of Inspection Team: 7. Recommendation: 8. Date of Final Review by Commission: 9. Action: Approved Denied Date Submitted to Town Clerk for Official Notice: 10. Date Applicant Notified: 11. Date Plaque Presented at Meeting of Town Board: