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N E W Y O R K S T A T E H O U S I N G F I N A N C E A G E N C Y - page 5 / 6

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5 / 6

FOR OFFICE USE ONLY

UNIQUE SITE NO.                                       

QUAD                                                            

SERIES                                                          

NEG. NO.                                                      

BUILDING STRUCTURE INVENTORY FORM

NYS OFFICE OF PARKS, RECREATION

   & HISTORIC PRESERVATION

DIVISION FOR HISTORIC PRESERVATION

(518) 237-8643

YOUR NAME:                                                                               DATE: ________________________________           

YOUR ADDRESS:                                                                         TELEPHONE:  ________________________                                                                                                       

ORGANIZATION (if any):  __________________________________________________________________                                                                                                                           

*   *   *   *   *   *   *    *   *   *   *  *  *   *   *   *   *    *   *   *   *   *   *   *   *   *   *   *  *   *   *   *   *   *   *    *     

IDENTIFICATION

1.  BUILDING NAME(S):__________________________________________________________________                                                                                                                                           

2.  COUNTY:                                        TOWN/CITY:                                    VILLAGE:______________                          

3.  STREET LOCATION:__________________________________________________________________                                                                                                                                             

4.  OWNERSHIP:       a.  public              b.  private    

5.  PRESENT OWNER:                                                                   ADDRESS:  ________________________                                                       

6.  USE:   Original:                                                                   Present:  _______________________________                                                                     

7.  ACCESSIBILITY TO PUBLIC:Exterior visible from public road:  Yes     No    

Interior accessible: Explain ______________________________________________________  

8.  BUILDING

    MATERIAL:              a. clapboard      b. stone         c. brick        d. board and batten

                                   e. cobblestone      f. shingles      g. stucco          other:

    BUILDING

    SYSTEM:                             

9.  STRUCTURAL                                        a. wood frame with interlocking joints

  b. wood frame with light members

  c.  masonry load bearing walls

  d.  metal (explain)                                                                                                      e.  _____________________________                                                           

10. CONDITION:            a.  excellent          b. good       c. fair       d. deteriorated    

11.  INTEGRITY:        .   original site       b. moved    If so, when? : _________________                

HFA Form 1510/14

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