Unless indicated below, this is a transcript of the original Society for the Preservation of Long Island Antiquities/Town of Brookhaven survey form. Since most of the surveys were conducted in the late 1970’s and early 1980’s, much of the information reflects that time period.

Corrections to obvious typographical and spelling errors have been made. Corrections to factual errors in the original surveys, and updates or comments on the information are either enclosed in [square brackets], or are clearly indicated as updated material from the context of the comments.

Sites with an Inventory Code suffix of “S” are supplemental sites not included in the original surveys.

BUILDING-STRUCTURE INVENTORY FORM

 If checked, this is a Supplemental Form, not in the original surveys.

Inventory Code:   ?InventoryCode=Br29C 
Prepared Date:   1970-01-01 
Last Modified:   1970-01-01 
Original Submitter
Submitter Name:  
Submitter Address:  

,  
Organization:  
Identification
1-Building/Site Name:    
2a-County:       2b-Town:       2c-Village:  
3-Street Location:    
Ownership
 4a-Public    4b-Private
5a-Present Owner:    5b-Address:   
Use

6a-Original:   

6b-Present:   

Accessibility
 7a-Visible From Road

 7b-Interior Accessible
7b-Interior Comment:   
Building Materials
 8a-Clapboard

 8b-Stone

 8c-Brick

 8d-Board & Batten

 8e-Cobblestone

 8f-Shingles

 8g-Stucco
8-Other:   
Structural System
 9a-Wood Frame Interlocking Joints    9b-Wood Frame Light Members:   9c-Masonry:
 9d-Metal
9d-Metal Comment:   
 9e-Other
 9e-Other Comment:   
Condition
   10a-Excellent   10b-Good   10c-Fair    10d-Deteriorated
Integrity
  11a-Original Site  11b-Moved If so, when?
11c-Alterations:    «»
Photo & Map
12-Photo Photos and images
13-Map
Threats
[Threats were not evaluated in the original South Shore Estuary Survey.  They are an evaluation by J. Deitz]
  14a-None Known:   14b-Zoning   14c-Roads
  14d-Developers   14e-Deterioration
14f-Other:   
14-Comment:   
Related Outbuildings and Property
 15a-Barn  15b-Carriage House  15c-Garage
 15d-Privy  15e-Shed   15f-Greenhouse
 15g-Shop  15h-Gardens   15i-Landscape Features
15i-Landscape Features:   
15j-Other:   
15-Comment:   
Surroundings of the Building
 16a-Open Land  16b-Woodland  16c-Scattered Bldgs.
 16d-Densely Built-up  16e-Commercial  16f-Industrial
 16g-Residential 16h-Other:   
Interrelationship of Building and Surroundings
17-Interrelationships:    
Other Notable Features of Building and Site
18-Notable Features:      «»
Significance
19-Initial Const Date:    
19-Architect:  
19-Builder:  
Historic and Architectural Importance
20-Importance:    «»
Sources
21-Sources: «»
Theme
22-Theme:    
Prepared By: 
   
Supplemental Material: