Maine Historic Preservation Commission: Grants: Capital Needs Survey: Online Survey

Online Capital Needs Survey

PROPERTY INFORMATION

Property Name (REQUIRED)

Address:

City:

Zip code:

County:

Property Type:

Other:

Is the property listed in the National Register of Historic Places?: Yes No

Date listed:
(If No, please complete a National Register Information Request form available from MHPC.)

Property Ownder

Name:

Address:

City:

State:

Zip code:

Phone:

Email:

Name:

Ownership:

Principal Contact:

Address:

City:

Zip code:

County:

Phone:

Fax:

Email:

Website:

RESPONDANT INFORMATION (If different from above.)

Name:

Organization:

Address:

City:

County:

Zip code:

Phone:

Fax:

Email:

Website:

DESCRIPTION OF CAPITAL NEEDS

Please identify the preservation and repair work that needs to be addressed at your historic property by checking all appropriate boxes. Prioritize the capital needs of your historic property, with (1) being the most immediate need and provide an estimated cost for the work.

Area of Need (check all that apply)			Est Cost
Drainage Maintenance/Repair			$
gutters	downspouts	perimeter drains
grading at building	vegetation removal	dry wells, swales
roof			$
roofing material	flashing	cupolas
chimneys	lightning protection	cresting or finials
Exterior Walls Maintenance / Repair			$
siding	painting walls, trim	remove synthetic siding
masonry repointing	windows	doors
cornice, trim	storm windows	porches
Structural Maintenance / Repair			$
foundation	posts / footings	framing: sills, trusses
tower framing	masonry piers	buttresses or arches
interior			$
finishes	plaster repair	historic fixtures
heating	electrical	plumbing
hazardous materials abatement
Accessibility and Barrier Removal			$
exterior access	interior access	lift or elevator
path of travel	bathroom	hardware
Archaeological Site Preservation			$
legal protection	physical protection	site stabilization
documentation	artifact conservation	intensive survey
Cultural Landscape Preservation / Restoration			$
paths, trails	vistas	gardens
plantings/trees	site stabilization	constructed elements
Other			$
Other Comments

Total Cost $			$

List all relevant reports, including Conservation Assessment Program (CAP) reports, Historic Structure Reports (HSR), Cultural Landscape Reports, Archaeological Surveys or other condition assessments for the subject historic property, and the date when they were completed.

Please answer the following questions as applicable to the historic property:

Annual Visitation Total:

Annual Visitation In-state:

Annual Visitation On-of-state:

Do you have an endowment or trust fund that supports the maintenance of the property? : Yes No

If yes, how large is the account?:

What are your annual operating expenses for this property?:

Does this property have a current Emergency Response Plan? : Yes No

Use the space below for any additional comments:

Thank you for your help!

Maine Historic Preservation Commission,
55 Capitol Street, State House Station 65,
Augusta, Maine 04333-0065
Phone (207) 287-2132
Fax (207) 287-2335

AGENCY INFORMATION

Online Capital Needs Survey

PROPERTY INFORMATION

Please answer the following questions as applicable to the historic property: