Lincoln Highway Historic Property Survey Form

Lincoln Highway Historic Property Survey
Year of Survey 2023

Thank you for participating in this statewide survey project to assess the condition of historic properties within the Lincoln Highway corridor. Knowing where the needs are, we will be more effective in providing assistance to property owners who request it. The information you provide will be kept confidential and not shared without your permission.

Please reply to the questions below:

Property name (if applicable)

Property address *

Address Line 1

Address Line 2

City

State

Zip Code

What best describes your role regarding the property? (select all that apply)

Owner
Tenant
Local official
Community member

Other role/s (explain)

How is the building being used? (select all that apply)

Residential
Commercial
Nonprofit
Vacant

Other use/s (explain)

What is the overall condition of the building(s) on this property? (select one)

Good
Fair
Poor

d. Briefly explain your answer

What is your assessment of each of the following to the best of your knowledge?

	Good	Fair	Needs Major Improvement	Unknown	Not Applicable
Exterior siding	GoodExterior siding Good	FairExterior siding Fair	Needs Major ImprovementExterior siding Needs Major Improvement	UnknownExterior siding Unknown	Not ApplicableExterior siding Not Applicable
Exterior paint	GoodExterior paint Good	FairExterior paint Fair	Needs Major ImprovementExterior paint Needs Major Improvement	UnknownExterior paint Unknown	Not ApplicableExterior paint Not Applicable
Foundation/basement	GoodFoundation/basement Good	FairFoundation/basement Fair	Needs Major ImprovementFoundation/basement Needs Major Improvement	UnknownFoundation/basement Unknown	Not ApplicableFoundation/basement Not Applicable
Roof	GoodRoof Good	FairRoof Fair	Needs Major ImprovementRoof Needs Major Improvement	UnknownRoof Unknown	Not ApplicableRoof Not Applicable
Porches	GoodPorches Good	FairPorches Fair	Needs Major ImprovementPorches Needs Major Improvement	UnknownPorches Unknown	Not ApplicablePorches Not Applicable
Exterior lights	GoodExterior lights Good	FairExterior lights Fair	Needs Major ImprovementExterior lights Needs Major Improvement	UnknownExterior lights Unknown	Not ApplicableExterior lights Not Applicable
Sidewalks/driveway	GoodSidewalks/driveway Good	FairSidewalks/driveway Fair	Needs Major ImprovementSidewalks/driveway Needs Major Improvement	UnknownSidewalks/driveway Unknown	Not ApplicableSidewalks/driveway Not Applicable
Windows	GoodWindows Good	FairWindows Fair	Needs Major ImprovementWindows Needs Major Improvement	UnknownWindows Unknown	Not ApplicableWindows Not Applicable
Interior walls	GoodInterior walls Good	FairInterior walls Fair	Needs Major ImprovementInterior walls Needs Major Improvement	UnknownInterior walls Unknown	Not ApplicableInterior walls Not Applicable
Interior paint	GoodInterior paint Good	FairInterior paint Fair	Needs Major ImprovementInterior paint Needs Major Improvement	UnknownInterior paint Unknown	Not ApplicableInterior paint Not Applicable
Interior ceilings	GoodInterior ceilings Good	FairInterior ceilings Fair	Needs Major ImprovementInterior ceilings Needs Major Improvement	UnknownInterior ceilings Unknown	Not ApplicableInterior ceilings Not Applicable
Interior floors	GoodInterior floors Good	FairInterior floors Fair	Needs Major ImprovementInterior floors Needs Major Improvement	UnknownInterior floors Unknown	Not ApplicableInterior floors Not Applicable
Electrical wiring	GoodElectrical wiring Good	FairElectrical wiring Fair	Needs Major ImprovementElectrical wiring Needs Major Improvement	UnknownElectrical wiring Unknown	Not ApplicableElectrical wiring Not Applicable
Interior lights	GoodInterior lights Good	FairInterior lights Fair	Needs Major ImprovementInterior lights Needs Major Improvement	UnknownInterior lights Unknown	Not ApplicableInterior lights Not Applicable
Fireplaces	GoodFireplaces Good	FairFireplaces Fair	Needs Major ImprovementFireplaces Needs Major Improvement	UnknownFireplaces Unknown	Not ApplicableFireplaces Not Applicable
Air conditioning	GoodAir conditioning Good	FairAir conditioning Fair	Needs Major ImprovementAir conditioning Needs Major Improvement	UnknownAir conditioning Unknown	Not ApplicableAir conditioning Not Applicable
Plumbing	GoodPlumbing Good	FairPlumbing Fair	Needs Major ImprovementPlumbing Needs Major Improvement	UnknownPlumbing Unknown	Not ApplicablePlumbing Not Applicable

Other assessments, comments or suggestions

Rate the following risks that might threaten the structure:

	Low risk	Moderate risk	High risk	Unknown	Not Applicable
Deterioration	Low riskDeterioration Low risk	Moderate riskDeterioration Moderate risk	High riskDeterioration High risk	UnknownDeterioration Unknown	Not ApplicableDeterioration Not Applicable
Fire	Low riskFire Low risk	Moderate riskFire Moderate risk	High riskFire High risk	UnknownFire Unknown	Not ApplicableFire Not Applicable
Pests	Low riskPests Low risk	Moderate riskPests Moderate risk	High riskPests High risk	UnknownPests Unknown	Not ApplicablePests Not Applicable
Demolition	Low riskDemolition Low risk	Moderate riskDemolition Moderate risk	High riskDemolition High risk	UnknownDemolition Unknown	Not ApplicableDemolition Not Applicable
Vandalism	Low riskVandalism Low risk	Moderate riskVandalism Moderate risk	High riskVandalism High risk	UnknownVandalism Unknown	Not ApplicableVandalism Not Applicable
Natural hazards, such as weather	Low riskNatural hazards, such as weather Low risk	Moderate riskNatural hazards, such as weather Moderate risk	High riskNatural hazards, such as weather High risk	UnknownNatural hazards, such as weather Unknown	Not ApplicableNatural hazards, such as weather Not Applicable

Other Risks, additional comments or suggestions

Respondent Name *

First

Last

Respondent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Respondent Email *

Respondent Phone *

As a token of our appreciation for your participation, we would like to send you four vintage-style Lincoln-Highway-themed postcards. *

Yes. please send my postcards.
No, I do not want the postcards.

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