Building operation permit stipulations for sidewalk work, August 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Bi1# I OO 121 Premise Address: IS TO n o - r

re e

Block: 7 Residential 0 Commercial p Name of Building: Lot Mix Use JJ Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: Telephone Number Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested ❑ Yes

visual inspection Kesults: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer I\i%tol" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer t111/2 to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer /2to1" 0>1" Facade Description:

Roof

Debris: Flo Visible /Fine Layer ❑ % to 1" ❑ > 1" Description: J W

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1' ❑ > 1'

Comments

Date: (9 / c)O/2002 Inspection by: Name: P1P Agency: P Name: Agency: I

NYC-WTC 000094290