Building information form, 113 Nassau Street, 2002

NYC 9111 Public Portal Document

VVTC Visual Survey Form 1001ZS' Premise Address:

Block: t\1f AU ResidentialEl Commercial D -r Name of Building: Lot: I Mix Use 0 Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: FAX: Address: On Site C ct• 17 '~ ) ~~ Name: Telephone Number. Building Owner Management A tivities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed []Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up 0 Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑No ❑ No Visible/Fine Layer ❑'/a to l" 0>1" South ❑ N/A ❑Yes❑No ❑ No ViSible/Fine Layer ❑ Ya to 1" 0>1' East ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ % to 1" 0>1' West ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Ya to l" 0>1'

i

Roof

Debris: 0 No Visible /Fine Layer 44 to1" ❑>1" Description:

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 ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/:to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"

Comments

Date: ,/ ~ „/2002 Inspection by: Name: C.. L" Agency: ,_ Name: Agency:

NYC-WTC 000099104