WTC building assessment form, facade and structural inspection

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 95 4

Block: Residential Comme al 0 Name of Building: Lot: Mix Use ❑ 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yato l" 0>1" South ❑ N/A "Yes ❑ No ❑ No Visible/Fine Layer Alto 1" D> 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" Facade Description: ?"z.,._ ww,.Cic,..s

Roof •

•1 •{,_4. Debris: ❑ No Visible /Fine Layer ~"/z to 1".I :. 0>1" Description:

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

Comments

Date: 7,_I 12002 Inspection Team: Name: Agency: Name: Agency: e NTERE

NYC-WTC 000100495