WTC Facade Inspection Form, 217 West Broadway

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: /

BI ':k: Residential Commercial Name of B I ing: Lot: y Mix Use 0 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 9 Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris 9>1. North South East 9 N/A ❑ N/A N/A 9 Yes ❑ No DYes ❑ No Yes ❑ No 9 No Visible/Fine Layer ❑ 3 to 1' 9 No Visible/Fine Layer No Visible/Fine Layer h to 1' % to 1' 0>1' H:0 1' West ] N/A 9 Yes ❑ No No Visible/Fine Layer 34 to 1' 9>1' Facade Description: ( _

Roof Debris: qiislbie Wine Layer 034 to 1' 9>1' Description:

Setbacks N/AI( Floor. Floor____ Floor____ 9 Debris: No Visible/Fine Layer Debris: No Visible/Fine Layer Debris: ❑ No Visible/Fine Layer % to 1' 34 to 1' 34 to 1' >1' >1' >1' Floor Debris: 0 No Visible/Fine Layer % to 1' >1' Floor Debris: ❑ No Visible/Fine Layer %e to 1' >1' Comments,

Date: ~I I 12002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000109706