Landmarks Preservation Commission application form, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form $f~ 10010 20 Premise Address: r_ cg St re e Block: Lj3 Residential 0VV Commercial 0 Name of Building: Lot: MixUseD 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 I J Yes

Visual inspection p esuizs: Facade: Inspected ebris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" 0>1' South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'v2tol' 0>1' East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%2to l' 0>1' West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Debris: , /Fine Layer No v~ible l 2 to 1' 0>1' Description: p•

Setbacks N/A ❑ Floor. Debris: 0 No Visible/Fine Layer 0 to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to V ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ V2 to V ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ Ma to 1' ❑ > 1'

Comments H

Date: o2 I 2/ /2002 Inspection by: Name: Agency: DE P Name: Agency: Y NYC-WTC 000112311