WTC Building Inspection Form, 205 Pearl Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100112.1 Premise Address:

Block: g Residential 0 Commercial Name of Building: Lot: Mix UseJ Other # of Stores: AKA's: Building Owner/Management: Pry Telephone Number: (2) z) - 9 oos- Name: Anni ¢t y c a

FAX: (2 (2_) 437- 3 c/ Address: do e

IUD ► 2.- 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 ❑'/to1" 0>1- South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [:]'/ to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No Cg NQ-Visible/Fine Layer ❑%to T 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer X to 1" ❑ > 1" Description:

Setbacks N/A [, Floor. Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'Ato 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"

Comments

Date: -/ /2002 Inspection Team: Name: - Agency: Ike Name: Agency: Id

NYC-WTC-000115173