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WTC building inspection form, 17 Ann Street, Oct 2001

Machine-extracted title · confidence 90%

Form recording facade and interior inspections for asbestos and air monitoring at a residential or commercial building.

NYC-WTC_000116457–000116458

Folder label: “17 ANN STREET 1001261, 90/23 BN# 1001261

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NYC 9/11 Public Portal Document

WTC Visual Survey Form . 10012.60 Premise Address: lg ANN sTREE-r Block: 9© Residential0 Commercial Name of Building: Lot: a Mix Use 0 Other 0 of Stories: AKA's: -r~-rera- AL-t.:cy u o Nvm 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 D No Locations: Copies of All Reports and Data Requested D Yes visual inspection Results: Facade: Inspected Debris North N/A Yes Q No No Visible/Fine Layer '%to1" 0>1". South N/A 9YesDNo No Visible/Fine Layer 334 to 1" 8>1" East 9 N/A 9 Yes ❑ No No Visible/Fine Layer % to 1" > 1" West 0 N/A DYes No Visible/Fine Layer 334 to 1" 9>1" Facade Description:

Roof

Debris: 0 No Visible /Fine Layer Ej 3§ to 1" '' "' 9>1" Description: oe6+~e~ianot we 1 %AOE FROM d)3 WAssr+& Sic AQ6 to & (c TW21WN StrE

Setbacks N/A D Floor:____ Debris: No Visible/Fine Layer 4 to 1" > 1" Floor.____ Debris: No Visible/Fine Layer 34 to 1" >1' Floor:____ Debris: No Visible/Fine Layer 4 to 1" '1' Floor. Debris: No Visible/Fine Layer % to V >V Floor:___ Debris: 0 No Vssible/Fine Lager 4 to 1" >1. Comments

Date: O 1 12002 inspection Team: Name: 'y A- / n-ozo Agency: 4'}C tQ_ Name: Agency:

1 NYC-WTC-000116458

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NYC-WTC_000116458Source: NYC Law Department, mirrored locally

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