DOT building operation permit, August 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercial ❑ Name of Building: Lot: Mix Use j I Other ❑ # of Stories: AKA's: Building Owner anagement: 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 Kesuits: Facade: Inspected Debris North N/A © Yes ❑ No ❑ No Visible/Fine Layer E]'/ to 1" 0>1" 0 South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑V2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V2 to 1" 0>1" Facade Description: ~ I~ ~ t:,i ~..~ [AJj N C'- H -c""'~ s & -i--

Roof

Debris: [] No Visible /Fine Layer ❑ %2 to 1" [1> 1" Description: j %c~rc

Setbacks N/A 0 Floor. Debris: ❑ No Visible/Fine Layer ❑%to1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer [:]'/2 to 1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer [j'/2 to 1" 0>1" Floor Debris: ❑ No Visible/Fine Layer ❑'/2to1" 0>1"

Comments

/ L /2002 Inspection Team: Name: AL Agency: Date: ' _Agency: Name: A), NYC-WTC 000127394