NYC-WTC_000220223

NYC 9/11 Public Portal Document

I DETAILED BUILDING EVALUATION SAFETY ASSESSMENT FORM Page 2 e Sketch (optional) Provide a sketch of the building or damaged portions. Indicate damage points

Estimated Building Damage If requested by the jurisdiction. estimate building damage (repair cost / replacement cost. excluding contents).

D None □ 0-1% 53 1-10* □ 10-30% □ 30-60% □ 60-100% □ 100%

RATING If there is an existing rating from a previous evaluation, check the appropriate box. EJ restricted - Stuctural □ UNSAFE - Structural Inspector ID I Previous rating: ® INSPECTED RESTRICTED - Collateral ® UNSAFE - Collateral Date ! If necessary, revise the rating based on the new evaluation and team judgement SEVERE conditions endangering the overall building are grounds for an UNSAFE rating. Local SEVERE and overall MODERATE conditions may allow a RESTRICTED USE rating. Indicate the current rating below and at the top of page one. □ RESTRICTED USE - Structural □ UNSAFE - Structural □ INSPECTED RESTRICTED USE - Collateral □ UNSAFE - Collateral

Record any use and entry restrictions:

FURTHER ACTIONS Check boxes below only if further actions are needed. rj Barricades needed in the following areas: ______________________________________

O Detailed Evaluation recommended: Q Structural O Geotechnical O Other:, Q Other recommendations:_________________________________ _

COMMENTS: /

CITY_21MC100_002833739

NYC-WTC_000220225