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Inspection •
Inspector ID: BS1 / MAC! Inspection date and time: /1 /14 L: vU ❑ AM ISI
Affiliation: CS TY Q F 7 G AP i Areas inspected: Of Exterior only ❑ Exterior and interior
Building Description Type of Construction
Building name: PAC. 7/214 7' ❑ Wood frame ❑ Concrete shear wall
Address: 1s r:L — j :i 7JS &■1 7? Ai L Ai /t ❑ Steel frame ❑ Unreinforced masonry
Tilt -up concrete ❑ Reinforced masonry
❑ Concrete frame ❑ Other:
Building contactlphone:
Number of stories above ground: / below ground: Primary Occupancy
Approx. "Footprint area (square feet): 4).0,4700 0 Dwelling Commercial 0 Government
❑ Other residential ❑ Offices ❑ Historic
Number of residential units: ❑ Public assembly f]. Industrial ❑ School
Number of residential units not habitable: ❑ Emergency services ❑ Other:
Evaluation Estimated Building Damage
Investigate the building for the conditions below and check the appropriate column. (excluding contents)
Observed Conditions: Minor /None Moderate Severe ❑ None
Collapse, partial collapse, or building off foundation ❑ ❑ I ❑ 0 -1 %
Building or story leaning ❑ ❑ ❑ ❑ 1 -10%
Racking damage to walls, other structural damage ❑ ❑ ❑ ❑ 10 -30%
Chimney, parapet, or other falling hazard ❑ ❑ ❑ 21 30 -60%
Ground slope movement or cracking ❑ ❑ ❑ ❑ 60 -100%
Other (specify) ❑ ❑ ❑ ❑ 100%
Comments: '. c.k . , ,J r ► —nl L f Aka r34 EN) O ';,E ,a 14.4
('[•1 tA��� 17 ratz.vL bAC-.L 714 AM .
Posting
Choose a posting based on the evaluation and team judgment. Severe conditions endangering the overall building are grounds for
an Unsafe posting. Localized Severe and overall Moderate conditions may allow a Restricted Use posting. Post INSPECTED
placard at main entrance. Post RESTRICTED USE and UNSAFE placards at all entrances.
❑ INSPECTED (Green placard) ❑ RESTRICTED USE (Yellow placard) RKINSAFE (Red placard)
Record any use and entry restrictions exactly as written on placard: S A T_r Ai . ST2�1: _ Tt-t r F
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Further Actions Check the boxes below only if further actions are needed.
❑ Barricades needed in the following areas:
Detailed Evaluation recommended: 'Structural ❑ Geotechnical ❑ Other:
❑ Other recommendations:
Comments: eOf'11 I& 5-rgA4 - r t4/AL &VA L 4LAT3'c7AJ LGitA A S .
o Copyright 1995.07. Applied Technology Council.
Permission is granted for unlimited : non- exclusive. non-commercial use and distribution of ATC evaluation forms, provided that this Copyright Notice appears on all copies and the Applied
Technology Council name shall not be used in any advertising or publicity of Licensee product. Permission is further subject to the following conditions: (1) Licensee does not reprint. repackage
or offer this form for sale or license ;and 121 no material gain or financial profit is to be made from any sate w license of this form. Placards may be used without restrictions for their intended use
as building postings. All rights not specifically granted to Licensee are herein reserved by ATC.
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