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A M~mOV or Nr Nivo NoOM Ony <br /> <br />(~;r <br />CLIENT: ' ~.~ r C, ~ L N !; l.~ j J TOWN: J r, ~ F L (7 jr t N C' C <br />JOB NO.: I ~ ~ S n C.' LI ~ INSPECTION NO.: <br />DATE: ~ ' ~ ~ , 19 ~ ~ SURVEY DONE: BEFORE ~I AFTER ^ <br />OWNER: , I)fIl is / l < 1 L' jL i~'1/~ (- ~'? . <br />DURING ^ <br />SHEET ~ OF <br />I <br />ADDRESS: Iii h X ~ I ~ ~ - } ( '? I C' // ~ C ~ /1( .7 . <br />OCCUPANT: ~ S /~ Nl ~. <br />ADDRESS: <br />OWNER'S REP:: ~ I ~ ~. L_ l- i• - /-'1 ,-~ /`. <br />ADDRESS: _ <br />^g <br />NAME OF W31 <br />(SEE LIST ^) <br />/ ~ ^~ ~ AGE 6F~9H+t9IN6s / ~ YRS. <br />TYPE OF OCCUPANCY: BASEMENT: <br />YES ^ NO ^ <br />LENGTH ? 1 FT. WIDTH_;rGT. HEIGHT FT. NUMBER OF STORIES <br />I <br />STRUCTURAL~FRAME: 5 I (% L L <br />Good ~ Avq. Poor <br />FOUNDATION: C.ONCRETE~CONCRETE BLOCKS ^ BR1Ck ^ OTHER ^ w ^ ^ <br />r~ER-oR-WAtL~r- ~f l/ ~ I~ n ~i~ ~ ~) ~ S i9 ~ I) L C S l /~` ^ ^ <br />ROOF: ^ ^ ^ <br />LOT SLOPE EROSION NEAR FOUNDATION WALL: YES ^ <br />i <br />BUILDING SETTLEMENT: YES ^ NO ^ WALL ALIGNMENT: <br />MAINROOF: DRAINAGE ADEQUATE <br />N ^ S ^ <br />BUILDING FACES: E.^ W ^ _ <br />I <br />ACCOMPANIE i BY: (REP. SIGNATURE) <br />I R~)EFUSED TO/SIGN ^ <br />INSPECTOR: I I, `;i~;N/~ t~~ L_ ~ ~ r APPROVED BY: _ <br />PICTURES ~ ~ ~ S / J ~ I/ ; ~. ! i ~ I. C <br />-~ NEV OF SYMBOLS <br />CRACK - <br />NAIL POP- NP <br />HAIRLINE-NL. <br />BUILDINQ - BLD <br />SUSPENDED TILE - 5T <br />ACOUSTICAL TILE - AT <br />NNYL TILE - VF <br />WOOD - WO <br />%~i <br />VME -NITRO CONSULT, INC. <br />FIELD REPORT <br />EXISTING STRUCTURAL CONDITIONS <br />YES ^ NO ^ <br />SEPARATION - SEP <br />BAD SEAM - BS <br />UNLEV EL CEI LINO - UC <br />CONCRETE BLOCK -CONC. BL <br />BRICK - BK <br />PANELING - PL <br />WALLPAPER - W- <br />`. <br />;, <br />UNLEV EL FLOORS - OF <br />BENT WALL - BW <br />SHEETROCK-SR <br />CARPET - C <br />FOUNDATION - FDN <br />BROKEN GLASS - BG <br />WATER STAINS - WS <br />NO ^ <br />N W _ <br />E O.K. <br />S <br />PLASTER - P <br />FIBERBOARD-FB <br />CONCRETE -CONC. <br />CRAZING - CR <br />SPALLING - SPL <br />PEELING PAINT - PP <br />