HomeMy WebLinkAboutBLD2007-00622 JEFFERSON COUNTY BUILDING DEPARTMENT ---4(-
379-4450 _ VO
RAPID EVALUATION SAFETY ASSESSMENT FORM
BUILDING DESCRIPTION OVERALL RATING: (Check One)
Owner's Name: r�►�L. -� 0 ( 1(�I�� 1.
Mailing Addr : P, S�o e„dro-„L wA INSPECTED (Green) 0
Phone °t'OSAtt' _ Exterior only —
Site Addr : '4 1,6' tt-t -x* Lb) _ Exterior & Interior
No. of Stories : LIMITED ENTRY (Yellow) —❑
Basement: Yes 0 No 0 Unk 0 UNSAFE (Red) L�
Section Township z Rage Z�
Parcel No. • (or)2.Z2D 40 v L INSPECTOR:
Inspector ID
Primary Occupancy: Dwelling ❑ Affiliation Sete ;�\-) GU. �0
Other Residential 0 Commercial ❑ Office 0 -
Industrial 0 Public Assembly 0 School 0 INSPECTION DATE:4 - \a,--Qi
Government 0 Emer. Serv. 0 Historic 0 Mo/day/year
Other Time ,..4t r;Lvv\ am pm
Instructions: Review structure for the conditions listed below. A "yes" answer to 1, 2, 3 or 5
is grounds for posting entire structure UNSAFE. If more review is needed, post LIMITED ENTRY.
A "yes" answer to 4 requires posting AREA UNSAFE and/or barricading around the hazard.
Hazards such as a toxic spill or an asbestos release are covered by 6 and are to be posted and/or
barricaded to indicate AREA UNSAFE.
More
Review
Condition Yes No Needed
1. Collapse, partial collapse, or buiding off foundation ❑ 0 0
2. Building or story noticably leaning 0 ❑
3. Severe racking of walls, obvious severe damage & distress 0 El 0
4. Chimney, parapet or other falling hazard - no co,t-,�. 0 0 ❑
5. Severe ground or slope movement present 0 B' 0
6. Other hazard present 0 0 0
Recommendations:
,-_ No further action required
O Detailed Evaluation required (circle one) Structural Geotechnical Other
O Barricades needed in the following areas:
❑ Other:
Posted at this Assessment: 21{Yes
Comments: -*kin lS -' GJ L _ J1./h cfCr, a/o/�p --j
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