INSPECTION COMMENCED Date:                                        

 

INSPECTION COMPLETED Date:                                      

 

 

INSPECTION MADE BY:                                                                 SIGNATURE:                                                                                   

 

PRINT NAME:                                                                                

 

TITLE:                                                                                              

 

 

 

 

ADDRESS:                                                                                      

 

 

  1.  DESCRIPTION OF STRUCTURE

 

a. Name on Title:

 

b. Street Address:

 

c. Legal Description:

 

d. Owner’s Name:

 

e. Owner’s Mailing Address:

 

f. Folio Number of Property on which Building is Located:

 

g. Building Code Occupancy Classification:

 

h. Present Use:

 

i. General Description:

 

Addition Comments:

 

 

j. Additions to original structure:

 

 

2. PRESENT CONDITION OF STRUCTURE

 

a. General alignment (Note: good, fair, poor, explain if significant)

 

1.   Bulging

 

2.   Settlement

 

3.   Deflections

 

4.   Expansion

 

5.   Contraction

 

b. Portion showing distress (Note, beams, columns, structural walls, floor, roofs, other)

 

c. Surface conditions – describe general conditions of finishes, noting cracking, spalling, peeling, signs of moisture penetration and stains.

 

d. Cracks – note location in significant members. Identify crack size as HAIRLINE if barely discernible; FINE if less than 1 mm in width; MEDIUM if between 1 and 2 mm width; WIDE if over 2 mm.

 

e. General extent of deterioration – cracking or spalling of concrete or masonry, oxidation of metals; rot or borer attack in wood.

 

f. Previous patching or repairs

 

g. Nature of present loading indicate residential, commercial, other estimate magnitude.

 

 

  

3. INSPECTIONS

a.   Date of notice of required inspection

 

b.   Date(s) of actual inspection

 

c.    Name and qualifications of individual submitting report:

 

d.   Description of laboratory or other formal testing, if required, rather than manual or visual procedures

 

e.   Structural repair-note appropriate line:

 

1.   None required

 

 

2.   Required (describe and indicate acceptance)

 

 

 

4. SUPPORTING DATA

 

a.                                                                              sheet written data b.                                                                              photographs

c.                                                                              drawings or sketches

 

 

5. MASONRY BEARING WALL = Indicate good, fair, poor on appropriate lines:

a. Concrete masonry units

 

b. Clay tile or terra cota units

 

c. Reinforced concrete tie columns

 

d. Reinforced concrete tie beams

 

e. Lintel

 

f. Other type bond beams

 

g. Masonry finishes -exterior

 

1.   Stucco

 

2.   Veneer

 

3.   Paint only

 

4.   Other (describe)

 

h. Masonry finishes - interior

 

1.   Vapor barrier

 

2.   Furring and plaster

 

3.   Paneling

 

4.   Paint only

 

5.   Other (describe)

 

i. Cracks

 

1.   Location – note beams, columns, other

 

2.   Description

 

j. Spalling

 

1.   Location – note beams, columns, other

 

2.   Description

 

k. Rebar corrosion-check appropriate line

 

1.   None visible

 

2.   Minor-patching will suffice

 

3.   Significant-but patching will suffice

 

4.   Significant-structural repairs required

 

 

l. Samples chipped out for examination in spall areas:

 

1.   No

 

2.   Yes – describe color, texture, aggregate, general quality

 

 

 

 

6. FLOOR AND ROOF SYSTEM

a. Roof

 

1.   Describe (flat, slope, type roofing, type roof deck, condition)

 

2.   Note water tanks, cooling towers, air conditioning equipment, signs, other heavy equipment and condition of support:

 

3.   Note types of drains and scuppers and condition:

 

b. Floor system(s)

 

1.   Describe (type of system framing, material, spans, condition)

 

 

c. Inspection – note exposed areas available for inspection, and where it was found necessary to open ceilings, etc. for inspection of typical framing members.

 

 

 

 

7. STEEL FRAMING SYSTEM

 

a. Description

 

b. Exposed Steel- describe condition of paint and degree of corrosion

 

c. Concrete or other fireproofing – note any cracking or spalling and note where any covering was removed for inspection

 

 

  

d. Elevator sheave beams and connections, and machine floor beams – note condition:

 

 

 

8. CONCRETE FRAMING SYSTEM

 

a. Full description of structural system

 

b. Cracking

 

1.   Not significant

 

2.   Location and description of members affected and type cracking

 

c. General condition

 

d. Rebar corrosion – check appropriate line

 

1.   None visible

 

2.   Location and description of members affected and type cracking

 

3.   Significant but patching will suffice

 

4.   Significant – structural repairs required (describe)

 

e. Samples chipped out in spall areas:

 

1.   No

 

2.   Yes, describe color, texture, aggregate, general quality: