LI-14174_ATTACH I_CERT OF SEISMIC COMPLIANCE.pdf

SEISMIC FORM B

CERTIFICATE OF SEISMIC COMPLIANCE

EXISTING BUILDING

Date: __________

This affirms that ________________________ served as engineer in charge of the seismic evaluation of the building located at ______________________________________________.

The building has the following characteristics:

ASCE Building Type: No. of Stories: Approx. Area:

Building Design Code: Year of Design Code: Year of Construction:

I have evaluated this building at the Life Safety Performance Level as set forth in the ICSSC RP 8, Standards of Seismic Safety for Existing Federally Owned and Leased Buildings, using ASCE/SEI 31 methodology:

___Tier 1 Evaluation

___Tier 2 Evaluation

___Tier 3 Evaluation

___Other (please explain below)

Documentation of this evaluation must be attached to this Certificate.

On the basis of the building characteristics and to the extent permitted by this level of evaluation it is my opinion that subject Building (check one) does / does not meet the Life Safety Performance Level of

ICSSC RP 8.

Affix Stamp and Sign Here

Engineer’s Name:

Firm:

Address:

Telephone:

License No.:

License State:

Expiration Date:

Comments:

Attach: ASCE/SEI 31 Checklist(s) Structural, Nonstructural, and Geologic Site Hazards and Foundation