Concrete Coalition

Building Profile

The purpose of this form is to gather basic information on seismic evaluation and retrofit.

Contributor information
Name:		Willing to provide additional information? Yes No Maybe Explain
Firm:
Contact data:
email
telephone
Date Form Completed

Building information (Name, location, and owner may be omitted if necessary. Please provide zip code.)
Name:			Owner:
Location:
Zip code:			Other Identifier
Lat:	Long:
Date of original construction
Size:
gross area		sf
height above grade		ft
no. of stories above grade
no. of stories below grade
Functional use(s) - check all applicable
residential office commercial industrial government		medical education emergency services assembly other
Original design data:
Code:
Design drawings available?		Yes No
NEHRP building type - check all applicable
C1 C2 C2A C3 C3A		PC2 PC2A other
Vertical load carrying system(s) and components - check all applicable
flat slab one-way slab and beam two-way slab and beam pan-loist waffle		columns R/C bearing walls infill walls other
Lateral resisting system(s) and components - check all applicable
MR frame R/C walls infill walls		slab/column frame other
Foundations
isolated spreads mat piers/piles other

Evaluation
Criteria
FEMA 178 FEMA 310 FEMA 356/ASCE 41 linear		FEMA 356/ASCE 41 nonlinear static nonlinear dynamic other
Deficiencies - check all applicable
discontinuous wall(s) short/captive columns shear critical columns strong beam/weak column punching shear beam-col joint		shear critical walls/panels flexure critical walls/panels foundation rocking/sliding other
Expected performance prior to retrofit
Performance level
Shaking intensity	Functional	Immediate occupancy	Life safety	Collapse prevention
Frequent (50%50yr)
Rare (10%50yr)
Very rare (2%50yr)

Retrofit
Techniques - check all applicable
add walls wrap columns add braces add moment frame add backup columns		reinforce walls reinforce/expand foundation base isolation damping other
Occupants
remained in building internally moved completely removed
Cost as a percentage of replacement value
<10% 10%-30% 30%-50% 50%-70% >70%
Expected performance prior to retrofit
Performance level
Shaking intensity	Functional	Immediate occupancy	Life safety	Collapse prevention
Frequent (50%50yr)
Rare (10%50yr)
Very rare (2%50yr)

Photographs/sketches Please provide a few annotated pictures, drawings, analytical data, etc.

Additional information Please provide any additional information that you feel is pertinent.