CYCLONE INSPECTION FORM

Building Name: ________________________________

P.O. Box 998369
Pago Pago, AS 96799 DENNIS GALLARDO
Inspectors Name: ____________________________________
684-254-6404
pioaconsulting@gmail.com

SECTION 1
FILOMENA ASELEMO-MOORS
1-1 BUILDING OWNER: ____________________________

1-2 AKENESE ASELEMO

MORTGAGEE: ______________________

1-3 PROPERTY LOCATION: Village of ______________________

ILIILI
Residential building with concrete column and beams, CMU and wooden wall,corrugated
metal sheet roofing, Concrete Slab on Grade, sliding glass and louver windows and glass door
1-4 BRIEF DESCRIPTION OF BUILDING STRUCTURE: ________________________________

1-5 70
Length: _____ft 50
Width: ______ft Single
Height: ___________ storey

SECTION 2

2-1 CLASSIFICATION FOR RESISTANCE TO CYCLONE DAMAGE

(a) Purpose of Inspection: To note any deficiencies and recommend remedial action (if necessary), to make good,
deficiencies within a reasonable time in an effort to minimize potential, future cyclone damage.

(b) Classifications for cyclone resistance are scheduled for the building components in their present state and for the same
components after completion. Recommended action based on the following scale which indicates along the top of the scale
the range of basic wind speeds in miles per hour.

Less than average (55-73mph) Category 1 (74-95mph) Category 2 (96-110mph) Category 3 (111-129)
3–4 5–6 7–8 9 - 10
BAD FAIR GOOD ✔ VERY GOOD

2.1.1 EXTERIOR ROOF SURFACE

Observe and note the condition of the following roof elements

Indicate general condition Good Adequate Poor N/A

(i) Roof cladding Good ✔ Adequate Poor N/A

(i.e. rusting , holes, openings , debris)

( ii ) Roof fixings and fasteners Good ✔ Adequate Poor N/A

(i.e. correct types , spacing
of screws, none loose , missing)

( iii) Gutters and Down-pipes Good Adequate ✔ Poor N/A

( iv) Flashing and Ridge Capping Good ✔ Adequate Poor N/A

(i.e. adequately fixed and sealed)

(v) Roof Ventilators Good Adequate Poor ✔ N/A

(i.e. clear of debris, adequately secured)

(vi ) Exposed Timber Work Good ✔ Adequate Poor N/A

(i.e. split or rotten boards or eaves)

PIOA Consulting & Engineering Cyclone Inspection Report

 2.1.2 ROOF STRUCTURE
Inspect and note condition of the following roof structural members (i.e. damp rot, inspect for infestation, cracking
etc and whether fixed to supporting structural members (not visible))

(i) Purlins and Battens Good ✔ Adequate Poor N/A

(ii) Rafters Good ✔ Adequate Poor N/A

(iii) Trusses Good ✔ Adequate Poor N/A

(iv) Fixing Methods Good ✔ Adequate Poor N/A

(i.e. correct types, location of fasteners)

(v) Fixing methods trusses/rafter to Good ✔ Adequate Poor N/A

top plate.

(vi) Observe and note condition of the Good ✔ Adequate Poor N/A
Underside of roof cladding
i.e. rusting, denting from debris etc...

2.1.3 CONCRETE BLOCK WALLS

Inspect and note general condition of concrete block walls

( i.) Are there any settlement or movement cracks through Yes ✔ None N/A
brick or mortar joints?

(ii) Has water penetrated into any cracks and rusted Yes ✔ None N/A
re-enforcing steel (i.e. rust stains)

(iii) Is there any cracking or separation between any Yes ✔ None N/A
‘inset-cast’ concrete columns and brick/block walls

2.1.4 INSPECT WALL TOP PLATE OR BOND BEAM:

(i) Is timber top plate and or bond beam in satisfactory ✔ Yes No N/A
condition? (i.e. no cracking rust in steel or rot in
timber?)

(ii) Are all ‘tie-down’ bolts/cast-in rods correct type ✔ Yes No N/A
and spacing?

(iii) Are ‘ tie-down’ bolts/cast-in rods rust free and ✔ Yes No N/A
securely fastened?

2.1.5. TIMBER FRAME WALL

During ceiling inspection of roof structure check and note condition of top plate (i.e. wood rot, insect infestation,
splitting etc......)

(i) Are the correct type and spacing of Good ✔ Adequate Poor N/A
‘tie-downs’ bolts/rods passing through
the top plate provided?

PIOA Consulting & Engineering Cyclone Inspection Report 2

 (ii) Are ‘tie-down’ bolts/rods securely Good ✔ Adequate Poor N/A
Tightened and corrosion free?

If building elevated on stumps or posts, inspect and note conditions of bottom plate connection to floor
substructure?

(i.) Are the tie down rods securely Good Adequate Poor ✔ N/A
fixed to floor substructure and
securely tightened?

(ii.) Is there adequate cross bracing Good Adequate Poor ✔ N/A

between stumps or posts?

2.1.6. TIMBER FRAME WALL ON CONCRETE SLAB

(i.) Are the ‘tie down’ rods securely Good ✔ Adequate Poor N/A
fixed to bottom plate and at
correct spacing?

(i) Are stud framing securely fixed to Good ✔ Adequate Poor N/A
bottom plate with cyclone ties?

2.1.7. WALL CLADDING

Inspect and note condition of cladding (i.e. rotten chamber boards, debris damage, moisture penetration at joints
etc.) Inspect fixing and fastening method of securing cladding to timber wall framework:

(ii) Are fixing the correct type number Good ✔ Adequate Poor N/A
and spacing?

(iii) Is cladding securely fixed to timber Good ✔ Adequate Poor N/A

Framework (i.e. no loose or
rusty screws or nails)

2.1.8 WINDOWS FRAMES, EXTERNAL DOORS and DOOR FRAMES.

Inspect windows and window frames and note general conditions:

(a.) Are there any broken louvers or window panes? Yes ✔ No N/A

(b) Are frames secure and fixed firmly into wall openings ✔ Yes No N/A
and no missing fixing screws?

(c) Are door frames secure and firmly secured into ✔ Yes No N/A
wall openings? (Did not open doors, no one home
on residential side )

(d) Are door stops and door hinges adequate to secure door ✔ Yes No N/A
and frame against cyclonic winds? (i.e. ensure screws
are in all hinge holes)

(e) Are glazing (glass) thickness can withstand minimum wind ✔ Yes No N/A
speed of 100 mph?

PIOA Consulting & Engineering Cyclone Inspection Report 3

2.1.9 PROTECTION OF EXTERNAL GLASS DOORS WINDOWS FIXED GLASS

CYCLONE SHUTTERS;

(a) Are there any cyclone shutters? Yes ✔ None N/A

(b) Are the shutters in good state of repair? Yes No ✔ N/A

(c) Do shutters open easily and close securely? Yes No ✔ N/A

(d) Are shutter hinges (or tracks if sliding) Yes No ✔ N/A

securely fixed to wall?

(e) If shutters are not permanently attached to exterior walls: Yes None ✔ N/A
Are they adequately stored?

2.1.10 THE SITE

Observe and note surroundings terrain and classify terrain category including possible future developments which
may alter terrain category.

TERRAIN CATEGORY (check ONLY one):

Terrain Category 1

Terrain Category 2

Terrain Category ✔ 3

TERRAIN CATEGORY 1 TERRAIN CATEGORY 2 TERRAIN CATEGORY 3

Exposed open terrain with no
or few scattered obstructions
and in which surrounding
objects are less than 5 feet
high (flat treeless plains, open
sea coast)
Open terrain with well
scattered objects having
heights generally 5-30 feet
(open parkland, sparsely built
up outskirts or towns)
Terrains of closely spaced
obstructions having the size
of domestic houses (well
wooded areas, suburbs, and
towns)

2.1.11 Observe structural condition of neighbouring buildings

and surrounding area (i.e. None close enough to cause damage) ✔ Yes None N/A

2.1.12 Observe condition and proximity of nearby trees.

Could trees fall, or lose limbs during a cyclone? ✔ Yes No N/A
(i.e. dead trees, brittle branches etc.)

2.1.13 Observe condition of surrounding area. Is there any loose Yes ✔ None N/A
material or rubbish littered about? (i.e. behind parking on
northeast side (minor))

PIOA Consulting & Engineering Cyclone Inspection Report 4

2.2 UPGRADING WORKS REQUIRED:

1. For repair: - loosed and rusted roofing

- rotted fascia board
- loosed and rusted flashing
- exposed rotted eves purlins( refer picture below )
2. Install/fix gutter and downspout
3. Bread fruit tree rear side need to remove
4. Provide cyclone shutter for doors and windows

2.3 GENERAL NOTES:

The building found out to be in adequate condition. Masonry and wooden wall,concrete column are
still intact and ceiling are adequately fastened.

PIOA Consulting & Engineering Cyclone Inspection Report 5

 2.4 CERTIFICATION:

We certify that we have inspected the premises described above and have made the recommendation detailed
herein for upgrading this premises. The report however recognizes that only representative sampling of the
structural components which are embedded, or otherwise out of view. In such cases the structural
components which cannot be seen are deemed to be either similar to those within view or in the case of
embedded items, of sufficient strength to resist the design loading.

Date of our first inspection: 01/29/2020

______________________

Date report signed: 01/29/2020

______________________

Signed: _______________________

Licensed Engineer: William E. Spitzenberg, P.E.

Qualifications: Professional Structural Engineer,

Utah P.E. License: 354279-2203

Licensed Builder/Engineering Firm: PIOA Consultants

Note: The inspector/writer of this report has been in cyclone winds gusting over 160mph in American
Samoa, but is not prepared to form an opinion on cyclone resistance with sustained winds above 129 mph.
This inspection report is limited to deficiencies present at the time of the inspection. Roof, mechanical equipment,
plumbing and electrical systems often fail without warning. New deficiencies can develop in buildings at any time,
especially in buildings which may lie vacant.

REVISITED (if required by Insurance Company)

SECTION 3

3.1 Building Owner: _______________________________

Property Location: _______________________________

3.2 Date of re-inspection(s) after upgrading, requested by underwriter (or initial day of
inspection if no upgrading is considered necessary): __________________

3.3 We consider that as of the original date of inspection (above), the building is likely to be
of a reasonable level of cyclone resistance within the limitations stated in Section 2.

Signed: ________________________________

Date: ________________________________

Qualification: ________________________________

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