HomeMy WebLinkAbout515 BROADWAY a
INVOICE DATE DUE DATE INVOICE# TOTAL DUE
04/12/2018 05/30/2018 2018-00000293 $80.00
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Customer#: 20953 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
KWIK STOP#4 715 Mulberry St
515 BROADWAY ST WATERLOO, IA 50703
WATERLOO,IA 50703 •
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION - 515 BROADWAY-4-18-18 FOR BILLING INQUIRY: (319)291-4323
[Description Total Price J
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
20953 04/12/2018 05/30/2018 2018-00000293 $80.00
Less Prepayment $0.00
Total Due-- $80.00
City of Waterloo
Commercial Fire Inspection Report
Inspection Number 1410
Prior Inspection 340
Number Fill this field if it is available,it will auto-fill business name and address.
Inspector* Jeff Siebel
Waterloo Fire Rescue
715 Mulberry Street Waterloo, IA 50703
Phone(319)-230-1224 Fax. (319)-291-4262
Email:Jeff.Siebel@waterloo-ia.org
File Upload
Address* 515 Broadway
Business name Kwik Stop 4
Inspection Date* 4/18/2018
Proprietor Mohammad Sarwar
Business Phone 391-232-6212
Email* Sarwar4335@yahoo.com
Email 2
Property Owner Mohammad Sarwar
Emergency Contact Mohammad Sarwar
Information
Phone 319-230-7134
Violations
CODE Violation &Location Corrected
Ref#
1 904.11.6. Provide current semi-annual kitchen hood fire suppression system
2 inspection/testing with all deficiencies corrected by a contractor
certified to work in the State of Iowa
Comments:
If violations noted during the inspection are not corrected by the given re-inspection date,additional fees
are as follows:
$100.00-First Re-inspection I$150.00 -Second Re-inspection I$200-Third and subsequent Re-inspections
Reports
Reports Semi-Annual Kitchen hood Cleaning for all Hoods
Comment AKA 3/14/18
Inspection Fee $ 70.00
Occupancy Fee $ 10.00
Re-inspection Fee $
Total Fee* $ 80.00
Received By Mohammad Sarwar
AN INVOICE OF THIS CHARGE WILL FOLLOW. DO NOT PAY FROM THIS FORM.
File Upload(for long
inspections)
Reinspection
Re-inspection# Date Time
1 5/9/2018