HomeMy WebLinkAbout2834 ANSBOROUGH AVE �� ��Ii� INVOICE DATE DUE DATE INVOICE# TOTAL DUE
�����\���!'- 09/04/2018 10/10/2018
��� 0/2018 2019-00010117 $50.00
Customer#: 21339
Please Make Check Payable and Remit To:
City of Waterloo
A TTN: City Clerk/Accounts Receivable
HY-VEE CLUB ROOM 715 Mulberry St
2834 ANSBOROUGH AV WATERLOO, IA 50703
WATERLOO,IA 50701
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION-2834 ANSBOROUGH AVE- 8-24-18
I FOR BILLING INQUIRY: (319)291-4323
I
LDescription
Total Price J
INSPECTION 1
OCCUPANCY FEE $40.00
$10.00
CUSTOMER# BILLING DATE DUE DATE
21339 I 09/04/2018 10/10/2018INVOICE# CHARGES
I 2019-00010 117 $50.00
Less Prepayment $0.00
Total Due--> $50.00
City of Waterloo
Commercial Fire Inspection Report
Inspection Number 1745
Prior Inspection 66
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* 2834 Ansborough
Business name l-ty-Vee#1 Club Room Only
Inspection Date* 8/24/2018
Proprietor Brian Larsen
Business Phone 319-233-3266
Email* 1860mgrsop1@hy-vee.com
Email 2
Property Owner Brian Larsen
Emergency Contact Dave Bowling
Information
Phone 319-380-8878
Violations
Ref# CODE Violation &Location
Corrected
1 NFPA 72 Provide current annual fire alarm inspection/testing report with deficiencies corrected by a contractor certified to perform work all
the State of Iowa. Report completed 1/23/18 by Robert Runles not
accepted at this time. Provide documentation of license with Iowa
State Fire Marshal's office.
Comments:
If violations noted during the inspection are not corrected by the given re-in
are as follows: spection date,additional fees
$100.00-First Re-inspection I$150.00-Second Re-inspection I$200-Third and subsequent Re-inspections
I 'Reports
Reports Annual Fire Sprinkler
Comment 11/17/18
Reports
Semi-Annual Kitchen hood Fire Suppression for all Hoods
Comment Proshield 4/18/18
Reports Semi-Annual Kitchen hood Cleaning for all Hood
s
Comment Iowa Fire Control 6/18
Inspection Fee $ 40.00
Occupancy Fee $ 10.00
Re-inspection Fee $
Total Fee* S 50.00
Received By Riley
AN INVOICE OF THIS CHARGE WILL FOLLOW DO NOT PAY FROM THIS FORM.
File Upload(for long
inspections)
Reinspection
Re-inspection# Date
Time
1 9/12/2018