HomeMy WebLinkAbout315 W 4TH ST INVOICE DATE DUE DATE INVOICE# TOTAL DUE
l���0 p■ ,r�•� 02/09/2018 03/15/2018 2018-00000150 $80.00
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Customer#: 20792 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
THE BROKEN RECORD 715 Mulberry St
315 W 4TH ST WATERLOO, IA 50703
WATERLOO,IA 50701
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION-315 W 4TH ST- 1-11-18 FOR BILLING INQUIRY: (319)291-4323
Description I Total Price
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
20792 02/09/2018 03/15/2018 2018-00000150 $80.00
Less Prepayment $0.00
Total Due- $80.00
City of Waterloo
Com rcial Fire Inspection Repor
Inspection Number 1189
Prior Inspection 172
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
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Address* 315 West 4th Street
Business name Broken Record
Inspection Date* 1/11/2018
Proprietor John Hayes
Business Phone 319-234-2254
Email* Reboot9580@yahoo.com
Email 2
Property Owner John Hayes
Emergency Contact John Hayes
Information
Phone 319-833-8946
Violations
Ref# CODE Violation &Location Corrected
1 Repair egress/exit light above main door.
2 Provide annual service for fire extinguishers.
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
Comment
Inspection Fee $ 70.00
Occupancy Fee $ 10.00
Re-inspection Fee $
Total Fee* S 80.00
Received By John Hayes
AN INVOICE OF THIS CHARGE WILL FOLLOW. DO NOT PAY FROM THIS FORM.
File Upload (for long
inspections)
Reinspection
Re-inspection# Date Time
1 1/31/2018