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Report t.._.. ' INSPECTION TYPE , Report of Inspection =r F �s^: ). K i; . , Department of Consumer & Business Services ': e` ` "�% Building Codes Division • Elevator Safety Program ELEVATOR 4 INSP 4 I DOCUMENT 1535 Edgewater NW, Salem, OR `` Y-'�' ). "f Mailing address: P.O. Box 14470, Salem, OR 97309 -0404 Information: 503 - 373 -1298, Fax: 503 - 378 -4101 AREA I INSP DUE BY I LAST INSP BY Web site: bcd.oregon.gov '` ` ' ' =3 ` RESPONSIBLE PARTY NAME AND ADDRESS I SITE NAME AND ADDRESS I INSPECTION RESULTS - SEE REVERSE SIDE I .5(..2 !1') •). 0SATISFACTORY INSPECTION 4! `''_' :;' F F.T ; ` ":' guar.. .. . . t' ; ® UNSATISFACTORY INSPECTION _.j:-ti.' a'' i..0 riJ 7:''. KW:',. CD WRITTEN VERIFICATION ACCEPTED •u P i`, -;' a' '.i i'',. 12 ® PROVISIONAL: EXPIRES /_I ® REQUIRED BY NEXT INSPECTION ® REMOVED FROM SERVICE INSPECTION REQUIREMENTS (M /R = MACHINE ROOM) I NO LOAD FULL LOADI ELEVATOR INFORMATION ® Fire service test/key switch tesVsmoke detector test is overdue (8.11.2.2.6) mo I year mo I year ERI n . N i 3FR 249295 FP; 1 1:, ® Annual safety test is overdue (8.11.2.2.2) ®®® ® ®® ,PF vt. 1 2.1u 2Ju L 2 i ti IN! ® Full load safety test overdue (8.11.2.3.1) ® ® m ®O ©1.'U'c _ iir 11/09 [.}3t;E ^l1)2rt ® Keep M/R access doors closed & locked (8.6.4.8.4) ® ® ®® ® ® 1 '1 E i c, ® Test & seal pressure relief valve (8.11.3.2.1) ®® ®®® ® Maintain min. illumination level in M/R (8.11.2.1.2/8.11.3.1.2) ®®®® ® ® ® Provide proper signage; see below (8.6.1.6.7) (0 ® ® (IN®® SPECIAL INSTRUCTIONS ® Emergency light/bell is inoperative (8.11.3.1.1) ® ®® ®®,® r:ID?%±•C" 0) 24 -hour communication device is inoperative (8.11.2.1.1/8.11.3.1.1) , ® ® ® ®CO ® Verify /reduce kinetic energy on doors (8.6.4.13.2) ®®® 0 ® ® 4:: ® Provide /update record of oil usage (8.6.5.7) ®® ®' ® Maintain a clean & dry elevator pit (8.11.2.1.5/8.11.3.1.5) ® Elevator M/R has unrelated storage (8.11.2.1.2/8.11.3.1.2) C12) CM ® Maintain min. illumination level in pit (8.11.2.1.5/8.11.3.1.5) PRIOR INSPECTION REQUIREMENTS ® Bldg. and/or M/R not accessible (ORS 460.135) (ECt1': ": `:s 1 ? . IIRE, ® Seismic tests overdue (OR amendments 8.11.2.2.10) ® Maintain/provide M/R fire extinguisher (8.6.1.6.5) ® Anti - egress device requires repair or adjustment (8.6.4.13.1) ® Elevator M/R keys/elevator keys onsite and available (8.1.3) CD 4 NO T hrs mins I hrs mins INSPECTION DATE mo day yea S ® ® A ® S ® ® O P CD CD v D 0.0 P CD ell) ®0 CD E 0 ® E ® E CD COGDC2D0 C ®® L ®® C ©® T ® ® ® .T ® ® ® R ®® ® ® ®® ® ®c:y ®® ® ® fP; . T T ®® I © ® I ®® ® o Unless otherwise noted on this report end pursuant to ORS 480.125(3), you are hereby notMed that all work ® M ® M ® ® ® (t) ' cited on this report shell be completed within 00 ❑ 120 ❑ Other days from date of this inspection or the unit may be remove from novice. . CO ® E ® E ® ® CD Z.) CONTACTS SIGNATURE y r" INSPECTOR'S SIGNATURE DATE ® ® ; X �' " fr.‘,„ f 'i <�l r' '��' :1/2_1=1,"2 440 -2536 (4 /09 /COM) AN ELEVATOR WHICH HAS CAUSED AN INJURY SHALL NOT BE OPERATED UN APPROVED BY THE ELEVATOR SECTION, PER ORS 460.045(7) CUSTOMEt2 COPY SEE REVERSE SIDE FOR INSTRUCTIONS I II I ! I' I I I I I • t REC1±��II, 0 • I ' O r :, I : 1 • i F EB 1 I 1 I ! � Cj • ■F LID M ' " ti ■ i, , . OP), CITY OF, � • A g i I I liU1I...DIN0 D I 1 1 � c. r I 1 I I ; I � I j II • • • j • , . l• . • • l L L(1/ - ' -i 4r -; LC '�� ��` �? (c, t? `.)' ... • • r . ••• 1 t 2 / . 72 I.•I I • • .... • • • •• ,i � G �7 1�}Ni p ..... • • -:�I � •••• • '1 ! r f 1. •••• a -h' �t,:,`1 '_' c.1-eit,! ,t, 4. w % 1 1) . ..) 1 ) `i . ) •••• • ::a•) Lt,) L;k. Q_. c i7r :. t ■ ;I I 1 Jv 1 ,i-1 f , M„ 1 �J I 3) 'h .' t, N I n I - - 1 f =O c-) 2 —� . I ICJ C 1 it CO L W ' .t..1__ - — i l',c -1 J,t.f7'. ,,4;• 6 4 „ +<..t L.1 lk , .7 I.) 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