Report J.. - INSPECTION PIPE
�,� 1, Report of Inspection io i:,..l . i t -ii .
1'_r� ;� `�ao Department of Consumer & Business Services
" ` ' = Building Codes Division, Elevator Safety Program ELEVATOR # ' 1LLSP 4 , DOCUMENT
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1535 Edgewater NW, Salem, OR N 135;'3 t <.;,: ) oz t
Mailing address: PO Box 14470, Salem, OR 97309 AREA 4 INSP DUE BY ' LAST INSP BY
Inspection information: (503) 373 -1298, TTY: 373 -1358 '
? V :; S I It.l -.4
Billing/Permits: (503) 378 -8559
RESPONSIBLE PARTY NAME AND ADDRESS i SITE NAME AND ADDRESS I INSPECTION RESULTS SEE REVERSE SIDE
i 1 7 0 ' 11 SATISFACTORY INSPECTION
. 1.^13PFR11fE; Tti,.4PE' EOf'(''1F:',f` EN1EP ja 'z3 jog • I 0) UNSATISFACTORY INSPECTION
15.i'G `.W Mlt.EN Wk' i. ;W o'is :I O WRITTEN VERIFICATION REQUIRED
cEK'1EPiiiii :JR ' i ; •3i - = C'E PROVISIONAL: EXPIRES Li _
® REQUIRED BY NEXT ANNUAL
'r(. ■ M HflI P Mi1i(:R il.f'JA1P (rc 11:.Q n nE ; ® REMOVED FROM SERVICE
INSPECTION REQUIREMENTS (RULE #) j NO LOAD FULL LOAD ELEVATOR INFORMATION
® FIRE SERVICE TEST IS OVERDUE (1206.7) nxol year jknoj year rFy. ' tHI i0 p ;t tii1,S•t a ;ut,,,
® ANNUAL SAFETY TESTIS OVERDUE (1002.2b) ® OD ® ® OD OD ( A vi;i I T1 • ''IGO ; c ht I t' L•5 .
® FIVE YEAR FULL LOAD TEST IS OVERDUE (1002.3a) ® m CO ® CD co r2i■E E'n1E - ..'' , RI') Pit '•E''iti ; EF
® RESHACKLE OF CABLE(S) IS OVERDUE (1206.3a) ® GD CD ® ® C) ur,IVE p` :
® TEST AND SEAL RELIEF PRESSURE VALVE (1005.2a)
® CHANGE HOSE BETWEEN PUMP UNIT AND JACK (1005.2d)
® INSTALL FIRE SERVICE SIGNS (211.7) ® m CD (D1D ® a) SPECIAL INSTRUCTIONS
OD EMERGENCY LIGHT /BELL IS INOPERATIVE (204.7a/211.1) ® ® ® ® ® ® , ing t;,'.1 :
® 24 HOUR COMMUNICATION DEVICE IS INOPERATIVE (211.1) ®m m ® m CD
® PHOTO EYE IS INOPERATIVE (112.5) ® ®® ® ® OD ; I -
® SECURE CARTOP EXIT FROM CAR TOP (204.1a)
® ELEVATOR PIT IS NOT CLEAN /DRY (1206.2a) TO TO
® ELEVATOR MACHINE ROOM HAS UNRELATED STORAGE (1206.2b) ID OD
® CAB AND /OR HOISTWAY GLASS IS NOT PROPERLY MARKED (204.1h) PRIOR INSPECTION REQUIREMENTS
® BUILDING AND /OR MACHINE ROOM IS NOT ACCESSIBLE (ORS460.135) ;'i 41 E Hi pi' ; • Ni:HE
® SEISMIC DEVICES AND OPERATION TESTS OVERDUE (1002.2j)
® INSTALLTIEST MACHINE ROOM FIRE EXTINGUISHER (1206.1h)
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I r.> , 1 r. 6 -_. i c.t-k " k t A1 I~A -l. ik _._ INSPECTION DATE
I NO T Drs mins I firs mins
mo day year
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E CD CD E CD E (2) (03) (3) (2) (82)
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UNLESS OTHERWISE NOTED, ALL WORK SHALL BE OD ® M CID M
COMPLETED WITHIN ,, ' DAYS ® CD E CD E aD ® CD m
CONTACT'S SIGNATURE ✓ �\ i INSPECTOR'S SIGNATURE DATE ® d
440-2536/12-97/COM. AN ELEVATOR WHICH HAS CAUSED AN INJURY SHALL NOT BE OPERATED UNTIL APPROVED BY THE ELEVATOR SECTION. PER ORS 460.045(6)
CUSTOMER COPY SEE REVERSE SIDE FOR INSTRUCTIONS
" = 1
Schindler Elevator Corporation
i
Final Acceptance Date
Contract # 40240
Dear Sirs:
We have examined the Pa s s e n g a r elevator No. 01
installedbyyouinthe Tigard Corp. Center Building "A" Building.
12123 SW 69th St., Tigard Or 97223
Street City State
d 4 1
and find same satisfactory and in accordance with the contract and we accept the elevator under the terms and guarantee of
said contract.
Baugh Construction Oron
Purchaser
ELEVATORS OR ESCALATORS ARE BEING TURNED OVER WITH THE FOLLOWING EXCEPTIONS: 0
(Damage to the equipment — other than noted below — will not be the responsibility of Schindler Elevator Corporation.) w �
Furthermore, in accepting this equipment, I agree that the architectural finishes on the cabs, entrances and fixtures are v
acceptable. Finally, please understand that we will accept no further "punch lists ". y
I acknowledge receipt of the following:
Car Station Keys Special Keys for Corridor & Car Station Fixtures
Door Release Keys Side Exit Door Keys Set of Cab Protective Pads
Emergency Power Keys Firemen's Retum Keys Other
Purchaser
Superintendent/Sales Rep.
MAINTENANCE
Our Contract includes 3 months of Contract Maintenance. This service is effective ' and will expire
. Our Service Technician will make periodic examinations and will perform all necessary adjustments, greasing,
oiling and replacement of parts necessary to keep the elevator equipment in operation. Replacement of parts due to accident,
misuse or negligence by parties other than Schindler is not included. All work will be performed during regular working hours
of regular working days of the trade. In addition, 8 hour Emergency Minor Adjustment Callback service is included.
FOR SERVICE
DIAL 1-800 -225 -3123 Your building Identification number is 343936
Notice: Providing a reliable and trouble -free installation is important to us. However, as you complete the remaining building
construction work, elevator misoperations or shutdowns may occur that are caused by job site conditions beyond our control.
These conditions include construction dust or debris, vandalism or misuse, voltage fluctuations and equipment room
temperature below 55 degrees F or above 90 degrees F. We will respond to your requests for service as quickly as possible.
Thank you for your understanding and patience.
CRDT.APP.
REG27120 (REV. 2/94) White: HQ/Finance Copy Yellow: Field Copy Pink: Customer Copy