HomeMy WebLinkAboutFire and Safety Inspections 2004-2009.Y
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YARMOUTH FIRE DEPARTMEIYT
96 OLD MAIN STREET SOUTH YARMOUTH MASSACHUSETTS 02664TELEPHONE (508)_398_221 2 FAX (508)-760_485S
FIRE AND SAFETY INSPECTION REPORT
TIME:o
Address of Inspection
lot a
Business Name:Tel.No
Contact Person:
Building Owners Name
Owners Address:
Sprinkler System Wet
UTILITIES LOCATIONElect. Panel Gas meter_OS&y Valve
Home
Cell
Tel.No.
Lock Box
Water meter
Al inspection of the above caption;d-property was conducted by the undersigned, dudns
;yj:Tr:l".T1,:#f, nre or saiery den;i;.; @;"";;.i"i;",. (vJ were observed and -
r
You are hereb) ordered to abare
+l;u,;l;;.;*u;,, . dill*lj#llflTfH,!'.,]:J'rations immediaterv. Fairure to
Signed:
Copy Received By:
.,
origina, - O$xer/TenaJll Yellow Copy - iire Depanmcnt
FPB O5.I
f1,7
n-
D.y
lc^ n- r
Title:7
]l^ph, ll0, k"(o, !( V{ol^hn";no(ice andenforcemen( oforders or regurarrons
Section 30. Violation of any lawful rule. order or regulation of the board or ofany
lawd,rl order of the marshal or lauful rule or order of the head of a fire department'
;ri;h-t;, whereof is not otherwise provided for' shall be punished by a fine of not
l-.",fr* nry dollars for each day during which such violation continues after actual
notice ofthe reguration, *r. o, o.a.i. Suc-h notice may be given by personal service or by
nostins the same in a .ontpituoi''liutt on tht premite' aliected Gereby The superior
Hili'i"iirf*.l,,i.ol.ii"l, ';'ii;;:;; '*'rcJ
anv rawtur rure' order or regulation or
the board. or any lau{ul otd"ro-itht'-*shat or rule or o-rder ofthe head of a fire
department, upon application t*pttti'ay of the marshal or the head of the fire
department.
527 CMR l:06;
( I ) Fire Code Violations Whenever the marshal' the head of the fire
department or any person to whom the marshal or head of the frre
il*-;;i has deiegated big authoriw in writing' finds in anv building or
.pi" *V p*;,r", u''rrioluti'oi of 527
-CMR
or any condition likely to cause
i,l.
-".
"lrrv "t"*le to easy ingress or egress from such building' they shdll'
in writing. order the same t;remedieJ Notice of the violation shall be
,".u.a i.iu.*.aance with the provisions of M.G.L. c. 148, $ 5, including'
but not limited to the following:"* 6 ;;;.ous conditioni which are liable to cause or contribute to the
,or.ua oinr. or explosion in or on said premises, building or structure or
.ndung., th. occuPants thereofl
(b) Conditions *hitf i"toi"'" with the efficiency and use of any fire
Protection equiPmentl
(c) obstructions to or on fire escapes' stairs' passagewuYt' doot:'^o]
*i.a.*t-ii"uf. to interfe;e with the egress of occupants or the operatron
ofthe fire dePartment in case of fire;
(d) Accumulation' of ati"i Jt *** material in air conditioning or
ventilating ty*t*t J' i'"ute in kitchen or other exhaust ducts;
(e) Accumulations "fgfl"*'; tit"tttn "ooti"g equipmenr' or oil'
;;:.r.';;;;;oon' undt'?t tound anv mechanica[ equipment:
in Accumulations "f Jbil' ;;tl p"p"l' boxes-shavings' or other
combustible materials' "' #t'ii"t t*'agt of uny cornbustible materiall
rs) Hazardous *"di,ii;;iri;;i.rni.f"ttiut-or improperlv used or
ft **ll1ffi'",qx;HT*,;i#i!i;x1",':l'"H'#"":
hazardous matertu"t -*ru*, arnounts of combustible' explosive or
(i) Dangerous or llrlldwrur o""-
irit.*i..
'r"ur*dous
malerials: ations which are in
Ii;''' ^'i'q:i,*::::,[Tilh,3;ffiH; :',rff*'
iiolation of the Provtst
EAST COAST FIRE & vEr\urLATroN' rNC'
16 KEI\TDNCX ROAD tJNTf..
'n-"' ulff'Hlli *ti-T"#"''n'o'
Culto .r:
Addrcss:/1, /)4 (A
Attn:
Phonc ll:
Scrvic. Tcch:
HOODRANGESYSTEMREPORT
Drt. ofScrvlcc:
l,ocation Of Syttcm:
Manufrcturcn
Cyllndcr Slzcs:
Fusiblc Llnls:
Tr[k drtc.:
Timc:
//A
Modcl:?r
L
{r .2 o Fucl Shut oft 1@ or Elcctric
acs v olvc tocation: hgz +<l'lt/
or NO
or NO
o
Hood Clcrnlng Co.:Lttt Drt.T..SYSTEM UL 3OO STANDARDS
INC APPLIIANCE ONS: LEFI ro RIGHr .i. FtrTE ALARII{S TIED INTO rIRE SYSTEM'r'/*
Scrvicc Tcchnician
21, Rcplrctd ftttlbh lhkt
22. Chcck trsvcl ofclblc
23. PiDc urd conduit !€c1Ir!ly brockctcd
24. Pmpcr scplt8tion bctwc€n &ycfs & flunc
25. Propcf clcrrlnca fllmc !o filt r
26, Exharrst ftn opcrrdog ProPcdY
27. All Flltds rQlac€d
2t. Pucl shut-off ln ON PGition
29. Mloud & rtflloto :c/scals in Phcc
30. R.Ph.G tysq! covct3
31. SyttcB opcrrtlonrl
32. Ct6n cyllndq& mount
33. Ecrvy grc$G bulld oP
34. Frn wEnirg siSn on hood
3J. Pcrsonncl inrmlcdon manual
36. Pmpcr hald pottblc cxtinguishcrr
37. Pmpr cxtinguishcn popcrly scwiccd
3E. Scrvtcc & ccrtifiostion t!8 on systcm
39. K chsr crdngubbcr on dtc
,10. L&rt dctaction or cablc changc
UU
UU
U
U
UU
x
Y DT N/Atlu ttL,]42 l)vu t-lwuu|d4) UL{U U%8KNA AlYlrlUti/y ugt )zU LTUUUUUTZJUtyu L)ulu t)VuuU4)U /U U t.,,.
U
NOTE DISCREPANCIES OR DEF.{CIENCIES
On this d!t., thc rlotc tylt.rn wlJ t stld rnd lruPcltad in ra4ordrnca *lth PmaldutEg oftho F!.c{l0y !dopt!.d .ditloB ofNFPA 17, l?A l0 ,95 lnd 6c
mrnufsclurc's mirual lnd wt!opcrrrd rccadint to thcsa procc.dura vilh .!.ult! itdicrtcd lbov!.
lcrnsc fl, 4?rD o*,t/rt/al
Customcr Signshrc:+ Prlntcd ta tc{
l. All applistlccs propcrly covsrcd corrrct nozzlcs
2. Duct i plalum covctld !v/ colrccl noTzlc
L Chcck Dotitionin8 ofdl nozzlca
o. Sy"t. inttlt"a in sccorduc. wruL strndards
J. Hood & duct Pactrrrio slalcd
6. Chccl if !.alt initr! qvidctlc. of tsmPcrirg
7. HLJ sFtcm bcrr dilchEgcd
E. Prcse.rc Srugc in gropct lltrgc
9. Chcck cutidgc wciSht
I 0. Hydmttltic tcsr drrc
ll. Chcmlctl ln Trnk
12. tntpctt Cylldrr tiphoo tubc for corrotlon
I l. Opcttts systm ftom tcrminal link
14. Tcst proPcr opcratlon of rcmolc
15. Chcck oPration of micro swilch
16. Chcck oPcrarion ofgr: valvc
17. Clcsn Nozlcs
18. ProPr nozJc covcrs in Plscc
19. Chcck fusc links and clcan
20. CsrtridSc Dstc
',M'A
L\
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9 -,
YARMOUTH FIRE DEPARTMENT
96 OLD MAIN STREET SOUTH YARMOUTH MASSACHUSETTS 02664
TELEPHONE (508)-398-2212 - FAX (508)-760-4858
FIRE AND SAFETY INSPECTION REPORT
Address of Inspection at
Por-t
Business Name: l fl Tel.No
Contact Person: f),.,., ..,I{ome
Cell.
Building Owners Name:
Owners Address
Tel.No.a1 !g
Sprinkler System M +Wet Lock Box
TITILITIES LOCATION
Elect. Panel Gas meter OS&Y Vatve Water meter
An inspection ofthe above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (V) were observed and
noted for correction:
U"-5
/1,o Mc tLr, *'t' I c.1-<..-t
vrol-ArroN rFT]ED:(lfYES. see back)
Signed fitte: LJ
By:Copy Receiv
Original OllllerlTenant Ycllow Copy - liirc Department FPB 05.I
r.lnn: trf ? lo-t TIWE: () b O
a*3
Dry
You are hereby ordered to abate or correct the deficiencies or violations immediatelv. Failure to
do so may result in civil and/or criminal complaints being filed.
Chapter 148: Section 30 Violations; notice and enforcement of orders or regulations
Section 30. Violation ofany la*ful rule. order or regulation of the board or ofany
law{ul order ofthe marshal or law{ul rule or order of the head of a fire department,
punishment whereof is not otherwise provided for, shall be punished by a fine ofnot
more than fifty dollars for each day during which such violation continues after actual
notice ofthe regulation. rule or order. Such notice may be given by personal service or by
posting the same in a conspicuous place on the premises affected thereby. The superior
court shall have jurisdiction in equir,," to enforce any lawful rule. order or regulation of
the board. or any lawful order of the marshal or rule or order of the head of a fire
department. upon application respectively ofthe marshal or the head ofthe fire
department.
(l)Fire Code Violations Whenever the marshal. the head of the fire
department or any person to whom the marshal or head of the fire
department has delegated his authority in writing, finds in any building or
upon any premises a violation of 527 CMR or any condition likely to cause
fire or any obstacle to easy ingress or egress from such building, they shall,
in writing, order the same to remedied. Notice of the violation shall be
served in accordance with the provisions of M.G.L. c. 148, $ 5, including,
but not limited to the following:
(a) Dangerous conditions which are liable to cause or contribute to the
spread offire or explosion in or on said premises, building or structure or
endanger the occupants thereof;(b) Conditions which interfere with the efficiency and use of any fire
protection equipment;(c) obstructions to or on fire escapes, stairs, passageways, doors or
windows, liable to interfere with the egress of occupants or the operation
ofthe fire department in case offire;
(d) Accumulations of dust or waste material in air conditioning or
ventilating systems or grease in kitchen or other exhaust ducts;
(e) Accumulations of grease on kitchen cooking equipment, or oil.
grease or dirt upon, under or around any mechanical equipmenti
(0 Accumulations of rubbish, waste. paper, boxes, shavings. or other
combustible materials. or excessive storage of any combustible material;
(g) Hazardous conditions arising from defective or improperly used or
installed electrical wiring, equipment or appliances;
(h) Hazardous conditions arising from defective or improperly installed
equipment for handling or using combustible, explosive or otherwise
hazardous materials:(i) Dangerous or unlawful amounts of combustible, explosive or
otherwise hazardous materials;
() All equipment. materials. processes or operations which are in
violation of the provisions and intent of 527 CMR.
527 CMR l:06;
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p
OSl..E6^\Oillilri
fr3 i.H(a.:" 'i 63*$XoDlt
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D\IAIVCEE
IRE
R(}TECTION
Complete Fire Protection . Installation & Serrrice
132 North Front Street, New Bedford, MA 02740
Toll Free: (800) 322-6785o Local: (508) 9934080. Fax: (508) 993-2313
NOTICE OF RELEASE OF LIABILTY
Customer: Jack's Outback Date: December 16,20M
Address: 16l ldain St, Yarmortt\MA 02675
This notice is to inform you of the N.F.P.A.96 and l7A recommendations as well as Statet and local fire codes requiring the
semlannual inspection / maintenance service needed for your automatic wet chemical fire suppression system(s).
This semi-annual inspectron / maintenance may be a requirement of your insurance company for l,our fire protection
insurance.
Advanced Fire Protection, Inc. is unable to schedule or perform this required inspection / maintenance service because of
the rcason(s) stated below:
_ Customer has refused inspection
/ Customer has obtained other means of service but it is not known if the service company is properly
authorized to perform maintenance for this fire system
_ Restaurant is under new management or ownership and has refused
inspection
Due to thc reason(s) indicated above. Advance Fire Protection, Inc. releases all responsibility and liability for the proper
operation of ic u'ct chcmical fire suppression s.vstem from the datc indicatsd belorv
N-ame:
Advan
t D{l/r- /e
P tion, Inc.
NOTE: A COPY OF THIS RELEASE OF LIABILITY WILL BE SENT TO YOUR LOCAL FIRE
DEPARTMENTS' ['IRE PREVENTION BUREAU.
tMassachusetts state building code CMR 780 Article l0 Section 1010.5-t0l1.2 reference NFPA l7 and l7A which require
u'et chemical firc suppression svstems to be inspected every six months. "7.3.1+ A trained person who has uldergone the
instructions necessan to perform the maintenance and recharge service reliabll and has the applicable manufacorer's listed
installation and maintenance manual and service bulletins shall service the wet chernical fire-extinsuishins svstem 6 months
apart as outlincd in 7.3.2.
.' ,[.",,^tl}ID.?f*lqr*
w
I
YARMOUTH FIRE DEPARTMENT
FIRE PREVENTION OFFICE
96 Old Main Street
So. Yarmouth MA 02664
Telephone (508) 398-2212 ------ Fax (508) 760-4858
MEMO
Date: April 30,2004
To: James A Pierson
Environmental Scientist
Atlantic Environmental Technologies Inc
From: Peter Raiskio Acting Deputy Chief
Subject: 21 E Jacks Outback Restaurant
On your 21 E request for information at the property located at 1 6l Rt.6A lJnlt #2,
Yarmouthport, I find no records of any UST/AST, spills or releases at this property, or
any adjoining properties.
o
o -j
YARMOUTH FIRE DEPARTMENT
96 Old Main Street South Yarmouth Massachusetts 02664-6010
Telephone (50E)-398-2212 - Fax (508)-760-4858
FIRE AND SAFETY INSPECTION REPORT
Address of Insp
Name
ection.
{-
W, L-J l^ar1<-
Owner: _ Martager_ Tenant _ Other (explain)
Darc: ,0t?9ot - 3D- il'l t
OwnersName: Q''LL*.-L lr,,v*Telephone _
An inspection ofthe above captioned property was conducted by the undersigned, during
which the following fre or safety deficiencies (D) or violations (V) were observed and
noted for correction:
Cl- r I?al.l.-.- ,^ i^n1c----,., 1,,, 14 du^rl;s /r.r/)
You are herebl' ordered to abate or conect the deficiencies or liolations rvithin
Titl
days. Failure to
do so mal in ciril or criminal complaiats bcing filed.
),L
Copy Received By 4))/-<-
Original - O*ie..Tenant ,O *fi,- Fire Ddprnoent
e:
FBP 99.I
Time: ? ,, 1o Telephone:
Owners Mailing Address. **r ,^ <
l.
Signed:/)/
.j YARMOUTH FIRE DEPARTMENT
96 Old Main Street South Yarmouth Massachusetts 02664-6010
Telephone (508)-398-2212 - Fax (508)-760-4858
FIRE AND SAFETY INSPECTION REPORT
Address of Inspection: UJ " rt Fh.^ !r -a Qe (,,,,-.. t
t 6l (r-qh rJ"f lh,t
Name: e l"-"* R., lu.
Owner N,tarrager- -iln
Date
Other (explain)
Time:SaG- J79- o-19
Owners Name:Hc"\.,l^t'
Telephone
Telephone
-
An inspection ofthe above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (V) were observed and
noted for correction:
You are hereby ordered to abate or corect the deficiencies or t'iolations within davs. Failure to
do so may result in cilil and /or criminal complaints being filed.
Signed Title: A -
t,L
Original - O\$er'Tenar( Yellolv Copy . Fire Dep.'llftnt FBP 99.I
I
Owners Mailing Address: S a ^-e
Copy Received By;2 ,e,/-t
o
o t
-
YARMOUTH FIRE DEPARTMENT
96 OLD MAIN STREET SOUTH YARMOUTH MASSACHUSETTS 02664
TELEPHONE (s08)-398-221 2 - FAX (508)-760-48 5 8
FTRE AND SAFETY INSPECTION REPORT
DATE:TIME: l3/S
Address of Inspection /(r Kk lA
BusinessName: .fi.lcs Oul be.[L -It rel.No 5o z 1(76
Contact Person:2r Home 6 Z 8 "-'Cell
Building Owners Name:5 Or.n c-Tel.No.
Owners Address: 5a rn t
Elect. Panel
TTTILITIES LOCATION
Gas meter OS&Y Valve Water meter
An inspection of the above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (V) were observed and
noted for correction:
Odz
You are hereby ordered to abate or correct the deficiencies or violations immediately. Failure to
do so may result in civil and/or criminal complaints being filed.
VIOLATION lSSUED:IfYES, S
Signed:Title:
ved By )[)(q' ht ,rb
A ctLS I NS
Copy Recei
Original - Owner/Tenant Yellow Copy - l-ire Department FPU 05-l
Insurance Co.
Chapter 14E: Section 30 Violations; notice and enforcement of orders or regulations
Section 30. Violation ofany lawful rule. order or regulation ofthe board or ofany
lawful order of the marshal or lar+firl rule or order of the head of a fire deparunent,
punishment whereof is not otherwise provided for, shall be punished by a fine ofnot
more than fifty dollars for each day during which such violation continues after actual
notice of the regulation. rule or order. Such notice may be given by personal service or by
posting the same in a conspicuous place on the premises affected thereby. The superior
court shall have jurisdiction in equity to enforce any laufirl rule, order or regulation of
the board, or any la*flrl order of the marshal or rule or order ofthe head ofa fire
department, upon application respectively ofthe marshal or the head of the fire
departrnent.
527 CMR l:061
( I ) Fire Code Violations. Whenever the marshal, the head of the fire
department or any person to whom the marshal or head of the fire
department has delegated liqauthority in writing, finds in any building or
upon any premises a violation of 527 CMR or any condition likely to cause
fire or any obstacle to easy ingress or egress from such building, they shall,
in writing, order the same to remedied. Notice of the violation shall be
served in accordance with the provisions of M.G.L. c. 148, $ 5, including,
but not limited to the following:
(a) Dangerous conditions which are liable to cause or contribute to the
spread offire or explosion in or on said premises. building or structure or
endanger the occupants thereof;(b) Conditions which interfere with the efficiency and use of any fire
protection equipment;(c) obstructions to or on fire escapes, stairs, passageways, doors or
windows, liable to interfere with the egress of occupants or the operation
ofthe fire department in case offire;
(d) Accumulations of dust or waste material in air conditioning or
ventilating systems or grease in kitchen or other exhaust ducts;(e) Accumulations of grease on kitchen cooking equipment, or oil,
grease or dirt upon. under or around any mechanical equipment;(0 Accumulations of rubbish, waste. paper, boxes, shavings, or other
combustible materials, or excessive storage ofany combustible material;(g) Hazardous conditions arising from defective or improperly used or
installed electrical wiring, equipment or appliances;
(h) Hazardous conditions arising from defective or improperly installed
equipment for handling or using combustible, explosive or otherwise
hazardous materialsi(i) Dangerous or unlawful amounts of combustible, explosive or
otherwise hazardous materials;
0) All equipment. materials, processes or operations which are in
violation of the provisions and intent of 527 CMR.
EAST COAST FIRE & VENTILATION,INC.
15 KENDRICK ROAD UNIT,I
WAREHAIi,I. MASS. 0257I
Phonc:l{88-13&5383 fq:50&291-4593
HOOD RANGE SYSTEM REPORT
cn*oocr: f,ak,r%,f Bc.t
Locstioo Of Syltcm:k:+c/te o,
Msnufacturcr:4u,.<r/Model
Cylindcr S Z
Time:
7--
Ann ,tu,/?z)
Phone #:?)r -362 -16I a Fusiblc Lints: # U MO' Fuel shut "n@
Scrvicc Tcch:A...y' S /.--o Tl\Ydttr,; Oq Y L Gas Valvc location:
or Elcctric
,
Hood Ch lrt Co':- Irtt Drb:- r'TSYSTEM UrL 300 STANDAXDS (@..-..--
COOKINC APPLIIANCE LOCATIONS : LEFT to RIGIIT r.' trIRE ALARMS TIED INTO FIRE SYSTEM NO
J-ld'S j- 36"
l. All applianccs propsrly covercd w/ corcct nozzlcs
2, Duct & plcnum covglrd w/ cor€ct nozzlo
3. chrck po6i[e[i[g of rll Dozztct
4. Sy*in iluhflcd itr aooordmc. WAJL St0ndards
5. Hood & dlct pcoctmtioos s€alcd
6. Chcck ifscals itrtac! cvidrncc oftstrrp€rirg
7. Hss sysrtr bcrn dlscbtrScd
t. Prlss[c glugp in pmpcr rmgc
9. Chccl( ortsidgo wsi8hl
10. Bydrortdlc t..t drtll. Six yc8r maintcrl8no€ d8tc
12. Inspcct sylindor end mount
13. @! cylrrm:tom tcmind lint
14. Tc$ propcr opGrotioll ofrqnot€
15. Chcck ap.* ofmlgm lwitdh
16. Chcct opctdion ofgas valvc
l?. Clcon Norzlcs
It. Propcr n .ozlc covcn in placc
19. Chcck fft$ liob Etrd clcan
20. Cairidgc Datc
L.'
t .-'I
l-"'--uL..-'_-1
L/''
---]-.-'L,.--
t.-
L/--vD
-_zD2-
1/-Mtt
--rz.' L.''-
L"-'-uA
1,.'
/t/'L-'L--
L.-
DA
NOTE DISCREPA}.ICIES OR DEFICIENC ES y',/2'? <
Scrvicc Tcchnician uir*alm*:4 9V Daky'A'.Z z+ -<4-
Customcr q,k + Pri rd:
*DonA 3
-Zliusk?
$[
Thc rboYc rcrvica
/'4
drat lhc vrs poaulty inaoctrd od firurd oodlaioo! to bc rs irdicicd @ tiir rcpoit
LAnt'lO
D.b ottuak t /2^2q-Of,
^dd,*, /6/ 4r.',2 5f ,?/-6./
tfonwor'' ' ,zoz'1-, zt- ".
NO
@.
21. R.placcd fi$ible links
22. Chcok tsavol of cablc
23. Ptpc lEd coodutt sccrrely bmcLasl
24, Propcr sg?aration betuaan frycrs & flrmc
25. hopcr clcrmcc f,.'hc to f,ltlr
26. Exbslst &n opcrating pmpcrly
27. All Filtcrs rcplaccd
2t. Fud sbut-offin ON pGition
29. Mstrusl & rEmot! scdscals in placc
30. Rcplacr systan covcr8
31. Syst opcralional
32. Clcan cylird* & mount
33. Ilcsr,y gEasc b{rild up
34. Fsn lvutrhg si8n on hood
35. PEirornEl iDlhrctioo tl[nurl
36. Pmpcr hand porlablc ortioguishcrs
37. Pmp€r cJdngulsh€f3 proFrly s.rflic.d
3t. Scrvicc & ccrtifcdiin tag @ sydlst
39, K d.rr cltlllrllcr or rltc
40. Last drtcclion oI csbl€ changc
On $it di!,lhc rbovr rldfl w tcr&d ud inrpcCcd iD Dcudrlcc aih Drlcafulr of ltc ,rlrcdy ldopcd cdiliru of NFPA 17, l7A I0 ,96 !d lh.
mlDuEatur'r tluoud !d wrr oF.rtod ecdfuf to frclc ProccduIt rith rlqda irdiga&d .bovc.
4,t,1YARMOUTH FIRE DEPARTMENT
96 Old Main Street South Yarmouth Massachusetts 02664-6010
Telephone (508)-398-2212 - Fax(508)-760-4858
FIRE AND SAFETY INSPECTION REPORT
Address of Insp.aion, -+{#kHl. /0/ 0 Rfurq '/P
Name: J
Owner: _ Manager_ Tenant Other (explain)_
Date: 'lllL/r{rine: li, l5 Telephone gD- ooQn
,JA0"
Owners Name:B 55oTelephone:29o- 5otL
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An inspection ofthe above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (V) were observed and
noted for correction:
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You are hereby ordered to abate or correct the deficiencies or liolations within days. Failure to
do so may result in civil and /or criminal complaints being filed.
Signed C Lq Title: &nk7Copy Received By
i.:
Original - Owner/Tena Yellorv Copy - Fire Deputment FUP 99-l
Owners Mailing Address: