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HomeMy WebLinkAbout6300-6388 Oakton. 11. ::�. CERTIFICATION / INSPECTION REPORT OCCUPANCY O L N7 of Ir LOCATION 610500 ®atmo HOUSEKEEPING C V Unsafe Conditions 1r❑ Ceiling Assembly g1 ❑ EX17WAYSIDOORS Obstructed / Locked 45 ❑ Maintained Rr ❑ Proper Hardware C❑ ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING Emergency Lights Exit Lights ■ to ■ ■ r � � /1 <' DATE J �y- ID# FD CONNECTION E C V FIRE ALARM C V Accessible ❑ ❑ Panel Accessible ❑ ❑ Maintenance ❑ ❑ Annual Test ❑ ❑ SPRINKLER SYSTEM NA PREPLAN INFORMATION Pressurized & Accessible J�❑ Kb Complete Annual Test Q ] - New Emergency Contacts El Sprinkler Clearance 46 b FIRE EXTINGUISHERS Required Charged/Tagged Accessible/Height KEY BOX /RA, Z*❑ Knox Box Required ❑ Keys Tested s❑ KITCHEN SYSTEMS NA v, UTILITY SHUTOFFS Chargedrfagged ❑ ❑ Accessible ,_,r Clean /Repair ❑ ❑ ❑ Iq Class K Extinguisher 110 ADDRESS VISIBLE ❑ 1r (front & rear) MECHANICAL/ HEAT APPLIANCES COMPRESSED CYLINDERS NA HAZARDOUS MATERIALS Clearance to ❑ ❑ Storage Unsafe Conditions ❑ ❑ Secured O ❑ Identification ❑ ❑ VIOLATION DESCRIPTIONS It v P SIGNATURES —��y Ins`pector Owner span COMPANY OFFICER: 4, r ! / oso REIN: REFUSAL OF INSPECTION ■ ■ ■ ■ ■ 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. VIOLATION DESCRIPTIONS SIGNATURES COMPANY OFFICER:' _ REIN REFUSAL OF INSPECTION SPECTION DATE: f® Z2.1 D ®� 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. HOUSEKEEPING C V FD CONNECTION NA C V FIRE ALARM �A CV Unsafe Conditions ❑ Accessible (!� El Panel Accessible ❑ ❑ Ceiling Assembly ❑ Maintenance IT ❑ Annual Test ❑ ❑ EXITWAYS /DOORS SPRINKLER SYSTEM NA PREPLAN INFORMATION Obstructed / Locked IO ❑ Pressurized & Accessible ../' 961/ Complete ❑ ❑ Maintained 2f 11 Annual Test i7 ❑ New Emergency Contacts ❑ ❑ Proper Hardware do Sprinkler Clearance CI ❑ ELECTRICAL FIRE EXTINGUISHERS KEY BOX NA Exposed Wires {r o Required l jJ o Knox Box Required ❑ ❑ Extension Cords it O a�Charged/Tagged ❑ M° Keys Tested ❑ ❑ Panel Obstructed EE!1,11 Accessible /Height Le E] Knockouts Needed L1(❑ '\ GCFI Outlet ❑ ❑ KITCHEN SYSTEMS /AT \ UTILITY SHUTOFFS EXIT LIGHTING Charged/Tagged 1)0 Accessible (o Clean/Repair I] 0 Emergency Lights If ❑ Class K Extinguisher ri ❑ ADDRESS VISIBLE Exit Lights V�G (front & rear) E7 ❑ MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDERS HAZARDOUS MATERIALS N Clearance to Rr 11 Storage V 00 Identification ❑ ❑ Unsafe Conditions V0 Secured p ❑ VIOLATION DESCRIPTIONS SIGNATURES COMPANY OFFICER:' _ REIN REFUSAL OF INSPECTION SPECTION DATE: f® Z2.1 D ®� 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. 1 OCCUPANCY l e0. 7-f V-e Pressurized & Accessible DATE lb 10"10' Maintained ❑ LOCATION_ I'_Il' ❑ Proper Hardware ID# d 40U Sprinkler Clearance ❑ HOUSEKEEPING C V FD CONNECTION NA C V FIRE ALARM NA C V Unsafe Conditions Ceiling Assembly EXITWAYS /DOORS 370 Accessible Li❑ Maintenance SPRINKLER SYSTEM NA !i7 ❑ Panel Accessible J4. ❑ Annual Test 9 ❑ PREPLAN INFORMATION Obstructed / Locked ❑ Pressurized & Accessible % ❑ Maintained ❑ Annual Test I'_Il' ❑ Proper Hardware ❑ Sprinkler Clearance ❑ ELECTRICAL FIRE EXTINGUISHERS Exposed Wires ❑ Required ❑ Extension Cords �r ❑ / ( /Charged/Tagged Q ow- Panel Obstructed ?r 11 v Accessible/Height f ❑ Knockouts Needed W ❑ GCFI Outlet ❑ KITCHEN SYSTEMS P! EXIT LIGHTING Chargedlraggad ❑ ❑ Clean /Repair ❑ ❑ Emergency Lights ❑ Class K Extinguisher ❑ ❑ Exit Lights t� L� ❑ K11 MECHANICAL l HEAT APPLIANCES COMPRESSED CYLINDERS Clearance to ❑ Storage ❑ ❑ Unsafe Conditions ❑ Secured ❑ ❑ VIOLATION DESCRIPTIONS Complete 19 ❑ New Emergency Contacts 6} ❑ KEY BOX (na) Knox Box Required ❑ ❑ Keys Tested ❑ ❑ UTILITY SHUTOFFS Accessible LB, ❑ ADDRESS VISIBLE (front & rear) 6` ❑ HAZARDOUS MATERIALS Tn n ❑ ❑ SIGNATURES COMPANY OFFICER: 6I:7 R REINSPECTION DATE: P/0 940, REFUSAL OF INSPECTION I. do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. ME OCCUPANCY {� j /-'� j /S� 1 DATE 0 l LOCATION ID# HOUSEKEEPING C VV FD CONNECTION NA C V FIRE ALARM C V Unsafe Conditions d o Accessible � ❑ Panel Accessible ❑ ❑ Ceiling Assembly )a' ❑ Maintenance ,@ ❑ Annual Test ❑ ❑ EXITWAYS/DOORS SPRINKLERSYSYEM NA PREPLAN INFORMATION Obstructed / Locked 0�13 Pressurized & Accessible ,0 ❑ Complete 16 ❑ Maintained ❑ Annual Test zT ❑ New Emergency Contacts i0 ❑ Proper Hardware ,0" ❑ Sprinkler Clearance ❑ ELECTRICAL FIRE EXTINGUISHERS KEY BOX Exposed Wires fT ❑ Required ,1?1 ❑ Knox Box Required ❑ ❑ Extension Cords 10'0 Charged/Tagged ❑ Keys Tested ❑ ❑ Panel Obstructed ja ❑ Accessible/Height Z ❑ Knockouts Needed RT ❑ GCFI Outlet ee ❑ KITCHEN SYSTEM$ N� UTILITY SHUTOFFS EXIT LIGHTING Charged/Tagged ❑ ❑ Accessible X0 Clean/Repair 110 Emergency Lights 41 ❑ Class K Extinguisher ❑ ❑ ADDRESS VISIBLE Exit Lights )2- ❑ (front & rear) 00 MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDERS HAZARDOUS MATERIALS NA Clearance to in ❑ Storage ❑ ❑ Identification ❑ Unsafe Conditions jz ❑ Secured ❑ ❑ VIOLATION DESCRIPTIONS >l i I't/ r �X� >r / i7-t0 4 � SIGNATURES COMPANY OFFICER: REINSPECTION OF INSPECTION Print Name 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. OCCUPANCY % N LOCATION Unsafe Conditions Ceiling Assembly EXITWAYS /DOORS Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING O w �� C V FD CONNECTION NA C V w❑ Accessible Y❑ Maintenance SPRINKLER SYSTEM NA -'yam ❑ Pressurized & Accessible CI ❑ Annual Test <D Sprinkler Clearance FIRE EXTINGUISHERS '� ❑ Required ❑ Charged/Tagged O Accessible /Height y❑ /' CJ ❑ KITCHEN SYSTEMS �NA� Charged/Tagged L /�/ Clean/Repair Emergency Lights $r ❑ Class K Extinguisher Exit Lights Nr ❑ MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDERS Clearance to X- ❑ Storage Unsafe Conditions 2r ❑ Secured DATE 101a R 15- ID# /l0 FIRE ALARM 6ll C V A] ❑ Panel Accessible ❑ ❑ iq ❑ Annual Test ❑ ❑ PREPLAN INFORMATION JR'❑ Complete ON ❑ Ac New Emergency Contacts J)r ❑ 0© KEY BOX ONA I O Knox Box Required ❑ ❑ 2"❑ Keys Tested ❑ ❑ &❑ UTILITY SHUTOFFS ❑ ❑ Accessible ❑ ❑ ❑ ❑ ❑ ADDRESS VISIBLE (front & rear) K ❑ / N7P H g NA ❑� /❑ iden Ptioffn ❑ ❑ 7 ■ VIOLATION DESCRIPTIONS SIGNATURES 6{m",, -b 00 9,L cx dm{ Inspector Owner /Occupant Print Name COMPANY OFFICER: A,(- REINSPECTION DATE: REFUSAL OF INSPECTION 1. do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. Name: KC-7e / d c Reinspection Date: A copy of this form has been presented to : Owner ❑ Tenant VIOLATIONS NOTED ON THE FIRE INSPECTION EPORT LETTER DATED 44 � HAVE BEEN: CORRECTED. hank you for cooperating with the Fire Department in its attempt to improve life sa a an ire protection in the community. ❑ PARTIALLY CORRECTED. Your attention is called to the items listed below, which still need attention. A reinspection will be made on the date indicated above. ❑ IGNORED. The items originally noted on the above date are still in violation, and have been listed below for your convenience. You are hereby notified to remedy the conditions as stated below by the reinspection date indicated above, or show cause why you should not be required to do so. ❑ IGNORED. inspection visits have been made to the above location, and the violations listed below have been repeatedly ignored. This violation notice is being forwarded to the Fire Prevention Bureau Director, and such further action will be taken as the law requires to gain compliance. 7 ' J aJ Folt Cp R4G c,7--1,,J a U c Or.,4 n old / Agent / manager / Representative oe Inspectin Officer REINSPECTION FORM Reinspection No. S- Location: G 3 2 Y U' pro S7-- f-� Date: 4(1 L Name: Ka -i t/JC Date:: o (o vl T 1 2D) A copy of this form has been presented to : Owner ❑ nant VIOLATIONS NOTED ON THE FIRE INSPECTI REPORT LETTER DATED.& JLt 1 HAVE BEEN: ❑ CORRECTED. Thank you for cooperating with the Fire Department in its attempt to improve life safety and fire protection in the community. PARTIALLY CORRECTED. Your attention is called to the items listed below, which still need attention. inspection will be made on the date indicated above. ❑ IGNORED. The items originally noted on the above date are still in violation, and have been listed below for your convenience. You are hereby noted to remedy the conditions as stated below by the reinspection date indicated above, or show cause why you should not be required to do so. ❑ IGNORED. inspection visits have been made to the above location, and the violations listed below have been repeatedly ignored. This violation notice is being forwarded to the Fire Prevention Bureau Director, and such further action will be taken as the law requires to gain compliance. Q rflZW 7Y S�4 1-7 - 1a7vsr �13e, /,c c Crm 1t Jr V7 s--AQ A,r P..i,.. vS7*j0) Z `O / _X.� ./%J'T),7 Jew A4.A, I. (-Le,, I J IG OCCUPANCY. ICC— X IAIe DATE'I'a LOCATION G 3 a g / 0 9--e,-rp�.J .�— I �2 S' X HOUSEKEEPING CCVV't, FD CONNECTION NA C V ---- Unsafe Conditions ❑_ids° Accessible ❑ Ceiling Assembly ❑ Maintenance .9 ❑ EXITWAYS /DOORS SPRINKLER SYSTEM NA Obstructed /Locked ❑ „@J Pressurized & Accessible -I ❑ aintained Annual Test ❑ Proper Hardware ❑ Sprinkler Clearance ❑ ELECTRICAL Exposed Wires Xl ❑ Rhockouts Needed K ❑ GCFI Outlet 16 ❑ EXIT LIGHTING Eme ency LU ntss 0 .licit Lights ❑s MECHANICAL / HEAT APPLIANCES FIRE `Acxessible/Heig p 11 KITCHEN SYSTEMS ( �A Charged/Tagged \ \\ ❑ ❑ Clean /Repair ❑ ❑ Class K Extinguisher ❑ ❑ COMPRESSED CYLINDERS 1@ Clearance to 9 ❑ Storage Unsafe Conditions .li ❑ Secured FIRE ALARM NA C V Panel Accessible ❑ Annual Test ❑ PREPLAN INFORMATION Complete ❑ New Emergency Contacts ❑ KEY BOX Knox Box Required ❑ ❑ Keys Tested ❑ ❑ UTILITY SHUTOFFS Accessible W ❑ ADDRESS VISIBLE (front & rear) HAZARDOUS MATERIALS ❑ ❑ identification ❑ ❑ ❑ ❑ VIOLATION DESCRIPTIONS fi®liT C—�XCr LrGAcr— MaSP - Ra[ '771M r� r7 fdaV.•s vSX In /r,t,� 3 `° Cz�aan,re n a� tt�ga o. r9 G'7,crrf2,e ��ioolt� SIGNATURES 4 Inspector COMPANY OFFICER: REFUSAL OF REINSPECTION Print Name vt-I ilv� i, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. OCCUPANCY Lvl /�l� DATE r LOCATION HOUSEKEEPING Unsafe Conditions Ceiling Assembly EX17WAYSIDOORS Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING C V FD CONNECTION 01 C V AJp— Accessible ❑ L1 0 u Maintenance ❑ ❑ SPRINKLER SYSTEM t /❑ Pressurized & Accessible ❑ ❑ �❑ Annual Test ❑ ❑ ❑ Sprinkler Clearance ❑ ❑ FIRE EXTINGUISHERS �❑ Required /❑ ❑ Charged/Tagged ❑ AoaessibWHeight �❑ ❑ Y❑ KITCHEN SYSTEMS NA Charged/Tagged ❑ ❑ Clean/Repair ❑ ❑ Emergency Lights ❑� Class K Extinguisher ❑ ❑ Exit Lights ❑y MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDER Clearance to �❑ Storage Unsafe Conditions X ❑ Secured 9 FIRE ALARM C V Panel Accessible ❑ ❑ Annual Test ❑ ❑ PREPLAN INFORMATION Complete �6 ❑ New Emergency Contacts / ❑ KEY BOX Knox Box Required ❑ ❑ Keys Tested ❑ ❑ UTILITY SHUTOFFS Accessible ❑ ADDRESS VISIBLE (front & rear) �p HAZARDOUS MATERIALS NA Identification ❑ ❑ REINSPECTION DATE: REFUSAL OF • , 1• do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. LUwirANY Ur- tl(:tK: !/r C � ON GROVE FIRE DEPARTMENT 6250 LJNooLNAvENUE 60053 847-470-5226 (Bus) 847-965-7711 (FAx) OCCUPANCY IViL eJ2' (V,/ 's —i "f D^ LOCATION 6 3 1� V 5L OCJ4�- �Nv�, HOUSEKEEPING Unsafe Conditions Ceiling Ass(mbly EXITWAYS /DOORS Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING hhhCrrr V FD CONNECTION C V ❑ Accessible ❑ ❑ ❑ Maintenance ❑ ❑ SPRINKLER SYSTEM 9I ❑ Pressurized & Accessible ❑ ❑ ❑ Annual Test ❑ ❑ ❑ Sprinkler Clearance ❑ ❑ FIRE EXTINGUISHERS R ■ is ■ rd ■ ■ Emergency Lights y+% ❑ Exit Lights ❑ MECHANICAL / HEAT APPLIANCES Required 1❑f ❑ Charged/ragged )5 ❑ Aeoessible/Height ❑ KITCHEN SYSTEMS NA ` Charged/Tagged ❑ ❑ Clean /Repair ❑ ❑ Class K Extinguisher ❑ ❑ DATE 31 2',7 r ID# 306 FIRE ALARM NA C V Panel Accessible ❑ ❑ Annual Test ❑ ❑ PREPLAN INFORMATION Complete rrrrrr((( ❑ New Emergency Contacts ❑ KEY BOX NA Knox Box Required ❑ ❑ Keys Tested ❑ ❑ UTILITY SHUTOFFS Accessible ADDRESS VISIBLE (front &rear) COMPRESSED CYLINDERS NA HAZARDOUS MATERIALS Clearance to ❑ Storage Unsafe Conditions ❑ Secured y ■ ❑ ❑ Identification >0 ❑ ❑ ❑ VIOLATION DESCRIPTIONS SIGNATURES REINSPECTION DATE: REFUSAL OF INSPECTION 1• do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. OCCUPANCY S,eA V '� 5L2 Q,n DATE 3 LOCATION �° �35�6 CMG V^ ZI '� ID# HOUSEKEEPING Unsafe Conditions Ceiling Assembly EXITWAYS /DOORS Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING C V FD CONNECTION � C V FIRE ALARM NA C V ❑ Accessible ❑ ❑ Panel Accessible ❑ ❑ ❑ Maintenance ❑ ❑ Annual Test ❑ ❑ SPRINKLER SYSTEM PREPLAN INFORMATION `I ❑ Pressurized & Accessible ❑ ❑ Complete 6 ❑ j� ❑ Annual Test ❑ ❑ New Emergency Contacts JT❑ ❑ Sprinkler Clearance ❑ ❑ FIRE EXTINGUISHERS KEY BOX 0 ❑ Required ❑ Knox Box Required ❑ ❑ 4, ❑ Charged/Tagged ❑ Keys Tested ❑ ❑ ❑ Accessible/Height �9 ❑ C3 ❑ � %❑ KITCHEN SYSTEMS /rvrl UTILITY SHUTOFFS Emergency Lights C1 ❑ Exit Lights V� ❑ MECHANICAL / HEAT APPLIANCES Clearance to `,�C7 ❑ Unsafe Conditions' ❑ Chargedlfagged ❑ ❑ Clean /Repair ❑ ❑ Class K Extinguisher ❑ ❑ COMPRESSED CYLINDERS NA Storage ❑ ❑ Secured ❑ ❑ VIOLATION DESCRIPTIONS Accessible (41 ■ ADDRESS VISIBLE (front & rear) ❑ HAZARDOUS MATERIALS Identification '❑ ❑ COMPANY OFFICER: � i y4 �� REINSPECTION DATE: REFUSAL OF INSPECTION 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. OCCUPANCY r as ���+ I /� L' �1 (U U, DATE LOCATION �// ✓ b G @a. tc� "TV ✓\ Ip 9'3 HOUSEKEEPING C V Unsafe Conditions1 ❑ Ceiling Assembly! ❑ EXITWAYS /DOORS Obstructed / Locked ❑ Maintained Proper Hardware 4 ❑ ELECTRICAL Exposed Wires )0 ❑ Extension Cords ❑ ❑ Panel Obstructed r ❑ Knockouts Needed >n ❑ GCFI Outlet 41 ❑ EXIT LIGHTING Emergency Lights 4 ❑ Exit Lights �Q ❑ MECHANICAL / HEAT APPLIANCES Clearance to Unsafe Conditions FD CONNECTION ,jt! Accessible Maintenance SPRINKLER SYSTEM Pressurized & Accessible Annual Test Sprinkler Clearance FIRE EXTINGUISHERS C V FIRE ALARM /`NA / C V ❑ ❑ Panel Accessible ❑ ❑ ❑ ❑ Annual Test ❑ ❑ PREPLAN INFORMATION 110 Complete ❑ ❑ ❑ New Emergency Contacts Y0� 't7❑ ■r Required ?a ❑ Chargedrragged 1,0 ❑ Acoessibie/Height & ❑ KITCHEN SYSTEMS NA Charged/Tagged ❑ ❑ Clean /Repair ❑ ❑ Class K Extinguisher ❑ ❑ �/�❑ Storage T'tT ❑ Secured KEY BOX & Knox Box Required ❑ ❑ Keys Tested ❑ ❑ UTILITY SHUTOFFS Accessible /9 ❑ ADDRESS VISIBLE ,�.� (front & rear) >92 ❑ CYLINDERS NA HAZARDOUS MATERIALS NA (� ❑ Identification )6 ❑ VIOLATION DESCRIPTIONS SIGNATURES Insp (tor COMPANY OFFICER: l� aryl `'� REFUSAL OF INSPECTION c"Cc. Print Name DATE: 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. REINSPECTION FORM Reinspection No. S' Location: X03'7 �2, ®RK-To.J S%�-- Date: Sz,—P ' ! 1E Name: L S�r Y SAsJ K y i rl C Reinspection Date: A copy of this form has been presented to : Owner 11 Tenant VIOLATIONS NOTED ON THE FIRE INSPECTI REPORT LETTER DATED i Z4 HAVE BEEN: CORRECTED. hank you for cooperating with the Fire Department in its attempt to improve life sa eery Tf9 ire protection in the community. ❑ PARTIALLY CORRECTED. Your attention is called to the items listed below, which still need attention. A reinspection will be made on the date indicated above. ❑ IGNORED. The items originally noted on the above date are still in violation, and have been listed below for your convenience. You are hereby noted to remedy the conditions as stated below by the reinspection date indicated above, or show cause why you should not be required to do so. ❑ IGNORED. inspection visits have been made to the above location, and the violations listed below have been repeatedly ignored. This violation notice is being forwarded to the Fire Prevention Bureau Director, and such further action will be taken as the law requires to gain compliance. y0J C®m) L Ucic W Owner % Agent / Manager / Representative Inspecting INSPECTION REPORT FORM Location: -(P3 % a Q/J.Cry�J So— Date:44 sS7� .9 QDI/ ' Occupancy: 54d k y I eIL ID#: S/® Contact Person: r r u Phone #: 67 7 1 — -7f 7 ❑ Fire Prevention Activity CEompliance Certificate ❑ Residential ❑ F.P. Permit Type of Inspection ❑ Complaint ❑ Fire Alarm ❑ Fire Pump ❑ Knox Box ❑ Construction Site ❑ UL 300 Suppression System ❑ Sprinkler System ❑ Other 9 J(t (O.�ir- bogEr Nor 71'Z�sv-- /,IS,�}x.� CDm�e� L— s=.r�C- -znG- �c�✓c7 .(.�G•� -r ®JC-2 f�L�2 24 rC47 23dG4 uo Cjeg Li4kkr G,JA46aou ec Tb OPFii 4 �Q Cr$ You are hereby notified that you either passed or are remed he conditions stated above within hours / days of this order. Appeal from this order may de within 10 days from the date of service. Direct such appeal to the Fire Captain of the Morton Grove Fire Prevention Bureau by telephone, (847) 47 6, or by writing the Office of the Fire Chief, 6250 Lincoln Ave., Morton Grove, IL 60053 r e Inspector: Received By: OCCUPANCY MORTON GROVE FIRE DEPARTMENT 6250 LiNcoLN AvENuE -..- . ... vE, 11-UNOIS .rr 847-470-5226 (Bus) 847-965-7711 (FAx) LOCATION U/--� -7 (o QeJ4 --b v DATE ID# - yS HOUSEKEEPING C V FD CONNECTION 'NA C V FIRE ALARM NA Unsafe Conditions ❑ Accessible Complete ❑ ❑ Panel Accessible Ceiling Assembly 9?J ❑ Maintenance .$' ❑ ❑ ❑ Annual Test EXITWAYS /DOORS Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING C V ■ ■ ■ Emergency Lights W ❑ Class K Extinguisher ❑ ❑ Exit Lights 7@ ❑ MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDERS N� Clearance to ❑ Storage ❑ ❑ Unsafe Conditions Secured ❑ ❑ VIOLATION SIGNATURES r COMPANY OFFICER: 46r, e ADDRESS VISIBLE (front & rear) W ❑ HAZARDOUS MATERIALS NA Identification ❑ ❑ REINSPECTION INSPECTION PA P �/s / -LI Pint Name 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. SPRINKLER SYSTEM6A / PREPLAN INFORMATION ❑ Pressurized & Accessible ❑ ❑ Complete rV ❑ 42 ❑ Annual Test ❑ ❑ New Emergency Contacts .$' ❑ ❑ Sprinkler Clearance ❑ ❑ FIRE EXTINGUISHERS KEY BOX dal ❑ Required P7 ❑ Knox Box Required ❑ ❑ ❑ Chargedlragged ❑ Keys Tested ❑ ❑ �p ❑ Accessible /Height ❑ ❑ KITCHEN SYSTEMS UTILITY SHUTOFFS Charged/Tagged ❑ ❑ Accessible ( ❑ Clean/Repair ❑ ❑ Emergency Lights W ❑ Class K Extinguisher ❑ ❑ Exit Lights 7@ ❑ MECHANICAL / HEAT APPLIANCES COMPRESSED CYLINDERS N� Clearance to ❑ Storage ❑ ❑ Unsafe Conditions Secured ❑ ❑ VIOLATION SIGNATURES r COMPANY OFFICER: 46r, e ADDRESS VISIBLE (front & rear) W ❑ HAZARDOUS MATERIALS NA Identification ❑ ❑ REINSPECTION INSPECTION PA P �/s / -LI Pint Name 1, do hereby refuse authorized representatives of the Morton Grove Fire Department entry into my business premises for the conduction of a Fire Inspection. OCCUPANCY �. ^r•1j�g, My 4c- DATE Complete `40 IK ❑ Annual Test ❑ LOCATION n Ci A 00 I ID# 5 O5 ❑ Sprinkler Clearance ❑ ❑ HOUSEKEEPING C V FD CONNECTIO NA 7 C V FIRE ALARM NA C V Unsafe Conditions ,R ❑ Accessible ❑ ❑ Panel Accessible ❑ ❑ Ceiling Assembly 19 ❑ Maintenance ( ❑ \ Annual Test ❑ ❑ EXITWAYS /DOORS Required \❑ \� SPRINKLER SYSTEM \[VA PREPLAN INFORMATION Knox Box Required Obstructed / Locked Maintained Proper Hardware ELECTRICAL Exposed Wires Extension Cords Panel Obstructed Knockouts Needed GCFI Outlet EXIT LIGHTING Emergency Lights Exit Lights .$l ❑ Pressurized & Accessible 110 Complete 0 ❑ IK ❑ Annual Test ❑ ❑ New Emergency Contacts , W ❑ H ❑ Sprinkler Clearance ❑ ❑ �''�'\ FIRE EXTINGUISHERS KEY BOXI: NA ) g ❑ Required -9 ❑ Knox Box Required ❑ ❑ C] ❑ Chargedfragged 9 ❑ Keys Tested 110 0 ❑ Accassible/Height $. ❑ g ❑ ❑ KITCHEN SYSTEM NA UTILITY SHUTOFFS Charged/Tagged Clean /Repair A ❑ gyp) Class K Extinguisher X 4 COMPRESSED CYLINDERS NA Storage ❑ Secured ❑ ❑ MECHANICAL I HEAT APPLIANCES Clearance to A ❑ Unsafe Conditions 19� ❑ SIGNATURES COMPANY OFFICER: r VIOLATION DESCRIPTIONS Accessible ADDRESS VISIBLE (front & rear) ❑ 11 '� HAZARDOUS MATERIALS NA Identification ❑ lelc, Nave OwnerfOccupant Print Name REINSPECTION REFUSAL OF INSPECTION 1• do hereby refuse authorized representatives of the Morton Grov Department entry into my business premises for the conduction of a Fire Inspection.