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CITY OF CARMEL, INDIANA VENDOR: 229400 *******ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIIRHECK AMOUNT: S 150.00* CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 311512 302 W WASHINGTON ST,RM E221 CHECK DATE: 05/23/17 INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1093 4239099 304619 25.00 OTHER MISCELLANOUS 1093 4239099 304624 25.00 OTHER MISCELLANOUS 1093 4239099 304625 25.00 OTHER MISCELLANOUS 1093 4239099 304626 25.00 OTHER MISCELLANOUS 1093 4239099 304627 25.00 OTHER MISCELLANOUS 1093 4239099 304628 25.00 OTHER MISCELLANOUS O 0 0 0 0 0 0 0 0 O co � cO (O cO (O (O CO (O (O * O A (D W W W W W W W W ik o ZO -S D Cl Z 00 z n CA)OW0 a a wwwwwwww < O allo. = a m rt o 0 0 0 0 0 0 O O o c v mo v a A A A A A A A A n co Z O m Q 0 0 0 0 0 0 0 0 m 3 0 c =' v 0 W L" W NA W O Oz ic O O CS` � � � a3 =r (n Cl A A A A A A A A n 3 -0 Z c Co P. yco co co co co co W co m c rn � < c 00000000 o -► ai co co co co co w w w -i To o co voi c ori tO w w w co w w w r :(1 p A (n co Z > > EA 69 b9 Efl Ef) 40 -rd) to EA > c0 3 Co 0 a N m DO N ip* O Z rn� c -n oUl Old Uld Ul 01 L"n cNr+ Lrl z O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 I 0 m * 3 Q - D o) = = M• m v - to 0 s _ CD c g cDa °' 3 a m n 0 D 0 a � m _� 0 (D Z.(D to 0 T 2 c o5 _ cD n ami fl. cn CD n m g CD m y m 3 o W a� m fD n n0i N o n a s a O Q. — p) (D CD (D S > O. n - m (D n -. O N < O O a 3 °« o Q n o m (D ' m N (n O' O O 201] INVOICE FOR INSPECTION / CERTIFICATE FEES State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:/Imyoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 uo information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE NUMBEP. LATEST PLEASE CARMEL CLAY PARKS & RECREATION I, INVOICE PAY THIS 304619 1411 E 116TH ST DATE AMOUNT! Owner Id ATTN DAWN KOEPPER CARMEL, IN 46032-3455 05/03/2017 759531 j Owner number User Name&Location of vessel Fee MONON COIMMUNITY CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W T Blr - Hot Water cleating BRYAN 04/05/2017 i National Board No. Inspection agency Name of inspector (This fee is 53252 HSBZ&I CO DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) j Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304619,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT r r 4 INVOICE FOR INSPECTION / CERTIFICATE FEES 2017 State Form 356(R4/9-93) , w Approved by the State Board of Accounts-1991 v Division of Fire and Building Safely BY; r 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your pa entso;N,;w DHS welSsife 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:l/myoracle.in.gov/dfbs/ldhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE NUMBER LATEST PLEASE CARMEL CLAY PARKS & RECREATION 304620 INVOICE PAY THIS 1411 E 116TH ST DATE AMOUNT! Owner!d ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 05/03/2017 V -- ----- --- ..-. Fee J Owner number User Name&Location of vessel MONON COMMUNITY CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 p Serial number Description of vessel Manufacturer Date Last Inspected W T Blr - Hot Water Heating IBRYAN 04/05/2017 National Board No. Inspection agency Name of inspector (This fee is 53259 IHSBI&I CO DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304620,05/03/2017 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT 2017 INVOICE FOR INSPECTION / CERTIFICATE FEES Approved by Division of Fireeoard of Accounts- 991 and Building ng Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE _ NUMBER LATEST PLEASE CARMEL CLAY PARKS & RECREATION INVOICE PAY THIS 304623 1411 E 116TH ST DATE AMOUNT! Owner Id ATTN DAWN KOEPPER 759531 - CARMEL, IN 46032-3455 05/03/2017 Owner number User Name&Location of vessel Fee MONON COMMUNITY CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected ' W T Boiler LOCHINVAR 104/65/2017 National Board No. Inspection agency Name of inspector (This fee is 184067 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) — Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304623,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT r 7" 2017 INVOICE FOR INSPECTION / CERTIFICATE FEES State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety s 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATF. NUMBER LATEST PLEASE CARMEL CLAY PARKS & RECREATION INVOICE PAY THIS 304624 1411 E 116TH ST i DATE AMOUNT! Owner Id ATTN DAWN KOEPPER —- --- 05/03/2017 7 759531 CARMEL, IN 46032-3455 Owner number User Name&Location of vessel MONON COMMUNITY CTR Fee 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 —Sepal number - --- -- - -- - - — — Description of vessel Manufacturer Date Last Inspected W T Boiler I LOCHINVAR 04/05/2017 National Board No. Inspection agency T Name of inspector (This fee is 195396 HSBI&I CO j DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304624,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT T^^-.��^ •��•.. ....nnninn fpr rnir rornMc INVOICE FOR INSPECTION / CERTIFICATE FEES f �, State Form 356(R4/9-93) �ti�l�Y j 2017 ` Approved by the State Board of Accounts-1991 1 .; Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payme eat IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY haps://myoracle.in.gov/d 01wesistartA&. ••••••..• g INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE NUMBER LATEST PLEASE CARMEL CLAY PARKS & RECREATION 304625 INVOICE PAY THIS j 1411 E 116TH ST DATE (AMOUNT! Owner Id ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 05/03/2017 Owner number I User Name&Location of vessel Fee THE MONON CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 -- Serial number Description of vessel Manufacturer Date Last Inspected : W T Boiler , LOCHINVAR 04/05/2017 IN Board No. Inspection agency Name of inspector (This fee is 181548 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA REINSPECTION--304625,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT --k—�- A-- .n i—for vour records INVOICE FOR INSPECTION CERTIFICATE FEES ti Olt State Form 356(R4/9-93) J4��A� 1 Approved by the State Board of Accounts-1991 1.Mail checks payable of Fire and Building Safety p y e to DEPARTMENT OF HOMELAND SECURITY You can pay all your p rSgpljgg ,lp�{�,�g�,�ite-,,,,,, y 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY haps://myoracle.in.gdv/df6�7idn�rreEsffnESf!tart'dtr--- INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone (317)232-1921 INDIANA STATE NUMBER CARMEL CLAY PARKS & RECREATION LATEST PLEASE 304626 i INVOICE PAY THIS 1411 E 116TH ST 1 DATE AMOUNT! Owner Id ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 05/03/2017 Owner number User Name&Location of vessel THE MONON CTR Fee l 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W T Boiler ! LOCHINVAR 04/05/2017 National Board No. Inspection agency Name of inspector (This fee is I 181626 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by 675 IAC 12-3-13) --I Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304626,05/03/2017 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT T-.^•1 —­•.. f—nn.finn fnr vour records INVOICE FOR INSPECTION CERTIFICATE FEES FBY �/� r 201 1/ State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety , ... 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments onlmeat'It"web site, 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE - --_--- T NUMBER CARMEL CLAY PARKS & RECREATION LATESTPLEASE INVOICE PAY THIS 304627 1411 E 116TH ST DATE (AMOUNT. Owner Id ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 05/03/2017 Owner number User Name&Location of vessel _TFee THE MONON CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W T Boiler LOCHINVAR 04/05/2017 National Board No. Inspection agency Name of inspector (This fee is 181533 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by 1- 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304627,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT T. he ­4­ti,t—n—tinn for vour records c 771 f a INVOICE FOR INSPECTION / CERTIFICATE FEES State Form 356(R4/9-93) `. Approved by the State Board of Accounts-1991 Division of Fire and Building Safety A. "........... ..... 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your paym ne is on to 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 ------ _--- ----- - — - -- � -- - INllIA211A STATE NUMBER CARMEL CLAY PARKS & RECREATION^ LATEST N j PLEASE PAY INVOICE THIS 304628 1411 E 116TH ST DATE AMOUNT! Owner Id ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 05/03/2017 Owner number User Name&Location of vessel THE MONON CTR Fee 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected ' W T Boiler ' LOCHINVAR 04/05/2017 National Board No. 11 Inspection agency Name of inspector (This fee is 181629 i HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by —1 ---_.--- 675 IAC 12-3-13) --� Inspection Date Inspector Name Inspection Type Due 04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304628,05/03/2017 S 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT