HomeMy WebLinkAbout06090093 Application
09;15/2006 12:38
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INDIANA DEPARTMENT OF FIRE AND BUILDING SERVICES
OFFICE OF THE STATE BUILDING COMMISSIONER
402 West Washington Street
IGCS Room W246
Indianapolis, IN 46204
AMUSEMENT DEVICE CORRECTION ORDER
IC 22.15.7.2
State Form 43132 (A2 /7~92)
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I Name of device
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Device class
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Name of owner
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Current inspection date
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Date application received
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inspection type .
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CODE VIOLATION CITED:
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NDT documentation received
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PLEASE ADVISE IN WRITING DAYS OF ACTION TO COMPLY
If corrections have no! been complied with, what action was taken?
lOuring periodic inspections check for compliance?
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INDIANA DEPARTMENT OF FIRE AND BUILDING SERVICES
OFFICE OF THE STATE BUILDING COMMISSIONER
402 West Washington Street \
IGCS Room W246
Indianapolis, IN 46204
AMUSEMENT DEVICE CORRECTION ORDER
IC 22.15.7.2
State Form 43132 (R2 I 7 -9?l
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Name of owner
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Address (nuinber and street, city, slate, ZIP code)
I Name of d.eVice .
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11 Speed (~ II;
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Registration number
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Current inspection dale
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Inspection type
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CODE VIOLATION CITED:
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REMARKS
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PLEASE ADVISE IN WRITING
DAYS OF ACTION TO COMPLY.
I During periodic inspections check for compliance?
I 0 Have 0 Have not
Jl corrections have not been complied with, what action was taken?
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Signature of owner-representative
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INDIANA DEPARTMENT OF FIRE AND BUILDING SERVICES
OFFICE OF THE STATE BUILDING COMMISSIONER
402 West Washington Street '
IGCS Room W246
Indianapolis, IN 46204
AMUSEMENT DEVICE CORRECTION ORDER
IC 22.15.7.2
Stale Form 43132 (R2 I 7-92)
Registration number
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Capaci.'y /
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Name 01 owner
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Address (number and street. city, slate, ZIP code)
I Name of device f \ I
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I Speed ~E; ~
I Serial number
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Device class
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Device manufaCturer J / -
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Address (number and street, city, state, ZIP code)
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...................-........................ r Telephone number
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Event city
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Current inspection date / .
3/11 010
Date application received
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Appointment set fOf: )
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Insured by:
......................... ........................, Telephone number
Inspection type (
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Dale fee paid
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I Time of day
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Fee amount
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:" , " CODE VIOLATION CITED:
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REMARKS .,0/
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I v I During periodic inspections check for compliance?
PLEASE ADVISE IN WRITING DAYS OF ACTION TO COMPLY. 0 Have 0 Have no'
If corrections have not been complied with, what action was taken?
Sic.~~~ .owne-icr€flresentalive. ') r
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