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Home My WebLink AboutElevator Inspection 2022-2-28 Elevator- Inspection Report Enclosed F-cF-oVF- R DD MAR -7 2022 • VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELEVATOR INSPECTION Data Processing Center 650 Halstead Avenue, Suite 106 Mamaroneck,NY 10543 February 28, 2022 Village of Rye Brook Department of Buildings 938 King Street Rye Brook, NY 10573 RE: Elevator Inspection QEI Report for 17 Berkley Dr. Enclosed please find our 2022 QEI reports for the inspection of the elevators/escalators located at the above referenced location. Sincerely, Tara Rooney Gotham Elevator Inspection Data Processing Center 650 Halstead Avenue, Suite 106 Mamaroneck, NY 10543 p 914 8351010 f 914 835 0084 trooney@gothamelevatorinspection.com QEI Elevator Inspection / Test Report Inspection 1 Location Information Address 17 Berkley Drive Application Number(If applicable) Town Rye Brook Speed 30 fpm Capacity 750 Ibs 2 Report Type 3 Fee Status Elevator Inspection/Test _j Filing Fee LJ Periodical Test Passenger ,J Fee Exempt with Proof Enclosed Z Routine Inspection ❑Freight ❑Acceptance Test 4 Applicant Information To be completed by the inspecting agency. Last Name First Name Middle Initial Business Name Gotham Elevator Inspection Business Telephone (212)292-4225 Business Address 521 Fifth Avenue,Suite 1700 Mobile Telephone City New York State NY Zip 10175 E-Mail tledden@gothamelevatorinspecWn.com BIS Registration# Agency Certification# 487001 License Number 487001 5 Owner Information Last Name Berens First Name Alicia Middle Initial Business Name Slade Elevator Business Telephone (908)228-9831 Business Address 1101 Bristol Road Mountainside, NJ 07092 Mobile Telephone City Mountainside State NJ Zip 07092 E-Mall alicia@slad"levator.com 6 Test Information List each device individually. Device types marked with an asterisk(')require Section 11 to be completed. o� cr0 y W o� tim Mr G O <tr k S� Q Q Q O Qm J 1-QEI-1 2/24/2022 X1 I X 2. 3. 4. 5. � Internal Use Only!i Y Batch Number Date Received Fee Paid Invoice Number Accepted Rejected Reason 3/11 QEI Inspection PAGE 2 7 Location Information Repeat information provided in Section 1. Address 17 Berkley Drive Application Number(If applicable) 8 Unsatisfactory Devices Refer to Page 3 for Elevator Part, Violation Condition,and Suggested Remedy codes. 1. Device#: Comments: Elevator Part Violation Condition Suggested Remedy 2. Device#: Comments: Elevator Part Violation Condition Suggested Remedy 3. Device#: Comments: Elevator Part Violation Condition Suggested Remedy 4. Device#: Comments: Elevator Part Violation Condition Suggested Remedy 5. Device#: Comments: Elevator Part Violation Condition Suggested Remedy 9 Property Owner's Statements and Signatures 11 Witnessing Agency's Statements and Signatures The above named Approved Elevator Inspection Agency has performed.on my behalf.an As a representative of an Approved Elevator Inspection Agency.I attest to have been witness inspeclioNtesl of the elevator(s)described above and on attached sheets. A copy of the to the inspection(s)itest(s)performed by the above named inspecting agency. These final report has been provided to me and appropriate inspection certificate(s)will be posted inspection(s)ltest(s)were performed in accordance with all NYC Administrative Code and other in accordance with NYC Administrative Code and other applicable laws and rules. applicable laws and rules. I further attest neither myself nor my agency have any affiliation with Falsification of any statement is a misdemeanor and is punishable by a fine or the above named inspecting agency. Falsification of any statement is a misdemeanor and is imprisonment,or both.It is unlawful to give to a city employee..or for a city employee to punishable by a fine or imprisonment,or both.It is unlawful to give to a city employee,or for a accept any benefit,monetary or otherwise,either as a gratuity for properly performing the city employee to accept any benefit,monetary or otherwise,either as a gratuity for properly job or in exchange for special consideration. Violation is punishable by imprisonment or performing the job or in exchange for special consideration. Violation is punishable by fine or both. Certified Organization: Gotham Elevator Inspection imprisonment or fine or both. Owner's Name(print): Alicia Berents Street Address:521 Fifth Avenue,Suite 1700 Signature and Date , City: New York State:NY Zip:10175 10 Inspecting Agency's Statements and Signatures Telephone Number:(212)2924225 Fax: (914)835-0084 As the above named Approved Elevator Inspection Agency,I have inspected tested the E-Mail Address:tledden@gothamelevatorinspection.com elevator(s) described above and on attached sheets in accordance with all NYC Administrative Code and other applicable laws and rules. The results of these inspections/ tests are indicated above and a copy of this report has been provided to the owner. Falsification of any statement is a misdemeanor and is punishable by a fine or ► imprisonment,or both.It is unlawful to give to a city employee,or for a city employee to Signature and Date accept any benefit,monetary or otherwise,either as a gratuity for property performing the job or in exchange for special consideration. Inspector's Name(print):N/A � ) Lic#: Signature and Date , NOTE:witnessing Agency Signatures not required if filing inspection results for Private Residential Certified Organization: Got am Elevator 1 Elevator,Conveyor.Dumbwaiter,or Material Lift. Inspector's N me(print): To as Ledden P39551 Signature and .ate , NOTE:Hazardous Conditions/Cease Use items shall not be reported on this form.These items shall be corrected immediatelV. �. 3/11 QEI Inspection PAGES 12 Elevator Part INSIDE CAR TOP OF CAR 51 Slack Rope Switch 77 Underside Platform 01 Emergency Stop Switch 26 Top Emergency Exit Cover 52 Hoist Cables 78 Tension Weight 02 Alarm System 27 Governor Release Carrier 53 Governor Ropes 79 Comp/Chains/Ropes/Switch 03 Car Enclosure 28 Door Hangers&Connectors 54 Car Counterweight Rope 80 Counterweight Runby 04 Side Emergency Exit 29 Door Operator 55 Drum Counterweight Rope 81 Counterweight Runby Signage 05 Car Door/Gate 30 Normal Limits 56 Hoist Machine 82 Plunger Gripper O6 Car Door/Gate Contact 31 Final Limits 57 Hoist Motor ESCALATOR/MOVING WALK 07 Door Reopening Device 32 Guide Shoes/Roller Guides 58 Worm/Gear/Bearings 83 Fire Shutters 08 Car Floor to Landing Still 33 Counterweight 59 Machine Brake 84 Skirt Switch 09 Car Floor 34 Hoistway 60 Lighting Machine Space 85 Skirt Deflection Device 10 Car Door Gibs 35 Electrical Wiring 61 Machine Disconnect SW 86 Comb Plate/Comb Plate Teeth 11 Car Button Station 36 Pipes and Ducts 62 Commutator 87 Landing Plate/Impact Switches 12 Car Lighting 37 Overhead&Deflector Sheave 63 Motor Brushes 88 Handrails/Handrail Safeties 13 Emergency Lighting 38 Traveling Cable&Junction 64 NYC Device# 89 Step/Thread 14 Car Mirror 39 Car Top 65 Unintended Car Movement 90 Key Switch 15 Certificate Frame MACHINE ROOM 66 Emergency Brake/Rope Gripper 91 Emergency Stop Button OUTSIDE HOISTWAY 40 Machine Room 67 Communication 92 Decking and Ballistrades 16 Hoistway Doors 41 Machine Room Door 68 Maintenance Log 93 Ceiling Guards 17 Hoistway Door Gibs 42 Controller—Selector 69 Code Data Plate 94 Deck Barricades 18 Hoistway Door Reinforcements 43 Reverse Phase Relay PIT 95 Internal Safeties 19 Hoistway Door Safety Retainer 44 Traction Sheave 70 Pit 96 Safety Signage 20 Vision Panel 45 Governor 71 Pit Light ALL TYPES 21 Interlocks 46 Governor Switch 72 Pit Stop Switch 97 Entire Device 22 Parking Device 47 Drum 73 Car Guide-Rails&Brackets 98 Current Five Year Tag 23 Hall Button Station 48 Pump Unit 74 Cwt Guide-Rails&Brackets 99 Current One Year Tag 24 Indicators 49 Drum Machine Limit SW 75 Buffers 100 Miscellaneous 25 Door Safety Retainer 50 Generator 76 Car Safety&Tail Rope 13 Violating Condition A Altered H Worn O Dirty V Not Level B Insufficient I Damaged P No Means of Access W Unlocked C Padlocked J Misaligned O Unguarded X Inoperative D Unsecured K Rusted R Illegal Y Oil Leak E Rubbing L Defective S Not Fire Retardant Z Water Leak F Lost Motion M Missing T Unlabeled AA Carbon Buildup G Improper Fuses N By-passed U Device Not Tagged BB Expired Tag 14 Suggested Remedy 01 Adjust 06 Properly Secure 11 Replace 16 Provide Means of Access 02 Clean 07 Provide 12 Reshackle 17 Re-inspection Required 03 Install Guards 08 Regroove 13 Seal 04 Patch 09 Remove 14 Shorten 05 Perform&File Test 10 Repair 15 Tag Device 3/11