INSP - VA Dallas September 2025 Packet.pdf
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- NTX Elevator Inspection
- Solicitation number
- 36C25727Q0031-0001
About this file
This document contains semi-annual elevator inspection reports for the VA Dallas Medical Center conducted on September 15-17, 2025, and September 16, 2025. The inspections cover 40 elevators across multiple buildings at the medical center located at 4500 S Lancaster Road, Dallas, Texas 75216. All inspections were performed by Metro Elevator or Urban Elevator companies and witnessed by Eugene M Kissinger (QEI Inspector License C-5598) from Reliant Elevator Inspections & Consulting, LLC. The inspections were conducted per ASME A17.1 and A17.2 elevator safety codes, with all tested elevators passing their inspections.
The reports document specific violations and required corrective actions for each elevator unit, categorized by building designation (Building 2, Building Fisher House, Building Bldg J2, Liberty Garage, Freedom Garage, Patriot Garage, Building 6, Building 7, Building 74, Building 3T-MRI, and Building 1). Common violations include pit and hoist-way lighting repairs, debris and rubbish removal, emergency lighting and alarm repairs, rescue operation maintenance, brake maintenance, door restrictor repairs, and machine room lighting provisions. Several elevators (designated P10, P13, and P14) received recommendations for removal from service until specific brake maintenance or repairs were completed. Building contact for all inspections is Ken Ballard at 214-742-8387, with elevator maintenance performed by Metro Elevator and Urban Elevator at 4500 S Lancaster.
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VA Dallas 9/25 Semi-Annual ELEVATOR INSPECTION
4602 Deepdale Drive Corpus Christi, Texas 78413 832-734-9977
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
ct.
1 of 11 Dallas
VA Dallas Medical Center - Building 2 P1 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227789 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016
A17.1 2.14.7.1.3 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
Repair emergency lighting and alarm.
9/17/2025
Troy Hale Metro Elevator
4500 S Lancaster
X
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
ct.
2 of 11 Dallas
VA Dallas Medical Center - Building 2 P2 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227790 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
3 of 11 Dallas
VA Dallas Medical Center - Building 2 P3 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227791 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
correct.
4 of 11 Dallas
VA Dallas Medical Center - Building 2 P4 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227792 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
rect.
5 of 11 Dallas
VA Dallas Medical Center - Building 2 P5 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227793 X
X 1952 2019 10
500 4000 2
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.11.10.1 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
Replace landing sill guards below the 1st opening (front fascia plate)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
orrect.
6 of 11 Dallas
VA Dallas Medical Center - Building 2 P6 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
227794 X
X 1952 2019 10
500 4000 2
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.2 5.1.1e 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.11.10.1 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
No water or oil shall be allowed to accumulate in pit.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
Replace landing sill guards below the 1st opening (front fascia plate)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
ect.
7 of 11 Dallas
VA Dallas Medical Center - Building 2 P7 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
650967 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.1 2.14.7.1.3 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
Repair emergency lighting and alarm.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
orrect.
8 of 11 Dallas
VA Dallas Medical Center - Building 2 P8 OTIS
4500 S Lancaster Rd Dallas TX 75216 RMH
650968 X
X 1952 2019 10
500 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.1 2.14.1.5 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
Repair emergency escape exit switch.
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
orrect.
9 of 11 Dallas
VA Dallas Medical Center - Building 2 P9 OTIS
4500 S Lancaster Rd Dallas TX 75216 HydroAccel-M
F - 155165 X
X 1994 2020 3
100 4000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 3.26.10 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair rescue operation
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
4500 S Lancaster
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
10 of 11 Dallas
VA Dallas Medical Center - Building 2 P10 Montgomery
4500 S Lancaster Rd Dallas TX 75216 Miprom 21
CTS - 145546
X
X 1994 2001 5
200 5000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.1 8.6.4.6.1c 2016 YES
A17.1 2.2.5 2016 YES
Recommend car P10 be removed from service until brake maintenance is completed.
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
Perform brake maintenance (brass pin collar out of brake housing)
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Semi-Annual inspection and testing per A17.1 and A17.2 elevator code. Inspection was performed by Metro Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC.
Elevator tests performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
ct.
11 of 11 Dallas
VA Dallas Medical Center - Building 2 P11 Montgomery
4500 S Lancaster Rd Dallas TX 75216 Miprom 21
CTS - 145547
X
X 1994 2001 5
200 5000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 8.6.4.7 2016 YES
A17.1 2.2.5 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Clean pit of debris and rubbish
Repair Pit and Hoist-way lighting (replace burnt out bulbs)
9/17/2025
Troy Hale Metro Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
1 of 1 Dallas
VA Dallas Medical Center - Building Fisher House P19 Schindler
4500 S Lancaster Rd Dallas TX 75216 330A
E - 1530-01 X
2008 2
100 3000 1
A17.1 8.6.1.4.1 2016 YES
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
9/16/2025
Troy Hale & Joey Hawthorn Uban Elevator
4500 S Lancaster
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
orrect.
1 of 16 Dallas
VA Dallas Medical Center Bldg P1 Dover
4500 S Lancaster Rd Dallas TX 75216 WCR
EE 5284
X
1997 2
125 4000 1
17. Due Date for Next 5 year Safety Test:
A17.1 8.6.1.4.1 2016
A17.1 3.26.10 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Periodic Test Tag, Site Documents
Repair rescue operation
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
4500 S Lancaster
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
2 of 16 Dallas
VA Dallas Medical Center Bldg J2 P2 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5276
X
X 1995 7
350 4500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Clean pit of debris and rubbish (potential sewage back flow)
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
3 of 16 Dallas
VA Dallas Medical Center Bldg J2 P3 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5268
X
X 1995 7
350 4500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.14.5.7 2016
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Restricted opening of car doors (repair or replace door restrictor)
Clean pit of debris and rubbish (potential sewage back flow)
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
rect.
4 of 16 Dallas
VA Dallas Medical Center Bldg J2 P5 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5269
X
X 1995 7
350 4500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016
A17.1 2.1.2 2016
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room. (replace burnt out bulbs)
Repair holes in hoist-way. (various floors)
Clean pit of debris and rubbish (potential sewage back flow)
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
rect.
5 of 16 Dallas
VA Dallas Medical Center Bldg J2 P6 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5270
X
X 1995 7
350 4500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016
A17.1 8.6.4.7 2016
A17.1 2.14.7.1.3 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room. (replace burnt out bulbs)
Clean pit of debris and rubbish (potential sewage back flow)
Repair emergency lighting and alarm.
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
6 of 16 Dallas
VA Dallas Medical Center Bldg J2 P7 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5271
X
X 1995 7
350 4500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room. (replace burnt out bulbs)
Clean pit of debris and rubbish (potential sewage back flow)
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
7 of 16 Dallas
VA Dallas Medical Center Bldg J2 S9 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5272
X
X 1995 7
350 6000 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016 YES
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room.
Clean pit of debris and rubbish
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
8 of 16 Dallas
VA Dallas Medical Center Bldg J2 S10 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5273
X
X 1995 7
350 6500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016 YES
A17.1 8.6.4.7 2016
A17.1 2.14.7.1.3 2016
A17.1 2.27.3 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room.
Clean pit of debris and rubbish
Repair emergency lighting and alarm.
Fire phase I - repair recall light and buzzer (In COP)
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing Address:
(Ex. johndoe@yourcompanyemail.com) Number, Street, Suite No., Apt. No. City State Zip
See instruction sheet for disclosure information
25. Elevator Mechanic Name: Elevator Company:
9 of 16 Dallas
VA Dallas Medical Center Bldg J2 S11 Dover
4500 S Lancaster Rd Dallas TX 75216 T-IV
CE 5274
X
X 1995 7
350 6500 1
A17.1 8.6.1.4.1 2016 YES
A17.1 2.2.5 2016 YES
A17.1 2.7.9.1 2016 YES
A17.1 8.6.4.7 2016
Ken Ballard 214 742-8387
Dallas Texas 75215
MCP's - Provide Test Tags, Site Documentation
Repair Pit & Hoist-way lighting (replace burnt out bulbs)
Provide 19fc of lighting in machine room.
Clean pit of debris and rubbish
9/15/2025
Troy Hale & Joey Hawthorn Uban Elevator
INSPECTION DATA - TO BE COMPLETED BY INSPECTOR
1. Unit # 2.Site Name: 3. Contract #: 4. Removed from Service Date: N/A
5. Building Name: Building Designation: 6.Manufacturer:
Building Physical Address: 7. Model Type:
Number, Street, Suite No., Apt. No. City State Zip
8. Serial Number:
9. Type of Unit: (Check one) Pass Esc. M.W Frt W.L. LULA Other (specify) :
10.Drive Machine: (check one) 11. Year Installed 12. Year Altered 13. # of Floors
Electric Hydraulic
14. Speed 15. Capacity 16. # of Car Openings
Other (specify)
17. Due Date for Next 5 year Safety Test: 19. Type of Inspection (check all that apply)
Annual New Installation Alteration Re-Inspection
18. Test Data Tag in Place:
Yes No Accident 5 Year Test OTHER Semi-Annual Item # Rule Code Year Violations (Use page ELE2a if additional pages are necessary) Check box if page 2 attached Repeat
21. Comments:
Annual inspection and testing per A17.1 and A17.2 elevator code. Testing was performed by Urban Elevator and witnessed by Eugene M Kissinger - QEI C-5598, elevator inspector for Reliant Elevator Inspections & Consulting, LLC. Elevator test performed correctly and passed with the violations noted above.
22. INSPECTOR SIGNATURE IS REQUIRED FOR CERTIFICATE PROCESSING
I certify that this is a true report of my inspection. I further certify that the information on this report is correct.
C-5598 Eug QEI INSP LIC# Inspector Name Printed Date Inspection Completed
CONTACT INFORMATION - TO BE COMPLETED BY OWNER OR OWNER AGENT
24. Building Contact Name: Contact Phone Number:
Area Code Phone Number
Building Contact Business/Public Email Address: Building Contact Mailing…
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