HomeMy WebLinkAboutB15-0026 Elevator permit.pdfNorthwest Colorado Council of Governments
ELEVATOR PERMIT APPLICATION
Permit# / <o// <t> 6 Jurlsdlctlo;{ow ~ of tJ k IL--Building omciaZ fl fU..DfJ ~0:6oJ
Total Fee _Q;LZ5 ,DQ D · id _I _,.Lt -'J J ,c_
Plan Reviewed and Approved by ~~~~~~:=:::::.i::::::;;...;~~ll'D .. 'L2-·-·
_........~'/L-This section to bia c;ompleted by NWCC
** All the following must be completed by the elevator contractor**
Inaccurate, llleglble or missing information will cause a delay in the application process.
Please complete "' ';eparate application per convey(HlC(!.
Jurisdiction Bulldlng Permit# e, 15 ~ 00;;... b State of Colorado conveyance IDtt _NA-·---
Job Address •. 2950 Booth Creek Dr Vall. CO 816!:>7
Job Name __ Flee_9.~!:. Res!.d_e_n_c_e _________ _
Job Malling Address 2950 Booth Creek Dr Valf:_co s1e5·7
Job Phone tJ. _____ 30~-62~~!4_3_3 _____ _ 1 mail
Elevator Company __ M_~ning Stm Fl.wato• .. _____ _ ". State License Number --bt~ 1"15--· J.
Malling Address___ __ 16165 Chffroc~ Ct ~~lorado Springs, CO 8092_1 .• ·-·--__
Phone# ___ •. ,.7-1.9-635xi:~-~-·-···-··-··. Email nct1ar.d~mselevut~~~?t:ii-.. : __ _
Unit# 02016-17
... ~-New Installation-Circle one {HYP -RHYP -Traction -Lift-Dumbwaiter -Other ~-~r.<? Elevat91
____ Alteration (unit cannot be returned to service u11t/l /11spected and approved by NWCCOG)
Cab modifications require submission of Material Safety Data Sheets (MSDS}
Describe work ___ P_rovide <i!nd install new elevalor
NOTICE
J hereby certify that l have read and cxanmu~d lhl> application
and know the some to be truu and correct. All provisions ot ~1W5
and ordinances governing thir. type of work will be compllec1 with
whether specified herein or not. The gr;;inlln9 of a 11errnlt does
not presume to give authority to 11lolnte or canu~I the provis·1011s
of any ot~ state ~;~I la'!' rcgulutlng con~tn1ctlon or the
pcrf0Ztl!i1~;( : --. '! -. ;,
Signature of contractor or at•thotiwd agent Date
Slgnat11ro of owner Oatl' ------··-· PAYMENT
Check1 Make p.iyablr. to NWCcoc.;.
Credit Card: call Cora Wintjl1rs <lt 970-166-0195 x I 14 to giv;~
CC lnfom19yon/,'.P t7o /for Credit Curd A.1 .. thorl1nti0<1.
le.{..:/, , t., r....-.. ,. · '· ·;·
Siynlllore Ll.ite
NEW INSTALkAUQN FEES
Passenger or freight elev11tor, LULA, escalator, moving walk:
Up to ~nd including $50,000 ol valui'tton " $:17S.OO
Owr $50,000 of valuation = $375.00 plus $7.00 tor c•<Kh
$1,000.00 or fraction r11ere.1t over $50,00lJ.lJO
Lift, Dumbwaiter or private residence elevator;
Up to .irn.l ltldlrdlng $20,000 of valuat1011 , .. $275.00
Over $20,000 of valu11tio11 ,.. $?7'i.OO plus $4.00 for cnch
$1,000.00 or fraction thcri·ot over $20,000.0U
f:'!AJ..QB.A!.llRATION FE!;S:
ret''> tor ffl3JOr alterations shilll be as~! forth in Tnbl~ :l·A ot 1111,
U11ilortn /\dmlnlstrntive Code or Tahlc I A··· see Current r~e Sdw.liule
on NWCCOG.oro weh!>·I•' fl1>vntor lnspcct1011 Progr,1m page
VALUA TlON ___ 1_8"'",5_7_4 _
TOTALFEE~~27~5~0~0__,~r~~~· .·I, / ·/' (,'/ .(
( l l,t' ,\. I J
r Co11veyilt1ce plan review;~~ field lnspect1011s Wiii be ~~nduc.tcd by NWCCO~·E;~~;~~;;;pcctlo~-~~(lqr:;~·l--;;l~n~ w~ll bt• Sl11Jlllill('(1 Ii
I NWCCOG tor review and approval. Schedule Inspections by emailing NWCCOG ilt Elevatur@NWCCOG.org. l
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