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HomeMy WebLinkAboutB15-0066 Elevator permit.pdf Northwest Colorado Council of Governments i , IC? ELEVATOR PERMIT APPLICATION t Permit# IC?--r/�O' Jurisdiction-TOO/k) OF (JAIL Building Official"a 1�u Total Fee c�-75 00 Date Paid '2q t `. Receipt# C G Plan Reviewed and Approved by ��...t Date Issued //..9/7This section to be completed by NWCCOG Permit Expiration Date // ' ee,��,,,,ye ** Permits expire in one year for new installations and six months for alterations**! ** All the following must be completed by the elevator contractor** Inaccurate, illegible or missing information will cause a delay in the application process. Please complete a separate application per conveyance. Jurisdiction Building Permit# .6 /6--00 Co tb State of Colorado Conveyance ID# NIP( Job Address 223B Beaver Dam Rd Vail,CO 81657 Job Name Gore Creek B Job Mailing Address 233B Beaver Dam Rd Vail, CO 81657 Job Phone# 303-623-7433 Email Elevator Company Morning Star Elevator State License Number CC-1-15 Mailing Address___ 16165 Cliffrock Ct Colorado SPrings, C) 80921 Phone# 719-635-7960 Email richard@mselevator.com Unit# 110215-03 X New Installation-Circle one(HYP—RHYP—Traction—Lift—Dumbwaiter—Other LU/LA ) Alteration (unit cannot be returned to service until inspected and approved by NWCCOG) Cab modifications require submission of Material Safety Data Sheets(MSDS) Describe work Provide and instal new elevator NOTICE NEW INSTALLATION FEES I hereby certify that I have read and examined this application Passenger or freight elevator,LULA,escalator,moving walk: and know the same to be true and correct. All provisions of laws Up to and including $50,000 of valuation = $375.00 and ordinances governing this type of work will be complied with Over$50,000 of valuation=$375.00 plus$7.00 for each whether specified herein or not. The granting of a permit does $1,000.00 or fraction thereof over$50,000.00 not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the Lift,Dumbwaiter or private residence elevator: perform ce ;nation. Up to and including$20,000 of valuation = $275.00 r 4 Over$20,000 of valuation = $275.00 plus$4.00 for each L /�7'U $1,000.00 or fraction thereof over$20,000.00 Signature of contractor or authorized agent Date MAJOR ALTERATION FEES. _ Fees for major alterations shall be as set forth in Table 3-A of the Signature of owner Date Uniform Administrative Code or Table 1-A—see Current Fee Schedule on NWCCOG.org website Elevator Inspection Program page. PAYMENT VALUATION 18,574 Check: Make payable to NWCCOG. Credit Card: Call Cora W' tern at 970-468-0295 x114 to give CC informa •' n. "i el for Credit Card Authorization, TOTAL FEE Z?> //. / Signature Date �" ^'� /S- i u5c c�/r 4�i k! nom... .. Conveyance plan review and field Inspections will be conducted byNWCCOG Elevator Inspection Program. Plans will be submiffte. d to NWCCOG for review and approval. Schedule inspections by emailing NWCCOG at Elevator©NWCCOG.org.