HomeMy WebLinkAboutB16-0034 Elevator permit.pdf Northwest Colorado Council of Governments
ELEVATOR PERMIT APPLICATION
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Permit# Jurisdiction Building Official t D—
Total Fee 76.00 Date Paid ti I �/s Receipt# t,ct 3( I
Plan Reviewed and Approved by Date Issued / /" ,16
this.section to to completed by NWC OG Permit Expiration Date
** 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# B16-0034 State of Colorado Conveyance ID#
Job Address 738 Sandy Lane
Job Name Amy Holm Claes
Job Mailing Address PO Box 5356 Vail CO 81658
Job Phone# 970-390-1315 Email holminvailc gmail.com
Elevator Company Colorado Custom lift State License Number CC-1-7
Mailing Address 416 29 Rd, Grand Ji unction CO, 81504
Phone# 970-245-4472 Email nffireQr cnlnnustnmlift nom
Unit#
New Installation-Circle one(HYP—RHYP—Traction—Lift—Dumbwaiter—Other )
Alteration (unit cannot be returned to servicie until inspected and approved by NWCCOG)
Cab modifications require submission of Material Safety Data Sheets(MSDS)
Describe work install new dumbwaiter in residence
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:
performanc- •f con- ion. Up to and including$20,000 of valuation =$275.00
" R ) Over$20,000 of valuation=$275.00 plus$4.00 for each
��111r�►►, ��►! 1 D�`��/LP $1,000.00 or fraction thereof over$20,000.00
Signature• co • .ctor or a thorized agent Da
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
Check: Make payable to NWCCOG. VALUATION r�; �
Credit Card: Call Cora Winters at 970-468-0295 x114 to give
CC information, Sign below for Credit Card Authorization, TOTAL FEE 41 3'5
Signature Date
j 1 2016
Conveyance plan review and field inspections will be conducted by NWCCOG Elevator Inspection Program. Plan vJlbe submitted to
NWCCOG for review and approval. Schedule inspections by emailing NWCCOG at Elevator@NWCCOG.o � 1