HomeMy WebLinkAbout08082018150843-0001__B17-0082.pdf Northwest Colorado Council of Governments
ln1 CONVEYANCE PERMIT APPLICATION
Permit# �l✓5 Juris s i i i TDW U Ar tr. _ Building Official C.3- J&9-i—CliC/
Total Fee 3 5 J.O0 ` ate Paid ' (" C ' Re ip # c20 (
Permit Approved by /..M� � Date Issued ,�7 ��
This box to be complet; by NWCCOG Permit Expiration Date /®
** Permits expire in one year for new installations and six months for alterations **
A separate Permit Application is required for each conveyance.
Job Address 354 Beaver Dam Rd#S, Vail, CO 81658
Job Name Zabalas Residence
Job Mailing Address 354 Beaver Dam Rd#5, Vail, CO 81658
Job Phone # 719-635-7960 Email richardt mselevator.com
Elevator Company Morning Star Elevator State License Number CC-1-15
Mailing Address 16165 Cliffrock Court, Colorado Springs, CO 80921
Phone# 719-635-7960 Email richard@mselevator.corn
NEW INSTALLATION (ALL items in this box required)
Conveyance Unit/Serial #: (N/A for residential)
State of Colorado Registration ID# CP - (N/A for residential)
x Jurisdiction Building Permit # B17-0082
x Is this for Passenger or Freight? Passenger
x Is this for Commercial qr R " ' l? Residential
Circle one: Hydraulic(Roped Hydraulic . Traction/Electric— Lift— Dumbwaiter—Other
x Plans/Drawings submitted with this Permit Application
ALTERATION — Detailed Scope of Work must be submitted with this Permit Application
Unit# State of Colorado Registration ID# CP -
The conveyance cannot be returned to service until inspected and approved by NWCCOG.
NOTICE NEW INSTALLATION FEES
I hereby certify that I have read and examined this Passenger or freight elevator,LULA,escalator,moving walk:
application and know the same to be true and correct. All Up to and including$50,000 of valuation= $500
provisions of laws and ordinances governing this type of Valuation$50,000-$199,999=$500 plus$20 for each$1,000 or fraction thereof over$50,000
work will be complied with whether specified herein or not. Valuation$200,000&up=$3,500 plus$10 for each$1,000 or fraction thereof over$200,000
The granting of a permit does of presume to give authority Lift,Dumbwaiter or private residence elevator:
to violate or .:nce th: . ovis ns of any other state or local Up to and including$20,000 of valuation =$350
law regulati•• c.�. . on the performance of Valuation $20,000&up=$350 plus$10 for each$1,000 or fraction thereof over$20,000
constructi► !/ MODIFICATION FEES:
1 /3160. Up to&including$10,400 of valuation=$350
Licensed Contractor Signature Date Total valuation of$10,001-$25,000=$500
Total valuation$25,001 &up= $500 plus$20 for each$1,000 or fraction thereof over
PAYMENT $25,001. L /) ';
Check: 'a•- .. .ble • WCcs VALUATION /6/per contract with owner
Ci-edit Car.. Cal WC,
5 • • give CC
informatior. ig�� '�.i • Authorization. TOTAL FEE 35Z)
Signa - Date Conveyance plan review and field inspections will be conducted by NWCCOG Elevator
Inspection Program, Schedule acceptance inspections by mailing
Revised 9/19/2017 NWCCOG at ElevatorONWCCOG.org.An approved Permit does not
constitute approval on final inspection.
RECEIVED AUG 0 1 2018