HomeMy WebLinkAboutElevator Permit ApplicationPermit #
Northwest Colorado Council of Governments
ELEVATOR PERMIT APPLICATION
15--0(1
Jurisdiction
Total Fee 02,7 5 ,C40 Date Paid .5-3-(6 Receipt # U (q -
Plan Reviewed and Approved by 7 ' # A 4j'N< .P Date Issued 'J/ II 1 1 S
Permit Expiration Date ./c_/ ) /(..,
** 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 # BLRE-6-11-2067 Date Registered with State of Colorado? (NA -Residential)
Job Address 2384 Hwy 325, Rifle, CO. 81650
Owner Mike and Lindsey Johnson _(Johnson Residence)
Mailing Address 2384 Hwy 325, Rifle, CO. 81650
Phone # 303.623.7433 Fax # 303.327.5570
Elevator Contractor
Mailing Address
Morning Star Elevator
16165 Cliffrock Court, Colorado Springs, CO 80921
Phone # 719.635.7960
Fax # 719.635.7968
** Permits expire in one year for new installations and six months for alterations **
X New Installation Unit or Contract # 102714-01
Alteration (unit cannot be returned to service until inspected and approved by N CCOG,
Describe Work Provide & install new residential elevator REQ
NOTICE
I hereby certify that I have read and examined this application
and know the same to be true and correct. All provisions of laws
and ordinances governing this type of work will be complied with
whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions
of anyotF�er stake or local law regulating construction or the
perfo
i on.
7_/2-111f
WffiaAlit60331 rotatatfibiNd: ,4eTotti tate
NEW INSTALLATION FEES
Passenger or freight elevator, lu\la, escalator, moving walk:
Up to and induding $50,000 of valuation = $375.00
Over $50,000 of valuation = $375.00 plus $7.00 for each
$1,000.00 or fraction thereof over $50,000.00
Lift, Dumbwaiter or private residence elevator:
Up to and induding $20,000 of valuation = $275.00
Over $20,000 of valuation = $275.00 plus $4.00 for each
$1,000.00 or fraction thereof over $20,000.00
MAJOR ALTERATION FEES:
Fees for major alterations shall be as set forth in Table 3-A of the
Uniform Administrative Code or Table 1-A.
VALUATION $19,200
TOTAL FEE $275 /
Please use credit card on file
RECEIVED
MAR 0 2 2015
NWCCOG
Elevator plan review and field inspections will be conducted by the Northwest Colorado Council of Governments. Plans will
be forwarded to NWCCOG for review and approval. Schedule inspections by contacting the NWCCOG Elevator Inspector at
970-468-0295 ext 108.