HomeMy WebLinkAboutConveyance Permit ApplicationNofthwest Coloraclo Council of Governments
CONVEYANCE PERMIT APPLTCATIO N
** Perrnits expire in one year for new insbllatlons and slx months for alterations *¡
'r* All the followíng must be completed by the elevator contractor **
Inaccurate, illegible or missing information will cause a delay in the application process.
A sepatate application is required far'æch conveyance.
Permít ¡ \i'lQ State of Colorarlo Registration to* ce- --- ¿(3'¿ _ _Jurísdiction Building
Job Address q"l*
Job Nôme
lob Mailing Address
Job Phone I )r''>¿¿c ) /13:t
'i)<.-(1 'L
I {lrí,t ) 't'
Er¡ail
*c-State License Number J-f 'ilT
't:/,'21
Phone f ,tt 1" --<{ -7.ióÕ
t'-tCt,ît lcf¿o
Emaíl
- 0l'lFermít #Jurisdlction
Plan Reviewed and Approved by
^)Total Fee 150,&ç e a
orÃc¡ôtf,lltJ ?(¿þ9p
"
Pernit Expiration Date
Rece¡pt #
Date Issued
Unit #C'î 17 i6, o'2_
'\. .- New Instållatlon- Pâssenger or Freight / Commerciaf dãIç¡glgntf-tal ;ÌÞ circle one on next t¡ne
Hydraulic - Roped Hydraulic - TractionlElectrlc - Lift' * Dumbwaíter - Ot¡er-lâD --l lfl"l .
Alterat¡on (unlt cannot þe returned to servl€e unttl lnspected and approved by A|VCCOG)
Cab modificatione require subnrlssion of Material Safety Data Sheete {MSDS)
Descríbe work q4e r'.)t t ñ)
NOTJçE
I hereûy ceñìry that I bave read ånd ¿xatt¡ned th¡s epplicãticn
and know th€ sðrne to be t¡ue anc qorrect. /ìll provís¡ons of laws
and ordin;rnces gw€rn¡ng thls type of work will t¡e complied with
wf¡ether specified herein or not. The granting of a ¡rernrít does
not io g¡ve to violate or cancel th€ pfovisions
requlðting constru.iío¡r ûr theof any
1l u/, t-
or'¿uthrlrized¿gcnl Dar.e
of olv¡er Date
NTW IISTåI,IATION FEFS
Pâssenger nr frelght elevator, LULA, escalator, nroving walk:
Up to and including $50,00û ôf völuðtion - 9500
Valuation $50,000"9199,999.' $50û Flirs S20 for eacl, s1.000 ur
íraction thrreof over' $5û,000
Vðluðtiorì $200,000 & up - 93,500 p[,s $10 for rach 11,û00 or
flacrion theresf cver $2¡J0,ù00
Llft, Oumbwalter or ptivâte residence elevêtor:
Up to and includiÍtg $?ù,000 of valuatlún = $150
Veluaijon s20.000 & up = 935û plus t,l0 Íor c¡c.h f 1.tlJ0 or
haction ihereof 0ver $2C,00û
¡TTE8ÀIIA¡üEEå
Up 1ô & including 310,û00 of vô¡uation - $35ü
Totðl valuai¡on of $10.001 $25,û00 = $50û
Tota: vâluêtion $25,001 & u¡: = $500 plus S70 ¡or crtch S1,000 or
fraciiun thertof t:ver 925,001.
of
Check:
Credit
PAYMËNT
ß at 970-468-0295 xl14 tû give
1Lk:r Credit Cård Authori:ãtiór¡-VALUATION\
TOTAL FEE
Signatule t)àte
Coriveyance plan revlew end fr(:'d inspsctiÐns will be conluct€d by NW'CCOG Eleva:or lnspÊctìor'l Progrðr¡ì. Pl¿ns ivill bë $ubnì¡üec tLr
NWCCOG ior revierv oro approval. Schedule inspections by enrailing NWCCOG at Elevatur'@t{Wccoc,org.
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