HomeMy WebLinkAboutElevator Inspection Certificate 12.10.19couNcrr of 6óv(tNsaNlS
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Colorado Custom Lift
NWCCOG Elevator Inspection Program
elevator@ nwccog. org or 970-455 - Lt7 5 or 97 0-455- LI7 6
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RESI DENTIAL CONVEYANCE ACC EPTAN CE CERTI FICATE
NWCCOG Conveyance Permit 18-156 acceptance inspection passed
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Name: Whitman Residence
Address: 20 Silver Spruce Dr., Carbondale, CO 81626
Jurisdiction Building Permit: #BLRE-09-t6-4441
T.t T VATOR INSPF(JIIOI,I I'ROGRAI¡
NoÊhwest Colorado Council of Governments
CONVEYANCE PERMIT APPLICATION
Permit # t 8't\b Ju tcç Buitdins om"¡*4,Y'M Sqt ÜtU¡'¿*
Total Fee o Paid lô,¡,/8 #JO
Permit Approved by Date Issued
This box to be by NWCCOG Permit Expiration Date
** Permits expire in one year for new installations and six months for alterations x*
A separate Permit Application is reguíred for each conveyance.
Job Address 20 Silver Spruce Dr, Carbondale, CO 81626
Job Name Whitman Residence
Job Mailing Address 1 10'1 Village Road Unit LL2B, Carbondale CO 81623
Job Phone #970-618-0480 Email Crawfordd esign bu ild@co mcast. net
Elevator Com Colorado Custom Lift State License cc-1-7
Mailing Address 416 29 Rd, Grand Junetion CO 8'1504
Phone #97A-245-4472 ¡ru¡¡ frontoffice@colocusto ml ift . com
NEW INSTALTATION (ALl- items in this box required)
-Conveyance
Unit/Serial #: N/A (N/A for residentiat)
State of Colorado Registration ID#(N/A for residential)
Jurisdiction Building Permit #BLRE-09-'16-4441
-Is
this for Passenger or Freight?Passenger
-rs
this for Commercial or Residentia ¡e Residential
-Circle
one: Hyd Traction/Electric - L¡ft - Dumbwaiter - Other
-Plans/
Drawings submitted Permit Application
Roped Hydraulic
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
I hereby cert¡fy 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 grant¡ng of a permit does not presume to give authority
to v¡olate or cancel the prov¡sions of any other state or local
law regulating or the of
i0
Contractor Date
Revised 9ltgl2$g
Passenger or fr.rnn, ","r",ffi "rn,Up to and including $50,000 o¡ rt¡u¿¡¡6¡ = $500
Valuation $50,000-$199,999=$500 plus $20 for each $1,000 or fraction thereof over $50,000
Valuation $200,000 & up=$3,500 plus $10 for each $1,000 or ftaction thereof over $20p.000
l-ifÇ Dumbwaibr or private residence elevator: ...--"
Up to and including $20,000 o¡ u.¡tl¿¡¡6¡ = $350
Valuation $20,000 & up=$350 plus $10 for each $1,000 or fraction thereofover $20,000
MODIFICÀTION FEES:
Up to & including $10,000 of valuation - $350
Total valuat¡on of $10,001 - $25,000 = $500
Total valuation $25,001 & up = $500 plus $20 for each $1,000 or fraction thereof over
$25,001.
VALUATION per contract with owner
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Conveyance plan rev¡ew and field ¡nspections will be conducied by NWCCOG Elevator
Inspection Program. Schedule acceptance inspections by emailing
NWCCOG at Elevator@NWCCOG.orq. An approved Permit does not
constitute approval on final inspection.
PAYMENT
Check¡ Make payable to NWCCOG.
Credit Card: Call 970-468-0295 x1 14 to give CC
¡nformation, Sign below for Credit Card Authorization.
Signature Date
TOTAL FEE z60f ,/ R[cElvED t:cT 11 ?ff18