HomeMy WebLinkAboutElevator Permit ApplicationNorthwest Colorado Council of Governments
CONVEYANCE PERMIT APPLICATION
Permit # c . p •' UD f
Total Fee 4'W // 47"
Permit Approved by
This box to be completed
Jurisdi
/ Catr-bokiAq. Building Official O/ A P
Paid
NWCC
2 2
Receip #
Date Issued 1 L�
Permit Expiration Date
i
• oel
** Permits expire in one year for new installations and six months for alterations ** 1
I A separate Perm' tApplicationlI is required for each conveyance.
Job Address 3 d' / Ir y(✓P 10l'
Job Name G /r/c1
Job Mailing Address
Job Phone # -7i 3 - R 2 Z— YS?3 Email
Elevator Company/11..S c iv% , h , }I)7
Mailing Address - 6114,-.4 err ,Q A t-• -v� kr
00- .+z ,1!4-.7
State License Number /1/)/6/
Phone # '171 J 94' r9 -TI Z
Email
NEW INSTALLATION (ALL items in this box required)
,,Conveyance Unit/Serial #: /1j 14
(N/A for residential)
_, ,State of Colorado Registration ID# CP _- _ _ _ (N/A for residential)
]urisdiction Building Permit # /3 L. gig— p q - 1 4 - - q 7 9
Is this for Passenger or Freight? P-311 r,
)C Is this for Commercial or Residential? (4-4
.,,.Circle one: Hydraulic - Roped Hydraulic — Traction/Electric — Lift — Dumbwaiter — Other 1 ) . zi
- 4,_Plans/Drawings submitted with this Permit Application bro".
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 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 compiled with whether specified herein or not.
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local
law regulating construction or the performance of
construction:
Signa,.`
PAYMENT
Check: Make payable to NWCCOG.
Credit Card: Call 970-4 A 95 x114 to give CC
In,. ation. Sign .,,.y •it r . Authorization,
▪ yr /
Date
Revis 9/ .5/2017
DEC 2 7 2019
Date
NEW.Xt STALLATION FEES
Passenger or freight elevator, LULA, escalator, moving walk:
Up to and including $50,000 of valuation = $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 fraction thereof over $200,000
Lift, Dumbwaiter or private residence elevator:
Up to and induding $20,000 of valuation = $350
Valuation $20,000 & up=$350 plus $10 for each $1,000 or fraction thereof over $20,000
MiODIFICATION FEES;
Up to & Including $10,000 of valuation = $350
Total valuation 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 4 a) ve. r --
TOTAL FEE y (o o
Conveyance plan review and field inspections will be conducted by NWCCOG Elevator
Inspection Program. Schedule acceptance inspections by emailing
NWCCOG at levatortaariwCC JC.orq. An approved Permit does not
constitute approval on final inspection.
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