HomeMy WebLinkAboutElevator Conveyance PermitNorthwest Colorado Council of Governments
CONVEYANCE PERMIT APPLICATION
Permit # Jurisdiction Au rGk(g Building Official `/ u" AAA
Total Fee g5o0°r Date Paid /i�/ �a Receipt # /°la 5C2 �SnH1
Plan Reviewed and Approved by tea«- Date Issued3
This box to be completed by NWCCOG Permit Expiration Date
** Permits expire in one vear for new installations and six months for alterations **
A separate application is required for each conveyance.
Job Address 10288 Hwy 13, Rifle, CO 81650
Job Name Oguin Residence
Job Mailing Address 240 Fieldstone, Siit, CO
Job Phone # 970-319-5596
Email
Elevator Company
Colorado Custom Elevator & Lift state License Number CC-1-7
11
Mailing Address 416 29 P
Phone # 970-245-4472
Email office@colocustomlift.com
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)
_Jurisdiction Building Permit # 61, Rk -/a - aa79 H l
Is this for Passenger or Freight? Passenger
_Is this for Commercial or Residril Residential
_Circle one: Hydraulic'm�oped Hydraulic raction/Electric — Lift — Dumbwaiter —Other,
1 Plans submitted with this Permit Application
ALTERATION -DESCRIBE
Unit #
State of Colorado Registration ID# CP_ _-_ _ _ — — —
The conveyance cannot be returned to service until inspected and approved by NWCCOG.
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 any other state or local
law regulating construction or the performance of
construction.
Brandy M Schell
Signature of contractor or authorized agent Date
Signature of owner
Date
PAYMENT
Check: Make payable to NWCCOG.
Credit Card: Pay online with credit card or electronic
check at: https://Www.colorado.gov/paymentlnwccog
Commercial Passenger or Freight Elevator, LULA, Lift, Escalator, Moving Walk or
Escalator:
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
Private Residence Elevator: Flat Fee = $500.00
ALTERATION 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 $18,340.00
TOTAL FEE $500.00
Conveyance plan review and field inspections will be conducted by NWCCOG Elevator
Inspection Program. Plans will be submitted to NWCCOG for review and approval.
Schedule inspections by emailing NWCCOG at Elevator@NWCCOG.org.