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HomeMy WebLinkAboutDeferred Inspection FormCOLORADO 19-01 Department of Local Affairs Divisionof}lousing JULY 2023 Please confirm if the LAW requires a fire protection system and/or wild fire mititgation for this modular structure. If so, please indicate if the inspection will be completed by a fire department (identify which one) or whether it will be completed by the Colorado Division of Fire Prevention Et Control. Manufacturer Responsibility The registered manufacturer is responsible for manufacturing a structure that is compliant with our Administrative Rules (CCR 1302-14). If items in the factory have not been completed, only to be completed in the field, you are still responsible for ensuring they have been completed for compliance. Please sign below that you have received this letter and acknowledge the items listed are to complete compliance of the structure, and items are to be inspected and passed for compliance in order to meet Rule 1,13.1 and section 24-32-3311(4), Colorado Revised Statutes (C.R.S.). *ATTENTION` A DOH issued insignia (silver for residential or blue for nonresidential or pink for tiny homes or black for multi -family) certifying its construction cannot be affixed to the structure until all "OC" items are completed on site and pass inspection. The same applies to modular structures manufactured by a certified manufacturer. Acknowledge Receipt and Understanding Normal permits and fees for these site work inspections are to be per the local jurisdiction. State approved plans for Factory -Built Construction may be obtained from the Builder/Manufacturer. A copy of this completed form is included with the DOH approved plans and must be included with the installation instructions and shipped with the unit. If the completed form has been damaged or lost during shipping, the manufacturer or its representative can obtain a copy from the DOH. Before any inspection is scheduled at the on -site location or Installation Authorization (required for modular homes and multi -family structures) is issued by the DOH, this form will be required to be signed and dated by the Building Official, or Approved Third Party Agent, or Fire Safety Official (if applicable), and submitted to the DOH. The DOH approved OC form will be included with the approved spec file, with the DOH Plan Reviewer signature below and their plan approval stamp on the page(s) with the OC listed items to be completed at the site location. That approved OC form should be submitted to the appropriate parties described in this form and submitted back to the DOH before any inspection is scheduled at the onsite location or Installation Authorization (required for modular homes and multi -family structures) is issued. DOH Plan Reviewer Name James Trout DOH Plan Reviewer Signature Date Approved 116/25 Contact email: Governor Jared 5 Polis I Rick M. Garcia. Executive Director I Alison George, Division Director nr Vie; r �S•, s 1313 iheiman SL., Room 320, Denver, CO 80Z03 P 303.864.7810 r 3U3.864.7857 TDD/TTY 303.864.7758 www.dola.colorado.Qov Sl engthening Colorado Communities ROUAL HOUSING OPPORTUNITY�,,lA7 COLORADO Department of Local Affairs Nvision otkousino JULY 2023 "OC" (On -site Construction) Form Please read below before signing form. Please See Attached Document at bottom of form for Specific plan and Manufacturer information. To: The Local Authority Having Jurisdiction (LAHJ) or other DOH approved third party inspection agency. By signing this form, you confirm that you have received and reviewed this form, and acknowledge that the identified components below are required to complete the construction of this modular structure onsite within your jurisdiction. Building Official Responsibility Please check the box labeled "Accept" and initial to confirm that you will take responsibility for inspections of the "OC" Inspection Items on behalf of the DOH. You also acknowledge that it will be done to the DOH approved plans. If you would like to defer inspection of the "OC" Inspection Items back to the DOH, please check the box labeled "Defer Inspection". "ATTENTION* "On -site Construction" or "OC" means on -site construction or modification of the factory -built structure that directly relates to the durability, quality, and safety; that is completed at the installation "site" as defined by section 24-32-3302(33), C.R.S.; using components not installed at the manufacturer's location; and to complete the compliance of that structure as reflected in the Division of Housing approved plans. These items do not include the component(s) required for setting and securing the structure for its installation. Fire Safety Official Responsibility (if applicable) The DOH defers the requirement of any fire protection system for all modular IBC (Section 901.2) and IRC (Section R313) structures as follows: An automatic fire sprinkler system shall be installed in buildings (IBC) OR one and two family dwellings and townhouses (IRC) OR Tiny homes as required by the local jurisdiction where the structure or home wilt be set. Final tests required by this Section shall be approved by a certified inspector. The inspector must be either an employee of the fire department having jurisdiction or another qualified individual with prior approval of the Colorado Division of Fire Prevention ft Control. Wild Fire mitigation requirements will be deferred for (IBC) OR one and two family dwellings and townhouses (IRC) OR Tiny homes as required by the local jurisdiction where the structure or home will be set. Final inspections required by locals shall be approved by a certified inspector. The inspector . must be either an employee of the fire department having jurisdiction or another qualified individual with prior approval of the Colorado Division of Fire Prevention it Control. Governor Jared S. Pops I Rick M. Garcia. Executive Director i Alison George, Division Director !� 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/Try.103.864.7758 www_dola.colorado.gov r0 Strengthenfna, Colorado Canmunitles 1 EQUAL HOUSING k4C�, OROSfUN11'Y "" , ar' COLORADO Department of Local Affairs Dlvtsion nl Wousing JULY 2023 Building Department Representitive Printed Name Building Department Representitive Signatlre Title G�SlGa1t-�G b G�AcL.- Date 10 -Z4-z5 ❑r1*RF o. Accept Defer Inspection Contact email:���I•J. C►t¢+..pCa4+,qY[ GOV If applicable: Fire Safety Official Printed Name__.. Fire Safety Official Signature.. .:_ _ —Date__ Contact email: Is a fire protection system required? (check one) Required Not Required If required, the inspection is to be performed by (check one): Fire Department: WA✓ T OR Colorado Division of Fire Prevention Ft Control Manufacturer's Authorized Quality Assurance Representative Printed Name kRls W6,6Y Al.5 0 W Manufacturer's Aut XTI- y ssuranre Representative Signature -- Date Contact ail:�ro visors S-kALAu=t.c.orn If the inspection has been deferred and the manufacturer elects to utilize an Approved Third Party Agency to inspect the "OC" items on behalf of DOH, please sign and date below. Approved Third Party Agent Printed Name Approved Third Party Agent Signature Date Contact email:_ Governoi Jared S. POWs I Rick M Garcia. Executive Director i Alison George. Division Director of i q >r 1373 Shr_nnan St., Room 320. Denver, CD 80Z03 P 303.864.7810 F 303.864.7357 TDD/TTY 303.864.T758 www.dola.colorado.gov yS •,;,..-V Strengthening Colorado Communities j* oOPPORrillr UNITY COLORADO A9.01 Department of Local Affairs Mvision OF) frusinq JULY 2023 Verify Inspection(s) Completed Once you have completed all of your assigned inspections identified in this form and they have passed for compliance, please sign and date below. Building Department Representitive Printed Name Building Department Representitive Signature Date Contact email: Or Approved Third Party Agent Printed Name,_ Approved Third Party Agent Signature _ _ �. _._Date Contact email: Fire Protection Systems (if applicable) Fire Safety Official Printed Name_ Fire Safety Official Signature Date Contact Please direct questions to manufactured. alansstate.co.us Governor hired S Polls I Rick ,A Garcia, Executive Director I Alison George. Division Director "co 1313 Sherman St.. Room 320, Denver CO 80203 P 303.864 7810 F 303.864.7857 TDD/TTY 303.864,7758 www.dota.colorado.gov� , Strrngtheninj, Colorado CommunitiP; COUAL HOUSR40 OPPORTUNITY } Igy6 ;' COLORADO Department of Local Affairs Dlvlsion of Housing JULY 2023 The following is based on information provided to the Division of Housing (DOH) and may be modified based on the actual findings of the field inspection. DATE: 12-5-24 MANUFACTURER: Kit HomeBuilders West ID NO.: 000175 CONTACT: Matt Duree MODEL NO.: 2512-M Laidlaw CO INSPECTION REQUIREMENTS: Check on site: "OC" Inspection Items PHONE No.: 208-454-5012 DOH P/A NO.: R-00065130C i], .:[riir .ti_ie r+_n1L inn rrticif sRr�llr__ nnA flnr�r nnnnnrtinn& r i - Insulation basement walls per ResCheck. - All landings, complete siding and trim. - Complete stairway construction. - Complete installation of drain lines and service hook-up. - Installation of furnace and ducting. - Complete water heater pop -off and drain pan drain to exterior of home. - Complete furnace condensation drain line to exterior of home. - Waterline marriage line connections and service hook-up. Complete installation of gas lines and service hook-up. - Electrical connections to furnace. - Electrical marriage line connections. - Electrical service hook-up. Complete thermal envelope 1313 Sherman St. EOUAL HOWMNG OPPOITUNITY Governs, Jared S. PoLs I RickM. Garcia, Executive Director I Alison George, Division Director ci.�_nE '. Room 320, Denver, CO S02.03 P 303 864.7810 F 303.864.7857 TDDiM 303.864.7798 www.dota.coforado.guy , SUengthening Colorado Communities k x r878 "