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HomeMy WebLinkAbout215 E Foothills Pkwy - Special Inspections/Field Verification - 02/04/2016t er ;!S~ \ Colorado Division of Department Oil and Public of Labor Safety and - Conveyance Employment Program Fax: Phone: 303-303-318-318-8534 8497 ~"3 633 17'1' Street Suite 500 Email: cdle_conveyance@state.co.us •116~·1' Denver, CO 80202-3610 Web: www.colorado.gov/ops Elevator Inspection .Report - Private Third-Party Inspector (Revised 11112/201·5) To receive a Certificate of Operation, the Conveyance Responsible Party (owner/operator) must submit this Inspection Report, along with the $30 processing fee (payable to the Division of Oil and Public Safety), to the Conveyance Program at the address listed above. Facility Information Facility Facility Address: Name: ?p,1.,-,:-:i ::l-: Jl-r- :-<-L. r=<,..; .,..-1- ~,p "4-? v-1 I< c (~~" 'ii\ ;. City: Facility I ID#M,i,: .,.I + :Ci> 3~s-LLih.c.. <Cf ._ County: Phone#: lc.'i 70 ..v~~rl- • 27.ZIP: (o -I~ SS~ - Responsible Party Information Contact Name: ~\(.,\.\.(\. ~Ci {.4"'-e,....,£ Company Name: \~L. l_ t -\-"'-" \:°(?a~ \ti.\\.\...< Address: ~'~ E ~~ ~ ~-\: \\';t{.. t City: I i:::ev---\-- G>lU."'<. State: I Cc>. jZIP: l ~S Phone#: C\ if\n - .SI~ · 2 ~Cf~ Email Address: t,, o LLV\.e...J~Q iJJ cle..v_t"~VVl Responsible Party Type: I ~ Owner D Facility Management J / Convevance Information OPS Conveyance #: CP- 15 - ©c;>O I ... a.. Job/Contract #: ~O 3 ~ OC(.~ 4- Original Code Data Plate Year: 2o\3 Year Installed: 'l.o l ~ Manufacturer: I \.lo IA...e..... Altered Code Data Plate Year: N/A Year Altered: ~IA- Conveyance Local ID #: I -~ z. Conveyance Use: f$. Passenger 0 Service 0 Freight Freight Class: DA OB 0 C1 OC2 OC3 Conveyance r Traction 0 Roped-Hydraulic 0 Vertical PL 0 Dumbwaiter 0 Home Elevator in Commercial Bldg. Type: O Hydraulic 0 LULA O Inclined PL 0 Material Lift O Other: Front Landings: 4- Rear Landings (if applicable): "'I a. Rated Speed: I l~O fpm Capacity: 4-&t>O lbs Total Rise: I 3b ft Mainterfance Contractor: \.-("" ' '"'° Inspection Information Inspection Date: 2:- 4-- \ ~ StartTime: I 11: c;')C) A-vi\ D Periodic 'bO Acceptance (notify OPS) l)f Test Witnessed Inspection Type: D Re-inspection Permit#: ' 'lfrcategory 1 ~ CategoryS Type: D Major D Minor Annual Safety Test Date: I ~ ~ -I (,,, Witnessed Safety Test Date: I Test tags in place? 'S.Yes DNo Code Reference Violation Description Repeat TCO bate Corrected Edition Year Reference (Check if additional violations listed on next page: 0) Yiolation 2 Violation 2 (Inspector only) Maintenance Control Program (~ A17.1 2013 8.6.1.2 1. General Requirements: ~ 0No 2. On-Site Documentation: ~ lfi No D D 3. Maintenance Records: lilt es ONo Comments: D D D D I D D I D D Inspection Result I El Annual (01 D Temporary C02 0 Construction CO 0 Removed from service 0 Dormant 1 All violations must !Se corrected prior to the next inspection. 2 TCO and repeat violations must be corrected within 90 days of the date of this inspection. Certification Information By signing below I certify that all statements made in this report are true to the best of my knowledge and that the inspection was performed according to current regulations and adopted codes. Inspector Name: ~ -· . .+ f...l.o.PPo Inspection Company Name: I I}. ~. Z::. Y 6'.c r:><:r:il~ Inspector Signature: "' ~ .-1.. it I\/~~~ Date: J~ 4-f <'., I Phone#: 1 4 ,{_~f~"q State License #: ~ 1 - I - ZS' - .... I•- I Colorado Division of Oil an~ Public Safety I I Elevator Inspection Report Form Page 1 of2