HomeMy WebLinkAbout2750 Illinois Dr - Special Inspections/Field Verification - 07/10/2018Colorado Department of Labor and Employment Phone: 303-318-8497
Division of Oil and Public Safety - Conveyance Program Fax: 303-318-8534
• <� 63317th Street, Suite 500 Email: cdle_conveyance@state.co.us
Denver, CO 80202 3610 Web: www.colorado.gov/ops
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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.
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Facility Name:
FLATS AT RIGDEN FARM
FacilityID #:
I Phone #:
1970 494-0609
Facility Address: 12750
ILLINOIS DR
City:
I FT COLLINS
County.
I LARIMER I ZIP:
80525
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Pa Information �j�;
v �f i29 r, a
s 7 Q' r
#:Responsf6le ..
*ae
Contact Name:
i e- e!S
Company Name: n ` U i d i1
Address:
4 3 w Z d
City:
i i, vL
ate:
t D
ZIP:
%
Phone #:
s 7j - 000
Email Address
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Responsible Party Type: ❑ Owner 9 Facility Management
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kt_Canve ance;irrfor(nation
OPSConveyance#,.
CP-17-000631
Job/Contract#:
EDV714
Original Code Data Plate Year. 12013
Year Installed:
2018
Manufacturer:
TK
Altered Code Data Plate Year:
Year Altered:-
Conveyance Local ID #:
1
Conveyance Use:
0 Passenger ❑ Service ❑ Freight
Freight Class:
❑ A ❑ B ❑ Cl ❑ C2 ❑ C3
Conveyance
❑ Traction ❑ Roped -Hydraulic ❑ Vertical PL ❑ Dumbwaiter ❑ Home Elevator in Commercial Bldg.
Type:
O Hydraulic ❑ LULA ❑ Inclined PL ❑ Material Lift ❑ Other:
Front Landings:
2
Rear Landings (if applicable):
I
I Rated Speed:
100 fpm
Capacity:
2500 Ibs
Total Rise: 10 ft
Maintenance Contractor:
JTK
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z;��..,Irispection,lnformatiort
Inspection Date:
7/10/2018 1 Start Time:
2 Acceptance (notify OPS)
O Test Witnessed
❑ Periodic
Permit #:
IP17-000261
O Category 1 Category 5
Inspection Type:
❑ Re -inspection
Type:
O Major El Minor
Annual Safety Test Date:
7/10/18
Witnessed Safety Test Date:
7/10/18
Test tags
in place?
® Yes ❑ No
Reference
r
Violation Description
Repeat
TCO
Oate torreaed
Code
y .:
= ` 'V listed
Violatioh ,
, Wig o s
(ns ector l) =;
on
p y
Year
Edltlon
:.Reference
:
(Check if additional violations iin.next page ,❑),,
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,
Maintenance Control Program (MCP)
1. General Requirements: F01 Yes No
A17.1
2013
8.6.1.2
2. On -Site Documentation: ILE F No
El
ElYes
3. Maintenance Records: IE Yes O No
Comments:
❑
❑
❑
❑
❑
❑
Inspection Result
1 0 Annual CO' ❑ Temporary CO' ❑ Construction CO ❑ Removed from service ❑ Dormant
violations must be c0rrectetl prior to the next mspect�on .;
zTCO peatviolations musrb'� corrected within 90;days of the"date
-'�
sF't a s $., v� ry a.ytH x
r=.
. ux x , N seertificatton,lifor7ationx,
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:
TIM SULLIVAN
Inspection Company Name: 11
ABOVE ELEVATOR INSPECTIONS
Inspector Signature:
I" "
Date:
7/10/18
1Phone #:
720.243.3042
State License #:
CI-1-34
Colorado Division of Oil and Public Safety Elevator Inspection Report Form Pagel of 2