HomeMy WebLinkAbout6183 S COLLEGE AVE - SPECIAL INSPECTIONS - 12/21/201581 �oizc�z
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December 21, 2015
Heath COnSti-LICtiOn
PO Drea%vcr I-1
Fort Collins. CO 30522
Re: Elevator Shaft
Elderhaus
6183 S. College Ave
Fort Collins, Colorado
Project No. 215013
Gentlenaen:
t'ii�•
c�GU.
A representative of Vleeks & Associates has reviewed the construction of the concrete
elevator pit and masonry shaft for the elevator addition to the referenced site.
Our review indicates the foundation elernents for the elevator pit are in substantial
accordance with the engineered plan for the -elevator by Weeks & Associates. In
addition the CMU shaft wall construction is in substantial accordance with the
engineered plan for the project by Weeks & Associates and with approved revisions to
the shaft vrall construction.
If we can be of further assistance please contact us.
Sincerely, '0' -�?,�
Weeks 8. AsS'oolt��es; .ljiq-
'� )f 23012
Gary G. �Icx't��i?;E.,
StruCtural Er2�DX'
/..�C' �::JI.: tI� l/'.)r:• :_); !'•.\�:.. �...ii r:� ._ ,• I or' ir:Ji lr;S, (,0 "-,r'.. ;
ii•�co� Colorado Department of Labor and Employment Phone: 303-318-8497
Division of Oil and Public Safety -Conveyance Program Fax: 303-318-8534
th
633 17 Street, Suite 500 Email: cdle_conveyance@state.co.us
•�'d'- Denver, CO 80202-3610 Web: www.colorado.gov/ops
Elevator Inspection Report - Private Third -Party Inspector
(Revised 8/12/2015
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.
Facilit Information
Facility Name:
Elderhaus
FacilityID #:
Phone #:
Facility Address:
6813 S. College Ave.
I City:
Fort Collins
County:
I Larimer
ZIP: 0525
Responsible Party Information
Contact Name:
Joanne Vande Walle
Company Name:
Elderhaus
Address:
6813 S. College Ave.
City:
Fort Collins
I State:
I co
I ZIP:
0525
Phone#:
(970) 221-0406
Email Address:
Joanne@elderhaus.org
Responsible Party Type:
1 Cd Owner ❑ Facility Management
Conveyance Information
OPS Conveyance #:
I CP- CP15-000234
Job/Contract #:
7242
Original Code Data Plate Year:
17.1-2013
Year Installed:
2015
Manufacturer:
Alliance
Altered Code Data Plate Year:
N/A
Year Altered:
N/A
Conveyance Local ID #:
1
Conveyance Use:
a Passenger ❑ Service ❑ Freight
Freight Class:
❑ A ❑ B ❑ Cl ❑ C2 ❑ C3
Conveyance
Type:
❑ Traction ❑ Roped -Hydraulic ❑ Vertical PL ❑ Dumbwaiter ❑ Home Elevator in Commercial Bldg.
'1 Hydraulic ❑ LULA ❑ Inclined PL ❑ Material Lift ❑ Other:
Front Landings:
2
Rear Landings (if applicable):
Rated Speed:
100 fpm
Capacity:
4000 Ibs
Total Rise: 8' 9.5" ft I
Maintenance Contractor:
I Morning Star Elevator
Inspection Information
Inspection Date:
11/06/15
Start Time:
01:00
Inspection Type:
❑ Periodic
El Re -inspection
Acceptance (notify OPS)
Vr Test Witnessed
Permit #:
IP15-000070
VJ Category 1 ❑Category S
Type:
❑ Major ❑ Minor
Annual Safety Test Date: 1
11/06/15
Witnessed Safety Test Date:
11/06/15
Test tags in place?
QI Yes ❑ No
Code Reference
Violation Description
(Check if additional violations listed on next page: ❑)
Repeat
Violation2
TCO
Violation
Date Corrected
(Inspector only)
Edition
Year
Reference
A17.1
2013
8.6.1.2
Maintenance Control Program (MCP)
1. General Requirements: UT Yes ❑ No
2. On -Site Documentation: V Yes ❑ No
3. Maintenance Records: (Z Yes ❑ No
❑
❑
Comments:
❑
❑
❑
❑
❑
❑
❑
❑
Inspection Result: I 66Annual CO' ❑ Temporary CO2 ❑ Construction CO ❑ Removed from service ❑ Dormant
' All violations must be 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:
Mark Corry
Inspection Company Name: I
Elevator Safety Services, LLC.
Inspector Signature:
Mark Corryy ==,=^ = ^° �`
Date:
11/07/15
1 Phone #:
1 970.515.5630 1
State License #:
CI-1-13
Colorado Division of Oil and Public Safety Elevator Inspection Report Form Pagel of 2