Loading...
HomeMy WebLinkAbout3550 Luthern ParkwayInspected by C'o , 16*0# 1 o Code Consulting L.L. zmms� 11111 M� MOMMME Expiration Date: 2/1/2014 Wheat Ridge, CO 80033 Inspected by Cho Code Consulting LLC am I ^ w • # MEHORM T Expiration Date: 211/2014 Lillibridge 3555 Wheran P am mo M. a v r# M LJOJ R.I#L# M, jlkwu" City • Wheat Ridge Building Division 7500 W. 29 Ave. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 To Lillibridge 1 3555 .cater Pkwa. y e #3 Wheat Ridge, 1 "00033 41 111 2111 111111 11 11 � TMIN111111 • ME Location Address: 3550 Lutheran Pkwy Elevator ID: I (south) City of Wheat Ridge Building Division 7500 W. 29 th Ave. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 To: Lillibridge 3555 Luthe Pkway. L #31 "wc Wheat Ridge, j IN 111 I'M M-T MT Te"T TT invoice. am= ;e if ME ME Location #: 18 Address: 3550 Lutheran Pkwy Elevator ID* 2 (north) Off m 0 t -. A' #0 - Inspected by 6011*0 Code Consulting LLC TOJORM, I I Expiration Date: 2/11/2013 Lutheran Med. Ctr. Engineering De 8300 W. 38th Ave. Wheat Ridge, CO 80 033 10 =_9 L? jj* 0 ' - . * # # f M `4 NEW Inspected by C� Code Consulting LLC F 1? MN djgM if MEMOM © #w ?2Mim mm. »M Expiration Date: 211/2013 Lutheran Med. Ctr. Engineering Der' 8300 W, 38th Ave. Wheat Ridge, CO 00 33 City of "IT'heat Ridge Building Division 7500 W. 29 Ave. Wheat Ridge, CO $0033 Office: 303-235-2855 * Fax: 303-237-8929 rpm invoice. H U�i' ITIN IF 11 Location #: 18 Address: 3550 Lutheran Pkwy Elevator ID: 1 (south) KNUMM U#2! To: Lutheran Med. Ctr. En ering t. 8300 W. 3 8t '" e. Wheat Ridge, *o0033 4 invoice. Boom m 1� � I �l�: I I q ly Elm= Location #: 18 Address: 3550 Lutheran Pkwy Elevator ID: 2 (north) N This is to certify'that the e yy inspected by Ddh Regional Council 4w of Governmeh (DR COG) amp Iffil �-# 01 2-1 I . • a • 11 mmummm Expiration Date'. 2111201E Lutheran Med. Ctr. Engineering De 8300 W. 38th Ave. Wheat Ridge, CO 80033 • 0 Building Department This is to certify 1h at the eIG'akor as ffidicatpON this certificate has been inspected on the &shown below and w s c, und safe to carry 2500 lbs. WO W MINNO pag" Inspected by 134M egional Council of Governmeff�DRCOG) I . MMUMME Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 City of Wheat Ridge Building Division 7500 W. 29 th AVO. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 To: Lutheran Med. Ctr. Eng 8300 W. 38th .Ave. Wheat Ridge, 3 1 . g 0033 . .. ....... 2ti (south) located at 3550 Lutheran "'milk Ow . . . . wing Cat. '14 0 [a rr Location Address: 3550 Lutheran Pkwy Elevator ID: 1 (south) INYSIM City of Wheat Ridge Building Division 7500 W. 29 Ave. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 �.� �f To: Lutheran Med. Ctr. End! '& 8300 W. 38th Wheat Ridge, b 0033 mggg ml m a E' " (north) located at 3550 Lutheran ej* "S .ring L t. MEMM im a • III �� � 111��! I! I �: I � 1� I I I I • 11731111:11! 1 1 ' I 123s.� Location M 18 Address 3550 Lutheran Pki Elevator ID 2 (north) Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29� Ave. Wheat Ridge, CO 80033 Building Department M All This is to certifN4b@t the efd ator as indicate ' this certificate has been inspected on the dafshown below and wa ound safe to carry 2500 lbs. Safety Inspection Date: 612/2010 Elevator Inspection Date: 6/212010 Certificate Issue Date: 3/1/2010 Expiration Date: 211/2011 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Inspected by De v�Regional Council of Governmen`(DRCOG) Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 Building Department Oa. IR This is to certify ; -t the elevator as indicat.d= kon this certificate has been inspected on the aw hown below and wa ound safe to carry 2500 lbs. 7 Safety Inspection Date: 6/2/2010 Elevator Inspection Date: 612/2010 Certificate Issue Date: 3/1/2010 Expiration Date: 2/1/2011 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Inspected by De .Regional Council of Governmei (DRCOG) Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 113pilding Department M gg 1A This is to certify"th.-at the eldva as - inidicall;@LT �Sn this certificate has been inspected on the a-, . s hown below and w6 and safe to carry 2500 lbs. Inspected by Ddftv'erflRegional Council of Government Safety Inspection Date: 11/30/2009 Elevator Inspection Date: 11130/2009 Certificate Issue Date: 3/11/2010 Expiration Date: 2/112011 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 Building D epartment , ppament L This is to certify that the eil as i this certificate has been inspected on the "*shown below and wad safe to carry 2500 lbs. 1pr Inspected by D eft _:fRegional Council of Governmeff (DRCOG) er. Location Number: Building Name: M --- -- ,[OB 11 A- 11 W- 4" Location: 3550, roftutw- Ap : ID Number: �4(nbiw Elevator Type: HIP Safety Inspection Date: 11/30/2009 Elevator Inspection Date: 11/30/2009 Certificate Issue Date: 31112010 Expiration Date: 211/2011 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29� Ave. Wheat Ridge, CO 80033 Location Number: EEB3 Building Name: II Location: 355 uth ID Number: Elevatorfiyp HP Safety Inspection Date: 12/1112001 Elevator Inspection Date: 12/11/2007 Certificate Issue Date: 5/112009 Expiration Date: 2/112010 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29� Ave. Wheat Ridge, CO 80033 Building Department This is to certify .t the eiator as�dicat n this certificate has been inspected on the dhown below and wa and safe to carry 2500 lbs. Safety Inspection Date: 12/11/2007 Elevator Inspection Date: 12111/2007 Certificate Issue Date: 5/112009 Expiration Date: 211/2010 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Inspected by DeHi Regional Council of Governme - °(DRCOG) INVOICE City of Wheat Ridge Building Division 7500 W. 29 Ave. Wheat Ridge, CO 80033 Office: 303 - 235 -2855 * Fax: 303 - 235 -2857 Date: 12/1512008 ID: 1 Please feel free to invoice. Thank you, if regarding your Please detach and send this stub in with your payment. Location M 18 Address: 3550 Lutheran Pkwy Elevator ID: 1 (south) Amount due: $210 INVOICE City of Wheat Ridge Building Division 7500 W. 29 Ave. Wheat Ridge, CO 80033 Office: 303 - 235 -2855 * Fax: 303 - 235 -2857 Date: 12/15/2008 ID: 2 (north) located at 3550 Lutheran y i q u Please remit payment, tertha= m ary 1, Please feel free to invoice. Thank you, if regarding your Please detach and send this stub in with your payment. Location #: 18 Address: 3550 Lutheran Pkwy Elevator ID: 2 (north) Amount due: $210 dress ! j a; /M7? DaXe eerYiFitG.YP. lPave py. v. QecaSQX F A/exK date of / i, .Day¢ inac./eo/ received � [irJ.aedLe.a -.� �( 77- S J /p 13 LU - I• �i 3�� f or 3� � z ?A b i! i I i i' i I� i; ZZ Mod DVI SIHI 3AOW3a ION 0(3 ` , ;doa 6ulpiins jo; joloodsul- wgoodsui ao; peo 'apew uaaq aney suoi;aaa]oo uay/N •su011e101n 6u1068ao{ au; 400JAOD o; pegljou Agajay aje noA _ :awes suw,ie -AO6 SMBI aleYS ao7Pue /41C) ;o suoileIoin 6uimolio; ay} puno; aney pue sasiwajd esay3 pue ein;ona;s siyypoloodsui Rep siyl aneq.I ;e pe4000l qop 83110N u01138aa03 r . t _ 3Jala 1d3HM d0 AIIo' squ-9£Z (£0£) 1N3UUJLUVd3G ONicnin8 BUILDING ADDRESS OWNER ADDRESS CITY OF WHEATRIDGE ELEVATOR INSPECTION CITY ZIP CODE CITY ZIP CODE BUILDING NAME PHONE MANUFACTURE UNIT NUMBER RAULIC CABLE ESCALATOR DUMBWAITER J ASS FRT PASS FRT 11 LAST SAFETY TEST DUE DATE MATERIAL LIFT DATE INSTALLED CAPACITY C/ , ` / . ' / [ ]wheelchair lift 0 2�� RECORDED C r�lf, v / 1�2IV / vl / Zbx n —l5 �--✓ u pp ?z_ ?� of v �� ja ��� — �v� 1(o -CO p� —oL cr �1 axe LI Lutheran Med.Ctr. Engnrg Dept 8300 W. 38th Avenue Wheat Ridge, Ridge, CO 80033 LDi CITY OF WNERTA' BUILDING INSPECTION ELEVATOR INSPECTIONS CITY 41P COO ...LAST SAFETY TEST NEXT D DATE }:� /!� CONDITION R F.- - ma y CC/ e vy 1:C13 lve // / so / DS / .3/ l MANUFACTURE UNIT NUMBER HYDRAULIC `CABLE /q A, CI PASSENGER C3 FREIGHT ❑ PASSENGER ❑ G ED FREIGHT ❑G ...LAST SAFETY TEST NEXT D DATE }:� /!� CONDITION R F.- - ma y CC/ e vy 1:C13 lve // / so / DS / .3/ l CITY OF . DEPARTMENT OF COMMUNITY DEVE ELEVATOR INSPECTIONS BUILDING ADDRESS CITY ZIP COD[ OWNER - ADDRESS - CITY ZIP CODI MANUFACTURE UNIT NUMBER HYDRAULIC CABLE ❑PASSENGER ❑PASSENGER EDGE ❑FREIGHT ❑FREIGHT El GE LAST SAFETY TEST NEXT DUE DATE. CONDITION RECORDED INSPECTIONS 2 $1 Si C /`' 5 / z( op 9 ,zv / 23 I� /o 0/ 0� 3 > OWNER ADDR I SS CITY ? ZIP CODE 0 MANUFACTURE UNIT NUMBER RAULIC CABLE a PASS I FRT PASS ] LAST SAFETY TEST ' NEXT DUE DATE MATERIAL LIFT wheelchair lift RECORD irGI' ONS ''7 j+ p Z- I- 99 ��(,k - °rG .7_ 7 - °+ 73 11A, - j I i C 9w €-a R-ID Lutheran Med.Ctr. Engnrg Dept. _ 8300 W. 38th Avenue Wheat Ridge, CO 80033 3 ss� ADDRESS 4 CITY OF WHEs7A'166 BUILDING INSPECTION ELEVATOR INSPECTIONS CITY ROU'A � ,�s7ol- �L°' ICJ PASSENGER 0FREIGHT g PASSENGER [3G ❑FREIGHT 0 . .LAST SAFETY TEST CONDITION 9,Z &f49e x,86 A2& xZ17 d SK, 97 a �, / �J�Ao,(/ I /s SSm�. /l 3a 9 CITY OF _ DEPARTMENT OF COMMUNITY DEVE ELEVATOR INSPECTIONS BUILDING ADDRESS CITY ZIP CODE I OWNER - ADDRESS CITY ZIP CODE MANUFACTURE .UNIT NUMBER HYDRAULIC CABLE ❑PASSENGER ❑FREEIGHT ❑PASSENGER ❑FREIGHT ❑GE, ❑GE, LAST SAFETY TEST DUE DATE CONDITION /y NEXT RECORDED INSPECTIONS r2 /- �i9 / 2I , dN, c l3 Il ,1V, 9 1 1 91 1 /Z6/` CITY OF WHEAT RIDGE 7500 West 29th Avenue Wheat Ridge, CO 80033 Phone: 303-235-2855 INVOICE November 19, 2004 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Elevator ID # 1 (squth) Total Cost Due: $132.00 Property /Elevator Location # 18 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Elevator Insueection For: 3550 Lutheran Pkwy CITY OF WHEAT RIDGE 7500 West 29th Avenue Wheat Ridge, CO 80033 Phone: 303 -235 -2855 INVOICE November 19, 2004 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Elevator ID # 2 (north) Elevator Inspection For: 3550 Lutheran Pkwy Total Cost Due: $132.00 Property /Elevator Location # 18 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 0 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 1 (south) HP 4/../01 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 12/7/01 2/7/02 2/7/03 Wheat Ridge, CO 80033 I Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 1 (south) HP 4/../02 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 12/18102 211/03 2/1/04 Wheat Ridge, CO 80033 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 2 (north) HP 4/../02 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 12/18102 2/1/03 2/1104 Wheat Ridge, CO 80033 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 2 (north) HP 4/../01 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 1217/01 2/7/02 2/7/03 Wheat Ridge, CO 80033 I I Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 1 (south) HP 41..101 Lutheran Med. Ctr. Engineering Dept. Inspection Issue Expiration 8300 W. 38th Ave. Date Date Date Wheat Ridge, CO 80033 1/2/01 5/31101 2/1/02 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy 2 (north) HP 41../01 Lutheran Med. Ctr. Engineering Dept. Inspection Issue Expiration 8300 W. 38th Ave. Date Date Date Wheat Ridge, CO 80033 1/2/01 5131/01 2/1/02 Certificate of Inspect City of Wheat Ridge, Coioia BUILDING DEPARTMENT This is to certify that the elevator as indicated on this inspected on the date shown below and was found safe Inspector: Randy Pabst LOCATION ID NUMBER TYPE 3550 Lutheran Pkwy 1 (south) HP Lutheran Med. Ctr. Engnrg Dept. 8300 W. 38th Avenue Inspection Wheat Ridge, CO 80033 Date 7/19/00 Certificate of Inspect City of Wheat Ridge, Coiora BUILDING DEPARTMENT This is to certify that the elevator as indicated on this inspected on the date shown below and was found safe Inspector : Randy Pabst LOCATION ID NUMBER TYPE 3550 Lutheran Pkwy 2 (north) HP Lutheran Med. Ctr. Engnrg Dept. 8300 W. 38th Avenue Inspection Wheat Ridge, CO 80033 Date 7/19/00 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Randy Pabst LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy SOUTH HP 4/29/99 Lutheran Med.Ctr.Engnrg Dept. Inspection Issue Expiration 8300 W. 38th Ave Date Date Date Wheat Ridge, CO 80033 7/15/99 7115/99 7/31/2000 Lutheran Med.Ctr.Engnrg Dept. 8300 W. 38th Ave Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Randy Pabst LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Parkway NORTH HP 4/29/99 Lutheran Med.Ctr. Engnrg Dept. Inspection Issue Expiration 8300 W. 38th Avenue Date Date Date Wheat Ridge, CO 80033 7/15/99 7115/99 7/31/2000 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 ' ELEVATORS DOVER ELEVATOR COMPANY 14 ANNUAL TEST HYDRAULIC INSPECTION & TEST ❑ ACCEPTANCE TEST (FILL OUT SEPARATE REPORT FOR EACH ELEVATOR) NAME OF BUILDING t f LOCATION ELEVATOR SERIAL NO. � +� �i6 - CITY & STATE 1 4, (IF NONE, USE MOTOR OR COTROL SERIAL NO.) DOVER SERVICE CONTRACT NO. BUILDING ELEVATOR NO. CUSTOMER P. O. NO. G's DATE ° cf t OFFICE MAKE OF ELEVATOR &.V_e14 RATED CAR SPEED a F.P.M. RATED CAPACITY V.0 LBS. TYPE OF ELEVATOR y S RATED CAPACITY TEST TO COMPLY WITH AMERICAN NATIONALSAFETY CODE ANSI A17.1 RULE 303 AND RULES 1005 & 1006. FLEX HOSE REPLACEMENT REQUIRED NOT MORE THAN 6 YEAR INTERVAL. Flex Hose and Fittings Tested at Relief Pressure For 30 Sec. Hose Tagged With Replacement Date & SAE Type Physical Dimensions of Reservoir Hose Replacement Date Condition of Reservoir Oil 42 Make (3) Round Trips Before Setting Relief Valve fl Test the relief valve setting . by first inching the empty car up to engage the plunger stop ring, and then by applying additional pump pressure as required to check the setting. The maximum setting must be no greater than 125% of working pressure to comply with the American National Safety Code ANSI A17.1 Rule 1005 & 303. Relief Valve Setting (40 P.S.I. (Should Be 125% of Heavy Load Up Working Pressure) Corrected Relief Valve Setting — P.S.I. (If Required) No Load Working Pressure: Up /P� P.S.I. No Load Car Speed: Up F.P.M. Down Ile r'T x� F.P.M. Relief Valve Sealed: ,'- �" NOTE: Code Requires Relief Valve Setting Be Sealed. See Rule 1005 and locate car at any convenient level. Open the disconnect switch and locate the elevation of the platform with respectdo a - convenient reference. Do not shut off any valves in the line. Provide adequate timbers or pipe as well as safety slings to support canard load if entering the pit. Tank Oil Level At Start of Standing Test f t'' � Tank Oil Temperature At Start of Standing Test 1 After a minimum of 15 minutes, note the position of the platform with respect to the chosen reference. ,� ( r . Length of Time Car Standing -Empty 1 fi'��` Amount Car Settled During Standing Period Oil Temperature At End of Standing Period Tank Oil Level At End of Standing Period c 1 Amount of Leakage At Packing During Test ' Condition of Piston Packing o �< NOTE: A CHANGE IN CAR POSITION WHICH CANNOT BE ACCOUNTED FOR BY VISIBLE OIL LEAKAGE OR TEMPERATURE CHANGE OF THE OIL INDICATES A LEAK IN THE CYLINDER OR IN THE UNDERGROUND PIPING, AND NEED FOR FURTHER INSPECTION TESTS OR REPAIRS. Pres. Switch Rule 306.14 Tested *Heavy Load Working Pressure: Up ,,,.__ P.S.I. *Heavy Load Car Speed: Up F.P.M. Down F.P.M. Normal and Final Terminal Stopping Devices Tested Standby (Emergency Battery Lowering) Power Operation Tested A Power Door System Tested: Torque. # Kinetic - Ft. # Emergency Terminal Speed Limiting Device Tested Was The Test Satisfactory: Yes ® No El If not explain. Representatives of the Insurance Company, City or State Inspector or Owner, Present at test: (Indicate Name and Title) MECHANIC'S SIGNATURE Copy of this Report Given to Customer: Yes © No ❑ -Acceptance Test Only Dc -eo-cs WHITE - BRANCH COPY SUPT. SIGNATURE CUSTOMER'S SIGNATURE ¢YELLOW - CUSTOMER COPY PINK - ZONE COPY i ELEVATORS DOVER ELEVATOR COMPANY ANNUAL TEST HYDRAULIC INSPECTION &TEST L DATE ❑ ACCEPTANCE TEST (FILL OUT SEPARATE REPORT FOR EACH ELEVATOR) OFFICE '`' ✓' t NAME OF BUILDING L4 - P /lAAl /4f ofF 56' LOCATION D� ! 4 ''iil ,:✓ ELEVATOR SERIAL N O i JG t7.5 C`ITV &STATE !T'i - f''1 i d6e, 60 (IF NONE, USE MOTOR OR CON T OL SERIAL NO.) DOVER SERVICE CONTRACT NO. 0. 1 , BUILDIN ELEVAT NO. CUST OMER. P. o. N JOB N $ MAKE OF ELEVATOR P+1lff"', RATED CAR SPEED 1>�� F.P.M. RATED CAPACITY LBS TYPE OF ELEVATOR er RATED CAPACITY TEST TO COMPLY WITH AMERICAN NATIONAL SAFETY CODE ANSI A17.1 RULE 303 AND RULES 1005 & 1006. FLEX HOSE REPLACEMENT REQUIRED NOT MORE THAN 6 YEAR INTERVAL. Flex Hose and Fittings Tested at Relief Pressure For 30 Sec. Hose Replacement Date Nose Tagged With Replacement Date & SAE Type Condition of Reservoir Oil <' a Physical Dimensions of Reservoir Make (3) Round Trips Before Setting Relief Valve 7 ❑ Test the relief valve setting by first inching the empty car up . to engage the plunger stop ring, and then by applying additional pump pressure as required to check the setting. The maximum setting must be no greater than 125 %of working pressure to comply with the American National Safety Code ANSI At 7.1 Rule 1005 & 303. .Relief Valve Setting "+ o P.S.I. (Should Be 125% of Heavy Load Up Working Pressure) Corrected Relief Valve Setting — P.S.I. (If Required) No Load Working Pressure: Up �' P.S.I. No Load Car Speed Up 3 F.P.M. Down F.P.M. Relief Valve Sealed: Vey NOTE: Code Requires Relief Valve Setting Be Sealed. See Rule 1005 and locate car at any convenient level. Open the disconnect switch and locate the elevation of the platform with respect to a -convenient reference. Do not shut off any valves in the line. Provide adequate timbers or pipe as well as safety . slings to support car and load if entering the pit. ,Tank Oil Level At Start of Standing Test *u. 7 Tank Oil Temperature At Start of Standing Test After minimum of 15 minutes, note the position o e platform with respect to the chosen reference. i Length of Time Car Standing -Empty t ..�7< Amount Car Settled During Standing Period S ri Oil Temperature At End of Standing Period 0 Tank Oil Level At End of Standing Period � Amount of Leakage At Packing During Test f ✓6v -. Condition of Piston Packing �fik" NOTE: A CHANGE IN CAR POSITION WHICH CANNOT BE ACCOUNTED FOR BY VISIBLE OIL LEAKAGE OR TEMPERATURE CHANGE OF THE OIL INDICATES A LEAK IN THE CYLINDER OR IN THE UNDERGROUND PIPING, AND NEED FOR FURTHER INSPECTION TESTS OR REPAIRS. c Pres. Switch Rule 306.14 Tested *Heavy Load Working Pressure: Up P.S.I. *Heavy Load Car Speed: Up '""'"` F.P.M. Down - """` V F.P.M. Normal and Final Terminal Stopping Devices Tested W Standby (Emergency Battery Lowering) Power Operation Tested X 0.1 `Power Door System Tested: Torque a a # Kinetic Ft. # Emergency Terminal Speed Limiting Device Tested Was The Test Satisfactory: Yes 0 No ❑ If not, explain. Representatives of the Insurance Company, City or State Inspector or Owner, Present at test:. " and Title) MECHANIC'S SIGNATURE "° ^ SUPT. SIGNATURE �.�. Copy of this Report Given to Customer: Yes El No ❑ CUSTOMER'S SIGNATURE *Acceptance Test Only f lic -sacs _ WHITE BRANCH COPY YELLOW - CUSTOMER COPY ".PINK -.. ZONE COPY: Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 50 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy SOUTH HP 4/8/98 Lutheran Med.Ctr.Engnrg Dept. Inspection Issue Expiration 8300 W. 38th Ave Date Date Date Wheat Ridge, CO 80033 6/10/98 6/10/98 6/30/99 Lutheran Med.Ctr.Engnrg Dept. 8300 W. 38th Ave Wheat.Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify that the elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 50 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Parkway NORTH HP 4/8/98 Lutheran Med.Ctr. Engnrg Dept. Inspection Issue Expiration 8300 W. 38th Avenue Date Date Date Wheat Ridge, CO 80033 6110/98 6/10/98 6/30/99 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Date: 6/19/98 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Quantity Description 1 Elevator inspection for: 3550 Lutheran Parkway �0r44 Total Cost $90.00 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Date: 6/19/98 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Quantity Description 1 Elevator inspection for: 3550 Lutheran Parkway 56"'A Total Cost $90.00 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify thatthe elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy NORTH HP 4/8198 Lutheran Med.Ctr. Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Inspection Issue Expiration Date Date Date 6/13/97 6/18/97 6/30/98 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify thatthe elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE INSPECTION DATE 1 3550 Lutheran Pkwy SOUTH HP 4/8198 Lutheran Med.Ctr.Engnrg Dept. 8300 W. 38th Avenue Wheat Ridge, CO 80033 Inspection Issue Expiration, Date Date Date 6/13/97 6/18/97 6/30/98 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify thatthe elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy NORTH HP 3/22/96 Lutheran Medical Office Bldg. 3550 Lutheran Parkway Wheat Ridge, CO 80033 Inspection Issue Expiration Date Date Date 3/22/96 3/28/96 3/31/97 Certificate of Inspection City of Wheat Ridge, Colorado BUILDING DEPARTMENT This is to certify thatthe elevator as indicated on this certificate has been inspected on the date shown below and was found safe to carry 2500 lbs. Inspector: Jack Bultman LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3550 Lutheran Pkwy SOUTH HP 3/22/96 Lutheran Medical Office Bldg. 3550 Lutheran Pkwy Wheat Ridge, CO 80033 Inspection Issue Expiration Date Date Date 3/22/96 3/28/96 3/31/97 r rv� /Jit �` `�` Cify o� klleat �iilye, � BUILDING DEPARTME f. .�. This is to certify that the Elevator f' has been inspected on the date shown below and was foul K C4 Inspector LOCATION 10 NUI 3550 Lutheran Pkwy #1 r y d J��' f Medical Office Bldg. rv3� \ \1 3550 Lutheran Pkwy 3/14 95 Wheat Ridge, CO 80033 oarE 1 QF sSC � INSPECiIO! T ertifirate- of Prtspi 4( l Wkeat e G' b ' BUILDING DEPARTME �.:.�• lT This is to certify that the Elevator has been inspected on the date shown below and was fou , Gi inspector rj03�J�)� LOCATION ID NU 3550 Lutheran Pkwy. #2N t y,Jl Lutheran Medical Office Bldg 3550 Lutheran Pkwy 3/14/95 d Wheat Ridge, CO 80033 DATE QF INSPECTIO x Q of �1xcsprrtin City � o� Wlceat dye, * �lo�u BUILDING DEPARTMENiT This is to certify that the filevator as has been inspected on t .date shown below and was found 'saf Inspector, �d — LOCATIOfl — d Ip=NOMBER 3550 Lutheran Pa"rkway.,. - #� tSrth F Lutheran MOB Bldg. Manager' '_ `_] - _ 3550 Lutheran Parkwy. � Wheat` Ridge, CO 80033 "`DATE E L OF INSPECTION d cke rfi fira t e of 1n pPt#io a��Nlleat �id�e, ' C'alo2�u ry BUILDING DEPARTMENT4,'° 'E .. � �' This into certify that the levator as has been insp cted on the date shown below ar d was found Inspector e r saf ,. Fx. COCAT]b - - ID 3558 Lutheran Parkway - #ki i5®ugh Lutheran 140B Bldg. Manager 3550 Lutheran Parkway �9 /9�4 3[ Wheat Ridge, CO 80033 DATE L OF INSPECTION �1y e +k� L wF3F3 �f��F � y�. ) .a�'� µ�p bn �"M #� 3 Nl�'m r } � b'"� '� a�'�... '�'_$. ' a T 42 � Y' "� v .� �.. a$ 4 .a. Y�'-.2 +v ✓'�$_ ' ° � Cher #i #ictt #r of �n��ec#io �u `BUILDING DEPARTMENT,' This is to certify that the, "'Ieuator o-' as has been inspected on the date shown below and4as 44Und saf ¢, �ttn s Inspector LDCATION [UNUMBER t J 3550 Lutheran Parkway Lutheran Medical 0££i6o 8idg .�9 3550 Lutheran Parkway ��� Wheat Ridge, CO 86033 � — "DATE E I Lf4 � � OF INSPECTION {[ %Errfifiratr of ;41nsprrtiv � 10000 / a�. r*> :,�, "rt;' `•� " DEPARTMENT -x This is to certify that they elevator a has been inspected on tFte`edate shown below and was found "saf Inspector 1 })i '4x LOCATI ON = ri, v a „I "NUMBER. 3550 Lutheran Partcwd� -- 22 North r Lutheran Medical Office < 3550 Lutheran Parkway -, Wheat Ridge, CO 80033 did �I �d' � � OF INSPECTION r a m �� s al yg�� k g ➢ " JiVi W,Nf;fAM e BUILDING DEPARTMENT,` "M This is to certify that the ."Olevator as 'a has been inspected on tfae.dute shown below and was`found�saf F�� �Ca nspector �> l I;OCATION tDVCiMBER 3550 Lutheran Parlcwa: kf sGut14 -- ;_ T Janet -Essex 3550 Lutheran Plcwq 5Y21'192 k Wheat Ridge, CO 80Q33 _ _ GATE L OF INSPECTION %urdif rate of ;' 4 1n0pertin BUILDING DEPARTIIINT, T? This is to certify that the ekevator as has been inspected on the , date shown below an'd vaslfou nd saf Inspector LOCATION = YJUtvIBER 3550 Lutheran 2'arkway= ff$ narth I_danet Essex 3550 Lutheran Parkwayf105`; ° "; a S}Z1f32' Wheat Ridge, CO 80033 „': DATE OF INSPECTION E L J ga %utd ifirate of r �nspec#ia LOCATION ID NUMBER '+35(0 _ 8t A ve .. - +y MM � , 'BUILDING DEPARTMENT, �� This is to certify that the ,'E;, .'3:� as g� has been inspected on the date sown below and'was found saf r Inspector x, 1K u . W. 3 � kveniue S #1 F W —ea,t ti{d4 e, CO 30033 DATE L OF INSPECTION J LOCATION ID NUMBER '+35(0 _ 8t A ve .. - +y MM u . W. 3 � kveniue S #1 F W —ea,t ti{d4 e, CO 30033 DATE L OF INSPECTION J %Lrd ifirate of �Ijnsverfia aT City o� Glllkeat :�ulye, Colr�ac BUILDING DEPARTMENT This is to certify that the, ELEV h "L'R as has been inspected on the date shown below and'was' found safi Inspector 8 35 - U W. 3 N tue �. C) f g9 ,. vue=a.o RiIg y C-0 W uJ DATE L OF INSPECTION LOCATION .1 D'NUMBER %Uatift>rtt #e of ;lInsyrdin o� l�llceat �dqe, �ilo�af BUILDING DEPARTM' T This is to certify that the TELEVATOR as has been inspected on the.date shown below and was found saf Inspector ;LOCATION - .ID'NUMBER 0 Wn J8 v�.':$. '+ 1 ' ' .:th rant ATec �.a•�.. I iri I .��. a�? .c, 8350 �n 38t Avenue, e, Ridge CO 8003' L OF INSPECTION Corr #ifiratr of ;nspertio City o� (Ilkeat dye, `Colo BUILDING DEPAktME,NT, „ ~, t . This is to certify that the EL.E]VATOR, as` has been inspected on the,da_te shown below and =was'found saf Inspector i L OF � .� i r ?..dt !`:Z .. c „G rQ :: DATE L INSPECTION .� � �� �� N,G"a� �.'*�v,;v".m� ^�.�G .a�•aw' ��o • .ate � ,�+"aa;� �' �w��'�"`:,y,��,�w'�"'k'�S�u"�', (LOCATION ',ID NUMBER L OF � .� i r ?..dt !`:Z .. c „G rQ :: DATE L INSPECTION .� � �� �� N,G"a� �.'*�v,;v".m� ^�.�G .a�•aw' ��o • .ate � ,�+"aa;� �' �w��'�"`:,y,��,�w'�"'k'�S�u"�', > wr#ifiratr of ;Ntsgrdio o kl�eat 0 NG DEPARfl t1 NT.'S, t(e e �. This is to certify that the, as ' has been inspected on the date shown below ah mas found saf Inspector / 1': 1� f 1 ' m u LOCATION 41111 1 8350 W. 38th Avenue fim t- N E.x `i era Medical �'}s'd'ida >,ad 3 38 th Aven � ��� W heat �Ridge, CO 8 0033 L VT TN: \; n t €.Ssex OF INSPECTION w ��� Ter#ifira e of ;Wnsyertiy BUILDING DEPARTMENT - This is to certify that the' : EL Fr n as has been inspected on the . shown below and` was found saf Inspector LOCATION ID. NUMBER F7_ -, ileilca C 8 Id , .. S� -at R Lre ° CC.e &' �? Q �... ry �+ Es ; OF INSPECTION