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HomeMy WebLinkAbout3555 Luthern Parkway0 t . . A* sa Inspected by Ca i 0 Code Consulting LLC SmEmm= 111MON MEMEM MMENEUMP Expiration D. 2/11/2014 Lillibridge Il 3555 Lutheran Pkway. Suite #38-0 Wheat Ridge, CO 80033 0 1 - . ' 0 0 - • MOMM MEHUMM Expiration Date: 2/1/2014 Lillibridge 3555 Lulthafan-Pk Wheat Ridge, CO 80033 Inspected by (�c "o Code Consulting LLC City of Wheat Ridge Building Division 7500 W. 291h AVe. Wheat Ridge, CO 8003 Office: 303-235-2855 * Fax: 303-237-8929 Date: 1/7/2013 To Lillibridge 3555 Luth era ' yPkway. e #31 Wheat Ridge, 0033 44f n on # 17 elevator ID: I U�• =1) # Location #: 17 Address: 3555 Lutheran Pkwy Elevator j City of Wheat Ridge Building Division 7500 W. 29th Ave. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 invoice. U�� , 23*z« «� Location #: 17 Address: 3555 Lutheran Pkwy Elevator ID: 2 (east) ME 2 31»,.2. #f2, < #2! MEUMM Expiration $at© 2/11/2013 I T17"A I - wNrPris"A 8300 W. 38th Ave Wheat Ridge, CO 8■ 033 Inspected by Code Consulting LLC A mm�- �# mmamm Expiration Date: 211/2013 Exempla Lutheran Med Ctr. Engineering d 8300 h Ave W. 38t Wheat Ridge, CO 80033 HIM' Inspected by Code Consulting LLC Cit,y of COMMUNrry DEVELOPMENT Wheat Ridge, CO 8003348001 P. 303.2352855 F. 303.237,8929 John C. Schumacher, J•., CBO Chief Building Official 7500 W, 29th Avenue Wheat Ridge, Colorado 80033 Office Phone: 303-235-2853 Fax: 303-237-8929 www.ci.wheatridee,co.us www.d.whearridge.coms City of Wheat Ridge Building Division 7500 W. 291h AVO. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 NK [a invoice. a UM # Location #: 17 Address 3555 Lutheran Pkwy Elevator City of Wheat Ridge Building Division 7500 W. 29th AVe. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 To: Exempla Lutheran Med tr. En ering dept 8300 W. 38 ve 9 4" t4 Wheat Ridge, 0033 Please feel free to invoice. H Location Address: 3555 Lutheran Pkwy Elevator Bpilding Dopartment This is to certify "that the elf tor as'j rid this certificate has been inspected on the hown below and w"und safe to carry 4000 lbs. MEMIME M-MENEWM MENUTNTilf Expiration Date: 2/l/201E 8300 W. 38th Ave Wheat Ridge, CO 80033 Inspected by © "hN"'"""' R Government "' 'egional Council of "DRCOG) Building Department This is to certify "that the er for as ffi'd►cated n this certificate has been Inspected on the 8"ap below and was> c und safe to carry 3000 tbs. r I 12HOE 8300 �V. 38th Ave Wheat Ridge, CO 80033 Inspected y D6 WRegional Council of Govemm RCOG) b To. Exempla Lutheran Me d*' 8300 W. 38th Ave Wheat Ridge, C ' 0033 ik r. En ering dept 1. ---- I- invoice. U�i, m H IF 111 1 �I I! � 111 fil Location 17 Address: 3555 Lutheran Pkwy Elevator ID: 1 (west) ME mo HE City of Wheat Ridge Building Division 7500 W. 291h AVe. Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 To: Exempla Lutheran Medi En ?Oering dept 8300 W. 38thAve Wheat Ridge, 3111" "'N" 0033 HIM m Im SAM U�s im 2��� Location #: 17 Address: 3555 Lutheran Pkwy Elevator Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 Building Department This is to certifyt t the elevator as indicat this certificate has been inspected on the drePshown below and wound safe to carry 4000 lbs. Inspected by D -, WRegional Council of GovernmehT(DRCOG) Location Number: 1k Building Name: ropB IV MOP Location: 355 m he, ID Number: Elevator Type: HP Safety Inspection Date: 6/212010 Elevator Inspection Date: 6/2/2010 Certificate Issue Date: 3/112010 Expiration Date: 2/1/2011 Exempla 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 that the elee"vator asndicat bn this certificate has been inspected on the dshown below and wa ound safe to carry 3000 lbs. Inspected by ber-Regional Council of Govemme RCOG) Location Number: Building Name: Location: ID Number: ElevatorTvpe: HP Safety Inspection Date: 61212010 Elevator Inspection Date: 6/2/2010 Certificate Issue Date: 3/1/2010 Expiration Date: 2/1/2011 Exempla 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 i A U. 0- This is to certifot bat the erd for as indicated on this certificate has been inspected on the shown below and wd safe to carry 4000 lbs. Inspected by DaNORegional Council of Govemme'ff Location Number: Building Name: Location: ID Number: ElevatorT e: HP Safety Inspection Date: 11130/2009 Elevator Inspection Date: 1113012009 Certificate Issue Date: 3/11/20110 Expiration Date: 21112011 Exempla 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 Bpilding Department 4z 'Ali tti This is to certify`that the el"eVator as indicatgo n this certificate has been inspected on the d'f -shown below and was#ound safe to carry 3000 lbs. Safety Inspection Date: 11/3012009 Elevator Inspection Date: 11/30/2009 Certificate Issue Date: 3/1/2010 Expiration Date: 2/112011 Exempla Lutheran Med Ctr. Engineering dept 8300 W. 38th Ave Wheat Ridge, CO 80033 Inspected by DenRegional Council of Government (DRCOG) Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 Building D partment a This is to certify t at the a vator as indicat n this certificate has been inspected on the hown below and wa ound safe to carry 4000 lbs. Inspected by DeA ; egional Council of GovernmeWDRCOG) Location Number: Building Name: Location: ID Number: ElevatorTvpe: HP Safety Inspection Date: 12/11/2007 Elevator Inspection Date: 12111/2007 Certificate Issue Date: 5/112009 Expiration Date: 2/112010 Exempla 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 Inspected by De $Regional Council of Governme : (DRCOG) Location Number: Building Name: IIB Location: ID Number: HP Safety Inspection Date: 12111/2007 Elevator Inspection Date: 12/11/2007 Certificate Issue Date: 51112009 Expiration Date: 2/1/2010 Exempla Lutheran Med Ctr. Engineering dept 8300 W. 38th Ave Wheat Ridge, CO 80033 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: 1 Please feel free to invoice. if regarding your Thank you, u� Please detach and send this stub in with your payment. Location M 17 Address: 3555 Lutheran Pkwy Elevator ID: 1 (west) 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 (east) located at 3555 2"'erth n Win Please remit payment ey Please feel free to invoice. Thank you, if regarding your Please detach and send this stub in with your payment. Location M 17 Address: 3555 Lutheran Pkwy Elevator ID: 2 (east) ID: 2 Amount due: $210 Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29"' Ave. Wheat Ridge, CO 80033 Building Department This is to certify that the elevator as indicatedi.bn this certificate has been inspected on the date shown below and was found safe to carry 4000 lbs. Safety Inspection Date: 41..102 Elevator Inspection Date: 12111/2007 Certificate Issue Date: 21112008 Expiration Date: 2/1/2009 Exempla Lutheran Med Ctr. Engineering dept 8300 W. 38th Ave Wheat Ridge, CO 80033 Inspected by Denver Regional Council of Government (DRCOG) Certificate of Elevator Inspection City of Wheat Ridge 7500 W. 29 Ave. Wheat Ridge, CO 80033 Building Department This is to certify'that the elevator as indicated i on this certificate has been inspected on the 0,10 , shown below and was °found safe to carry 3000 lbs. Safety Inspection Date: 4/../02 Elevator Inspection Date: 12/11/2007 Certificate Issue Date: 2/1/2008 Expiration Date: 2/1/2009 Exempla Lutheran Med Ctr. Engineering dept 8300 W. 38th Ave Wheat Ridge, CO 80033 Inspected by Denver Regional Council of Government (DRCOG) ESE V.47—aRSa ....� . <; 9 Dade Dd'e cc Fi' ' �a.Ve .h v _PY -' r `,Qece.cy4C vad F Next[ dnXe pf rips e<<4a.- I LL 6 - 7 c J� Cl `7 -3 1 0 0 l W I ok" t+0335 i if ;j i' Ii {il fj LI _ s. it I f i I' I j!I BUILDING ADDRESS OWNER ADDRESS CITY OF WHEATRIDGE ELEVATOR INSPECTION CITY ZIP CODE CITY DNE NUMBER MANUFACTURE UNIT NUMBER HYDRAULIC CABLE ESCALATOR DUMBWAITERS I �.fll PASS FRT. - PASS FRT LAST SAFETY TEST ( r q 'xv NEXT DUE DATE MATERIAL LIFT wheelchair lift DATE INSTALLED / / CAPACITY �/ a-r RECORDEte - z � NS -`0 - 9S 0 `1�►5 99 Viz — V� - �- 1 ,2 - BUILDING NAME CITY OF BUILDING DEPT LERkTOR INSPECTIONS ILDING uIT LIP Cl Ty ZIP COD, MANUFACTURE UNIT NUMBER ;HYDRAULIC CARL$ �^ _ �®C�,p © I r4 PASZRNGER ❑FREIGHT ❑PASSENGER ❑FREIGHT GEE ❑GE � �..\ LIST SAFETY TEST W NEXT Dtia nATa CONDITION 5 UJILj' / � D ^ �! 9 Gvt n r: BUILDING ADDRESS CITY ZIP CODE OWNER ADDRESS CITY/ ZIP CODE MANUFACTURE al LAST SAFETY TEST r -C,>5 UNIT NUMBER HYDRAULIC CABLE .. PASS �. FRT PASS 7 NEXT DUE DATE MATERIAL LIFT [ ] wheelchair lift � NS Ao 2 . i6 0 ,7 - 19-cot lL -'? --vi Jam— b-- I 7- _r CITY OF BUILDING DEPT EL9VATOR INSPECTIONS q �6 C �IfC(/r'd !?•� C1TY ZIP c0DI Lutheran Med.Ctr. Engnrg Dept 8300 W. 38th Avenue C TY ZIP CODE �4n W Ridge, CO 800 I MANN �UFACTURE UNIT NUMI R HYDRAULIC CABLE � P/�S:S HNGHR CD HNGER ❑GE K/O C _ ❑FREIGHT ❑fR EIGHT ❑ GH, I, L%+57 SAfElI' FSf NEXT DUE DATE,{�.� CONDITION 2, 0(f, 7 3 € C 3 ' y,a� /,q3 ) o 1 15 1 3 , /i 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 # Elevator Inspection For: 1 (West) 3555 Lutheran Pkwy / Total Cost Due: $132.00 Property /Elevator Location # 17 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 ■ 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 (east) Elevator Inspection For: 3555 Lutheran Pkwy Total Cost Due: $132.00 Property /Elevator Location # 17 Lutheran Med. Ctr. Engineering Dept. 8300 W. 38th Ave. Wheat Ridge, CO 80033 PtEAst RETuR` ' ruffs wrota rT uR Wien Yov1R PAYMwr Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions Elevator Address: 3555 Luthe Pk Total due: $132.00 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 ft AST RETURN THIS INVOICE VW WiT14YO R PAYMENT Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions Property /Elevator Location # 17 Elevator Address: 3555 Lutheran Pkwy Total due: $132.00 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 PLEAS= RETURN nM INVOICE SWR WITH IFOUR PAYMENT Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions Property /Elevator Location # 18 Elevator Address: 3550 Lutheran Pkwy Total due: $132.00 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 AEAST RETURN M IS .INMICE STtlR WITH YOUR PAYMENT Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions ProperWElevator Location # 18 Elevator Address: 3550 Lutheran Pkwy Total due: $132.00 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 Pit - ASE RETURN THIS INVOICE MR WITH YOUR PAYMENT Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions Property/Elevator Location # 19 Elevator Address: 3655 Lutheran Pkwy Total due: $132.00 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 City of Wheat Ridge Building Department 7500 W. 29th Ave. Wheat Ridge, CO 80033 PLEASE RETURN JM INVOKE STUD WITH YOUR PA ENT Thank You City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 (303) 235 -2855 Please call if you have any questions Property /Elevator Location # 19 Elevator Address: 3655 Lutheran Pkwy Total due: $132.00 s JA f "J 2 Z— t City of Wheat Ridge Building Department 7500 W. 29th 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 4000 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY 3555 Lutheran Pkwy 1 (west) HP 4/../02 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 12118/02 2/1/03 2/1/04 Wheat Ridge, CO 80033 I -/ }mss J�m �d , — dad 3� 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 3000 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3555 Lutheran Pkwy 2 (east) HP 4/../02 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 12118/02 2/1/03 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 4000 lbs Inspector : Bill Gardner 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 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 3000 lbs Inspector : Bill Gardner (LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3555 Lutheran Pkwy 2 (east) HP 41../01 Lutheran Med. Ctr. Engineering Inspection Issue Expiration Dept. Date Date Date 8300 W. 38th Ave. 1217/01 2/7/02 2/7103 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 4000 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3SSS Lutheran Pkwy 1 (west) 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 5/31/01 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 3000 lbs Inspector : Bill Gardner LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3555 Lutheran Pkwy 2 (east) 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 5131101 2/1/02 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 3555 Lutheran Pkwy 1 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 safc Inspector: Randy Pabst LOCATION ID NUMBER TYPE 3555 Lutheran Pkwy 2 HP Lutheran Med. Ctr. Engnrg Dept. 8300 W. 38th Avenue Inspection Wheat Ridge, CO 80033 Date 7/19/00 N 5 b :3 , 1 ' ® ELEVATORS DOWER ELEVATOR COMPANY V ANNUAL TEST ❑ ACCEPTANCE TEST HYDRAULIC INSPECTION & TEST (FILL OUT SEPARATE REPORT FOR EACH ELEVATOR) DATE �P`f OFFICE ,j 3 NAME OF BUILDING ii,t'i6- PerPteW 1V11iF; LOCATION ��.L�t - �° ELEVATOR SERIAL NO. �.. �" ` t'� CITY &STATE ? W, g f�'"C' -t (IF NONE, USE MOTOR OR CONTROL SERIAL NO.) DOVER SERVICE CONTRACT NO. �,.� -' g° 7+ �}„' ¢ f BUILDING ELEVATOR NO. ---,, CUSTOMER P. 0. N JOB NO. MAKE OF ELEVATOR Cfie. RATED CAR SPEED F.P.M. - RATED CAPACITY eld LBS. TYPE OF ELEVATOR (fit r," r 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 Replacement Date Hose Tagged With Replacement Date & SAE Type Condition of Reservoir Oil Physical Dimensions of Reservoir Make (3) Round Trips Before Setting Relief Valve 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 greaterthan 125% of working pressure to comply with the American National Safety Code ANSI At 7.1 Rule 1005 & 303. .. - Relief Valve Setting W10 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 r✓a P.S.I. No Load Car Speed Up 12e F.P.M. Down F.P.M. Relief Valve Sealed: . NOTE: Code Requires Relief Valve Setting Be Sealed. Bee 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 i entering the pit. r➢ s, I Tank Oil Level At Start of Standing Test C^.° f Tank Oil Temperature At Start of Standing Test !. After a minimum of 1.5 minutes, note the position of the.,platform with respect to the chosen reference. r Length of Time Car Standing -Empty .f "A •4' le l. Amount Car Settled During Standing Period Oil Temperature At End of Standing Period Tank Oil Level At End of Standing Period �e Amount of Leakage At Packing During Test 'Vdt ° e Condition of Piston Packing .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 VP - Power Door. System Tested: Torque — - I / # Kineti _ Ft. # Emergency Terminal Speed .Limiting .Device Tested 5` Was The Test Satisfactory: Yes Q No ❑ 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-W -GS _ - WHITE - BRANCH COPY SUPT SIGNATURE CUSTOMER'S SIGNATURE °f % %' YELLOW - CUSTOMER COPY PINK - ZONE COPY r Y! Y ��..�f.i',� �{�- . W ...v i .. .., v s "�� 5... b.Y .n � J Q .` . t • n � .- ��_�- .. ELEVATORS DOVER ELEVATOR COMPANY ANNUAL TEST HYDRAULIC INSPECTION & TEST t DATE (FILL OUT SEPARATE REPORT FOR EACH ELEVATOR) E] ACCEPTANCE TEST OFFICE 0, NAME OF BUILDING �^�' /. - 4C�d�J r " LOCATION _ 116 ELEVATOR SERIAL N rlTV &STATE ILV °r ✓ °s� (IF NONE, USE MOTOR OR CONTROL SERIAL NO.) DOVER SERVICE CONTRACT NO. BUILDING ELEVATOR NO. '`> CUSTOMER P. 0. NO. JOB NO. MAKE OF ELEVATOR AJt'U t`f..- RATED CAR SPEED + F.P.M. RATED CAPACITY � 4� LBS. TYPE OF ELEVATOR 04 S i 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 Replacement Date Hose Tagged With Replacement Date & SAE Type Condition of Reservoir Oil 4A Physical Dimensions of Reservoir Make (3) Round Trips Before Setting Relief Valve fl Test the relief valve setting first inchi the em r g y g 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 0 P.S.I. (Should Be 125% of Heavy L "dad Up Working Pressure) Corrected Relief Valve Setting °`"'"° P.S.I. (If Required) No Load Working Pressure: Up t3Cb P.S.I. No Load Car Speed: Up _2;!,`3 F.P.M. Down 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 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 — After a minimum of 15 minutes, note the pos Length of Time Car Standing -Empty Oil Temperature At End of Standing Period Amount of Leakage At Packing During Test f" 1 Tank Oil Temperature At Start of Standing Test ition of the platform with respect to the chosen reference. C,7F Al, Amount Car Settled During Standing Period Tank Oil Level At End of Standing Period Condition of Piston Packin 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 'V . Standby (Emergency Battery Lowering) Power Operation Tested per. Power Door System Tested: Torque " # Kinetic Lp` Ft # Emergency Terminal Speed Limiting Device Tested M Was The Test Satisfactory: Yes 1Sd No ❑ If not explain. Representatives of the Insurance Company, City or State Inspector or Owner, Present at test MECHANIC'S SIGNATURE V Copy of this Report Given to Customer: Yes ® No ❑ *Acceptance Test Only Dc -so -GS WHITE - BRANCH COPY SUPT. SIGNATURE CUSTOMER'S SIGNATURE^ -'sf 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 2500 lbs. Inspector: Randy Pabst LOCATION ID NUMBER TYPE SAFETY INSPECTION DATE 3555 Lutheran Pkwy ONE 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 7115199 7/31/2000 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 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 3555 Lutheran Pkwy TWO HP 4/29/99 Lutheran Medical Ctr. Eng. Dept Inspection Issue Expiration 8300 W 38th Avenue / B. Crawfor . Date Date Date Wheat Ridge, CO 80033 7/15/99 9/15/99 7/31/2000 Lutheran Medical Ctr. Eng. Dept 8300 W 38th Avenue / B. Crawfor Wheat Ridge, CO 80033 BUILDING DEPARTMENT (303) 235 -2855 CITY OF WHEAT RIDGE Correction Notice Job Located at v`�s�Lca� I have this day inspected this- strueturs -arid- these - premises and have found the following violations of City and/or State laws gov- erning same You are hereby notified to correct the foregoing violations. When corrections have been made, call for inspection. Date 0 -Vip 00 Inspector for Building Dept. DO NOT REMOVE THIS TAG FORM WR6 -22 BUILDING DEPARTMENT (303) 235 -2855 CITY OF WHEAT RIDGE Correction Notice Job Located at I have this day inspected this structure and these premises and have found the following violations of City and/or State laws gov- ern n ing,same 'ndnt� Ij --�° You are hereby notified to correct the foregoing violations. When corrections have been made, call for inspection. Date i ". Inspector for Building Dept. DO NOT REMOVE THIS TAG FORM WR6.22 - -------- ---- ---- I Al, 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 3555 Lutheran Pkwy ONE HP 418/98 Lutheran Med. Ctr. Engnrg Dept Inspection Issue Expiration 8300 W. 38th Avenue Date Date Date Wheat Ridge, CO 80033 6/10/98 6/10/98 6/30/99 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 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 3555 Lutheran Pkwy TWO HP 4/8/98 Lutheran Medical Office Bldg. Inspection Issue Expiration 3555 Lutheran Pkwy Date Date Date Wheat Ridge, CO 80033 6/10/98 6/10/98 6/30/99 Lutheran Medical Office Bldg. 3555 Lutheran Pkwy 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 3555 Lutheran Pkwy Lutheran Medical Office Bldg 3555 Lutheran Pkwy Wheat Ridge, CO 80033 ID NUMBER TYPE E • IN SAFETY INSPECTION DATE 4/8/98 --11 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 3555 Lutheran Pkwy HP 4/8/98 Lutheran Medical Office Bldg. 3555 Lutheran Pkwy Wheat Ridge, CO 80033 Inspection Date Issue Date Expiration Date 6/13/97 6/18197 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 3555 Lutheran Pkwy ONE HP 6/28/96 Lutheran Medical Office Bldg. 3555 Lutheran Pkwy 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 3555 Lutheran Pkwy TWO HP 6/28/96 Lutheran Medical Office Bldg. Inspection Issue Expiration 3555 Lutheran Pkwy Date Date Date Wheat Ridge, CO 80033 3/22/96 3/28/96 3/31/97 (gatif icate of ;JmapT City of piked 7461 G BUILDING DEPARTME f ..�. This is to certify that the Elevator 1 �1r has been inspected on the date shown below and was fou t 'r 0�h l p inspector a LOCATION ID NU Lutheran Pkwy #1 Lutheran Medical Office Bldg. 3555 Lutheran Pkwy 3/14/95 f�.' � Wheat Ridge, CO 80033 DATE INSPECTIO OF (ger#ificate of (lttsp City of RAW �i 61 C BUILDING DEPARTMI This is to certify that the I Elevator has been inspected on the date shown below and was fo Inspector J.. (Zee Lutheran Medical Office Bldg. 3555 Lutheran Pkwy. Wheat Ridge, CO 80033 � W 4 'Kw • + V }3�,M d 3 4 x:Tn`n { �" '$ Y` y U °yr, V + � ta TY rx` k 4v \'0.r nf " _eM MRFM C�Br # tfka h of * ;4jnspertWn " BUILDING DEPARTMENT This is to certify that the' rt-)Elevator as. has been inspected on the date shown below an was fopnd saf Inspector D NU LOCATION NUMBER f r 1 � v _ 3555 Lutheran Parkwa #1 �� F MOB III r Bldg. Manager 3555 Lutheran y Parkwa E Wheat: Ridge, GO 80033 " DATE L i� w OF INSPECTION M R `°', 9 �a"%m'�_' r:' ger#i#irat of �ln ertiv f �� City�o� Wkeat lye, Colo BUILDING DEPAkiM NT This is to certify that the Elevator �� � 'as has been inspected on the`aiate shown below and yvas4c)gnd`sai Inspector LOCATION ' xID(NUMBER �y 4 3555 Lutheran Pdfkway , -#2_ Lutheran P'IOB III Bldg. > ?Manager 3555 Lutheran Parkway 3�g�g. � ' Wheat- Ridge, -CO 80033 OF INSPECTION DATE � � J �� INSPECTION M ``^ '* .�v+i 'a�w��wf "s pm. ..'"rn`:y�;,, � � .� '�w o- ,ry 3'�. ^„w�. T"".' ✓��` ^.. -.� c�v � +,t ^w. r L?n �" Cuerfifutt #e of usper io ` W zWkeat idle b 6U Bl)IWING DEPAk ME'N�T„' as This is to certify that the, has been inspected on the`.dare shown below anA ;'v��s;fo 'nd saf Inspector _ ER °�° ° LOCATI N = s a1i 3SSS Lutheran Paksaay w #fL — " FLutheran MOB III 3555 Lutheran Parkway -` k �/$ /�3 -� Wheat dodge, CO 80033 _ DATE OF INSPECTION , ,.. -. ���'+��,`tr -�8,w. W AN I: l �tWYIT #'.b' mN.f r�4'SV' ,....ham:. ^. °dwv _5. . MNrn$: „ wt�..!.._.v'+'Pni +MF.. _L?v..•'. LOCATION -4 Qlat of ns Et#io —` \ Q k 'BUILDING DEPAR°T1NEN7 - This is to certify that the - 13e_ vator , a ,; has been `inspected on the "date shown below and was'liound saf h. Inspector LOCATION -4 'ID)OMB *R. —` 3555 Lutheran Paxkwa",2 - - k a f Lutheran YOB III —` 3555 Lutheran Parkway k Wheat Ridge, CO 80033 ��� � DATE OF INSPECTION � ✓5 l^�^aew'^�x` wF`'nC 4.4�w. �� ""'n v'^,,,m'�,. wN -M P .�, '"n', ,+ �� ^v .•,.q,.m . ..p� ' • , . < e ' '+w '*. k a rx.+` z�1.•�4''� !,= * s` t, m+`i'ry .E wr d^`\ A T urd i#iratr of ; iv o� vw dye, °��Colo BUILDING DEPAOA1N 1 . This is to certify that the: .elevator as has been insp ct on th ate shown below an'd was found sat Inspector CPCAT( = 1p,' UM4ER 3555 Lutheran Earlc�iiy Liri to Tt- �- v y> 1 1:atheran MOB III Massageffient „' 3555 Lutheran Parkway ,n ' Wheat Ridge, CO 80033 5`12bJ92" DATE L OF INSPECTION (�ertif ratr of ;3Inspertin off, ulye,iuu BUILDING DEPARTMENT This into certify that the ievator ';.as has been insp cted'on,the date shown below and' Inspector r ��-- y w I Lutheran MOB III Management 3555 Lutheran Parkway � E Wheat Ridge, CO 80033 DATE OF INSPECTION E L J LOCATION. _:: `,iD,NUMBER 3555 Lutheran Parkway IInt-7 r ��-- y w I Lutheran MOB III Management 3555 Lutheran Parkway � E Wheat Ridge, CO 80033 DATE OF INSPECTION E L J