Date Received ELEVATOR SUBCODE - nj.gov...Temp. Cert. of Comp. Cert. of Compliance Issue Date Year...

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CERTIFICATION IN LIEU OF OATH I hereby certify that I am the (agent of) owner of record and am authorized to make this application. IDENTIFICATION-APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000 Block Lot Signature Work Site Location TECHNICAL SECTION ELEVATOR SUBCODE DEVICES CHARACTERISTICS Traction/Winding Drum Hydraulic Roped Hydraulic Escalator/Moving Walk Dumbwaiter Stairway/Chair/Man Lift Auxilary Power Generator Counterweight Governor Oil Buffers Manufacturer Machine Room Location Number of Stops Number of Openings Travel (ft.) Speed (f.p.m.) Type of Operation Type of Control Passenger/Freight Capacity Temp. Cert. of Comp. Cert. of Compliance Issue Date Year of Installation/Major Alteration Expire Date Number Date ID ID ID ID ID ID ID U.C.C. F155 (rev. 5/03) Internet version Date SUPPLEMENT FOR MULTIPLE EQUIPMENT Qualification Code Date Received Control # Date Issued Permit # Applicant: When submitting this form to your Local Construction Code Enforcement Office, please provide one original plus three photocopies.

Transcript of Date Received ELEVATOR SUBCODE - nj.gov...Temp. Cert. of Comp. Cert. of Compliance Issue Date Year...

Page 1: Date Received ELEVATOR SUBCODE - nj.gov...Temp. Cert. of Comp. Cert. of Compliance Issue Date Year of Installation/Major Alteration Expire Date Number Date ID ID ID ID ID ID ID U.C.C.

CERTIFICATION IN LIEU OF OATHI hereby certify that I am the (agent of) owner ofrecord and am authorized to make this application.

IDENTIFICATION-APPLICANT: COMPLETE ALL APPLICABLEINFORMATION. WHEN CHANGING CONTRACTORS, NOTIFYTHIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000

Block Lot

SignatureWork Site Location

TECHNICAL SECTIONELEVATOR SUBCODE

DEVICES CHARACTERISTICS

Traction/Winding Drum

Hydraulic

Roped Hydraulic

Escalator/Moving Walk

Dumbwaiter

Stairway/Chair/Man Lift

Auxilary Power Generator

Counterweight Governor

Oil Buffers

Manufacturer

Machine Room Location

Number of Stops

Number of Openings

Travel (ft.)

Speed (f.p.m.)

Type of Operation

Type of Control

Passenger/Freight

Capacity

Temp. Cert. of Comp.

Cert. of Compliance

Issue DateYear of Installation/Major Alteration

Expire DateNumber

DateID ID ID ID ID ID ID

U.C.C. F155 (rev. 5/03)Internet version

Date

SUPPLEMENT FOR MULTIPLE EQUIPMENT

Qualification Code

Date ReceivedControl #

Date IssuedPermit #

Applicant: When submitting this form to your Local Construction Code Enforcement Office, please provide oneoriginal plus three photocopies.

Riverside Fire Volume , Issue LESSONS FROM THE GREAT … › readyriverside › CERT › pdf...CERT Highlights and Updates 4 Save the Date 5 CERT Class 38 6 CERT Class 39 7 Public

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id -matric cert.

id -matric cert.

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