Fillable Elevator Safety 150 Des Moines Street Des Moines, (Office of the Chief Information Officer)

Fill Online, Printable, Fillable, Blank Elevator Safety 150 Des Moines Street Des Moines, (Office of the Chief Information Officer) Form

Use Fill to complete blank online OFFICE OF THE CHIEF INFORMATION OFFICER (IA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Elevator Safety 150 Des Moines Street Des Moines, (Office of the Chief Information Officer)

On average this form takes 6 minutes to complete

The Elevator Safety 150 Des Moines Street Des Moines, (Office of the Chief Information Officer) form is 1 page long and contains:

  • 1 signature
  • 8 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Office of the Chief Information Officer

BROWSE OFFICE OF THE CHIEF INFORMATION OFFICER (IA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Building name
Rated speed
Rated capacity
Address/location
City
State
Zip
State inspector’s printed name
Fold on the dotted line and display top portion in elevator
Iowa Division of Labor
Elevator Safety
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-725-5612/515-725-5608
Fax: 515-242-5076
elevators@iwd.iowa.gov
www.iowaelevators.gov
Temporary Construction Permit Application
Approved Denied
Issue date:
ID #: Exp. Date:
Signature Date
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
For deaf and hard of hearing, use Relay 711.
09.06.2018
600-013
FOR OFFICE USE ONLY
Application and permit fees must be paid before a permit will be issued.
Initial inspection fee - $200.00 Renewal inspection fee - $100.00
Responsible party’s name
Company name
Phone number
Email address
Address
City
State
Zip
The safety test was performed under the rated load.
Landing entrances are guarded, locked and unlocked from the hoistway side only.
Landing call buttons are not operated unless the hoistway door-locking devices are installed and operative.
A notice is posted at each entrance stating the equipment has not been finally accepted.
I certify the elevator complies with the requirements found in Iowa Administrative Code Section 72.23(89A) and with ASME A17.1,
Section 5.10. The elevator will be used for construction materials and construction personnel only.
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Elevator Safety 150 Des Moines Street Des Moines, (Office of the Chief Information Officer)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document