Form DBPR HR-7023 "Affidavit of Elevator Plans Code Compliance" - Florida

What Is Form DBPR HR-7023?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBPR HR-7023 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

ADVERTISEMENT
ADVERTISEMENT

Download Form DBPR HR-7023 "Affidavit of Elevator Plans Code Compliance" - Florida

Download PDF

Fill PDF online

Rate (4.5 / 5) 31 votes
DBPR HR-7023 – Affidavit of Elevator Plans Code Compliance
STATE OF FLORIDA, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road, Tallahassee, FL 32399-0783
Phone: 850.487.1395 – Email:
dhr.elevators@myfloridalicense.com
Internet:
www.MyFloridalicense.com/DBPR/elevator-safety/
Please direct questions about this affidavit to the Department of Business and Professional Regulation’s Customer Contact Center at
850.487.1395.
Affidavit of Elevator Plans Code Compliance
I,
, acting as agent of the below named registered elevator company,
do hereby attest that the plans for elevator installation and/or modification to be located at (insert the complete US
Postal Service physical street number and name for the permit to be approved):
meet or exceed the minimum standards of Chapter 399, Florida Statutes, Chapter 61C-5, Florida Administrative Code
(FAC), and Chapter 30 of the Florida Building Code adopted by Rule 61G20-1.001, FAC, or variance granted thereto.
For elevators complying with ASME A17.7:
Please check here ____ and provide with this affidavit a copy of the Certificate of Conformance for each component that
complies with ASME A17.7.
A copy of the Certificate of Conformance and Certificate of Conformance Report must be posted in the machine room
and available for review by elevator personnel at all times.
Registered Elevator Company
Certificate of Competency # OR Certified Elevator Inspector #
and Expiration Date
Signature of Agent
Printed Name
Date
STATE OF FLORIDA
COUNTY OF __________
The foregoing instrument was acknowledged before me this ________ day of _________________, 20__ , by
_________________________________, who is personally known to me or who has produced
____________________________________________________________________________________ as
identification and who has taken an oath.
________________________
Notary Public, State of Florida
_________________________
Printed Name
Commission Number:
My Commission Expires:
Complete this affidavit and submit it with the application and required fee to the address on this form. Please use the entire
9-digit zip code in the address above to ensure proper handling.
2018 January
61C-5.006, F.A.C.
Page 1 of 1
DBPR HR-7023 – Affidavit of Elevator Plans Code Compliance
STATE OF FLORIDA, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road, Tallahassee, FL 32399-0783
Phone: 850.487.1395 – Email:
dhr.elevators@myfloridalicense.com
Internet:
www.MyFloridalicense.com/DBPR/elevator-safety/
Please direct questions about this affidavit to the Department of Business and Professional Regulation’s Customer Contact Center at
850.487.1395.
Affidavit of Elevator Plans Code Compliance
I,
, acting as agent of the below named registered elevator company,
do hereby attest that the plans for elevator installation and/or modification to be located at (insert the complete US
Postal Service physical street number and name for the permit to be approved):
meet or exceed the minimum standards of Chapter 399, Florida Statutes, Chapter 61C-5, Florida Administrative Code
(FAC), and Chapter 30 of the Florida Building Code adopted by Rule 61G20-1.001, FAC, or variance granted thereto.
For elevators complying with ASME A17.7:
Please check here ____ and provide with this affidavit a copy of the Certificate of Conformance for each component that
complies with ASME A17.7.
A copy of the Certificate of Conformance and Certificate of Conformance Report must be posted in the machine room
and available for review by elevator personnel at all times.
Registered Elevator Company
Certificate of Competency # OR Certified Elevator Inspector #
and Expiration Date
Signature of Agent
Printed Name
Date
STATE OF FLORIDA
COUNTY OF __________
The foregoing instrument was acknowledged before me this ________ day of _________________, 20__ , by
_________________________________, who is personally known to me or who has produced
____________________________________________________________________________________ as
identification and who has taken an oath.
________________________
Notary Public, State of Florida
_________________________
Printed Name
Commission Number:
My Commission Expires:
Complete this affidavit and submit it with the application and required fee to the address on this form. Please use the entire
9-digit zip code in the address above to ensure proper handling.
2018 January
61C-5.006, F.A.C.
Page 1 of 1