Form DBPR HR-7015 "Application for Permit to Install, Alter or Relocate an Elevator and Certificate of Operation" - Florida

What Is Form DBPR HR-7015?

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-7015 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR HR-7015 "Application for Permit to Install, Alter or Relocate an Elevator and Certificate of Operation" - Florida

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DBPR HR-7015 - APPLICATION FOR
PERMIT TO INSTALL, ALTER OR RELOCATE AN ELEVATOR
AND CERTIFICATE OF OPERATION
Thank you for your permit application! The Department of Business and Professional Regulation’s Bureau of Elevator
Safety is ready to assist you through the licensing and regulatory process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. Toward that goal, we are a resource you can use to assure that the
permit process meets the requirements of the law.
This packet contains information regarding the legal requirements for your permit. It is very important that you familiarize
yourself with this information before you begin construction. If you have questions, or need any clarification, please
contact the DBPR Customer Contact Center at 850.487.1395 or go online to
www.MyFloridalicense.com/DBPR/elevator-
safety/. Because our knowledge and authority are in state government requirements, it is very important that you also
contact local officials regarding any city and county requirements to register this activity.
APPLICATION REQUIREMENTS
Complete form DBPR HR-7015, Application for Permit to Install, Alter or Relocate an Elevator and Certificate of
Operation in its entirety.
Complete form DBPR HR-7023, Affidavit of Elevator Plans Code Compliance, stating that the plans and drawings are
in accordance with applicable laws.
Pay fee. Please make one payment per application with the check payable to the Department of Business and
Professional Regulation. The fees are:
Permit to Install – $325 ($250 permit fee + $75 certificate of operation fee)
-
Permit to Alter – $200
-
Permit to Relocate – $325 ($250 permit fee + $75 certificate of operation fee)
-
Submit one permit application and one affidavit for each elevator. Do not submit plans or drawings.
Please send your completed application, affidavit and required fee to:
Department of Business and Professional Regulation
Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
61C-5.006, F.A.C.
Page 1 of 3
DBPR HR-7015 - APPLICATION FOR
PERMIT TO INSTALL, ALTER OR RELOCATE AN ELEVATOR
AND CERTIFICATE OF OPERATION
Thank you for your permit application! The Department of Business and Professional Regulation’s Bureau of Elevator
Safety is ready to assist you through the licensing and regulatory process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. Toward that goal, we are a resource you can use to assure that the
permit process meets the requirements of the law.
This packet contains information regarding the legal requirements for your permit. It is very important that you familiarize
yourself with this information before you begin construction. If you have questions, or need any clarification, please
contact the DBPR Customer Contact Center at 850.487.1395 or go online to
www.MyFloridalicense.com/DBPR/elevator-
safety/. Because our knowledge and authority are in state government requirements, it is very important that you also
contact local officials regarding any city and county requirements to register this activity.
APPLICATION REQUIREMENTS
Complete form DBPR HR-7015, Application for Permit to Install, Alter or Relocate an Elevator and Certificate of
Operation in its entirety.
Complete form DBPR HR-7023, Affidavit of Elevator Plans Code Compliance, stating that the plans and drawings are
in accordance with applicable laws.
Pay fee. Please make one payment per application with the check payable to the Department of Business and
Professional Regulation. The fees are:
Permit to Install – $325 ($250 permit fee + $75 certificate of operation fee)
-
Permit to Alter – $200
-
Permit to Relocate – $325 ($250 permit fee + $75 certificate of operation fee)
-
Submit one permit application and one affidavit for each elevator. Do not submit plans or drawings.
Please send your completed application, affidavit and required fee to:
Department of Business and Professional Regulation
Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
61C-5.006, F.A.C.
Page 1 of 3
DBPR HR-7015 – Application for Permit to Install, Alter or Relocate an Elevator and Certificate of Operation
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:
www.MyFloridaLicense.com/contactus/
Internet:
www.MyFloridalicense.com/DBPR/elevator-safety/
Please direct questions about this application to the Department of Business and Professional Regulation’s Customer Contact Center at
850.487.1395.
Section 1 – Elevator Permit Type (Client Code 2101)
Please check the appropriate box and include the appropriate fee:
Installation (1030) - $325
Alteration (3020) - $200
Relocation (1030) - $325
Estimated date of completion
For Installations ONLY: Is this installation replacing a current or previously licensed elevator?
Yes (provide license number below)
No
REQUIRED FOR ALTERATION PERMITS & INSTALLATIONS REPLACING EXISTING
Elevator License Number
ELEVATORS. Must be included or the application will be returned.
Scope of Work – describe briefly the work to be done:
Does the elevator meet the minimum standards of Ch. 30 of the Florida Building Code?
Yes
No
If no, a variance must be approved prior to approving the permit. Enter variance number, if applicable:
Section 2 – Elevator Owner Information (MA)
Note: This address will be designated as the "address of record" for the party responsible for licensing and operation of this elevator.
Owner Name (please check one:
Corporation
Partnership
Individual)
Street Address or Post Office Box
(US Postal Service mailing address)
City
Florida County
State
Zip Code (+4 optional)
Country
Primary E-Mail Address (Optional)
Primary Business Phone Number
Section 3 – Building Location Information (LL)
Note: This address will be designated as the physical location address for this elevator.
Building Name
Elevator Nickname
(DBA)
(DBA) (e.g. #1, Bldg A, Atrium, etc.)
Building Address
(Enter complete US Postal Service physical street name and number for the building location)
City
Florida County
State
Zip Code (+4 optional)
E-Mail Address (Optional)
Primary Business Phone Number
Section 4 – License Mailing Information (LM)
Note: This address will be used by the department for all mailings to the elevator owner, including the certificate of operation and license
renewal notices.
Routing Name (
)
e.g., Management Company, contact name
Street Address or Post Office Box
(US Postal Service mailing address)
City
Florida County
State
Zip Code (+4 optional)
Country
E-Mail Address (Optional)
Primary Business Phone Number
Page 2 of 3
2018 January
61C-5.006, F.A.C.
DBPR HR-7015 – Application for Permit to Install, Alter or Relocate an Elevator and Certificate of Operation
Section 5 – Elevator Information
Elevator Class: Please check the appropriate box.
01-Traction Passenger
07-Moving Walk
14-Sidewalk Elevator
15-Material Lift/Dumbwaiter with
02-Hydraulic Passenger
08-Inclined Lift
Automatic Transfer Device
09-LU/LA (Limited Use /
16-Special Purpose Personnel
03-Traction Freight
Limited Application)
Elevator
04-Hydraulic Freight
10-Dumbwaiter
17-Inclined Stairway Chairlift
05-Hand Power Passenger
12-Escalator
18-Inclined & Vertical Wheelchair Lift
06-Hand Power Freight
13-Hand Elevator
19-Rack and Pinion / Screw Column
Manufacturer’s Number
Capacity in Pounds
Landings
Travel in Feet
Speed Up
Speed Down
Building Type: Please check the building type that best describes the primary use.
C-Commercial (ex. airports, banks, department
HP-Hospitals (medical centers, nursing homes, adult
stores, office buildings)
congregate living facilities, etc)
CC-Community College
I-Industrial (papermills, power plants, manufacturing)
CD-Condominiums
R-Food service
CH-Churches
S-Schools (except grades K-12)
CI-City Buildings
SE-Schools grades K-12
CO-County Buildings
ST-State agencies
H-Public lodging (hotel, motel, apartment)
U-Universities
Section 6 – Registered Elevator Company (REC)
(Company performing the work covered by this permit)
Note: The permit will be mailed to the mailing address on file for the REC listed in this section.
REC Name
REC License Number
Elevator Company Contact Name
Primary Business Phone Number
Primary E-Mail Address (Optional)
Alternate Phone Number (Optional)
Section 7 – Applicant Signature
Pursuant to Sections 399.03 and 399.07, Florida Statutes, the undersigned hereby applies for a permit to install, alter or
relocate an elevator in the building located at the address indicated.
I understand that:
I must attach DBPR HR-7023 Affidavit of Elevator Plans Code Compliance stating that the plans and drawings are
in accordance with the minimum code requirements.
All construction relating to the elevator installation must comply with the Florida elevator codes.
A temporary certificate of operation will be issued upon completion of a satisfactory inspection with no cited violations
and will be valid until receipt of the original certificate of operation or up to 60 days, whichever occurs first.
SECTION 559.79(2), Florida Statutes: Each application for a license or renewal of a license issued by the Department of
Business and Professional Regulation shall be signed under oath or affirmation by the applicant, or owner or chief
executive of the applicant without the need for witnesses unless otherwise required by law.
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand that
my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I
declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of
any material information on this application may result in criminal penalty or administrative action, including a
fine, suspension or revocation of the permit.
Name of Authorized Applicant
Social Security Number*
Signature of Authorized Applicant
Date
* Under the Federal Privacy Act, disclosure of Social Security Numbers is voluntary unless specifically required by Federal statute. In this instance,
disclosure of social security numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598,
and 559.79, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support
agency to assure compliance with child support obligations.
NOTE: Every permit issued becomes invalid unless the work authorized by such permit is commenced within 6 months after
issuance, or if the work authorized by such permit is suspended or abandoned for a period of 60 days after the time the work
is commenced. (Rule 61C-5.006(1), Florida Administrative Code)
Page 3 of 3
2018 January
61C-5.006, F.A.C.
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.
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