Missouri Division of Fire Safety Elevator Safety Unit
Missouri Division of Fire Safety Elevator Safety Unit
The following procedures shall be followed to obtain plan review approval and issuance of a state installation/
alteration permit:
To avoid delays, please submit plans/documentation at least sixty (60) days before beginning such project.
Fee Structure:
- Plan review fee $150.00
- Fee per elevator opening $25.00
- Installation/Alteration Permit Fee $25.00
Alterations Only:
see table on page 2
EXAMPLE Elevator:
Two story building, one elevator, door opens one side on each level, therefore, considered two openings: Total
Cost: $225.00 (Plan Review Fee -$150.00, openings $50.00 ($25.00 X 2), and Permit Fee $25.00)
All other alterations are required to conform to A17.1-2004 with 2005 Addendum and 2005 Supplement
section 8.7.
* Plans submitted with permit
** Scope submitted with permit
MISSOURI DEPARTMENT OF PUBLIC SAFETY P.O. BOX 844, JEFFERSON CITY, MO 65102, (800) 877-5688
MISSOURI DIVISION OF FIRE SAFETY DATE STATE ID OFFICE USE ONLY
ELEVATOR SAFETY UNIT APPROVAL
INSTALLATION/ALTERATION PERMIT APPLICATION
TYPE OF ACTION EQUIPMENT TYPE ELEVATOR - FREIGHT - HYDRAULIC ESCALATOR PERSONNEL LIFT
INSTALLATION ELEVATOR -PASS -HYDRAULIC ELEVATOR - FREIGHT - TRACTION MOVING WALK PLATFORM LIFT
ALTERATION ELEVATOR - PASS - TRACTION DUMBWAITER MAN LIFT STAIR LIFT
LOCATION (ADDRESS, CITY, STATE, ZIP CODE) LOCATION IN BUILDING BUILDING USAGE
OWNER NAME (IF DIFFERENT FROM APPLICANT) OWNER ADDRESS OWNER CITY, STATE, ZIP CODE
NEW EXISTING
NUMBER OF LANDINGS NUMBER OF OPENINGS CAPACITY (POUNDS) CONTRACT SPEED (FPM) PLATFORM SIZE (FEET X FEET) TYPE OF SAFETY
(PEOPLE PER MINUTE)
X
NUMBER OF OPENINGS IN CAR BUFFERS DEPTH OF PIT
SPRING STROKE:
OIL LOAD RATING:
MOTIVE POWER (VOLTS) AC DC PHASE
SIZE: SIZE:
YES NO
I will see to it that the proposed work is faithfully carried out as described in this application and as shown on the plans accompany-
ing same, and not otherwise. Provisions of laws and ordinances applying to the premises and the proposed work will be complied
with whether stated in application and plans or not. Local code compliance is required if applicable.