The URL can be used to link to this page

Home My WebLink AboutState of Colorado Third Party Inspection and Defermant of InspectionGSi,i3::;if** STATE OF COLORADO Cover Sheet for Building Specifications, Third Panty Reviews, and QA Manuals JULY 2023 Plant l.D. Number: 179Name of Manufacturer:Northstar Syste mbuilt lvlanufacturer Add ress :203 lndustrial Drive, Redwood Falls, MN 56283 Manufacturer Contact Name and Contact Number:Amanda Johanneck 507-644-6600 Manufacturer Contact Email address:amanda orthstarsb.com Third Party lnspection Agency (if not CDOH). RADCO Third Party Plan Review Agency (if appticable). RADCO Third Party Plan Review Approval Name/Number (if applicabte): FactoryType: FB X FBNR Tiny Homes l'lUD Hornes RenewalDocument Type:New Plan y' Revision NSs103 WagstromModel Name/No.: MANUFACTURER CERTIFIES that only approved equipment and materiats witl be used and the instatlations sha[[ be made in accordance with approved plans and applicable codes and provisions of the Cotorado Division of Housing. Manufacturer agrees to in-ptant inspection of units manufactured under the above plan approvat. Apptication shatl \a be made for and insignia affixed to each factory buil.t unit that is subject to Colorado statutes and which it- \ ' -$ Nmanufactured or is to be sold, offered for sate, or occupied in the state of Cotorado. \-\)qs DIV. OF HOUS]NG, 1313 SHERMAN STREET, RM 320, DENVER, CO. BO2O3 Contact Information: FB/FBNR Factory manufactured.plans@state.co.ts or Tiny Homes dola tinyhonres@state'co.us Sq. Footage Unfinished: CDOH Approval StamP Sq. Footage Finished:1,980 $tate r:f Colsraricl Divisicn ol Flousing Jul/1b/?*2,4 APPROVED PLANS Subject t* field inspection Approval NumberCDOH P R-00062570C Expiration Date 511125 resl COLORADO Department of Local Affairs Division of Housing IULY 2023 'rOC" (On-site Construction) Form Please read below before signing forrn- please See Attached Document at bottom of form for Specific ptan and Manufacturer information To: The Locat Authority Having Jurisdiction (LAHJ) or other DOH approved third party inspection agency. By signing this form, you confirm that you -have received and reviewed this form, and acknowtedge that the iient-lfied components betow are rbquired to comptete the construction of this modutar structure onsite within Your jurisdiction' Buitding Officiat Responsibitity ptease check the box [abeted ,,Accept" and initiat to confirm that you witl take responsibitity for inspections of the .,oC" lnspection ltems on behatf of the DoH. You also acknowtedge that it witl be done to the DOH aPProved Ptans. lf you woutd tike to defer inspection of the "oC" lnspection ltems back to the DoH, ptease check the box labeled "Defer lnsPection". *ATTENTION* ,,On-site Construction, or .OC" means on-site construction or modification of the factory-built structure that directty retates to the durability, quality, and safety; that is compteted at the instattation "site" as ;;;i"A by iection 24-32-3302{::), i.n.s.; using components not installed at the manufacturer's location; ind to complete the comptiance of that structure as reflected in the Division of Housing upJrouui ptans. These items do not inctude the component(si required for setting and securing the structure for its installation. Fire safety officiat Responsibitity (if appticabte) The DoH defers the requirement of any fire protection system for a[[ modular IBC (section 901.2] and IRC (Section R313) structures as fotlows: An automatic fire sprinkter system shal.i be instatted in buitdings (lBc) oR one and two famity dweltings unJ to*ni,ouses (lRt) oR Tiny homes as required by the [oca[ jurisdiction where the structure or home witt be set. Final tests requir-ed by this Sect'ion shatt be approved by a certified inspector. The inspector must be either un "*ptoy!* of thl fire department having jurisdiction or another quaiified individual with prior approval of the Cotorado Divisjon of Fire Prevention & Controt' Witd Fire mitigation requi rements witt be deferred for (lBC) oR one and two famity dweltings and townhouses (lRC) OR TinY homes as required by the tocaL jurisdiction where the structure or home witt be set. Finat inspections required by locats shatt be aPProved bY a certified inspector. The inspector must be either an emPtoYee of the fire department having jurisdicti on or another qualified individual &overns| JaretJ 5. Folis I Rick ih. fiarcia, Execritlve 0iiect*r' I Alison 6eorge, Eivisjon Dir*ctor 1311 Sherman si., Ro*nr 3?s, Denver, co 80?03 p 303.s64.?81* F 3*3.864.7857 TD#lrrY 303.864'773S * wv.tjnla'coiorado'gnv Sfrengfirening Co{or*da tommunities tn lauAr r{su$lN$ oPror?ul{ rYY reel COLORADO Department of Loeal Affairs Division of Housingl IULY ZA23 ptease confirm if the LAHJ requires a fire protection system and/or witd fire mititgation for this modular structure. lf so, ptease indicate if the inspection wi[[ be compteted by a fire department (identify which one) or whetherit witt be compteted by the Colorado Division of Fire Prevention & Controt' Manufacturer ResPonsibi titY The registered manufacturer is responsible for manufacturing a structure that is compliant with our Adminiltrative Rutes (CCR 1302-14). lf items in the factory have not been completed, only to be cfipteted in the field, you are still responsible for ensuring they have been compteted for comptiance' please sign betow that you have received this letter and acknowtedge the items listed are to complete compliance of the structure, and items are to be inspected and passed for compliance in order to meet Rute 1.13.1 and section 74-32-3311(4), Colorado Revised Statutes (c.R.5.). "ATTENTION" A DOH issued insignia (sitver for residentiat or bl.ue for nonresidential or pink for tiny homes or btack for mutti-famity) certifying its construction cannot be affixed to the structure until al[ "OC" items are compteted on site and pass inspection. The same appties to modular structures manufactured by a certified manufacturer. Acknowtedge Receipt and Understanding Normat permits and fees for these site work inspections are to be per the [oca[ jurisdiction. State approved plans for Factory-Built Construction may be obtained from the Buitder/Manufacturer. A copy of this compteted form is inctuded with the DOH approved ptans and must be included with the instatlation instructions and shipped with the unit. lf the compteted form has been damaged or lost during shipping, the manufacturer or its representative can obtain a copy from the DOH. Before any inspection is scheduled at the on-site location or lnstattation Authorization (required for modular ho*"t and multi-family structures) is issued by the DOH, this form witl be required to be signed and dated by the Buitding Officiat, or Approved Third Party Agent, or Fire Safety Officiat (if applicabte), and submitted to the DOH. The DOH approved OC form witt be inctuded with the approved spec fite, with the DOH Pl.an Reviewer signature betow and their plan approval stamp on the page(s) with the OC tisted items to be completed ufth. site location. That approved OC form should be submitted to the appropriate parties described in this form and submitted back to the DOH before any inspection is scheduted at the onsite location or lnstattation Authorization (required for modutar homes and mutti-famity structures) is issued. DOH Ptan Reviewer N DOH Ptan Reviewer Date Approved 7115124 Contact email It Covernar Jarec! 5. Polis I Rick id, Carcjx, Execulive $ireclsr I Alison Oeorge, Sivision Sirector 1ji3 Sherrnan St., Ro*n] 3?*, senrrer, c0 B0?03 P 303.864.7810 f 303.864.7s57 TDDITTY 303,864.7758 rorrvw.tJ*la.calorado'gr.rv 5t rcngthafii i1g Cs{orcda Contm*nif ies SOTAI HOU'ING opr0*TUN rfY resl COLORADO Department of Local Affairs Division of Housing luLY 2423 Buitding Department Representitive Printed Na Building Department Representitive Signatu Date-E -J-e-'L(- Lf.hS Contact emai[:z}=rlrdAcceptDefer lnspection lf applicable: Fire Safety Officiat Printed Fire Safety Officiat Signatu Contact emait:- ls a fire protection system required? (check one) Required lf required, the inspection is to be performed by (check one): 6;.rc'gF1€'l-D - <ovr'rt{" <o.tr Not Required Fire DePartment: ( OR Cotorado Division of Fire Prevention & Control Manufacturer's Authorized Quatity Assurance Representative Printed Name-Amanda Johanneck Manufactu rer's Autho rized Quatity Assurance Representative 4naa/a,06t1a2a24 Contact emait:amanda.iohan neck@northstarsb.com lf the inspection has been deferred and the manufacturer elects to utitize an Approved Third Party Agency to inspect the "OC" items on behalf of DOH, ptease sign and date betow. Approved Third Party Agent Printed Approved Third Party Agent Signatu Contact emait:- Governor Jared 5. Folis I Rick irl. Carcia, fxecrttjve D:rectsr I Alison Seorge, ]ivision 0irector Ijj3 Sherftan St., Raom 3?0, *enver, C0 80203 P 3S3.864.7810 F 3S3.$64.7857 TDIiTTY 303.864'7-158 rstrvr.dola.col*rad*.g$' Sfrengfireni*g tstorsda ftmrfi$nif ies ilil e4l$J{t HtrUStNC$ProrrirN,ft