The URL can be used to link to this page

Home My WebLink AboutDepartment of Housing DocsA� �a COLORADO 17 ®� Department of Local Affairs tiles "OC" (On -site Construction) Form Please read below before signing form. Please See Attached Document at bottom of form for Specific plan and Manufacturer information. To: The Local 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 acknowledge that the identified components below are required to complete the construction of this modular structure onsite within your jurisdiction. Building Official Responsibility Please check the box labeled "Accept" and initial to confirm that you will take responsibility for inspections of the "OC" Inspection Items on behalf of the DOH. You also acknowledge that it will be done to the DOH approved plans. If you would like to defer inspection of the "OC" Inspection Items back to the DOH, please check the box labeled "Defer Inspection". *ATTENTION* "On -site Construction" or "OC" means on -site construction or modification of the factory -built structure that directly relates to the durability, quality, and safety; that is completed at the installation "site" as defined by section 24-32-3302(33), C.R.S.; using components not installed at the manufacturer's Location; and to complete the compliance of that structure as reflected in the Division of Housing approved plans. These items do not include the component(s) required for setting and securing the structure for its installation. Fire Safety Official Responsibility (if applicable) The DOH defers the requirement of any fire protection system for all modular IBC (Section 901.2) and IRC (Section R313) structures as follows: An automatic fire sprinkler system shall be installed in buildings (IBC) OR one and two family dwellings and townhouses (IRC) OR Tiny homes as required by the local jurisdiction where the structure or home will be set. Final tests required by this Section shall be approved by a certified inspector. The inspector must be either an employee of the fire department having jurisdiction or another qualified individual with prior approval of the Colorado Division of Fire Prevention Et Control. Wild Fire mitigation requirements will be deferred for (IBC) OR one and two family dwellings and townhouses (IRC) OR Tiny homes as required by the local jurisdiction where the structure or home will be set. Final inspections required by locals shall be approved by a certified inspector. The inspector must be either an employee of the fire department having jurisdiction or another qualified individual with prior approval of the Colorado Division of Fire Prevention Et Control. Governor Jared S. Polis I Rick M. Garcia, Executive Director I Alison George, Division Director j:c7r cps. 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/TTY 303.864.7758 www.doLa.colorado.gov Strengthening Colorado Communities I EQUAL HOUSING fg76 OPPORTUNITY DOLA COLORADO Department of Local Affairs Donlon of Housing JULY 2023 Please confirm if the LAHJ requires a fire protection system and/or wild fire mititgation for this modular structure. If so, please indicate if the inspection will be completed by a fire department (identify which one) or whether it will be completed by the Colorado Division of Fire Prevention Et Control. Manufacturer Responsibility The registered manufacturer is responsible for manufacturing a structure that is compliant with our Administrative Rules (CCR 1302-14). If items in the factory have not been completed, only to be completed in the field, you are still responsible for ensuring they have been completed for compliance. Please sign below that you have received this letter and acknowledge the items listed are to complete compliance of the structure, and items are to be inspected and passed for compliance in order to meet Rule 1.13.1 and section 24-32-3311(4), Colorado Revised Statutes (C.R.S.). *ATTENTION* A DOH issued insignia (silver for residential or blue for nonresidential or pink for tiny homes or black for multi -family) certifying its construction cannot be affixed to the structure until all "OC" items are completed on site and pass inspection. The same applies to modular structures manufactured by a certified manufacturer. Acknowledge Receipt and Understanding Normal permits and fees for these site work inspections are to be per the local jurisdiction. State approved plans for Factory -Built Construction may be obtained from the Builder/Manufacturer. A copy of this completed form is included with the DOH approved plans and must be included with the installation instructions and shipped with the unit. If the completed 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 Installation Authorization (required for modular homes and multi -family structures) is issued by the DOH, this form will be required to be signed and dated by the Building Official, or Approved Third Party Agent, or Fire Safety Official (if applicable), and submitted to the DOH. The DOH approved OC form will be included with the approved spec file, with the DOH Plan Reviewer signature below and their plan approval stamp on the page(s) with the OC listed items to be completed at the 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 scheduled at the onsite location or Installation Authorization (required for modular homes and multi -family structures) is issued. DOH Plan Reviewer Name James Trout DOH Plan Reviewer Signature Date Approved 101301P5 Contact email: Governor Jared S. Polis I Rick A Garcia, Executive Director I Alison George, Division Director 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/TTY 303.864.7758 www.dola.cotorado.gov Strengthening Colorado Communities ",0 EQUAL HOUSING OPPORTUNITY COLORADO Department of Local Affairs Division of Housing Building Department Representitive Printed Name_ Building Department Representitive Signature Tit Date 11 Accept F-1 Defer Inspection Contact email: If applicable: Fire Safety Official Printed Name Fire Safety Official Signature Contact email: ate JULY 2023 Is a fire protection system required? (check one) Required Not Required If required, the inspection is to be performed by (check one): Fire Department: (NAME) OR Colorado Division of Fire Prevention Et Control Manufacturer's Authorized Quality Assurance Representative Printed Name Brandi Hansen Manufacturer's Authorized Quality Assurance Representative Signature Bwa"d M"Ifea Date. 9.9.25 Contact email: brandi@smartpads.co If the inspection has been deferred and the manufacturer elects to utilize an Approved Third Party Agency to inspect the "OC" items on behalf of DOH, please sign and date below. Approved Third Party Agent Printed Name Approved Third Party Agent Signature Date_ Contact email: Governor Jared S. Polis I Rick M. Garcia, Executive Director I Alison George, Division Director '01F. Cgz 09 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/TTY 303.864.7758 www.dota.cotorado.gov ?p Strengthening Colorado Communities . .l EQUAL HOUSING OPPORTUNITY 1876 « COLORADO Department of Local Affairs Division of Housing Verify Inspection(s) Completed JULY 2023 Once you have completed all of your assigned inspections identified in this form and they have passed for compliance, please sign and date below. Building Department Representitive Printed Name Building Department Representitive Signature Dare Contact email: Or Approved Third Party Agent Printed Name Approved Third Party Agent Signature_ Contact email: Fire Protection Systems (if applicable) Fire Safety Official Printed Name Fire Safety Official Signature Contact email: Da Date Please direct questions to manufactured. Dlans@state.co.us Governor Jared S. Polis I Rick A Garcia, Executive Director I Alison George, Division Director 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/TTY 303.864.7758 www.doLa.colorado.gov Strengthening Colorado Communities w EQUAL HOUSING OPPORTUNITY 67 COLORADO ® Department of Local Affairs Division of Housing JULY 2023 The following is based on information provided to the Division of Housing (DOH) and may be modified based on the actual findings of the field inspection. DATE: 9.8.25 MANUFACTURER:SummitMods CONTACT: Kathryn Stassen MODEL NO.: Custom Leadville INSPECTION REQUIREMENTS: Check on site: "OC" Inspection Items Completion of MEP connections per plan Completion of Thermal envelope per plan Final hookup of appliances compliance with solar and EV ready code completion of air barrier checklist Completion of blower door test ID NO.: 5307 PHONE NO.: 970-819-8107 DOH P/A NO.: R-00071250C Governor Jared S. Polis I Rick M. Garcia, Executive Director I Alison George, Division Director �oF� C 1313 Sherman St., Room 320, Denver, CO 80203 P 303.864.7810 F 303.864.7857 TDD/TTY 303.864.7758 www.doLa.coLorado.gov Strengthening Colorado Communities # �. EQUAL HOUSING at 1876 x OPPORTUNITY