Republic of the Philippines

Department of Labor and Employment

REGIONAL OFFICE NO _____

APPLICATION TO INSTALL ELEVATOR/MANLIFT/DUMBWAITER

1. Owner/Establishment: _____________________________________________________________________________
2. Address: _______________________________________________________________________________________
3. Owner/Manager: _________________________________________________________________________________
4. Building where Elevator/Manlift/Dumbwaiter is to be installed: ______________________________________________
_________________________________________________ No. of stories: __________________________________
5. Name and signature of person to supervise installation: __________________________________________________
_______________________________________________________________________________________________
Board of Mechanical Engineering Reg. No. License No.
6. When building was erected ___________________________ Installation is an addition _________________________
__________________________ Addition erected, when? ________________________________________________
6A. Elevator; Check whether ___________________ Passenger or ____________________ Freight _________________

SPECIFICATIONS
7. Type: __________________________________________________________________________________________
(Traction, drum, double-belt, hydraulic, plunger)
Motive power: ___________________________________________________________________________________
(Hand, electric, direct-connected, steam, line-shaft)
8. Height of lift ___________ Feet ___________ Inches, from _____________ floor to ______________ floor _________
9. Location of hoisting machine ___________________________ No. of hoistway landings ________________________
10. Capacity ________________ Weight of car complete _________________ Speed ______________ ft./min _________
11. Inside dimensions of car: ____________________________ Construction of car frame: _________________________
12. Car enclosure: Material ________________ No. of sides _____________ height ______________ Thickness _______
13. Top on car _____________________ Grilles _________________ Mesh __________________ Solid _____________
Self-closing hinges section 18” in depth full width of car __________________________________________________
(Yes or No)
14. Emergency exit in car: _______________________ Location: _______________________ Size: _________________
Emergency switch in car: __________________________________________________________________________
15. Number of opening in car _______________________________ No. of compartments in car ____________________
16. Gates on car at _________________________ sides; type _______________________________________________
Height ________________________ ; contacts _______________________ Emergency release _________________
17. Distance between controller and handle on car gate ___________________________________________________ on
hoistway gate or door. _____________________________________________________________________________
18. Electric light in car __________________________________________________ Car gate or door tracks countersunk
19. Clearance between edge of car platform and landing sill __________________________________________________
Edge of car platform and door used at landing sill _______________________________________________________
20. Overhead clearance: Distance of run-by of car at upper limit of travel ________________________________________
_______________________________________________________________________________________________
21. Number of hoist cables _____________________________________ Material _______________________________
Diameter _________________________ Roping 1 to 1 __________________________ 2 to 1 ___________________
22. Any cables outside of hoistway __________________________________; guarded 7’0 from floor _________________
23. Number of counterweight cables: Car ________________________________ Drum ___________________________
24. Diameter of smallest sheaves: Hoisting ___________________________; counterweight _______________________
Compensating ___________________________________________________________________________________
25. Distance between top of counterweight and overhead beams when buffers are completely compressed
_______________________________________________________________________________________________
26. Pit buffers: Type _______________________________________; Compression ______________________________
Counterweight buffers: Type __________________________________; Compression __________________________
27. Number of counterweight sections ___________________________ Weight of each section _____________________
Counterweight section and frames through-bolted _______________________________________________________
28. Counterweight guard: Entire travel ____________________________________; height from pit __________________
under clearance ___________________________________; compensating chains ____________________________
29. Control: Automatic push-button _________________________; constant-pressure push button ___________________
Switch _______________________ Hand cable _________________________; self-centering ___________________
30. Current: A.C _________________ D.C. ____________________ Reverse-phase relay to shunt type ______________
_____________________________________________
31. Car guide rails ________________________________________ Dimensions ________________________________
(Steel or Wood)
32. Counterweight guide rails _____________________________________ Dimensions ___________________________
(Steel or Wood)
33. Brake: Electromechanical __________________________________; Mechanical _____________________________
self-locking _____________________________________________________________________________________
34. Terminal limit stops _______________________________________________________________________________
(on car) (in hoistway) (on machine) (on operating device)

35. Hoistway pit: Distance lowest landing to bottom of pit ____________________________________________________

partition between adjacent pits __________________________________; height ______________________________
36. Rope lock ___________________ type ___________________ locking device for safe lift loads __________________
37. Speed Governor: Type ________________________________ Location ____________________________________
Safety Switch: On governor ____________________________; on safety ____________________________________
38. Car safeties: Location _________________________________; gradual ____________________________________
(Crosshead) (Bottom) (Clamp)
39. Automatic speed retarder _____________________________ Counterweight safeties __________________________
40. Platform under overhead sheaves and open spaces over hoistway __________________________________________
Material _________________________ Solid ________________________ Thickness _________________________
41. Skylight ______________________________ Exterior window above platform ________________________________
Exterior window immediately below platform ___________________________________________________________
42. Width of flooring beyond contour of machine __________________________ Handrail _________________________
43. Distance from floor to center to bow on top of car (trap-door installation) _____________________________________
_______________________________________________________________________________________________
44. Signals__________________________________________ Type __________________________________________

_____________________________________
Name and Signature of Owner/Manager

_____________________________________
Establishment

EVDL No _______________________
Plan Fee _______________________
O.R. No. _______________________
Date __________________________
Date Received __________________
Received by ____________________

NOTE:
The detailed working drawings of the elevator/manlift/dumbwaiter, the hoistway and installation plans shall
accompany this application and shall be prepared, signed and sealed by a PROFESSIONAL MECHANICAL
ENGINEER.