Specifications

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Please Print! Survey must be fully completed and dated for order processing. Ship to: Job ___ or Shop ___ (check one)
Job Name ___________________________________________________________________________________________
Code in Force ( i.e. A17, Title 8, B44)______________________________________________________________________
Job Address _________________________________________________________________________________________
City ________________________________ State ________ Zip/Postal Code_______________ Country_______________
Car #________ Number of Landings ________ Travel __________ft Pit Depth ________ft Car Speed: ______fpm.
Jack Mfg._______________ Plunger Wall Thickness ______ inches Capacity of Car _______ lbs. Car Weight _________ lbs.
Original Elevator Installing Company: _________________________ Date of installation _________ Mfg.’s Job Number ___________
Include LifeJacket Information Display Option LJ4050 (additional charge applies): ____ Yes ____ No (Required in Michigan)
Packing, specify style and size ____________ Packing Must be Replaced Is Controller: ____ Solid State OR ____ Relay
Is Pit prone to fl ooding? Yes _____ No _____ - - - - - - - - - - - - - (if yes, NEMA 3R conduit [liquitite fl ex] is supplied)
Does elevator have a bottom fi nal limit switch? Yes _____ No _____ - - - - (if yes, it must open prior to buffer engagement)
Does Cylinder have a tapped bleeder hole in the head? Yes _____ No _____ - - - - (if no, optional drill and tap is supplied)
Is 120VAC available in controller? Yes _____ No _____ - - - - - - - - - - (if no, 480/240 to 120 transformer is supplied)
How many ‘wiring’ feet from controller to Cylinder head? ____Ft - - - (length of shielded cable sent for set coils and encoder)
Special delivery instructions (e.g., Do you have a forklift to get it off the truck?) _______________________________________
Pit Information Record dimensions to 3 decimal places ( i.e. 1.234). DO NOT USE FRACTIONS
The plunger diameter (PD) must be accurately measured to thousandths of an inch. Using a diameter tape, measure the
plunger in at least three (3) places. Record these measurements in the blanks below. Start measurements a foot or so
above the packing head.
(PD) 1 ____.___________ 2 ____.___________ 3 ____.______ ____ 4 ____.____________
See diagrams on page 2 for graphic illustration of dimensions. These dimensions must be accurate for
proper fi t. All dimensions below must be in inches.
(BSD)___________” (UFD)_____________” (FD) __________” (CD) ___________” (BN)___________”
Buffer spring diameter Upper Flange Diamter Flange Diameter Cylinder Diamter Number of Buffer springs
*cannot exceed 17" dia.
(RB)____________” (BS)_____________” (SD)___________” (BB)____________”
Runby Buffer Stroke Strike Distance Between Buffers distance
(CHF)____________” (CHC)_____________”
(LifeJacket legs are made to CHF height unless checked here)
Top of cylinder to top of footer Top of cylinder to fl oor
Company _______________________________ Address __________________________________________________
City ____________________________________ State _____________________Zip/Postal Code _________________
Survey completed by ________________ ______________________________ Date ____________________
PO # __________________ Charge # _______________________ Adams Order # ____________________
Phone # ______-________________ Fax #______-__________________ Serial # _________________________
Adams Safety Products LifeJacket
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Ordering Survey