Fillable Application for Mechanical Permit (City of Rockville)

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Application for Mechanical Permit (City of Rockville)

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BROWSE CITY OF ROCKVILLE (MD) FORMS

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Revised 11/9/2018 TWD
Department of Community Planning and Development Services
Inspection Services Division
240-314-8240 / 240-314-8265 (Fax)
www.rockvillemd.gov/isd
Application for Mechanical Permit
Please type or print clearly. Incomplete applications cannot be processed.
Property Address: ______________________________________________________________
Property Owner: _______________________________ Phone: (_____) ______ - ___________
Property Owner’s Address (if different): _____________________________________________
Commercial Residential
Licensed
Business Name:
Licensed
Master’s Name:
Phone
Number
Address:
I hereby certify that I have the authority to make the foregoing application, that the application is correct, and that the construction shall conform to the Rockville City Code, and all other
codes and regulations or private building restrictions, if any, which may be imposed on the above property by deed. The granting of a permit does not presume to give authority to violate or
cancel the provisions of any other state or local law regulating construction or the performance of construction. I have read and understand the Permit Conditions available from the
Inspection Services Division.
Master’s Signature:
ORIGINAL SIGNATURE REQUIRED
Date:
MECHANICAL WORK
HEATING COOLING
#____ @ BTU____________________ #____ @ BTU____________________
#____ @ BTU____________________ #____ @ BTU____________________
#____ @ BTU____________________ #____ @ BTU____________________
#____ @ BTU____________________ #____ @ BTU____________________
Diffusers/ducts/grilles: # ______ Pre-fabricated fireplaces: # ______
Wood stoves/inserts & prefabricated fireplaces: # ______
Fuel tanks: ______ (total capacity of all tanks in gallons)
Grease Duct: # ______ linear ft. Geothermal
Multi-family dwelling units #_________
(Includes all heating/cooling equipment, ducts, diffusers, and grills within the dwelling unit.)
Other: ____________________________________________________________________
GAS WORK
ALL gas work MUST be performed by a Master Plumber or Gasfitter only
Appliances: # ______ Type: __________________________________________________________________________________________
(e.g., stove, dryer, fryer, etc.)
(Gas logs/prefabricated fire places must be accompanied by manufacturers test literature); ___________________________________________________
(Generators must be accompanied by a house location survey/aerial, with setbacks, dimensions and location indicated. Provide HOA approval as required)
Conversion to gas: # ______ Boiler: __________ BTU
FEES ARE NON-REFUNDABLE
FOR OFFICE USE ONLY
MEC 20 ___________
BLD 20 ___________
PRJ 20 ___________
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Application for Mechanical Permit (City of Rockville)

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Completed 4 August 2020

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