Building Department
100 Hughes Road
Madison, Alabama 35758
Phone: 256-772-5644
FAX: 256-772-5601
http://www.madisonal.gov
Mechanical Permit
ePermitting: www.buildportal.madisonal.gov
CASH CREDIT CHECK#:
Building Permit#: Date:
Mechanical Permit#: Email Address:
Street Address: Subdivision / Lot#:
Property Owner’s Name: Contact#:
Mechanical Contractor: Contact#:
Company Address:
City of Madison License #: HVAC License #:
Contract Price, if for a repair: $
Job Type: New Replacement
Type: Residential Commercial
Check Appropriate Box:
GAS (requires separate gas permits, if additional piping is installed) ELECTRIC (requires separate electrical permit)
*A separate electrical permit is required for every new installation.
New Single Family Home / per dwelling unit in Multi-Family structures
& Commercial systems, per separate system.
Total contract price of work multiplied
by .0125
Repair/replacement of HVAC system or component. (no ductwork
required)
Total contract price of work multiplied
by .01 but not less than $25.00
Minimum permit fee for work not provided for herein.
I certify and acknowledge that I have read this application, that all information provided herein is true and correct, and all work performed as described
above and for which a permit is issued shall conform to all City Codes, Ordinances and State Laws and plans and specifications herewith submitted. By signing
this application, I am certifying that I will meet all requirements as a contractor under the laws of the State of Alabama, to include any exemptions as
provided by law and that I am authorized by the owner to execute this document as his or her agent. As a contractor, I certify and agree to protect all public
improvements and public utilities adjacent to or serving the property on which the proposed structure or structures described above are located, whether or
not the said improvements or utilities are the property of the City of Madison. I further agree to make or cause to have made repairs to, satisfactory to the
City of Madison, public improvements or utilities damaged as a result of actions, misuse, or lack of care on the part of any of my employees, agents,
subcontractors, or suppliers of materials of said public improvements or utilities.
Applicant Signature: Date:
Permit Specialist: Date
click to sign
signature
click to edit
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