Fillable Hvac Mech Application 7.6.18 (Louisville Jefferson County Metro Government)

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Hvac Mech Application 7.6.18 (Louisville Jefferson County Metro Government)

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File type: PDF

U.S.A. forms for Louisville Jefferson County Metro Government

BROWSE LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT (KY) FORMS

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Louisville-Jefferson County Metro Government
CONSTRUCTION REVIEW DIVISION
Department of Codes and Regulations
444 S. 5
th
St. – Louisville, KY 40202
Phone: 502.574.3321 Web Site: louisvilleky.gov/government/construction-review
H V A C - M E C H A N I C A L P E R M I T A P P L I C A T I O N
I hereby certify that I am the owner of record or the owner of record authorizes the proposed work and I attest that I currently maintain an active State HVA/C Contractors License.
Signature of Owner or Contractor
Date
Location:
Subdivision:
Lot #
(street address is required for all applications)
(If applicable)
Please provide a brief description of your project below:
Estimated Cost:
$
Related Building Permit #:
Contractor
State Lic. #:
Address:
Phone:
City:
State:
Zip:
Cell:
HVAC Contractor:
State Lic. #:
Phone:
Email:
Owner:
Email:
Address:
Phone:
City:
State:
Zip:
Cell:
Unit Type
Combination System:
Number
Unit Type
Boilers:
Number
Heating System:
Radiators/Fin Tubes/Convectors:
A/C System:
Commercial Dryers:
Roof Top Units:
Range Hood without Suppression:
Chillers/Cooling Towers:
Range Hood with Suppression:
Manufactured Fireplace:
Spray Booth Ventilation/ Exhaust Fans:
Mech Refrigeration Compressors:
Other:
SIZING CALCULATIONS- INITIAL RESIDENTIAL SYSTEMS ONLY (Required at, or before, 1
st
inspection
Date of Calculations:
Orientation of Structure:
Design Conditions:
Winter-
Outside:
Inside:
Summer-
Outside:
Inside:
Heat Gain:
BTUH
Heat Loss:
BTUH
Square Footage:
Application Type
☐ New One & Two Family
☐ New Multifamily Apartments
☐ New Commercial
☐ Existing One & Two Family
☐ Existing Multifamily Apartments
☐ Existing Commercial
Equipment Type
☐ Gas ☐ Electric ☐ Oil ☐ Water to Air
Estimated Cost:
$
Permit Fee:
$
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Louisville-Jefferson County Metro Government
CONSTRUCTION REVIEW DIVISION
Department of Codes and Regulations
444 S. 5
th
St. – Louisville, KY 40202
Phone: 502.574.3321 Web Site: louisvilleky.gov/government/construction-review
HOMEOWNER HVAC PERMIT CERTIFICATION STATEMENT
Address:
Related Building Permit Number:
By signing this application it is understood that I, ______________________ am the owner of the above mentioned property and am
currently residing in the above-mentioned property; if I am not currently residing in the property, I attest that I will reside there upon
completion of the work. I also affirm that the home is not currently for sale, and that any and all HVAC related work being done in the above
mentioned home is being completed by me and no one else. I also understand that the work must meet the Kentucky Building code and I
am responsible for contacting the local EPA regarding reclaiming of Freon Certification. I am also required to obtain the inspection(s)
from the Division of Construction Review to ensure the above requirements have been met. This includes a final inspection. If I am found to
have falsified this application in any way, I will face legal action including a fine and/or imprisonment.
Signature of Owner or Agent
Date
Subscribed and sworn to before me on this the
of
20
.
Notary Public:
My Commission Expires:
*MAKE CHECKS PAYABLE TO METRO FINANCE*
Installation Cost in $
Permit Fee in $
2,000 or less
$125
$2,001 to $10,000
$180
$10,001 to $25,000
$270
$25,001 to $50,000
$330
$50,001 to $75,000
$390
$75,001 to $100,000
$500
$100,001 to $150,000
$630
$150,001 to $200,000
$760
$200,001 to $250,000
$885
$250,001 to $300,000
$1025
$300000 to $400000
$1150
$400001 to $500000
$1500
$500001 to $600000
$1725
$600001 to $700000
$1900
$700001 to $800000
$2125
$800001 to $900000
$2355
$900001 to $1000000
$2590
$1000001 to $1100000
$2820
$1100001 to $1200000
$3050
$1200001 to $1300000
$3280
$1300001 to $1400000
$3510
$1400001 to $1500000
$3735
$1500001 to $1600000
$3965
1. 1 &2 Family Dwellings, initial system $105 for the first system, $50
for each additional system. A system may be either a heating or
cooling system, or combination.
2. Multi-Family Dwellings, initial system $105 for the first system, $50
for each additional system. A system may be either a heating or
cooling system, or combination.
3. The minimum permit fee for other residential HVAC permits, such
as replacements, shall be $105. This does not include manufactured
fireplaces.
4. Commercial / Non-Residential: Each permit fee shall be calculated
per the following table based on the total dollar value of each HVAC
installation, either actual or estimated. It shall be the obligation of the
installing contractor to supply the complete value, including labor and
material costs regardless of the purchaser. An exact figure does not
need to be provided to the Department but the application shall
include an affirmed, signed statement that the value lies within certain
limits as listed in the left hand column of the table.
5. Inspections-Each permit shall include 3 inspections and no
additional cost. The fee for any additional inspections shall be $50.
The department retains the right not to issue any additional permits to
the applicant until the additional inspection fees are paid in full.
6. Other HVAC permit types: Mechanical Refrigeration ($40 per
compressor); manufactured fireplaces ($35 per unit); and Range
Hoods ($100 per hood). These permits include 2 inspections.
7. Permit holder is responsible for requesting required inspections.
8. Make Checks Payable to: Develop Louisville or Construction Review.
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Hvac Mech Application 7.6.18 (Louisville Jefferson County Metro Government)

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Completed 3 August 2020

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