Fillable MECHANICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

Fill Online, Printable, Fillable, Blank MECHANICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland) Form

Use Fill to complete blank online CITY OF MIDLAND (MI) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

MECHANICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

On average this form takes 17 minutes to complete

The MECHANICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland) form is 2 pages long and contains:

  • 1 signature
  • 0 check-boxes
  • 63 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Midland

BROWSE CITY OF MIDLAND (MI) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Rev 10/20 Page 1 of 2
MECHANICAL PERMIT APPLICATION
CITY OF MIDLAND – BUILDING DEPARTMENT
333 W. ELLSWORTH ST., MIDLAND, MI 48640
989-837-3383
PROJECT ADDRESS __________________________________________________________________
OWNER __________________________________________________PHONE___________________
EMAIL ____________________________________________________________________________
CONTRACTOR INFORMATION
CONTRACTOR_____________________________________________PHONE____________________
CONTRACTOR ADDRESS ______________________________________________________________
CITY/STATE/ZIP_____________________________EMAIL___________________________________
LICENSE # ________________________________________ EXPIRATION DATE __________________
CELL/ALT. PHONE _____________________________________ FAX # _________________________
___________________________________________________________________________________
HOMEOWNER AFFIDAVIT: (if permit is under homeowner’s name)
I hereby certify the mechanical work described on this permit application shall be
installed by myself in my own home in which I am living in or about to occupy. All work
shall be installed in accordance with the Michigan Building Code and shall not be
enclosed, covered up, or put into operation until it has been inspected and approved
by the City Mechanical Inspector. I will cooperate with the City Mechanical Inspector
and assume the responsibility to arrange for necessary inspections.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180
DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ THIS APPLICATION AND ALL PROVISIONS OF LAWS AND
ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE
GRANTING OF A PERMIT DOES NOT GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SECTION 23a OF THE CONSTRUCTION CODE ACT OF 1972, 1972 PA 230, MCL 125.1523A, PROHIBITS A PERSON FROM CONSPIRING TO CIRCUMVENT
THE LICENSING REQUIREMENTS OF THIS STATE RELATING TO PERSONS WHO ARE TO PERFORM WORK ON A RESIDENTIAL BUILDING OR RESIDENTIAL
STRUCTURE. VIOLATORS OF SECTION 23a ARE SUBJECTED TO CIVIL FINES.
SIGNATURE OF OWNER OR CONTRACTOR ________________________________________________________
(Homeowner signature indicates compliance with Homeowner Affidavit)
PRINTED NAME_________________________________________________DATE________________________
click to sign
signature
click to edit
Rev 10/20 Page 2 of 2
LOCATION AND DESCRIPTION OF WORK: _________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
FEE SCHEDULE
PERMIT ITEM NO. FEE TOTAL
BOILER, COMPRESSOR, ABSORPTION SYSTEM:
OVER 3 – 15 HP/ 100,000 – 500,000 BTU _____ $15.00 ______________
OVER 15 – 30 HP/ 500,000 – 1,000,000 BTU ______________ $20.00 ______________
OVER 30 – 50 HP/ 1,000,000 – 1,750,000 BTU ______________ $25.00 ______________
UP TO 3 HP/ LESS THAN 100,000 BTU ______________ $9.00 ______________
AHU ˂ 10,000 CU FT PER MINUTE ______________ $6.00 ______________
AHU ˃10,000 CU FT PER MINUTE ______________ $10.00 ______________
ANNUAL PERMIT (AS AUTHORIZED BY IBC SECTION 105.1.1) ______________ $1200.00 ______________
APPLIANCE VENT, CHIMNEY OR VENT DAMPER ______________ $15.00 ______________
DUCTS/AIR DISTRIBUTION PER SQ FT (Conditioned spaces only) ______________ $.01 ______________
EVAPORATIVE COOLER, OTHER THAN PORTABLE ______________ $6.00 ______________
EXHAUST FAN DUCTS ______________ $5.00 ______________
FIRE SUPRESSION ______________ $6.00 ______________
FURNACE ˂ 100,000 BTU ______________ $9.00 ______________
FURNACE ˃ 100,000 BTU ______________ $11.00 ______________
GAS WATER HEATER ______________ $10.00 ______________
GAS PIPING, UP TO 5 OUTLETS ______________ $6.00 ______________
GAS LOG FIREPLACE/ LOG LIGHTER ______________ $6.00 ______________
MECHANICAL OTHER (ANY CODE REGULATED ITEM NOT LISTED) ______________ $6.00 ______________
RESIDENTIAL AIR CONDITIONING ______________ $9.00 ______________
SOLID FUEL BURNING APPLIANCE ______________ $9.00 ______________
SUSPENDED, WALL, FLOOR – HEATER ______________ $9.00 ______________
CONTRACTOR’S LICENSE REGISTRATION (YEARLY) ______________ $15.00 ______________
BASIC PERMIT ISSUING FEE (ALWAYS APPLIES) $20.00
$20.00
TOTAL: ______________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

MECHANICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document