MECHANICAL SUBCODE
TECHNICAL SECTION
A. IDENTIFICATION - APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL PA ONE CALL 8-1-1 OR 1-800-242-1776 BEFORE DIGGING.
Work Site Location ______________________________________________________________________________
______________________________________________________________________________________________
Owner in Fee: __________________________________________________________________________________
Tel. _______ ________________________ Email ________________________________________________
Address _______________________________________________________________________________________
street municipality zip code
Contractor: _______________________________________________ Tel. _______ ______________________
Address _________________________________________________ Email ______________________________
______________________________________________________________________________________________
Sheet Metal License No. _______________ Issuing Municipality ___________________ Exp. Date __________
Home Improvement Contractor Registration No. Exemption Reason (if applicable): ____________________________
CIty of Allentown Business License No. ______________________ Exp. Date ____________________
B. MECHANICAL CHARACTERISTICS
Use Group Present: R-5
Heating System Work: [ ] New OR [ ] Modification to Existing OR [ ] Conversion OR [ ] Replacement
Type: [ ] Hydronic [ ] Hot Air
Fuel Type: [ ] Gas [ ] Oil [ ] Electric [ ] Solar [ ] Other _______________________
Estimated Cost of Mechanical Work $ ___________________________________
C. CERTIFICATION IN LIEU OF OATH
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application.
_________________________________________________________
Applicant’s /Contractor’s Signature
D. TECHNICAL SITE DATA
DESCRIPTION OF WORK:
JOB SUMMARY (Office Use Only)
PLAN REVIEW INSPECTIONS Dates (Month / Day)
[ ] No Plans Required ____________ Type: Failure Failure Approval Initial
INITIAL
[ ] Mechanical Plans Approved Gas Piping _______ _______ _______ _______
Date: _________ Approved by: ___________ Appliance _______ _______ _______ _______
Joint Plan Review Required: Chimney / Vent _______ _______ _______ _______
[ ] Elec. [ ] Plumb. [ ] Fire [ ] Elevator Oil Piping _______ _______ _______ _______
[ ] Bldg. Oil Tank _______ _______ _______ _______
SUBCODE APPROVAL for PERMIT LPG Tank _______ _______ _______ _______
Date: _______________________________ Hydronic Piping _______ _______ _______ _______
Approved by: _________________________ Fireplace _______ _______ _______ _______
SUBCODE APPROVAL for CERTIFICATE Chimney Cert. _______ _______ _______ _______
[ ] CA [ ] CCO Other__________ _______ _______ _______ _______
Date: _______________________________
Approved by: _________________________
NO. FIXTURE / EQUIPMENT FEE (Office Use Only)
____ Water Heater $__________________
____ Fuel Oil Piping Connections __________________
____ Gas Piping Connections __________________
____ Steam Boiler __________________
____ Hot Water Boiler __________________
____ Hot Air Furnace __________________
____ Oil Tank __________________
____ LPG Tank __________________
____ Fireplace __________________
____ Generator __________________
____ Other __________________
Archive Fee $ ___________________
Certificate of Occupancy $ ___________________
State Permit Surcharge Fee $ ___________________
TOTAL FEE $ ___________________
Master Permit #
Permit #
click to sign
signature
click to edit
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