Fillable RESIDENTIAL HVAC/GAS LINE APPLICATION (Clark County Board of Commission)

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RESIDENTIAL HVAC/GAS LINE APPLICATION (Clark County Board of Commission)

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BROWSE CLARK COUNTY BOARD OF COMMISSION (OH) FORMS

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G:\BUILDING REGS\Forms - Masters\Applications\Updated Forms 11/6/19
RESIDENTIAL HVAC/GAS LINE APPLICATION
PLEASE PRINT OR TYPE APPLICATION NO:_______________
PLEASE SEE SUBMITTAL REQUIREMENTS PART B
OFFICE USE ONLY
HVAC/GAS PIPING PERMIT FEES
Application Fee …………………………………………….$40
MECHANICAL CONSTRUCTION
New System ……………………………..…………….…$90
Replacement System………………………………….$45
Ductwork Only…………………………………………..$10
Ventilation Equipment.………………………….…..$10
Unit Heaters/Mini Split………………………………$45
GAS Piping
New Gas Piping……………………………………$45
Reconnect, Repair Gas Piping……………….$45
Field Inspection………45 x______ =______
Plan Review Fee……………………….…………………$20
Work Without Permit………………………….……$200
SUBTOTAL __________
1% OBBS State Assessment Fee __________
TOTAL PERMIT FEE __________
1. PROJECT INFORMATION
What City, Village, or Township is this project located in_____________________
Project Address______________________________________________________
City/State/Zip Code___________________________________________________
Project Description___________________________________________________
This project is:
Part of other New Construction, Alterations, or Change of Use
HVAC/Gas line drawings included with building plans
A stand-alone New Work Project, Addition, or Repair
Natural Gas provider:
Columbia Gas
Vectren
Propane
2. PROPERTY OWNER
Name______________________________________________________________
Phone_____________________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
3. HVAC/GAS PIPING CONTRACTOR
Contact Person______________________________________________________
Cell Phone__________________________________________________________
Company Name______________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
Phone_______________________ Fax___________________________________
E-Mail_____________________________________________________________
OFFICE USE ONLY
Received:
Counter
Mail
Fax
E-mail
Date______________Intake Person___________
Plans Reviewed by __________Date__________
Plans Approved by___________Date__________
Notified Permit ready by _________Date________
Paid ____________ Date ___________________
4. APPLICANT
Contact Person______________________________________________________
Company Name_____________________________________________________
Address____________________________________________________________
City, State, Zip Code__________________________________________________
Phone____________________________ Fax______________________________
E-Mail_____________________________________________________________
I hereby certify that I am the Owner of Record, that I have been authorized by the
Owner to make this application as his Agent, and that we agree to conform to ALL
laws of the County and the State, and that all information on this application is
truthful to the best of my knowledge. I also understand that UPFRONT FEES ARE
NON-REFUNDABLE AND NONTRANSFERABLE.
Applicant Signature____________________________Date___________
RESIDENTIAL HVAC/GAS PIPING PLAN SUBMITTAL FORM Part B
General Instructions
• The application shall be filled out completely.
• The application may be faxed or e-mailed to our office at anytime. Once the application is approved
the staff will call the applicant indicating approval and total cost of permit. It is the applicant’s
responsibility to check periodically on the status of this application.
• All work shall conform to the current edition of the Residential Code of Ohio.
Submittal Requirements
NEW DWELLINGS /ROOM ADDITIONS
1. Duct layout. 2. ACCA Manual J load calculations. 3. Manufacturer’s specifications for the
appliance/equipment.
BASEMENT FINISH
1. Duct layout. 2. Exhaust. 3. Mechanical ventilation unless approved glazing is provided.
GAS PIPING
1. Indicate fuel type. 2. Submit single-line drawing indicating pipe size. 3. Pipe material.
4. BTU rating of appliances and equipment connected.
HEATING AND COOLING EQUIPMENT AND APPLICANCES SHALL BE INSTALLED IN
ACCORDANCE WITH THE MANUFACTURER’S INSTALLATION INSTRUCTIONS AND THE
REQUIREMENTS OF THE RESIDENTIAL CODE OF OHIO. RCO M1401.1
For more information or questions:
Clark County Community & Economic Development
Springview Government Center
3130 E. Main Street, Suite 1A
Springfield, OH 45505 General E-mail: communitydevelopment@clarkcountyohio.gov
(937) 521-2160 Website: www.clarkcountyohio.gov/communitydevelopment
(937) 328-2621 fax
Office Hours
Monday through Friday
Office opens at 7:30 am
Front Counter closes at 4:00pm
Office closed at 4:30 pm
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RESIDENTIAL HVACGAS LINE APPLICATION (Clark County Board of Commission)

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Completed 17 July 2020

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