Venting information
Existing chimney
Inside
Outside
Type-B Metalbestos
Type-A Metalbestos
Reline chimney
Direct vent
Specifications
Make _____________________
BTU Input ________________
Tonnage __________________
Application for Mechanical Permit
Address of construction ____________________________________________________________________________
Owner’s name ___________________________________________________Phone ___________________________
Owner’s address __________________________________________________________________________________
Contractor ______________________________________________ Business phone ___________________________
E-mail address ________________________________________________________
Contractor’s address _______________________________________________________________________________
Applicant’s signature Print name Date
Street City State Zip
Section 1 – General Information
PLEASE PRINT OR TYPE
Section 2 – Description of Property and Project
Contractor is required to schedule a rough-in inspection before any concealment.
By signing the application, the applicant certifies that the installation will comply with the regulations of the Newburgh Heights
Building Code and State Codes.
TO THE BUILDING COMMISSIONER: This application is submitted for a permit to erect, add to, alter or repair a structure as described
in this application and any drawings which accompany it. The acceptance of the permit shall be considered an agreement on the part of the
applicant or his agents to comply with the Building and Zoning codes of the City of Newburgh Heights, or other orders, requirements or
specifications slated in the permit.
In signing this application, the contractor or owner’s agent certifies that the work is authorized by the owner or record.
Applicant is Owner Contractor Owner’s agent
Permit No. Date Received
Estimated cost of Project $
Date
Type of Structure
Single family
Two family
Three family
Apartment
Commercial
Other (describe)
Type of Work
New structure
Addition
Alteration
Repair
Demolition
Replacement
Other (describe)
Type of installation
Furnace
Duct work ft.
Hot water boiler
Steam boiler
Air conditioner
(site plan required)
Air handler
Thru the wall heater
Unit heater
Gas logs
Wood burning unit
Type of installation
Roof top unit
Replacement
New (plans required)
Exhaust fan
Hood fan
Refrigeration
Cooling tower
Other
# of units # of units# of units
For A/C condensing units, site plan
showing unit location(s), distance to
property lines, etc., must be submitted
on a separate sheet.
Village of Newburgh Heights Housing and Building Department
3801 Harvard Ave., Newburgh Heights OH 44105 Phone: 216-641-4654
