Fillable Water-heater-change-out-form BUILDING PERMIT APPLICATIONS CURRENTLY IN REVIEW

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Water-heater-change-out-form BUILDING PERMIT APPLICATIONS CURRENTLY IN REVIEW

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100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561) 742-6350 Fax: (561) 742-6357
S:\Development\BUILDING\Forms-Templates-Signs\Water Heater Change Out Form 8-2015.docx
(11/00,12/00,1/01,4/01,6/02,12/02,1/03,4/03,6/03,7/04,12/06,7/07,8/07, 01/09, 04/09, 01/10; 08/15)
CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT | BUILDING DIVISION
100 East Boynton Beach Boulevard • Boynton Beach, FL 33425 • (561) 742-6350 • Fax 742-6357
_____________________________________________________________________________
WATER HEATER CHANGE-OUT
The applicant is required to complete this form in order to receive a turn-around permit for an Exact Water
Heater Change-Out.
_______ I affirm that either a representative of my company or I have inspected the existing conditions
and there is no upgrade of the electrical system or service wiring changes required for the new unit(s)
being installed. I also affirm that there is an electrical disconnect within sight and the water heater
is not cord-receptacle connected, meeting the requirements of 2011 NEC, Article 422 inclusive.
An electrical sub-permit may be required for any additional electrical work. All work shall comply
with the 2011 NEC.
Print legibly or type and fill out form completely.
Owner’s Phone #
Owner’s Cell Phone #
Permit Number:
Single-family
Other
Multi-family
Commercial
Industrial
Job Address: (including unit number and gate code, if applicable)
Make of Unit
Total Watts of Each Unit
Size (Gallons)
Heat Recovery Unit
Yes
No
Make of Unit
Total Watts of Each Unit
Size (Gallons)
Heat Recovery Unit
Yes
No
Location of Water Heater:
Qualifier or (print)
License No.
Signature:
Phone No.
Cell Phone
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Water-heater-change-out-form BUILDING PERMIT APPLICATIONS CURRENTLY IN REVIEW

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Completed 2 July 2020

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