Mechanical Permit Application

APPLICATION FOR MECHANICAL PERMIT Complete all sections on both pages except for the two sections marked “For Office Use”. Application Date_____________________________ PROJECT INFORMATION & LOCATION: Project Type: □ Commercial, □ Multifamily, □ Residential Project Name:____________________________________ Work Type: □ Elevator, □ Fire Suppression, □ Mechanical Project Address_______________________________________________________ Unit/Suite/Floor_________ Zip Code__________ Locator/ Subdivision or Parcel No.____________________________ Building/Center Name ______________________________________ Lot No._______ □ Unincorporated County, or Municipality______________________________________ Fire District______________________ WORK DESCRIPTION: NO. PERMIT Brief description of mechanical construction scope of work: OWNER/TENANT INFORMATION: ____________________________________ Property Owner_______________________________________________________________________________________ Last Name First Telephone Fax Email Owner’s Address ______________________________________________________________________________________ Street Address City State Zip Code Tenant/Business Name ________________________________________________________________□Existing, □ New* *If a New Tenant/Business indicate the Previous Tenant/Business Use _________________________________________ ARCHITECT/ENGINEER INFORMATION: Name & Address Telephone Fax Email If New Tenant/Business Indicate The Previous Tenant/Business Use _____________________________________ PRIMARY CONTACT INFORMATION IF OTHER THAN APPLICANT: Name & Address Telephone Fax Email APPLICANT CERTIFICATION & INFORMATION I CERTIFY THAT I AM THE OWNER IN FEE OR AGENT AUTHORIZED TO APPLY FOR THIS PERMIT, THAT I HAVE AN AGREEMENT WITH THE OWNER/LESSEE TO PREFORM THIS WORK; AND THAT I AM AUTHORIZED TO AND DO CONSENT TO ENTRY ONTO THE PREMISES BY ST. LOUIS COUNTY EMPLOYEES FOR INSPECTION OF WORK PERFORMED UNDER THIS PERMT. THE SCOPE OF WORK INDICATED AND COST ESTIMATES ARE TRUE AND CORRECT. IF A PARTIAL PERMIT IS BEING REQUESTED, I REQUEST AUTHORIZATION TO PROCEED WITH THE CONSTRUCTION INDICATED IN ORDER TO ALLOW CONSTRUCTION TO COMMENCE. I ACKNOWLEDGE THAT IF AUTHORIZATION IS GIVEN THAT I WILL BE PROCEEDING AT MY OWN RISK WITHOUT ASSURANCE THAT A PERMIT FOR THE ENTIRE WORK OR STRUCTURE WILL BE GRANTED. I AM RELEASING ALL LIABIITY, INDEMNIFYING AND HOLDING HARMLESS ST. LOUIS COUNTY, ITS OFFICERS, EMPLOYEES, AGENTS, AND ANY ASSIGNS FOR ANY EXPENSE, ERROR, OR OMIISSION RESULTING IN SUCH ISSUANCE. SHOULD IT BE DETERMINED AT ANY TIME BY ST. LOUIS COUNTY THAT THE AUTHORIZED CONSTRUCTION NEEDS TO BE REMOVED, MOVED, CORRECTED, OR MODIFIED IN ANY FASHION, THAN SUCH REMOVAL OR CORRECTIVE WORK WILL BE AT OUR EXPENSE. Contractor Name & Address Tel No. Lic # Signature Fax # Date Printed Name Email Applicant Other Than Contractor □ Owner, □ Architect, □ Engineer, □ Tenant, □ Other _____________________ Name & Address Tel # Reg # Signature Fax # Date Printed Name Email Note: Licensed Contractor must sign application before permit can be issued. Page 1 of 2 (Print/Copy As A 2-Sided Document Is Preferred) TYPE OF WORK TYPE OF STRUCTURE New Construction RESIDENTIAL MULTI-FAMILY COMMERCIAL NON-HABITABLE Addition Alteration Single-Family 3 or 4 Multi-Family ASSEMBLY Antennas Replacement Two-Family 5 or more Multi- Theatres Attached Garage Family Restaurant Barn Repair Townhouse(s) Night Club Carport Foundation Units/Building _________ Churches/Religious Detached Garage Shell Units/Permit___________ Recreation Center Fence Interior Finish Note: Two-Family and Note: Multi-Family buildings Exhibition Hall Fireplace Fire/Storm Damage T ownhouse type buildings have common areas such as Banquet Center Generators must have independent common entry stairs, corridors, Occupancy dwelling units with individual hallways, breezeways, and/or Taverns & Bars Patio Cover Miscellaneous Work entrances. No common areas. common basement areas. BUSINESS Patio/Deck/Porch Office/Bank/Professional Pergola MECHANICAL Carwash Res. Greenhousee Clinic Retaining Walls Conveying Equipment: Fire Suppression: Pressure Vessels: Fire Station Shed Auto Lift……….# ____ Buildin g Sprinklers.#____ Boilers: Doctor’s Offices Signs Conveyor………# ____ Kit Hood Suppress..#____ Low Pressure……#____ Laboratories Solar Panel/Array Crane…………...#____ Other (explain/list below) High Pressure……#____ EDUCATION Swimming Pool Dumbwaiter……# ____ Non Potable Tank…#____ Schools Tanks Elevator….……..#____ HVAC Systems: Other (explain/list below) Child Day Care Tower Escalator………..#____ Air Conditioning: FACTORY/INDUSTRIAL Trash Enclosure Material Lift……#____ Total Tons __________ Process Piping: Manufacturing Plant Other Platform Lift.…...#____ Heating System(s): Type__________________ Industrial Laboratories Stairway Lift……#____ Total MBH__________ (Fuel, Gas, Hydronic, Med. etc.) Utilities Parking Lot Other (explain/list below) HVAC Equipment: HIGH HAZARD Air Handlers/ERU..# ____ Other Components: Flam. & Comb. Liquids FOR OFFICE USE Exhaust Systems: Chiller……………# ____ Duct Work…………#____ Storage or Manufacturer Gov’t / Public Owned Condenser…………#____ Fire/Smoke Dampers#____ Tire Storage (Bulk) Dryer……………#____ PERMIT FEES Fan Exhaust……..#____ Cooling Tower…...# ____ Flue Replacement….#____ Other High-Hazard Kitchen Hood(s): Evaporator Cooler..# ____ Refrigerant Line(s)...#____ Storage or Manufacturer Processing ____________ Type I Hood….#____ Fan Supply………..#____ Registers/Diffusers...#____ INSTITUTIONAL Mechanical ___________ Type II Hood…#____ Forced Air Furnace.#____ Other (explain/list below) Nursing Home Inspection ____________ Day Nurseries Res. Kit. Hood..#____ Infra-Red Heater …#____ ________ ____________ Makeup Air Unit…#____ Other Equipment: Hospitals Med Gas Exhaust.#____ Penalty ____________ Motor Exhaust.….#____ Radiant Heat…….. #____ Fireplace…………..#____ Jails Paint Spray Booth.#____ Single Package Unit#____ Fuel Dispenser…….#____ Residential Care and Total Fees ____________ Smoke or Fume….#____ Solar Heat…………#____ Gas Logs…………..#____ Assisted Living Filing Fee Pd __________ Other (explain/list below) Unit Heater…….….#____ Generator (Emerg)...#____ MERCANTILE Other (explain/list below) Kit Equip (Comm)...#____ Retail/Wholesale/Stores Balance Due ___________ UG Fuel Tank(s)….;#____ Service Station Fees Paid ____________ Other (explain/list below) Markets RESIDENTIAL Special & Other Items: Date Dormitories Description _____________________________________________ Quantity ______ Issued _____/_____/_____ Hotels/Motels Description _____________________________________________ Quantity ______ Issued By _____________ STORAGE Description _____________________________________________ Quantity ______ Office/Warehouse APPROVALS & DATE Description _____________________________________________ Quantity ______ Lumber Yard Est. Cost ______________ Code Correction Work: __________________________________________________ Repair Garage Parking Garage Plan Rev. ______________ Inspections Required: One, Two, > Two, Provide # Req’d ____________ Box No. ______________ Comments/Information: __________________________________________________ Folder Other Permit References: ____________________________________________________ Estimated Cost of Mechanical Construction Work: $___________________ FOR OFFICE USE Record Check____________________ Violation Check__________________ Transient Employer Documents Notified__________________Date______ #OP_____________ PA Flat Closet Permit No._____________________ Page 2 of 2 (Print/Copy As A 2-Sided Document Is Preferred) K:\Permdata\Permit App Forms\MECHANICAL - 2014.docx 01/15/15 .

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