Mechanical Inspection Technical Form

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Executive Summary

This document is a Mechanical Inspection Technical Form, an application used by property owners or contractors to request a mechanical inspection for a permit. It requires detailed identification information for the applicant (owner or contractor), including contact details, addresses, and relevant contractor license numbers. The form also requests technical site data, a description of the proposed mechanical work (e.g., heating system, fuel type, fixtures), and an estimated cost of the mechanical work. It includes sections for office use related to plan review, subcode approvals, and inspection dates, as well as a fee breakdown.

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Document Text

--- Document: Mechanical Inspection Technical Form Document ---
US
NIZVY JENISEY
ERIFORM CONSTATION
MECHANICAL INSPECTION
TECHNICAL SECTION
A. IDENTIFICATION-APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000.
Block
Work Site Location
Owner in Fee:
Tel.
Address
Contractor:
Address
street
Lot
e-mail
Qualification Code
municipality
zip code
Tel.
e-mail
C. CERTIFICATION IN LIEU OF OATH
Date Received
Control #
Date Issued
Permit #
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application.
Sign here:
Print name here:
D. TECHNICAL SITE DATA
DESCRIPTION OF WORK
B. MECHANICAL CHARACTERISTICS
Contractor License No.
Home Improvement Contractor Registration No. or Exemption Reason
Federal Emp. ID No.
Use Group Present:
Exp. Date
FAX:
R-3, R-4 or R-5
Proposed: R-3, R-4 or R-5
Heating System work: [
] New OR [ ] Modification to Existing OR [ ] Conversion OR ( ) Replacement
Type: [] Hydronic ( ) Hot Air
NO.
FIXTURE/EQUIPMENT
Fuel Type: [ ] Gas [ ] Oil
Estimated Cost of Mechanical Work $
( ) Electric [ ] Solar
[ ] Other
Water Heater
JOB SUMMARY (Office Use Only)
PLAN REVIEW
[] No Plans Required
( ) Mechanical Plans Approved
Date:
Approved by:
Joint Plan Review Required:
[] Bldg. [ ] Elec. ( ) Plumb. [ ] Fire.
[ ] Elev.
SUBCODE APPROVAL for PERMIT
Date:
Approved by:
SUBCODE APPPROVAL for CERTIFICATE
Date:
[ ] CA
Approved by:
[ ] CCO
INSPECTIONS
Type:
Gas Piping
Appliance
Chimney/Vent
Oil Piping
Oil Tank
LPG Tank
Hydronic Piping
Fireplace
Chimney Cert.
Other
DATES
Failure
Failure Approval Initial
FEE (Office Use Only)
$
Fuel Oil Piping Connections
Gas Piping Connections
Steam Boiler
Hot Water Boiler
Hot Air Furnace
Oil Tank
LPG Tank
Fireplace
Generator
Other
Administrative Surcharge $
Minimum Fee $
State Permit Surcharge Fee $
TOTAL FEE $
U.C.C. F145 (rev. 04/15) Applicant: When submitting this form to your Local Construction Code
Enforcement Office, please provide one original plus three photocopies.
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