Mechanical/gas Permit Application Form
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1
2PERMIT #___________________
DEPARTMENT OF DEVELOPMENT AND PERMITS
Code Compliance Division
Tel.
382-6249
P. O. Box 15225
382-6324
382-6018
Chesapeake, VA 23328
Fax
382-8448
Date:____________________
Inspection Request: 382-2489
Email:
develop-permits@cityofchesapeake.net
APPLICATION FOR MECHANICAL/GAS PERMIT
A permit is hereby requested to install the following mechanical/gas/fire protection system at:
Address__________________________________________________________________ Suite #__________
Subdivision________________________ Builder/Owner/Occupant___________________________________
Mechanical Co. Name________________________________________________ State Reg. #_______________________ A B C
Master Mech. Signature___________________________________________________ Phone_______________________
Master Gas Fitter Signature______________________________________________________ Phone_______________________
PRINT Signature Name_____________________________________________ Ches. Bus. License #_______________________
Business Address____________________________________________________________________________________________
Structure is ___New ___Foundation ___Old ___Addition ___Moved
___Residential ___Commercial ___Industrial
Code Used: ____Inter. Mech. Code (IMC)
____Inter. Res. Code (IRC)
____Inter. Fuel Gas Code (IFGC)
MECHANICAL
EQUIPMENT AND NUMBER OF UNITS TO BE INSTALLED
MINIMUM PERMIT FEE $40.0
(Fuel)
Gas Pack ____ Gas Logs ____ Fireplace (Type)_____________Water Heater ____ LP Tank_______ Size (BTU)______________
Heat Pump (Air to Air)_____ Heat Pump (Water to Air)_____ Other________________ Size (BTU)______________
Furnace: Electric_____ Oil_____ Gas_____ Commercial Hood_____ Paint Booth_____ Size (BTU)______________
Ventilation System: AC_____ HVAC_____ Size (BTU)______________ Elevator(s)_____ Escalator(s)_____
Other: __________________ _____ _________________ _____ __________________ _____ ___________________ _____
Contract Value $____________
Permit Fee $______________
GAS
INSTALLATION/PIPING
MINIMUM PERMIT FEE $40.00
Logs____ Gas Pack Comb.____ Water Heater____ Furnace_____ Range____ Grille____ Dryer____ Generator ________
Fireplace_____ LP Service Line______ Other____________________ Sized for _________________ Pressure (lbs or inches)
Gas Type: ___Natural ___LP
Total BTU_________________ Contract Value $____________Permit Fee $___________
A diagram showing mechanical/gas equipment sizing, duct design and BTU’s is required. This diagram may be
faxed after the permit is issued but prior to any inspection. Please reference the applicable permit number on the
diagram.
The code official shall be notified when the construction reaches the stage of completion for an inspection. The permit holder shall
assure that the inspections have been conducted and approved by the code official when applicable. A certificate of occupancy,
indicating completion of the work for which a permit was issued, shall be obtained prior to any occupancy. I understand that the
permit is granted for the work shown and described in this application. Any falsification, misrepresentation or misleading information
given VOIDS the permit.
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