Hvac Permit Application - 1 & 2 Family Dwellings
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1HVAC P
A
- 1 & 2 F
D
ERMIT
PPLICATION
AMILY
WELLINGS
PROPERTY INFORMATION
Property Address: _______________________________________________________ Zoning District: ________ Ward: _______
Location of Work (space, floor level, suite, etc.):________________________________ Parcel ID: ________ - _____ - ________
Owners Name: _______________________________________________________________email:________________________
Address: ______________________________________________________________
Phone: (
) ______ - ___________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) ______ - ___________
CONTRACTOR INFORMATION
Name: _____________________________________________________________________ email: _______________________
Address: ______________________________________________________________
Phone: (
) ______ - ___________
City: ______________________________ State:______ Zip Code: _____________
Fax:
(
) ______ - ___________
ESTIMATED COST OF WORK: $ _________________________
____________________________________________________
Signature
HVAC DIMENSIONAL INFORMATION (Complete only if HVAC unit(s)are located outside of the building)
Type
Location
Height
Length
Width
(furnace, A/C)
(ground, roof, etc.)
(Feet)
(Feet)
(feet)
Main Structure
HVAC Unit
HVAC Unit
HVAC Unit
If unit(s) is/are located outside of the building, please attach a survey or plot plan to this application for zoning approval.
FEE SCHEDULE
Plot Plan
Fee for No. of Dwelling Units
Write Subtotal for
Items Installed
Required
One
Two
Each Line
New Furnace Only
No
$70.00
$140.00
Replacement Furnace Only
No
$50.00
$100.00
New (add on) A/C or Heat Pump Only
Yes
$50.00
$100.00
New Furnace and New A/C
Yes
$70.00
$140.00
Replacement Furnace and New A/C
Yes
$70.00
$140.00
Replacement Furnace & Replacement A/C
No
$50.00
$100.00
Replacement A/C Only
No
$50.00
$100.00
PA UCC Fee
$4.00
SUBTOTAL OF HVAC FEE
Electrical Permit Fee
(If separate electrical permit is required)
PA UCC Fee
ADD $4.00
(If separate electrical permit is required)
Scanning Fee- $2.00 per page or drawing
Document Storage Fee- $1,50 per page or drawing
GRAND TOTAL OF ALL PERMITS
$
Permit No.___________
Invoice No.___________
Check No.___________
Approved by: _________________________________________________________
Date: ______________________
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