Form Center

City of Oldsmar Application for Mechanical Permit

2. 6th Edition (2017) FLORIDA MECHANICAL/ENERGY CONSERVATION CODE APPLIES

4. Permit # _______________________

5. Permit Fees $ ______________________

6. Date Received _____________________

8. Property Owner's Name

9. Phone

10. Address

12. Contractor's Name

13. Phone

14. Address

16. Email Address:

17. Contractor's State License

18. PCLLB No.

20. Job Address

21. Job Description

23. Legal Description/Parcel ID

24. Area of improvement:

    (in sq ft)

25. Total job costs

27. Bonding Company

28. Address

29. Architect/Engineer's Name

30. Address

32. Mechanical Fee Schedule
    

    Base Fee, Residential and Commercial: $50.00---Residential, New (per dwelling unit) Base Fee + $5.00 for each additional $1000 or fraction over $1,000 --- Residential AC Unit Replacement: $50.00 --- Commercial, New or replacement: Permit Fee is based on Total Value of project - See Fee Schedule Table

34. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENT TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
    Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for STRUCTURAL, ELECTRICAL WORK, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, ETC.

    Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for STRUCTURAL, ELECTRICAL WORK, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, ETC.

36. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.
    OWNER'S ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information contained in this mechanical permit application is true and correct.

    OWNER'S ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information contained in this mechanical permit application is true and correct.

38. Permit Applications shall be submitted on paper and .PDF format, for review and contain all the items listed. In addition, building, plumbing, electrical, and environmental plans shall be submitted to secure this permit, when applicable. The construction permit fee is based on a $50.00 fee, plus additional fees according to value per thousand of valuation or fraction thereof. Application is valid for 180 days. Permit is extended for 6 months after each successful inspection. Permit expires after 1 year. Permit fee is non-refundable.
    Contractors must maintain, State License, General Liability and Workman's Compensation Insurance.

    Contractors must maintain, State License, General Liability and Workman's Compensation Insurance.

40. MECHANICAL INSTALLATION TO BE COMPLETED

    Select Jobs Being Completed

    1. A/C Heat Pump (new)
    2. A/C Heat Pump (change out)

    1. Refrigeration Unit
    2. Clothes Dryer

    1. Range Hood
    2. Broiler

    1. Commercial Hood
    2. Other
42. Size and Seer

43. Other

    State the work being done

44. Select One

    1. Owner
    2. Authorized Agent
    3. Contractor

46. Print Name

47. Signature: ________________________________________

48. Date: ______________________

50. Approved by:
    ___________________________________________

    ___________________________________________

51. Date:
    ____________________

    ____________________

Leave This Blank:


52. Print Only

* indicates a required field