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                                                MECHANICAL PERMIT APPLICATION This document has been designed  
  Print              Clear                                  City of Muskegon                                                                 to complete online, print, SIGN, and  
Date                                                               933Terrace St. P.O. Box 536                                                          Permit #
                                                                                                                                              mail to the city with all associated  
                                                                    Muskegon, MI 49443-0536                                                  fees.  This form IS NOT designed to  
                                                                              (231)724-6758                                                       be submitted electronically.
I. JOB LOCATION
Job Address                                                                                   Has a building permit been issued for this project?
                                                                                                     YES               NO               NOT REQUIRED
Name of Owner/Agent                                                                           Owner Address

II. CONTRACTOR /HOMEOWNER INFORMATION
       Contractor       Name                                                                                        License Number                           Expiration Date
       Homeowner
Address(Street & Name)                                                     City                                     State                                    Zip Code
                                                                                                                               MI
Telephone Number                     Federal employer ID Number (or reason for exemption)                           MESC Employer Number (or reason for exemption)
(       )
Workers Compensation Insurance Carrier (or reason for exemption)                                                    Contractor information registered with the City of
                                                                                                                    Muskegon        YES                              NO
III. TYPE OF JOB
Class of work (check all that apply)
          NEW BUILDING                                        ADDITION                                       ALTERATION                                        REPAIR

          RESIDENTIAL                                           COMMERCIAL                               INDUSTRIAL                                          OTHER
Description of work

IV. FEE SCHEDULE ­ Enter the number of items being installed. Multiply by the unit price for the total fee.
                                             FEE         #ITEMS            TOTAL                                                                   FEE           #ITEMS          TOTAL
Base Fee (Non-refundable)                   $35.00                                                    Air Handlers/Heat Wheels
Heating                                                                                               Under 10,000 CFM                              $20.00
Residential (includes duct &                                                                          Over 10,000 CFM                               $60.00
piping)  $50.00 Commercial Hoods                                                                                                                    
                                                                                                                                                   $15.00
Gas/Oil burning equipment
                                   New
and/or conversion or replacement            $30.00                                                    Heat Recovery Units or Thru-
                                                                                                      the-wall fan coils                            $10.00
Water Heaters                               $10.00                                                    Unit Ventilators                              $10.00
Flue/vent Dampers                             $8.00                                                   Unit Heaters (terminal units)                 $15.00
Solid fuel equipment complete               $30.00                                                    Bath & Kitchen Exhaust                          $5.00
Gas Fire Places $20.00 Duct  $.10 per ft.  Min $25.00                                                                                               
                                                                                                                                                   $.10 ft
Chimney, Factory Built
(installed Separately)                      $25.00                                                    Piping includes process,heating,
                                                                                                      boiler and refrigeration lines                $.05 ft
                                                                                                            $.05 per ft.   Min $25.00
Heat Pumps (residential  $30.00
                                                                                                      Restaurant Hood $15.00
Heat Pumps  (commercial, Pipe not
included  $30.00                                                                                      Gas Piping
                                                                                                      Testing for new service                       $20.00
Boiler                                      $30.00                                                    Gas Piping (each opening)
                                                                                                             (new installation)                       $5.00
Humidifier                                  $10.00                                                    Fire Suppression/Protection
Air conditioning & Refrigeration                                                                      Sprinkler $.75 each   Min $25.00              $.75 ea
Residential A/C                             $30.00                                                    Inspections (additional or
Evaporator Coils                            $30.00                                                    reinspection or final)                        $35.00
Refrigeration (Split systems)               $30.00                                                    Special/Safety Inspection                     $50.00
Chiller                                     $30.00                                                    Inspection to turn on gas
                                                                                                      (Flat fee)                                    $25.00
Cooling Towers $30.00 Hourly Rate                                                                                                                   
                                                                                                                                                   $50.00
                                                                                                      Plan Review Fee                                 25%
Compressor                                  $30.00                                                    Other
Rooftop Htg/AC Combo                        $60.00                                                    Rcvd By                App. By               Total Fee

V. HOMEOWNER AFFIDAVIT
I hearby certify the mechanical work described on this permit application shall be installed by myself in my own home which I am living or am about to
occupy. All work shall be installed in accordance with the mechanical code and shall not be enclosed, covered up, or put into operation until it has been
inspected and approved by the Mechanical Inspector.  I will cooperate with the plumbing inspector and assume responsibility to arrange all necessary
inspections.
VI. APPLICANT SIGNATURE
Section 23a of the state construction code act of 1972, 1972 PA 230, MCL 125.1523a, prohibits a person from conspiring to circumvent the licensing
requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of section 23a are
subjected to civil fines."
Signature of Licensee or Homeowner(Homeowner                                                                                                    Date
signature indicates compliance with Section V)
                                                                                                                                                                                  M3/02