This form complies with the State of Michigan application guidelines.

(08)Application for Mechanical Permit for City of Hartford            Permit Number CH                   DATE:

Job Name: Job Address: Job Phone: Parcel Number:
Owner Name: Address: Telephone: Email:
Mechanical Contractor: Address: Telephone: Email:
License Number: Boiler Installer License Number: Fed. ID or reason for exemption: MESC or reason for exemption:
Applicant Signature  Section 23a of the state construction code act of 1972, Act No 230 of the Public Acts of 1972, being Section 125.1523a of the Michigan compiled Laws, 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 subject to civil fines.  Signature of Licensee or Homeowner (homeowner and contractor must also sign affidavit below)____________________________________
Homeowner Affidavit  I hereby certify the mechanical work described on this permit application shall be installed by myself in my own home in which I am living or about to occupy. All work shall be installed in accordance with the State Mechanical Code and shall not be enclosed, covered up, or put into operation until it has been inspected and approved by the Mechanical Inspector and assume the responsibility to arrange for necessary inspections. Signature of Homeowner ___________________________________
Contractor Affidavit I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his authorized agent. And we agree to conform to all applicable laws of the State of Michigan. All information submitted on this application is accurate to the best of my knowledge. Signature of Contractor (signed by Mechanical Contractor of Record)_______________________________
1 Application Fee Non-refundable 75.00 1 75.00
2 Residential or Commercial Heating System (including Duct, Chimney, and Gas Piping) 50.00    
3 Residential or Commercial change out (no ducts or gas piping except plenium) 30.00    
4 Residential, commercial and yard Boilers 30.00    
5 Fuel fired Water Heater 5.00    
6 Solid Fuel Equipment (includes Chimney) 30.00    
7 Fireplace (Gas or wood includes Chimney) 30.00    
8 Chimney, Factory built, but installed as a replacement or for future use. 25.00    
9 Solar, set of 3 panels (including piping to and from panels)  Add Hydronics. 20.00    
10 Gas Piping; each opening - New installation or modifications not included elsewhere. Air test 5.00    
11 Air Conditioning (includes split AC systems and Heat Pumps) Per 5 ton unit or portion. 30.00    
12 Bath, Dryer, and Range exhaust system, each. 5.00    
13 LP Gas piping System 20.00    
14 Hydronic, process piping, and gas pipe mains (over 1 Inch) $.05 Per foot (Min $25) .05    
15 Ductwork (Modifications, additions, for residential and Commercial) (Min $25) .10    
16 Air Handlers and heat wheels each 20,000 CFM or portion. 20.00    
17 Rooftop.  Each 150,000 BTUH or less heating capacity.  Add A/C #11 for combinations. 80.00    
18 Heat boxes, heat recovery units, heat coils, VAV boxes, unit ventilators or 24" and larger fans.  Humidifiers, Commercial Hoods (per 6 ft). 10.00    
19 Suspended unit heaters per 100,000 btuh or portion. 15.00    
20 Fire suppression protection price per head (includes Plan review) (Min $20.00) .75    
21 Split refrigeration system price per evap coil or condenser.  Price is for each item. 30.00    
22 Hourly Inspection Rate.  Use this for unlisted equipment, large or difficult projects. 75.00    
23 Final non-refundable Inspection. Final inspection fees are required on all permit applications. (The same as the State of Michigan Permit application) 75.00  1  $75.00
                                                                                                                             Total    

You should be able to reach the Mechanical Inspector at his office between 8:00 and 9:00 nearly any morning.  Try at other times as well.  Telephone.....269 427 7543.  FAX service is not available at present. Email is the best way to leave a message.  EMail to    walt@waltdevisser.com .  MAKE CHECKS PAYABLE TO CITY OF HARTFORD and Mail application to:

City of Hartford 

C/O Walter L. De Visser, Sr. 

63263 CR380

Bangor, MI 49013

 When this application is signed (or stamped or coded with a number) by the Mechanical Inspector and the Permit Number is affixed, This form becomes the  permit.  

Walter L. De Visser, Sr.________________________________

GENERAL: Mechanical work shall not be started until the application for permit has been filed. All installations shall be in conformance with the State Mechanical Code. No work shall be concealed until it has been inspected. The telephone number for the inspector is provided on the permit form. When ready for an inspection, call the inspector providing as much advance notice as possible. The inspector will need the job location and permit number. This request should be made by the contractor of record.

EXPIRATION OF PERMIT: A permit remains valid as long as work is progressing and inspections are requested and conducted. A permit shall become invalid if the authorized work is not commenced within six months after issuance of the permit or if the authorized work is suspended or abandoned for a period of six months after the time of commencing the work. A PERMIT WILL BE CANCELLED WHEN NO INSPECTIONS ARE REQUESTED AND CONDUCTED WITHIN SIX MONTHS OF THE DATE OF ISSUANCE OR THE DATE OF A PREVIOUS INSPECTION. CANCELLED PERMITS CANNOT BE REFUNDED OR REINSTATED. This is important and is enforced.

Notes: ITEM #2, RESIDENTIAL HEATING SYSTEM: This item is used for the installation of a heating system in a new residential structure. Items # 8, #10, and #15, SHOULD NOT BE charged again. Replacement systems should be itemized. ITEMS #13 is for LP vendors only. A homeowner must own tank to install. If homeowner does not own tank, a license mechanical contractor must install tank. Hoods for commercial use: Should be listed under item #22 as unlisted equipment. Wood/fuel fired yard boilers and water heaters are to be listed under items #6, #14(total pipe or tube), and #18(Heat coil) if connected to a residence or shop but no permit is required if connected only to ag buildings.

Multiple Visits: It is the contractor of recordís obligation to provide access at the inspection site. There must be a key, persons on site, or a provision by the contractor for access including ladders if required and an address post or mailbox with number provided. An additional visit because the site is not marked or access is not provided may be charged at the rate of $50 per visit and a final may not be issued until this fee is paid.