Village of Saukville HVAC Permit Application

Village of SaukvilleHVAC Permit ApplicationAdministered by:Village of Grafton Inspection Department860 Badger Circle, Grafton, WI 53024-9436p (262) 375-5305 f (262)375-5312tjohnson@village.grafton.wi.usJOB ADDRESS: ___________________________________________________________________Type: Residential Commercial Industrial ExemptNewHeating A/C Vent Exhaust SystemPROPERTY OWNER’S INFORMATIONProperty Owner’s Name:_____________________________________________________________Address (if different than job address): _________________________________________________City/State: _________________________ Zip: _____________ Phone: ______________________If Applicable:Lessee name: _____________________________ Address: _______________________________City/State: __________________________ Zip: ____________ Phone: ______________________CONTRACTOR’S INFORMATIONFirm’s Name: _______________________________ Address: ______________________________City/State: ___________________________ Zip: ____________ Phone: _____________________Contractor’s Name (License Holder):_________________________________________________________________________(Please complete Contractor Info Form, if not already done, to supply address, license numbers, etc.)Description of work: ________________________________________________________________Value of HVAC work: $______________________________________________________________PLEASE COMPLETE & TOTAL PROJECT/FEE INFORMATION ON REVERSE SIDEI hereby certify that all statements, forms, and attachments submitted hereto are true and correct tothe best of my knowledge and belief:Name of Applicant (please print):_____________________________________________________Applicant’s Signature: ___________________________________ Date: ____________________**Request for inspections will not be scheduled unless the permit number is supplied at the time of the request**

TYPE/BRAND: ___________________________________SIZE: __________________________________________COST: _________________________________________AMOUNTTOTALOUTPUT FURNACE BTUs UP TO 150,000 _____ 50.00 __________ADDITIONAL 50,000 BTUs _____ 17.00 __________AIR CONDITIONER UP TO 3 TON _____ 50.00 __________ADDITIONAL TONNAGE _____ 17.00 __________DISTRIBUTION VENTING SYSTEM –MINIMUM - 1 st 100 S.F. _____ 50.00 __________DISTRIBUTION VENTING SYSTEM -EACH ADDITIONAL 100 S.F. _____ 1.90 __________EXHAUST SYSTEM _____ 165.00 __________FIREPLACE _____ 50.00 __________COMMERICAL HVAC PLAN REVIEW _____ 60.00__________TOTAL FEES:__________SEPARATE ELECTRICAL PERMIT REQUIRED3/14