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HVAC PERMIT APPLICATION CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] For City Use Only: Permit # Date: Issued By: Expires: Project Address: Description of Work: HVAC Contractor Information (Permits are emailed to contractors. Please print legibly.) Name: Address: Phone: E-mail: Wisconsin HVAC Contractor Expiration Date: Wisconsin HVAC Qualifier Expiration Date: Property Owner Information Name: Address: Phone: E-mail: Project Information Building Status: _____Existing Building Type: _____Residential _____Industrial _____Commercial Type of System: Water ______Forced Air ______Other: Name & Model BTU Input: BTU Output: Project Cost: Fee Description Qty Cost Subtotal Project Cost Fee: $4 per $1,000 (rounded up to nearest $1,000) $ 4.00 $ Gas Connection Fee: $6 each $ 6.00 $ Base Permit Fee: UDC Residential $50 or Commerical $100 1 $ $ Fee Total $ The HVAC Contractor shall call for the required inspections. Failure to do so may result in a $50.00 charge and possible removal of any finish surfaces covering the HVAC work. The applicant certifies that all information is correct and that all pertinent City Ordinances will be complied with in performing the work for which this permit is issued. Signature of Contractor or Homeowner if Applicable: Print Name: Date: REQUIRED INSPECTIONS (IF APPLICABLE): ROUGH; ABOVE CEILING; FINAL ---PAGE BREAK--- BUILDING INSPECTION DEPARTMENT CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] BUILDING INSPECTION CHECKLIST Subcontractors shall request inspections for their own work by contacting the BUILDING INSPECTION DEPARTMENT at (608) 821-8370. Failure to give proper inspection notification may result in fines. The Building Permit Applicant (signature on application) is responsible for verifying that all required inspections have been made. Any developer/contractor who calls for an inspection before the work is ready for inspection may be assessed a fine of fifty dollars ($50.00) per inspection. ❑ EROSION CONTROL INSPECTION to be completed prior to footing inspection. Perimeter erosion control measures shall be placed within 24 hours after beginning excavation. ❑ FOOTING INSPECTION to be completed after f01ms and required reinforcing are in place, but before concrete is poured. ❑ FOUNDATION INSPECTION to be completed before backfilling. ❑ ROUGH INSPECTION to be completed for each category below before work is covered or concealed. o UNDERGROUND/UNDERSLAB PLUMBING/ELECTRICAL/HVAC o UNDER FLOOR VAPOR BARRIER (BASEMENT) o BUILDING FRAMING o ELECTRICAL o PLUMBING o HVAC ❑ INSULATION INSPECTION to be completed after insulation and vapor barrier are in place, but before they are covered or concealed. ❑ FINAL INSPECTION to be completed for each category below after all work is completed, but before use or occupancy. o BUILDING o ELECTRICAL o PLUMBING o HVAC INSPECTION RESULTS will be posted on the doorjamb of a bathroom (residential) or near the front door (commercial). Work shall not proceed until required inspections are completed and approval has been granted. If a required inspection is not completed within two working days after proper notification has been given, the contractor may proceed to the next phase of construction. THE MIDDLETON BUILDING CODE REQUIRES THAT A CERTIFICATE OF OCCUPANCY BE ISSUED BY THE BUILDING INSPECTOR PRIOR TO THE OCCUPANCY OR USE OF THE BUILDING. THIS ALSO COVERS USING A BUILDING FOR STORAGE OR MOVING ITEMS INTO THE BUILDING.