Residential Plumbing Permit
Residential Plumbing Permit
Residential Plumbing Permit
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Paper from GIS must be submitted with thisapplication. All new addresses contact theGIS Department at (740) 455-7195NO PAPER NO PERMITIsometric DrawingRequired<strong>Plumbing</strong> permit appliesto job locationApplicant: check one <strong>Plumbing</strong> Contractor Homeowner<strong>Permit</strong> No.Date Received<strong>Residential</strong> Application for <strong>Plumbing</strong> <strong>Permit</strong>/Plan ReviewStreet Address of JobJob Site InformationName/CompanyCityTownshipAddress (number & street)Building Owner’s NamePhone No.CityStateZipBuilding Owner’s AddressPhone Number<strong>Plumbing</strong> ContractorRegistration No.I agree to install the plumbing in accordance with the plans as approved by the Board of Health.I further agree to call for inspection(s) as required by the Board section 4101:3-1 thru 4101:3-13 O.A.C.Signature of <strong>Plumbing</strong> Contractor/HomeownerCity State ZipBuilding Type: New Existing Apartments HomeUndergroundInspectionsWater Temps Inspector WitnessW.H. Water Pressure #LavShoRough InBath Tub _____Reinspection fee………….…… $50.00(must be paid before final)Final Insp.Application fee……………………………………………………….… $ 50.00___CommentsTotal fixture count from above: _______X $15.00…………………Plan review fee……:…………………………………………………..Custom Shower Inspection of $ 50.00$ ____________$ ____________$ ____________<strong>Permit</strong>s left dormant for more than one year are subject to review andrevocationPenalty for Installing <strong>Plumbing</strong> Prior to <strong>Permit</strong> ($150.00 Penalty)… $ _____________Total <strong>Plumbing</strong> Fees by totaling entries from above………………$ _____________
<strong>Permit</strong> #Complete job site addressOffice useonlyFixturesNo.FixturesFixtures1 Air Admittance Valve 21 Pressure Reducing Valve2 Automatic Washer 22 Recirculating Pump/Line3 Backflow Devices 23 Sewage Ejector4 Backwater Valve 24 Shower Stall5 Bath Tubs 25 Custom Built Shower6 Bidets 26 Sink, Bar7 Booster Pump 27 Lavatory8 Building Drain 28 Sink, Kitchen9 Building Sewer 29 Sump Pump10 Dishwasher 30 Tempering Valve11 Drains, Floor /Hub 31 Thermal Expansion Tank12 Drains, Roof 32 Trap Primer13 Drain, Storm 33 Urinals14 Drinking Fountain 34 Water Closets15 Garbage Disposal 35 Water Heater16 Hose Bibb / Outside Faucet 36 Water Softener/RO17 Ice Maker Outlet 37 Water Service18 Inside Water Piping 38 Other19 Lawn Irrigation20 Laundry TubTotal fixture countNo.FixturesReinspection Fee ……..$50.00<strong>Plumbing</strong> fixture worksheet <strong>Residential</strong>(must be paid before final)Application fee……………………………………………..………… $50.00____Total fixture count from above: ___________X $15.00………..….$ _____________Plan review fee…..:……………………………..…………….……..$ _____________Custom Shower Inspection Fee ____$50.00_______$ ______________Penalty for Installing <strong>Plumbing</strong> Prior to <strong>Permit</strong> ($150.00 Penalty)….$ ____________Total <strong>Plumbing</strong> Fees by totaling entries from above………………$ ______________Plan Review Fees1 – 20 Fixtures $50.0021 – 40 Fixtures $75.0041 – 60 Fixtures $100.0061 – 80 Fixtures $125.0080 + $150.00<strong>Permit</strong>s left dormant for more than one year are subject to review and revocation.
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