Online Plumbing Application

Property Address:

Property Owner(s) Name:

(if different from applicant's name)

Applicant's Information:

Date:

Owner/Applicant Statement

I certify that the information submitted is corrected to the best of my knowledge and understand that any falsification is reason for the Local Plumbing Inspector(s) to deny a permit

This application is for:

New Plumbing	Yes
Relocated Plumbing	Yes

Type of structure to be served:

Single Family Dwelling	Yes
Modular or Mobile Home	Yes
Multiple Family Dwelling	Yes
Other (specify below):	Yes

Plumbing to be installed by:

Master Plumbing	Yes
Oil Burnerman	Yes
MFG'd. Housing Dealer/Mechanic	Yes
Public Utility Employee	Yes
Property Owner	Yes

License Number:

Column 1:

Number	Type of Fixture
	Hosebib / Sillcock
	Flood Drain
	Urinal
	Drinking Fountain
	Indirect Waste
	Water Treatment Softener, Filter, Etc.
	Grease / Oil Separator
	Roof Drain
	Bidet
	Other:
	Fixture (subtotal) Column 1

Column 2:

Number	Type of Fixture
	Bathtub (and Shower)
	Shower (separate)
	Sink
	Wash Basin
	Water Closet (Toilet)
	Clothes Washer
	Dish Washer
	Garbage Disposal
	Laundry Tub
	Water heater
	Fixture (subtotal) Column 2

Hook-Up & Piping Relocation

Maximum of 1 Hook-Up

	Hook-Up: to public sewer by those cases where the connection is not regulated and inspected by the local sanitary district.
	Hook-Up: to an existing subsurface wastewater disposal system.
	Piping Relocation: of sanitary lines, drains, and piping without new fixtures.

OR

Transfer Fee ($10.00)

SEE PERMIT FEE SCHEDULE FOR CALCULATING FEE

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Totals

	Total Fixtures
	Fixture (subtotal) Column 1
	Fixture (subtotal) Column 2
	Fixture Fee
	Transfer Fee
	Hook-Up & Relocation Fee
	Permit Fee (total)

Permit Information:

Type of Fixture:

OR

Town Office Address

CONTACT