Plumbing Permit Application PDF Details

Are you thinking about doing some work on your home's plumbing? If so, it's important to make sure that you get the proper permits from your local government first. In many cases, this process can be relatively simple - all you need is a plumbing permit application form. Fortunately, you don't have to go through the trouble of tracking down one of these forms on your own - we've got them all right here on our website. Just download the document that corresponds to your location, and you'll be ready to get started.

We've gathered some technical information regarding the plumbing permit application. Prior to fill out the form, it is usually definitely worth learning more details on it.

QuestionAnswer
Form NamePlumbing Permit Application
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesVIII, Michigan, VIIa, 23a

Form Preview Example

Plumbing Permit Application

I. Job Location

Authority:

1972 PA 230

Completion:

Mandatory to obtain permit

Penalty:

Permit cannot be issued

 

 

NAME OF OWNER/AGENT

 

 

 

 

 

HAS A BUILDING PERMIT BEEN OBTAINED FOR THIS PROJECT?

 

 

 

 

 

 

 

Yes

No

Not required

STREET ADDRESS AND JOB LOCATION (Street Number and Name)

NAME OF CITY, VILLAGE OR TOWNSHIP IN WHICH JOB IS LOCATED

COUNTY

 

 

 

City Village

Township OF:

 

 

 

II. Contractor / Homeowner Information

 

 

 

 

 

 

 

 

 

INDICATE WHO THE APPLICANT IS

NAME OF PLUMBING CONTRACTOR OR HOMEOWNER

CONTRACTOR LICENSE NUMBER EXPIRATION DATE

Contractor

Homeowner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Master

Water Treatment Installer

 

 

 

 

 

 

 

 

 

ADDRESS (Street Number and Name)

 

 

CITY

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER (Include Area Code)

 

 

 

 

FEDERAL EMPLOYER ID NUMBER (or reason for exemption)

 

 

 

 

 

 

 

 

 

WORKERS COMPENSATION INSURANCE CARRIER (or reason for exemption)

 

UIA NUMBER (or reason for exemption)

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF MASTER PLUMBER

 

 

 

 

 

 

MASTER LICENSE NUMBER

 

EXPIRATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BUSINESS / BRANCH ADDRESS

 

 

CITY

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

III. Type of Job

Single Family

 

New

Sewer Only

Water Service Premanufactured Home Setup (State Approved)

State Owned

 

Other

 

Alteration

Special Inspection

Only

Manufactured Home Setup (HUD Mobile Home)

School

 

 

IV. Plan Review Required

Plans must be submitted with an Application for Plan Examination and the appropriate deposit before a permit can be issued, except as listed

below.

 

Plans are not required for the following:

 

1.

One-and two-family dwelling containing not more than 3,500 square feet of building area.

2.

Alterations and repair work determined by the plumbing official to be of a minor nature.

3.

Buildings with a required plumbing fixture count less than 12.

 

4.

Work completed by a governmental subdivision or state agency costing less than $15,000.00.

If work being performed is described above, check box below “Plans Not Required.”

 

Plans are required for all other building types and shall be prepared by or under the direct supervision of an architect or engineer licensed pursuant to 1980 PA

299 and shall bear that architect’s or engineer’s seal and signature.

 

Plan Review Project No. _______________________________________

Plans Not Required

V. Applicant Signature

Section 23a of the state construction code act of 1972, 1972 PA 230, MCL 125.1523A, 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 subjected to civil fines.

SIGNATURE OF PLUMBING CONTRACTOR, MASTER PLUMBER, WATER TREATMENT INSTALLER OR HOMEOWNER (Homeowner’s signature indicates

DATE

compliance with Section VI. Homeowner Affidavit)

 

 

 

VI. Homeowner Affidavit

I hereby certify the plumbing 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 Michigan Plumbing Code and shall not be enclosed, covered up, or put into operation until it has been inspected and approved by the Plumbing Inspector. I will cooperate with the Plumbing Inspector and assume the responsibility to arrange for necessary inspections.

Complete Application on Back Side

VIIa. Fee Clarification

Item #2, Mobile Home Unit Site: WHEN item is used for sewer excavations in a new park, the permit application should include the application fee plus the number of unit sites. WHEN setting a mobile home in a park, or a mobile or modular home on private property, a permit should include the application fee, a sewer or building drain, and a water service or water distribution pipe.

VIIb. Fee Clarification (continued)

Item #3, Fixtures, Floor Drains, Special Drains and Water Connected Appliances Include:

 

Water Closets

Sink (any description)

Slop Sink

Drinking Fountain

Floor Drain

Water Outlet or Connection to any Make-up Water Tank

Bathtub

Emergency Eye Wash

Bidet

Condensate Drain

Roof Drain

Water Outlet or Connection to Heating System

Lavatories

Emergency Shower

Cuspidor

Washing Machine

Grease Trap

Water Outlet or Connection to Filters

Shower Stall

Garbage Grinder

Dishwasher

Acid Waste Drain

Starch Trap

Connection to Sprinkler System (Irrigation)

Laundry Tray

Water Outlet Cooler

Refrigerator

Embalming Table

Plaster Trap

Water Connected Sterilizer

Urinal

Ice Making Machine

Water Heater

Bed Pan Washer

Water Softener

Water Connected Dental Chair

Autopsy

Water Connected Still

 

 

 

Water Connection to Carbonated Beverage Dispensers

Plus Any Other Fixture, Drain or Water Connected Appliance Not Specifically Listed

Item #25, Domestic Water Treatment and Filtering Equipment: A license is not required for the installation of domestic water treatment and filtering equipment that requires modification to an existing cold water distribution supply and associated water piping in buildings if a permit is secured, required inspections performed and the installation complies with the applicable code. If the enforcing agency determines a violation exists, it shall be corrected by the responsible installer. The permit application shall include the application fee, the number of water treatment devices recorded in item #25 for $5.00 each and the appropriate water distribution pipe (system) size fee.

VIII. Fee Chart - Enter the number of items being installed, multiply by the unit price for total fee.

Fee

# Items

Total

1.Application Fee (non-refundable)

2.Mobile Home Park Site*

3.Fixtures, floor drains, special drains, water connected appliances

4.Stacks (soil, waste, vent and conductor)

5.Sewage ejectors, sumps

6.Sub-soil drains

Water Service

7.Less than 2”

8.2” to 6”

9.Over 6”

10.Connection (bldg. drain-bldg. sewers)

Sewers (sanitary, storm or combined)

11.Less than 6”

12.6” and Over

13.Manholes, Catch Basins

* See VIIa. Fee Clarification Item #2 on front **See VIIb. Fee Clarification Item #25 above

IX. Instructions for Completing Application

Fee

# Items

Total

Water Distributing Pipe (system)

14.3/4” Water Distribution Pipe

15.1” Water Distribution Pipe

16.1-1/4” Water Distribution Pipe

17.1-1/2” Water Distribution Pipe

18.2” Water Distribution Pipe

19.Over 2” Water Distribution Pipe

20.Reduced pressure zone back-flow preventer

25.Domestic water treatment and filtering equipment only**

26.Medical Gas System Inspections

21.Special Insp. (pertaining to sale of building)

22.Additional Inspection

23.Final Inspection

24.Certification Fee

Total Fee

General: Plumbing work shall not be started until the application for permit has been filed. All installations shall be in conformance with the Michigan Plumbing Code. No work shall be concealed until it has been inspected. 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.

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 180 days after issuance of the permit or if the authorized work is suspended or abandoned for a period of 180 days after the time of commencing the work. A PERMIT WILL BE CLOSED WHEN NO INSPECTIONS ARE REQUESTED AND CONDUCTED WITHIN 180 DAYS

OF THE DATE OF ISSUANCE OR THE DATE OF A PREVIOUS INSPECTION. CLOSED PERMITS CANNOT BE REFUNDED.

The Department will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability or political beliefs. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency.

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