Plumbing Subcode Technical

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Executive Summary

This document is identified as a Plumbing Subcode Technical Document, specifically a U.C.C. F130 form for a plumbing permit application. It outlines fields for applicant identification, technical site data, a description of plumbing work including fixture quantities and associated fees, and certification details. The form requires information such as the work site location, owner and contractor details, and estimated cost of plumbing work for permit purposes, rather than soliciting bids for a project.

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--- Document: Plumbing Subcode Technical Document ---
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PLUMBING SUBCODE
TECHNICAL SECTION
B. PLUMBING CHARACTERISTICS
U.C.C. F130 (rev. 11/09)     1 White = Inspector Copy     2 Canary = Office Copy     3 Pink = Office Copy     4 Gold = Applicant Copy
D. TECHNICAL SITE DATA
Date Received
Control #
Date Issued
Permit #
A. IDENTIFICATION—APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000.
Block
Lot
Qualification Code
Work Site Location
zip code
municipality
street
Address
e-mail
Tel. (              )
Owner in Fee:
Exp. Date
Contractor License No.
Federal Emp. ID No.
FAX:
(              )
Home Improvement Contractor Registration No. or Exemption Reason (if applicable):
DESCRIPTION OF WORK
Est. Cost of Plumbing Work    $
Private Well
Public Water
Water Service Size
Private Septic
Public Sewer
Building Sewer Size
Proposed
Present
Use Group
Contractor:
Tel.
(              )
Address
e-mail
Sink
Floor Drain
Shower
Lavatory
Bath Tub
Urinal/Bidet
Water Closet
Backflow Preventer
Interceptor/Separator
Sewer Pump
Washing Machine
Hot Water Boiler
Steam Boiler
Gas Piping
Fuel Oil Piping
Water Heater
Hose Bibb
Drinking Fountain
Dishwasher
LPGas Tank
Greasetrap
Stacks
Sewer Connection
Water Service Connection
Other
$
TOTAL FEE
State Permit Surcharge Fee
Minimum Fee
Administrative Surcharge
FIXTURE/EQUIPMENT
QTY.
FEE (Office Use Only)
$
$
$
$
[    ]  Licensed Plumbing Contractor      [    ]  Exempt Applicant
C. CERTIFICATION IN LIEU OF OATH
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application and perform the work listed on this application.
Gas Piping
Gas Equipment
Sewer
Water
Rough
Slab
LPGas Tank
Fixtures
TCO
Solar
Fuel Oil Piping
Final
Print name here:
Applicant sign/Contractor
sign and seal here:
Approved by:
Date:
Type:
Dates (Month/Day)
INSPECTIONS
Initial
Approval
Failure
Failure
JOB SUMMARY (Office Use Only)
PLAN REVIEW
Joint Plan Review Required:
Approved by:
Date:
CA
[    ]
CO
SUBCODE APPROVAL for CERTIFICATE
[    ]
[    ] CCO
SUBCODE APPROVAL for PERMIT
Date:
Approved by:
[   ] Bldg.   [   ] Elec.   [   ] Fire.   [   ] Elev.
No Plans Required
[   ]
Plumbing Plans Approved
[   ]
Partial -Underslab Utilities Approved
[   ]
Approved by:
Date: