Plumbing Subcode Permit

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Executive Summary

This document appears to be a Plumbing Subcode Permit application form for Woodlynne, New Jersey. It includes sections for applicant identification, technical site data (listing of plumbing fixtures), plumbing characteristics (use group, piping, sewer and water information), and a job summary for office use. The form also includes a certification section, fee calculation, and routing information for copies.

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Document Text

--- Document: Plumbing Subcode Permit Document ---
PLUMBING
US
INFORMCONSTRUCTO
SUBCODE
NEW JERSEY
TECHNICAL SECTION
A. IDENTIFICATION-APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000.
Date Received
Date Issued
Control #
Permit #
D. TECHNICAL SITE DATA (List of all fixtures.)
NO.
FIXTURE/EQUIPMENT
Block
Work Site Location
Owner in Fee
Address
Tele. (
Contractor
Address
Lot
Water Closet
Urinal/Bidet
Bath Tub
Lavatory
Shower
Floor Drain
Sink
Dishwasher
Drinking Fountain
Washing Machine
$
Tele. (
Fax (
)
Lic. No.
Federal Emp. No.
B. PLUMBING CHARACTERISTICS
Use Group
Present
Proposed
Hose Bibb
Water Heater
Fuel Oil Piping
Gas Piping
Steam Boiler
Hot Water Boiler
Building Sewer Size
Public Sewer
Water Service Size
Public Water
Private Septic
Private Well
Sewer Pump
Est. Cost of Plumbing Work $
Interceptor/Separator
Backflow Preventer
JOB SUMMARY (Office Use Only)
Greasetrap
Sewer Connection
PLAN REVIEW
INSPECTIONS
[ ] No Plans Required
Type:
Failure
Dates (Month/Day)
Failure
Water Service Connection
Approval Initial
Stacks
Joint Plan Review Required:
Slab
Other
[ ] Building
[ ] Electric
Rough
Other
[ ] Fire
[ ] Elevator
Water
Other
[ ] Plumbing Plans Approved
Sewer
Date:
Fixtures
Approved by:
Gas Equipment
Administrative Surcharge
Gas Piping
SUBCODE APPROVAL
Solar
$
Minimum Fee
$
DCA Training Fee
$
TOTAL FEE
$
[ ] CO [ ] CCO
[ ] CA
TCO
Date:
Approved by:
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.
Signature - Contractor's Seal
I] Licensed Plumbing Contractor
[ ] Exempt Applicant
FEE (Office Use Only)
UCC F130
1 White Inspector Copy
2 Canary = Office Copy
(rev 3/96)
3 Pink = Office Copy
4 Gold Applicant Copy