Page 17 - 2018 Residential Building Packet

PLUMBING PERMIT APPLICATION 2801 89TH STREET, STURTEVANT WISCONSIN 53177-0595

DATE: PERMIT NO: TAX KEY NUMBER:
OWNER’S NAME: PHONE NUMBER:

JOB SITE ADDRESS:

______ Water Closets FIXTURES & CONNECTIONS ______ Garbage Disposal
(NUMBER OF ITEMS THAT APPLY)

______ Water Heaters

______ Bath Tubs ______ Dishwasher ______ Catch Basin

______ Sinks ______ Urinals ______ Bar Connection

______ Laundry Trays ______ Showers ______ Water Softener

______ Floor Drains ______ Storm Sump ______ Other

______ Wash Basin ______ Sanitary sump ______ Sill Cocks

______ Wash Machine Box

# ______ of fixtures @ $15.00 per fixture

Connection to main sewer, holding tank/mound $90.00 plus $.75 per ft. for each ft. over 100 ft.

Storm sewer installation $90.00 plus $.75 per ft. for each ft. over 100 ft.

Building sewer abandonment @ $70.00

Septic tank abandonment @ $80.00

Well abandonment or registration @ $80.00

Sanitary building drain @ $90.00 plus $.75 for each ft. over 100 ft.

Storm building drain @ $90.00 plus $.75 for each ft. over 100 ft. (COMMERICAL ONLY)

TOTAL PERMIT FEE:

TOTAL ESTIMATED JOB COST:

RE-INSPECTION FEE: $175.00

MINIMUM FEE: $70.00 ALL FEES EFFECTIVE JANUARY 2014

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It is hereby agreed between the undersigned (as owner or agent) and they theVillage of Sturtevant, that for and in consideration of the premises and of the

permit for the execution of plumbing installation for pipes, drain, fixtures, etc. as above described, to be issued and granted by the inspector of buildings, that

the work will be done in accordance with the descriptions set forth in this statement, and it is further agreed to alter or install same in strict compliance with the

Ordinances of the Village of Sturtevant, with Wisconsin Statues and Administrative Code, and to obey any and all lawful orders of the Plumbing Inspector of

theVillage of Sturtevant. Inspections shall be one trip for the rough, and final, and building service, with one re-inspection if needed. Additional trips, the re-

inspection fee will apply per trip. To schedule inspections call (262) 664-7847.

CONTRACTOR CREDENTIAL#__________________________MP LICENSE#_________________________________

COMPANY NAME: PHONE:

BUSINESS ADDRESS: CITY: STATE: ZIP CODE:

APPLICANTS SIGNATURE:

APPROVED BY: DATE:

PLUMBING INSPECTOR rev 2014