HomeMy WebLinkAboutPlumbing Permit Application (Fillable)Ver 6 .0 01/18/2012 DEPARTMENT OF PUBLIC WORKS COUNTY OF HAWAI ‘I BUILDING DIVISION PLUMBING PERMIT APPLICATION READ CONDITION BELOW Permitee is qualified to do the work and possess a valid license pursuant to the provisions of Chapter 444 or 448E of the Haw ai ‘i Revised Statutes. Permi tee is hereby authorized to install the plumbing as shown, in accordance with provisions of the County of Hawai ‘i Plumbing code as amended. Per Section 17 -18 (f) of the Hawai ‘i County Code (“Suspension or Revocation”), the administrative authority may, in writing, suspend or revoke a permit issued under provisions of this code whenever the permit is issued in error, or on the basis of incorrect information supplied, or in violation of any ordinance o r regulation or any of the provisions of this code. Thi s permit becomes null and void if work is suspended at any time during construction for 120 days or more, or if any work is d one on the same building or structure in violation of the County of Hawai ‘i Plumbing Code or State Statutes governing same. Refund request for permit fee paid must be received by the Building Division within 90 days from issue date of this permit. Notification for Inspection is mandatory. I h ereby acknowledge that I have read this application and state that the above is correct and a gree to comply with all County and State Laws regarding plumbing. M Z S PL PAR LOT (3) B UI LD ING PERMIT# APPLICATION NUM BER #A: MAIL TO: PICK UP PHONE # PERMITEE’S SIGNATURE ** DATE JOURNEYMAN’S SIGNATURE ** DATE APPROVED BY SIGNATURE DATE ** Signature required Hawai‘i County is an Equal Opportunity Provider and Employer Legal Owner Phone Plumbing Contractor License No Phone Lessee/Tenant Phone Addr e ss Cell PROJECT LOCATION: Email EST COST OF WORK: Journeyman License No Phone Engineering Date Flood Zone Address TYPE OF WORK RE SIDENTIAL NON -RESIDENTIAL NEW REPAIR GAS AS BUILT NO WORK STARTED IRRIGATION ADD ITION SOLAR SEWER CONNECTION ABANDONED CESSPOOL PLUMBING ONLY ALTERATION OTHER SUPPLEMENT TO M______________________ STRUCTURE CONNECTED TO: PUBLIC SEWER* Wastewater Approval _________________________________________________ Received Electronic Approval *Sewer connection shall be approved by Waste Management prior to backfilling. Failure to notify the divi sion may result in re -excavation for in spection. PRIVATE SEWER CESSPOOL SEPTIC SYSTEM DESCRIPTION OF WORK DETAILS ON BACK FEE DRAINAGE AND WATER SUBTOTAL $ FUEL GAS SYS TEM SUBTOTAL $ BASE PERMIT FEE $ 10.00 WAIVER $ PENALTY FEE $ CHECK NO.: TOTAL FEE $
Ver 6 .0 0 1/1 8 /201 2 DRAINAGE AND WATER SYSTEM QTY ITEM UNIT CHARGE FEE Bathtubs Rough In Only Rough In Qty ____ @ $ 4.00 Dishwashers @ $ 4.00 Drinking Fountains @ $ 4.00 Floor Drains @ $ 4.0 0 Floor Sinks @ $ 4.00 Garbage Disposals @ $ 4.00 Grease Interceptors @ $12.00 Interceptors (Sand, dirt, etc…) @ $12.00 Laundry Trays @ $ 4.00 Showers Rough In Only Rough In Qty ____ @ $ 4.00 Sinks (Kitchen) Rough In Only Rough In Qty ____ @ $ 4.00 Sinks, Bar @ $ 4.00 Sinks, Service @ $ 4.00 Sinks, Hand @ $ 4.00 Sinks, 3 compartment @ $ 4.00 Stand Pipe w/trap (clothes washers ) @ $ 4.00 Sumps (Sewage) @ $12.00 Urinals @ $ 4.00 Wash Basins Rough In Only Rough In Qty ____ @ $ 4.00 Water Closets Rough In Only Rough In Qty ____ @ $ 4.00 Building Sewer or Building Drain Stubout @ $20.00 Sanitary Drainage &/or vent piping ( Add., Alter ., Repair) @ $20.00 Grey Water Drainage (Utility Room ONLY) @ $20.00 Vacuum Breakers or Backflow Device @ $12.00 Water Heaters (Electric, Gas, Oil, Solar) @ $ 4.00 Water Piping ( Add., Alt., Repair) @ $ 4.00 Water Spri nkling System including backflow preventer (Lawn, garden, etc.) @ $12.00 Water Supply System @ $ 4.00 Water Treatment Equip. (UV Filter) @ $ 4.00 Water Pump @ $ 4.00 MISC. FIXTURES @ $ 4.00 @ $ 4.00 DRAINAGE AND WATER SYSTEM SUB TOTAL $ FUEL GAS SYSTEM QTY ITEM UNIT CHARGE FEE Gas Piping (For the installation of gas appliances) @ $12.00 Gas Piping System (Lab Equip. or other misc. outlets) @ $12.00 Gas Piping System (Ext. Lamps, Luau torches, etc.) @ $12.00 Broilers (Gas) @ $ 4.00 Dryers @ $ 4.00 Hot Plates @ $ 4.00 Ovens @ $ 4.00 Ranges @ $ 4.00 Refrigerators @ $ 4.00 (Gas) Water Heater gas connection @ $ 4.00 Fireplace @ $ 4.00 BBQ @ $ 4.00 MISC. APPLIANCES @ $ 4.00 @ $ 4.00 FUEL GAS SYS TEM SUBTOTAL $