APPLICATION FOR GAS PERMIT
TOWN OF TRINITY
Job Site Address Lot #
Owner or Builder Phone #
Gas Plumber Phone #
Type of Work To Be Performed: ______ New Construction______ Existing Bldg.
UNumber of BTU’s per Appliance
Grill - _____________________ Logs_______________________________
Unit Heater ________________ Furnace ____________________________
Range _____________________ Water Heater _______________________
Dryer______________________ TOTAL BTU _________________________
Max. Piping Distance_____________________ Size of Piping_________________
Contract Amount________________________
Permits are valid for six (6) months after insurance unless extended by the Building Inspector.
Where work for which a permit is required is started or proceeded prior to obtaining said permit,
the fees shall be doubled, but the payment of such double fee shall not relieve any persons from fully
complying with the requirements of the 2003 IRC/2003 International Fuel Gas Code in the
execution of the work nor from any other penalties prescribed herein.
I hereby certify that the information contained herein is true and correct. Falsification of this
information is grounds for revoking the permit. All provisions of laws and ordinances governing
this type of work be complied with whether specified here or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Required inspections:
1
P
st
P- Concealed
2
P
nd
P- Rough – End
3
P
rd
P- Final
SIGNATURE OF CONTRACTOR DATE
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OFFICE USE ONLY
PERMIT FEE $___________________________ RECEIPT # ___________________
_____________________________________________________________UG-_______________
Issued by Date Permit Number
