Department of Community Planning and Development Services
Inspection Services Division
240-314-8240 / 240-314-8265 (Fax)
www.rockvillemd.gov/isd
Application for Plumbing Permit
Please type or print clearly. Incomplete applications cannot be processed.
Property Address: ______________________________________________________________
Property Owner: _______________________________ Phone: (_____) ______ - ___________
Property Owner’s Address (if different): _____________________________________________
NEW CONSTRUCTION EXISTING CONSTRUCTION
Type of use: Residential (Single Family) Commercial (including multi-family residential)
Are you adding new fixtures or equipment: Yes No Existing water line size: _________
Existing water meter size: _________
Existing sewer line size: _________
Total Number of Existing Fixtures_______
NOTICE: Water Service Demand calculations are required for all residential plumbing permit applications that involve the installation of additional
fixtures. Calculations must be based on the International Residential Code (IRC) or the International Plumbing Code (IPC).
Fixtures & Equipment
Enter number of fixtures or equipment (Total number of fixtures _______ )
Sink, kitchen
Dishwasher*
Water closet, mop sink
Sink, laundry tray
Ice maker
Urinal
Sink, floor
Insta-hot
Bidet
Sink, compartment*
Drinking fountain
Shower
Sink, lavatory
Washer standpipe
Bathtub
Hose bib/sill cock
Water heater
Drain, floor
Pressure tank
Water heater, tankless
Backflow preventer
Yard/wall hydrant
Water softener
Backwater valve
Mixing box
Dental pump equipment
Air admittance valve
Emergency eyewash
Recirculating/water booster pump
Swimming pool fill line
Emergency shower
Grinder pump
Ejector pump
Drain, floor
Drain, roof
Drain, trench
Trap primer
Lawn irrigation connection
Neutralizer for special waste
Other
(Please list)
Wok Station*
Information on materials/chemical(s) to be
neutralized is required. Provide information on
separate sheet at the time of permit application.
Greaser interceptors: _____ Size: _____ gal. Oil separator/interceptors: _____ Size: _____ gal.
Interceptor Location: ______________________________________________________________
NOTE: Outside installations require a site plan showing exact location of interceptor or separators. Information on manufactures
listing and construction may be required. Interceptors cannot be located in areas designated as parking spaces.
*Indicates these fixtures should be connected to a grease interceptor
Revised 07/08/11
Taps, Services, and Meters
Meters (size in inches)
Existing meter size: _____ New meter size: _____ Fire meter size: _____
Sub-meter size: _____ Hydrant meter on private property: _____
(Must be related to construction activity. A meter deposit is required.)
Taps (size in inches)
Existing tap size: Water: _____ Sewer: _____ Fire: _____
New tap size: Water: _____ Sewer: _____ Fire: _____
Services (size in inches)
Replacement water service: _____ Length: _____
Replacement sewer line: _____ Length: _____
New water service: _____ Length: _____
New sewer line: _____ Length: _____
New connection, repair, or replacement material
Water connection material: _______________________________________ Length: _________ ft.
Sewer connection material: _______________________________________ Length: _________ ft.
I hereby certify that I have the authority to make the foregoing application, that the application is correct, and that the construction
shall conform to the Rockville City Code, and all other codes and regulations or private building restrictions, if any, which may be
imposed on the above property by deed. 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. I have read and understand the
Permit Conditions available from the Inspection Services Division.
Business Name:
Master’s Plumbers Name:
Phone
#
Address:
City License #:
Master’s Signature:
ORIGINAL SIGNATURE REQUIRED
Date:
FEES ARE NON-REFUNDABLE
All persons who perform taps on City property must hold a WSSC tap license: A separate permit must be obtained from the City
of Rockville Public Works Department for all work within the City of Rockville right-of-way.
A water and sewer location card must be completed and provided to the plumbing inspector at the time of inspection for all new
and replacement water services and sewer lines.
Homeowners are prohibited from installing water or sewer laterals, and meter settings.
The Master Plumber listed on the permit application, or authorized representative of the Master Plumber, must install all meters.
Permit will expire 6 months after issuance if no inspections have been made and the work covered by the issued permit has not
started. Request for permit extensions must be made prior to the permit expiration date indicated on your permit. Expired
permits cannot be re activated.
No work is to be covered or otherwise concealed without inspection.
Revised 07/08/11