Fill - Free fillable Department of Community and Economic Development UNDERGROUND SPRINKLER (City of Green Bay) PDF form

City of Green Bay

Department of Community and Economic Development

100 North Jeffer

son Street, Room 608, Green Bay, Wisconsin 54301-5026

(p) 920.448.3300 (f) 920.448.3426 greenbaywi.gov

UNDERGROUND SPRINKLER SYSTEM PERMITS

Please note that an Underground Sprinkler System Permit application will not be

processed unless a Licensed Contractor Plumbing Permit is provided at the same

time. If work is being done in the right-of-way, a hold harmless agreement must also

be submitted at that time.

Underground Sprinkler companies must be licensed through the City of Green Bay.

For licensing information, call the Clerk's Office at (920) 448-3010 or visit the

Clerk's Office website at greenbaywi.gov.

www.greenbaywi.gov

Plumbing Contractor:________________________________________

(Licensed Contractor Plumbing Permit must be provided.)

Project Address:___________________________________________

Owner's Name:____________________________________________

Owner's Email: ________________________Phone #: _____________

Value of Work $___________________________________________

Contractor's Name:_________________________________________

Contractor's Address: _______________________________________

Contractor's Email: _________________________________________

Contractor's Phone #: _______________________________________

Contractor License #___________

Plumbing License #_____________

• 66HF*UHHQ%D\0XQicipal Ordinance. A permit shall be issued prior to commencing work, or

permit fees shall be doubled.

• Sec. 16.06(7)(a), Green Bay Municipal Ordinance. Plans and specifications for plumbing to be installed

in and/or outside all buildings, structures, parks, areas, or complexes shall be submitted to the

'HSDUWPHQWRICommunity and Economic Development for written approval prior to commencing

work.

• Sec. 9.33(1), Green Bay Municipal Ordinance. Any person intending to place a private transmission

facility in the public right-of-way shall obtain a revocable permit approved by the Common Council at

least 30 days prior commencing work.

• DSPS 382.41 All water systems shall be protected against contamination per requirements of DSPS

382.41.

• Sec. 145.06(1)(a), Wis. Stats. No person may engage in or work at plumbing in the state unless

licensed to do so by the department. Please note: cross-connection devices are required

to be installedbyalicensedplumberonly.

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

UNDERGROUND SPRINKLER

SYSTEM PERMIT APPLICATION

This section for City use only

Project #: ____________________

Permit Code:

____________________

Permit Fee: ____________________

____________________

Parcel #:

Receipt #:

Date:

____________________

The applicant agrees to comply with the City of Green Bay Municipal Ordinance, Wisconsin

Administrative Code, and with the conditions of approval; understands that the issuance of the permit

creates no legal liability, expressed or implied, on the 'HSDUWPHQWRU0XQLFLSDOLW\ and certifies that

all the above information is accurate.

Signature of Applicant _____________________________________________________________

Conditions of Approval

Submit completed applications, site plan, and fee to the above-listed address.

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at

least one business day in advance. Final inspections are required for all projects.

Check box for Online Payment

The information below must be provided for notification of project number and permit fee. This is

required to make payment on-line.

Phone _________________ Fax _________________

Email _____________________

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signature

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

www.greenbay.wi.gov

LICENSED CONTRACTOR

PLUMBING PERMIT

(INTERNAL)

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

All fields must be completed before permit will be processed.

Project Address:

Owner's Name:

Phone #: Owner's Email:

Plumbing/Utility Contractor:

Contractor’s Address:

Contractor's Email:

Contractor's Phone #:

Value of Work:

I hereby make application for a permit for the following described sewer/plumbing work at the above location.

General Interior Plumbing

Total Number of Fixtures

Total Number of Appliances

Total Number of Appurtenances

Total Count

Description of Work:

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one business

day in advance. Final inspections are required for all projects.

Contractor's Signature:

Master Plumber Credential #

Check box for Online Payment

The information below must be provided for notification of project number and permit fee. This information is required to make

payment online.

Phone

Fax

Excerpt from City of Green Bay Plumbing Code:

Section 16.06 Permit must be procured before starting work: If any work regulated by the Plumbing Ordinance for which a permit is required

is commenced without a permit first having been obtained thereof, double the permit fee herein prescribed shall be paid when a permit finally

is obtained. Payment of any fee mentioned in this Section, however, shall in no way relieve any person of the penalties that may be imposed for

violation of the Plumbing Ordinance.

(Rev 6/2020)

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

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signature

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

C:\DocumentsandSettings\adriennegr\Desktop\UndergroundSprinklerPermit.docx_EEW_7.29.09



This Agreement made and entered into this ____ day of _______________, 20____, by and

betweentheCityofGreenBay(“CITY”)and__________________________________________

(“PROPERTYOWNER”).



WHEREAS, the undersigned is (are) the recorded owner(s)  ofParcelNo. __________, which is

commonlyknownas______________________________________,GreenBay,Wisconsin;and



WHEREAS,thePROPERTYOWNERdesirestoinstallaundergroundsprinkler(irrigation)system

intheCITY’spublicright‐of‐way;and



WHEREAS,theCommonCounciloftheCityofGreenBayhasenactedanordinancepermitting

theplacementofPrivateTransmissionFacilitiesintheCITY’spublicright‐of‐way;and



WHEREAS, the Private Transmission Facilities Ordinance requires that the PROPERTY OWNER

executea  hold harmlessagreementrelievingthe CITYfromanyandallliability growingoutof

theplacementofsuchprivatetransmissionfacility.



NOW,THEREFORE,itisagreedbyandbetweentheCITYandPROPERTYOWNERasfollows:



1. ThePROPERTYOWNERacknowledgesandagreesthattheyarefullyawarethatanyportion

ofanundergroundsprinklersystemlocatedwithintheCITY’spublicright‐of‐wayisclearlyat

riskandthatnoassurancesofitsprotectioncanbegivenbytheCITY.



2. ThePROPERTYOWNERunderstandsandagreesthattheCITYassumesnoresponsibilityfor,

or liability arisingout of, installation, car

e, operation, future maintenance or repair of any

portionoftheundergroundsprinklersystem.



3. The PROPERTY OWNER understands and agrees that the installation and existence of the

underground sprinkler system within the CITY’s public right‐of‐way shall not, in any way,

interferewiththerightof theCITY,itscontractorsorotherutilitiestoexcavatethereinfor

repair, maintenance or installation of any street, sidewalk, public utility,

telecommunication,cabletelevision,orforanyothernecessarypublicpurpose.



4. ThePROPERTYOWNER understandsandagreestheCITY willnot,under anycircumstance,

maintain, repair, or replace any portion of said system which might be subsequently

damaged or removed by any work, accident, and maintenance activity or construction

operationrelatedtoItem3above.



HOLDHARMLESSAGREEMENT/PERMIT

FORUNDERGROUNDSPRINKLERSYSTEM

INPUBLICRIGHT‐OF‐WAY



C:\DocumentsandSettings\adriennegr\Desktop\UndergroundSprinklerPermit.docx_EEW_7.29.09



5. All sprinkling heads shall be so located, shielded, adjusted or directed that they will not

sprinklerthepublicroadwayorpublicsidewalkwheninoperation.



6. Allsprinklingheadsshallbesoconstructedsothattheywillnotprojectabovegroundlevel

whennotinoperation.



7. The PROPERTY OWNER hereby agrees to indemnify and hold harmless the CITY from any

andallliability,lossordamagestheCITYmaysufferastheresultofclaims,demands,costs,

judgment, or legal fees, including attorney fees arising out of the installation, placement,

use,andoperationoftheundergroundsprinklersystemintheCITY’spublicright‐of‐way.



8. ThePROPERTYOWNERfurtheragreesthatitwillwaiveanyandallclaimsagainsttheCITY,

itsagents,officials,oremployeesthatariseoutofanydamagetotheundergroundsprinkler

systemwhilelocatedintheCITY’spublicright‐of‐way.



9. This hold harmless agreement shall commence on the date of the execution hereof by

PROPERTYOWNERandshallcontinueuntiltheundergroundsprinklersystemisabandoned

orremovedorthepermitisrevoked.



10. This Agreement shall be binding upon and inure to the benefit of the heirs, grantees,

successorandassignsofthepartiesheretoandshallconstituteacovenantrunningwiththe

land with respect to the private premises served by the underground sprinkler system

permittedhereunder.



PROPERTYOWNER:



____________________________________ ____________________________________



SignatureSignature



____________________________________ ____________________________________

 PrintNamePrintName



____________________________________ ____________________________________

 DateDate



CITY:



____________________________________

 DirectorofPublicWorks



____________________________________

 Date





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