Fillable FORM NO. BI 10 Rev 8/19: Application for (City of Virginia Beach)

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FORM NO. BI 10 Rev 8/19: Application for (City of Virginia Beach)

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FORM NO. BI 10 Rev 8/19
Application for Plumbing Permit
CITY OF VIRGINIA BEACH ∙ PERMITS AND INSPECTIONS
2875 Sabre Street, Suite 500 · Virginia Beach, VA 23452 · (757) 385-8066
FAX (757) 385-5777 · www.vbgov.com/buildingpermits
Date ___________________ Associated Permit # ____________________________
A permit is hereby requested for the following construction at:
Street address: __________________________________________________________ Lot #/Suite #: ___________________
GPIN: __________________________________________________________________________________________________
Owner/Occupant Name: ___________________________________________________ Owner Phone #: _________________
Email Address: __________________________________________________________ Cell Phone #: _________________
Company Name: ________
___________________________________________ State Registration #: ____________________
Contract Value: $
Building Type: New Addition Existing Moved
Residential Commercial
Equipment: New Replacement Relocation
Public Utilities Receipts #:
Fixtures:
Residential Only: Full Bath Groupings __________ Half Bath Grouping: __________ Kitchen Sink/Dishwasher: __________
Service Lines and Site Appurtenances * DSC approved plans required
Drains
Master Tradesman/Owner Name (Please Print): ________________________ Master Tradesman/Owner Signature: ____________________________
I und
erstand this permit is granted only for the work shown and described in this application.
Any falsification, misrepresentation, or misleading information given VOIDS this permit.
** FOG Compliance and Grease Trap Plan Approval: ________________________________________________________________________________
On-Site Water Distribution*: 1 Building 2+ Buildings: ________
On-Site Sewer Collection*: 1 Building 2+ Buildings: ________
Interior Line Replacement: Water Sewer
Exterior Line Replace/Reroute: Water Sewer
Conversion (PU Receipt Required) Water Sewer
Cut-Off Water Sewer
Each
Backflow DC
Backflow PVB
Backflow RP
Backflow Removal
Booster Pump
Clean Out
Force Main
Grease Trap **
Grinder Pump
Sub-Meter
Sump Pump
Each
2 Compartment Sink
3 Comp Sink LG 2”
3 Comp Sink SM 1-1/2”
Baptismal
Bar Sink
Bathtub
Bidet
Clinical Sink/FlushingRim/HopDrain
Dental Lav/Cuspidor
Dipper Well
Dishwasher
Drinking Fountain
Electric Water Heater
Eye Wash
Gas Water Heater
Hand Sink
Hose Bibb (Attached)
Hose Bibb (Detached)
Ice Cream Machine
Ice Machine
Jacuzzi Tub
Kitchen Sink
Laundry Tub
Lavatory
Medline (Surgical Vacuum)
Medline (Waste)
Mop Sink 2” Trap
Mop Sink w/ 3” P-Trap
Oil/Water Separator
Pedicure Chair
Each
Private Water Closet
Public Water Closet
Shampoo Sink
Shell Building
Shower
Shower (Outside)
Shower Pan
Surgeons Sink
ULF Rebate
Urinal
Vegetable Sink
Washing Machine (Com/Res)
Each
Roof Drain
Trench Drain: 2”
Trench Drain: 3”
Trench Drain: 4”
Trench Drain: 6”
Each
Open Site/Hub Drain 1.5”
Open Site/Hub Drain 2”
Open Site/Hub Drain 3”
Open Site/Hub Drain 4”
Open Site/Hub Drain 6”
Each
Floor Drain/Floor Sink 1.5”
Floor Drain/Floor Sink 2”
Floor Drain/Floor Sink 3”
Floor Drain/Floor Sink 4”
Floor Drain 6”
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FORM NO. BI 10 Rev 819: Application for (City of Virginia Beach)

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Completed 4 June 2021

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