Fillable Plumbing HVAC Worksheet (Town of Brookhaven)

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Plumbing HVAC Worksheet (Town of Brookhaven)

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Brookhaven

BROWSE TOWN OF BROOKHAVEN (NY) FORMS

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New construction must have a plumber’s signature.
Owner’s signature is acceptable only for an existing residential
Dwelling where the owner is doing the plumbing work. 1-2019
Plumbing HVAC Worksheet
Building Permit #: ___________ Date of Permit: __________Residential________Commercial: _________Worksheet Date:_________
Location of Building: _________________________________________ Section: ___________ Block: ___________ Lot: ____________
Owner Name: _____________________________________ Address: _______________________________________________________
Basement
1
st
Floor
2
nd
Floor
3
rd
Floor
Other
Fee
Total Units
Air Handlers
Blowers/Boilers/Space Heaters/Furnace
Central A. C.
Bath Tubs
Showers
(Floor) Drains
(Roof) Drains
Hand Sink
Kitchen Sinks
Lavatories (Bathroom Sinks)
Stacks (Number Of) Residential
Stacks (Number Of) Commercial
Urinals
Water Closets (Toilets)
Dishwasher
Drinking Fountain
Hot Water Supply – Oil/Gas Tank-less
Hydronic Solar Collectors
Indirect Waste
In-ground Tank Installation
Lawn Sprinklers
Outlet (Future)
Outside Hose Bibs
Utility Sinks/Laundry Tubs
Washing Machines
Other ( )
Other ( )
Total Fees:
Town of Brookhaven
Building Division
One Independence Hill, Farmingville
NY 11738 • Phone 631-451-6333 • Fax 631-451-6341
Plumbing Business Name: __________________________________
Business Address: _________________________________________
Telephone Number __________________________
Suffolk County Consumer Affairs License ______________________
Expiration Date: _____________________
Plumbing work is being done by:
Owner Signature_________________________________
Agent Signature__________________________________
OR
________Licensed Plumber
Signature ________________________________________
Printed Name_____________________________________
________________________________________
Notary Signature
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Plumbing HVAC Worksheet (Town of Brookhaven)

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Completed 2 August 2020

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