If this relates to a Building Permit - indicate Building Permit # here:
Owners Name:
Contractor:
Contractors Reg. # (Hilliard):
Telephone Number:
Signature of Applicant:
Date:
COUNT COUNT COUNT COUNT
Air Admittance Valve
Air Hammer Arrestor Lavatories Sink, Hand Washing
Automatic Clothes Washer Lift Station Sink, Utility / Mop
Backflow Preventers Pedicure Chair Sterilizers
Back Water Valve Piping System, Sanitary Sump Pump
Bath Tubs Piping System, Storm Tempering Valve
Bed Pan Washers
Piping System, Water Trap Primer
Bidet
Remove & Cap Fixture
Urinal
Coffee Maker
Rough in Future Fixture Washing Machine
Dental Cuspidors
Showers
Water Closets
Dilution Sump Sink, 3 Compartment Water Storage Tank
Dish Washers Sink, Bar
Whirpool Tub
Sink, Exam Room Other 0
0 0 Sink, Floor 0
0 0 0 0 0
or or
RESIDENTIAL
COMMERCIAL Approval Information:
ISO attached?
Application and first fixture Application and first fixture
Number of remaining fixtures x $15.00 Number of remaining fixtures x $20.00
TOTAL Inspection fee = TOTAL Inspection fee = Date Issued:
Permit Number:
Amount Paid:
3800 Municipal Way, Hilliard, OH 43026
NO CASH payments accepted.
we do accept; checks, money order or credit
FIXTURE
Make checks payable to City of Hilliard
TOTAL FIXTURES- ALL COLUMNS
Sink, Food Prep
* Plan Review - Revisions after initial approval will be charged on a per fixture basis ($60) * Re-inspection Fee - Based Upon Disapproved Inspections ($100)
*
State approved modular home plumbing inspection and Permit ($60) * Afterhours Inspections - requires 24 hours notice ($500)
FIXTURE
Ice Machine (not w/i refrigerator)
FIXTURE
FIXTURE
Drain, Floor
0
0
$0
$0
COMMERCIAL OR MULTI-FAM 4+
TO BE COMPLETED BY APPLICANT
MISC. FEES (to be collected & scheduled by Franklin County Public Health ONLY 614-525-3160)
Drinking Fountain
NEW
REMODEL
RESIDENTIAL 1,2,3 FAMILY
Plan Review - Commercial Permits require review of plan & isometrics by FCPH. Approval sheet required w/ application to Hilliard.
$60
$200
$200
$60
* Gas pressure tests and gas line inspections require a separate permit & inspection (see Hilliard miscellaneous permit application)
YES
YES
Select "YES" or "NO" from the drop down to calculate the applicable RESIDENTIAL or COMMERCIAL total.
Laundry Tub
Interceptor, Garage / Oil
Interceptor, Grease
Interceptor, Solid
Drain, Hub
Drain, Roof Storm
Drain, Roof Secondary
Drain, Trench
Expansion Tank
Eye Washer
Garage Catch Basin
Hot Water Heater
Hot Water Recirc. System
Ice Bin
The undersigned hereby applies for a permit to do plumbing and a inspection of same at the following location and in accord with Chapter 4101:2-51
Plumbing Inspections are performed by Franklin County Public Health - 614-525-3160
Incomplete or incorrect applications will be returned unprocessed.
This application must be properly filled out and returned to the office of the Hilliard Building Division at least four days prior to the date of the FIRST INSPECTION,
Commercial accompanied by a fee calculated upon the following basis: Approved application must be on the job site for inspection.
TO BE COMPLETED BY APPLICANT
Job Address:
Owners Phone# :
click to sign
signature
click to edit
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