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PlumbingApplication - Plumbing Application - Revised Draft

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U.S.A. forms for City of Bridgeport

BROWSE CITY OF BRIDGEPORT (CT) FORMS

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Form1230(4.3.20)



Plumbing

PermitNo.

_______

CITYOFBRIDGEPORT,BUILDINGDEPARMENT

APPLICATIONFORPLUMBINGPERMIT



Building

Permit#_________

ThisSectionToBeCompletelyFilledOutByApplicant



HOLDHARMLESS/RELEASE

CityofBridgeportandBridgeportBuildingDepartmentrequiresthatpermitteeshallindemnifyandhold‐harmless"City/Department",

it's employees andagents and release both from any and all claims on actions brought by third parties for injuries or damages of

property in connection with granting of this permit and work to be performed there under. Permittee may be required to insure

againstsuchclaimsinamountsappropriatetomeetsuchobligation.City/Departmentshallhavetherighttoreviewandspecify

suchamountandscopeofcoverageasitmaydeemappropriateforactivitiesconductedunderthispermit.



IHEREBYMAKEAPPLICATIONFORAPERMITTODOPL UMBINGWORK‐INACCORDANCE

WITHTHEBUILDINGCODE‐INABUILDINGASHEREINAFTERDESCRIBED:

AddressofWork Date

NearestCrossSt Owner Address

OwnerAddressCity/TownState:Zip:

UseofBuilding

FrameMasonryNewOldAddition

Remarks



LOCATION

FIXTURES B 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Toilets             

Lavatories             

Baths             

StallShowers             

Sinks             

HotWaterHeater             

             

PLUMBERMUSTRECEIVEAPERMITBEFORECOMMENCINGWORK.

Estimateofvalue$ LicensedContractor:

ReceiptNo. Signature

Fee BusinessAddress

 CTStateLicenseNo.Phone



PermitNo._____________APPLICATIONFORFIREPROTECTIONPERMIT

Sprinklers

DryWetPipeSchedule HydraulicallyCalculated

SystemDemand:PSI:GPM:

No.ofheads:NewRelocated

Standpipes

No:andsizeofrisers:

No.ofStories:



OtherSystems

C0

HalonChemicalOther

Remarks



PERMITMUSTBEISSUEDBEFORECOMMENCINGWORK.

Estimateofvalue$ LicensedContractor:

ReceiptNo. Signature

Fee BusinessAddress

 CTStateLicenseNo.Phone



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Completed 11 July 2020

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