For Office Use Only:
CITY OF BROOKFIELD
Inspection Services Department
2000 North Calhoun RD, Brookfield, WI 53005
262-796-6683
PROP. TAX ID:
PERMIT #
DATE ISSUED:
http://www.ci.brookfield.wi.us
□
BLDG PERMIT
□ Residential □ New
□ Commercial □ Alteration
PLUMBING PERMIT APPLICATION
Street Address: ________________________________________________________________________ Suite/Unit No. ___________________
Owner/Occupant Name: Phone:
Applicant is: □ Contractor □ Homeowner
Contractor: _______________________________________________________________ Phone: _____________________________________ Street Address: ________________________________________________ City: ________________________ State: ______ Zip: ___________
Check box if you would like
State Credential No:
E-mail:
your permit emailed.
For Office Use Only:
FIXTURE OR ITEM
- FIXTURE QTY FIXTURE
- QTY
____ Air Admittance Valve ____ Area or Deck Drain ____ Back Flow Preventer ____ Bar Sink ____ Bathtub ____ Beer Tap
____ Interceptor
Laterals & Connections
____ Kitchen Sink ____ Laundry Tub ____ Lavatory ____ Lawn Irrigation ____ Manhole
The prices listed below are for the first 100’. Over 100’ is an additional $.48 per foot.
QTY FEE TOTAL
$59.50
Sanitary Bldg. Drain / Bldg. Drain Branch ( __________linear ft.)
____ Beverage Dispenser ____ Bidet ____ Carbonator
____ Pedicure Chair ____ Pot Sink ____ Pressure Reduce Valve ____ Prep Sink
Sanitary Bldg. Sewer ( __________linear ft.) Storm Drain ( __________linear ft.)
$59.50 $59.50 $59.50 $59.50 $59.50 $59.50
____ Case Drain
Water Service ( __________linear ft.)
____ Catch Basin
____ Coffee Maker ____ Dental Device ____ Dishwasher ____ Drinking Fountain ____ Emergency Eye Wash ____ Ejector Pump ____ Floor Drain ____ Garbage Disposal ____ Hose Bibb ____ Hub/Receptor ____ Ice Compartment ____ Ice Maker
____ Roof Drain ____ Service/Mop Sink ____ Shampoo Sink ____ Shower Stall/Mixer ____ Sink ____ Sump Pump ____ Urinal ____ Washer Connection ____ Water Closet (Toilet) ____ Water Heater ____ Water Outlet ____ Water Treatment Device ____ ____________________
Backwater Valve (Req’d for new single-family homes)
Exterior Line Repair: □ Drain □ Sewer □ Water Seal/Abandon: □ Sewer □ Water
Connection to City Water Size: (Pressure exceeding 80 psig requires PRV)
$59.50
Meter Setup/Deduct Meter (Brass ball valves Required) Re-Inspection Fee
$59.50 $59.50
.48¢
Additional Footage Other/Misc:
Quantity X $15.00
Subtotal =
Subtotal =
GENERAL: The application must be filled out completely & submitted with the required fees or it will be rejected and returned. The Conditional Plan Approval must be submitted with application for projects that require DSPS plan review. Water service and sewer repair, and water heater replacements will be considered emergency work. Permit is to be submitted within 24 hours of the start of the job.
NOTE: Plumbing work shall not be started until the approved plumbing permit is received by the contractor/homeowner. Work started prior to receiving an approved permit will be required to pay a TRIPLE fee.
Fixtures Subtotal Laterals Subtotal
===$
TRIPLE FEE x 3
(where applicable)
Total Permit Fee
Please allow 48 hours for permit processing.
INSPECTIONS: Request by phone 262-796-6683.
The following information must be given:
● APPLICATION NUMBER ● AM (8:30am-Noon) or PM (Noon-2:30pm)
*Minimum Permit Fee is $59.50
The minimum permit fee is not refundable.
Applicant Signature:
The undersigned applicant agrees to comply with the ordinances of the City of Brookfield and all laws of the State of Wisconsin. Applicant is obligated to ensure that all required inspections and final inspection is made.
Master Plumber / Homeowner: ______________________________________________
Date: ________________________
- S:\Handouts\APP MASTERS\2020\plumbing permit application 2021.docx
- May-21
PURPOSE OF INSPECTION
- INSPECTION DATE
- INSPECTION NOTES
S:\Handouts\APP MASTERS\2020\plumbing permit application 2021.docx
