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BRC Form 002 Rev’d: 05/2021; 09/2023;02/2026 Page 1 of 2 PLUMBING PERMIT APPLICATION This permit application is intended for applicants seeking a permit to do plumbing work. Please note that plumbing work may only be done by a plumber licensed to work in the City of Albany. If we can assist you in completing this form, do not hesitate to ask. GENERAL INFORMATION JOB SITE ADDRESS: TOTAL COST OF WORK (INCLUDING COST OF MATERIALS): 1% OF TOTAL WORK COST: APPLICANT: LICENSE NO.: EMAIL: PHONE: ALL PERMITS ARE EMAILED TO THE LICENSE HOLDER OWNER: EMAIL: PHONE: FEE CALCULATION FLAT FEE (CHECK WHAT APPLIES): COMMERCIAL OR RESIDENTIAL WITH THREE OR MORE UNITS RESIDENTIAL $100 FEE WITH 1% SURCHARGE ON TOTAL COST OF WORK & MATERIALS FIXTURES FEE (INDICATE HOW MANY OF EACH FIXTURE YOU WILL BE INSTALLING): $50 FEE TYPE NO. TYPE NO. TYPE NO. TYPE NO. WATER CLOSETS $10 EACH LAVATORIES $10 EACH BATH TUBS $10 EACH LAUNDRY HOOK-UPS $10 EACH KITCHEN SINKS $10 EACH SHOWERS $10 EACH SERVICE SINKS $10 EACH DRINKING FOUNTAINS $10 EACH WATER HEATERS $20 EACH URINALS $10 EACH DISHWASHERS $10 EACH GREASE INTERCEPTOR $10 EACH PLEASE ADD THE FLAT FEE TO THE FIXTURES FEE AND APPLY THE SURCHARGE, IF APPLICABLE. TOTAL FEE: CHIMNEY LINERS $20 EACH OTHER (DESCRIBE): $10 EACH OTHER (DESC.): $10 EACH OTHER (DESCRIBE): $10 EACH INSURANCE: HAVE YOU SUBMITTED PROOF OF THE NECESSARY INSURANCE TO BRC? YES NO WORKER’S COMPENSATION: HAVE YOU SUBMITTED PROOF OF WORKER’S COMP COVERAGE? YES NO STAFF USE ONLY PERMIT NO.: APP. FEE: REC’D BY: DATE REC’D: DATE ISSUED: ASSIGNED TO: SCANNED BY: ---PAGE BREAK--- BRC Form 002 Page 2 of 2 JOB SITE ADDRESS: PROJECT DESCRIPTION (IF NEEDED, PLEASE PROVIDE A DESCRIPTION OF THE PROJECT): DETAILED PLANS OR OTHER DOCUMENTS ARE ATTACHED (REQUIRED): YES NO Certification: I hereby certify that I have examined this application and know the information contained therein to be correct. I understand that the granting of a permit does not grant authority to violate or ignore any law, that this permit authorizes only the work described herein and will expire, unless otherwise noted, in one year from the date of issuance. Date: AFFIDAVIT FOR CLASS A PLUMBERS WITH NO EMPLOYEES I HEREBY ATTEST THAT I AM MAKING THIS APPLICATION FOR PERMIT AND THAT I HAVE NO EMPLOYEES, NOR ANY PARTNERSHIP AGREEMENT WITH ANYONE. SIGNATURE OF LICENSE HOLDER: DATE: Plumbing Permit Instructions City of Albany Plumber’s License. Permits for plumbing work will only be issued to plumbers licensed to do work in the City of Albany. Plumbers with licenses in municipalities who maintain reciprocity with the City of Albany may apply for a temporary Class B license using the Class B License Application form available in our office or on the City’s website. Stop Work Orders. Note that this permit, if authorized, applies only to the work described herein and that a stop work order may be issued if the work goes beyond what was applied for. Fee Calculation. Commercial and residential properties of three or more units are subject to a $100 fee. Residential properties are subject to a $50 fee. An additional fee of $10 for the installation of each of the following: water closets, lavatories, bath tubs, showers, kitchen sinks, laundry hook-ups, drinking fountains, service sinks, urinals, and dishwashing machines. An additional $20 fee applies to the installation of each chimney liner and water heater. Finally, a 1% surcharge is applied to the total cost of the project for work done on commercial and residential properties of three or more units. Inspections. All projects are subject to a rough and final inspections and no inspection may occur until a complete application has been submitted to the department. Please request inspections at least 24 hours in advance and no inspection request will be accepted by voice or email. Insurance. Either the owner of the contractor is required to have a liability policy naming the City of Albany as insured or co-insured covering the work described in the permit application. This liability policy must be, at minimum, in the following amounts: a) $100,000.00 – Personal Injury – single incident b) $300,000.00 – Personal Injury – cumulative c) $ 50,000.00 – Property damage Proof of Insurance. Before we may issue a plumbing permit, we must have proof of insurance. A contractor may file an Owner’s and Contractor’s Protective Liability Policy, naming the City of Albany as an additional insured, for the individual job, in the required amounts; or the contractor may file a blanket policy with the City, covering all work to be undertaken within the period of the policy. Worker’s Compensation. As per NY GML § 125, we cannot issue a permit without proof of worker’s compensation insurance. From contractors, we will need one of the following: 1) WCB form C- 105.2 or U-26.3, 2) WCB form SI-12 or GSI -105.2, 3) WCB form CE- 200, and/or 4) WCB form DB 120.1 or 120.2 or the signed affidavit above.