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APPLICATION FOR PLUMBING PERMIT Please indicate the location of work below Accurate LOCATION and OWNER information is required for permitting. Address City State MT Zip Directions to property County Is job located inside city limits? Name of Building or Businesses in building 17 digit GEOCODE PARCEL# Lot Block Size of Property (acres) Section Township Range Owner Name Mailing Address City State Zip Email Phone Plumbing Contractor License Number Permit Mailing Address City State Zip Email Phone Number of fixtures/traps in each box $10 EACH Type of Building (REQUIRED) Bath Coffee Single Family Lavatory……………………. Drinking Fountain………………. Multiple Family Dental Commercial/Public Floor Accessory Building Water Closet (Toilet).. Area Type of Work (REQUIRED) Kitchen Sink……………… Indirected New Service Sink……………… Grease Alteration/Addition Wash/Laundry Tray…… Bar Sewer Service Type (REQUIRED) Dishwasher……………… Floor/MopSink…………..……… Public Sewer System Laundry Sump drain/Lift Station…….. Septic System Car Wash Sump……….. Glass Potable Water Source (REQUIRED) Ice Machine………….….. Aspirator……………………………. Potable Water Source Glass Fill Station………. X‐Ray Public Utility Schedule of Fees (required for permitting) Fee Number Amount Due Each Permit (except water heater replacements) $30.00 Gray water system, commercial or residential $75.00 yes / no Repair or alteration of drainage or vent piping $10.00 yes / no Installation, alteration, or repair of water piping and/or treatment $10.00 yes / no Each Water Service tie‐in $10.00 x = Each Building and Trailer Park Sewer tie‐in $15.00 x = Each Water heater (or replacement) $10.00 x = Each Storm drain and storm drainage $10.00 x = Each Lawn sprinkler,fire protection system, any meter, or backflow protection device $10.00 x = 1‐4 Hose bibb, unprotected fixture, vacuum breaker, and/or backflow protection device $7.00 EA X = Note: Each fixture, hose bibb, breaker, and backflow over 4 is $2 each. Example: 5 hose bibb is $30 5+ Hose bibb, unprotected fixture, vacuum, breaker, and/or backflow protection device $2.00 EA X = Each Industrial water pre‐treatment equipment including its drainage and vent $10.00 x = First 5 medical gas piping systems: oxygen___ nitrogen___ vacuum___ medical air___ $75.00 x = Each Medical gas piping system after initial five $10.00 x = Each Plumbing fixture or trap (TOTAL FROM TABLE ABOVE) $10.00 x = Total Fee MASTER PRINT MAIL TO: CITY OF BELGRADE / 91 E CENTRAL AVENUE / BELGRADE, MT 59714 BUILDING DEPARTMENT PHONE: 406‐388-3763 I hereby make application for a permit to do plumbing work in accordance with all Title 50, Chapter 60, Section 505, MCA and ARM 24.301.301 and ARM 24.301.361. BCP‐1 (Rev. 8/2013) ***All Incomplete Applications will be Returned Unprocessed*** Make checks payable to: /ŝƚLJ ŽĨ .ĞůŐƌĂĚĞ