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PLUMBING PERMIT APPLICATION CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] For City Use Only: Permit # Date: Issued By: Expires: Project Address: Description of Work: Plumbing Contractor Information Name: Address: Phone: E-mail (REQUIRED): Wisconsin Plumbing License Expiration Date: Property Owner Information Name: Address: Phone: E-mail: Project Information Building Status: _____Existing Building Type: _____Residential _____Industrial _____Commercial Water fixtures above elevation 998.0 will not be allowed unless Owner installs private booster pump to increase in-house pressure. inch water service from property line to building inch sewer lateral from property line to building inch water service from property line inch sewer lateral to property line Water Calculations: # DFU’s The City of Middleton requires Bacteria Samples for water services above including distribution piping. Number of Fixtures Auto Wash Grease Trap (STATE APPROVAL REQUIRED) Storm Sewer Back Water Valve Laundry Sump Pump Bar Waste Machine Waste Urinal Catch Basin Open Site for HVAC Water Closet Cellar Drain Pressure Reducing Valve (80 LB MAX) Water Heater Dishwasher RO Systems GAS TESTING REQUIRED: Disposal Shower RES. COMM. Down Spouts Sill Cocks 2# 4# Drinking Fountain Sinks (ALL SINKS) Dryer Stove Floor Drain Softener Fireplace (See page two for fee calculation.) ---PAGE BREAK--- PLUMBING PERMIT APPLICATION CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] For City Use Only: Permit # Date: Issued By: Expires: Fee Description Qty Cost Subtotal Water (per 100’) $ 100.00 $ Meter Couplings $ 15.00 $ San Sewer (per 100’) $ 100.00 $ Storm Sewer (per 100’) $ 100.00 $ Sprinkler (lawn) $ 25.00 $ Air Admittance Valve (AAV) $ 50.00 $ Fixtures: $6 each $ 6.00 $ Base Permit Fee: UDC Residential $50 or Commerical $100 1 $ $ Fee Total $ The Plumbing Contractor shall call for the required inspections. Failure to do so may result in a $50.00 charge and possible removal of any finish surfaces covering the plumbing work. The applicant certifies that all information is correct and that all pertinent City Ordinances will be complied with in performing the work for which this permit is issued. Signature of Contractor or Homeowner if Applicable: Print Name: Date: REQUIRED INSPECTIONS (IF APPLICABLE): WATER/SEWER; GROUNDWORK; GAS PIPING; ROUGH; FINAL ---PAGE BREAK--- BUILDING INSPECTION DEPARTMENT CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] CAUTIONARY STATEMENT TO OWNERS OBTAINING BUILDING PERMITS (Part of Ply 4 for Applicants) 101.65(1r) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a building permit with a statement advising the owner that: If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or insured as required under s. 101.654 the following consequences might occur: The owner may be held liable for any bodily inquiry to or death of others or for any damage to the property of others that arises out of the work performed under the building permit or that is caused by any negligence of the contractor that occurs in connection with the work performed under the building permit. The owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the contractor of the one- and two- family dwelling code or an ordinance enacted under sub. because of any bodily injury to or death of others or damage to the property of others that arises out of the work performed under the building permit or because of any bodily injury to or death of others or damage to the property of others that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit. ---PAGE BREAK--- BUILDING INSPECTION DEPARTMENT CITY OF MIDDLETON 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 MAIN [PHONE REDACTED] • FAX [PHONE REDACTED] EMAIL: [EMAIL REDACTED] BUILDING INSPECTION CHECKLIST Subcontractors shall request inspections for their own work by contacting the BUILDING INSPECTION DEPARTMENT at (608) 821-8370. Failure to give proper inspection notification may result in fines. The Building Permit Applicant (signature on application) is responsible for verifying that all required inspections have been made. Any developer/contractor who calls for an inspection before the work is ready for inspection may be assessed a fine of fifty dollars ($50.00) per inspection. ❑ EROSION CONTROL INSPECTION to be completed prior to footing inspection. Perimeter erosion control measures shall be placed within 24 hours after beginning excavation. ❑ FOOTING INSPECTION to be completed after f01ms and required reinforcing are in place, but before concrete is poured. ❑ FOUNDATION INSPECTION to be completed before backfilling. ❑ ROUGH INSPECTION to be completed for each category below before work is covered or concealed. o UNDERGROUND/UNDERSLAB PLUMBING/ELECTRICAL/HVAC o UNDER FLOOR VAPOR BARRIER (BASEMENT) o BUILDING FRAMING o ELECTRICAL o PLUMBING o HVAC ❑ INSULATION INSPECTION to be completed after insulation and vapor barrier are in place, but before they are covered or concealed. ❑ FINAL INSPECTION to be completed for each category below after all work is completed, but before use or occupancy. o BUILDING o ELECTRICAL o PLUMBING o HVAC INSPECTION RESULTS will be posted on the doorjamb of a bathroom (residential) or near the front door (commercial). Work shall not proceed until required inspections are completed and approval has been granted. If a required inspection is not completed within two working days after proper notification has been given, the contractor may proceed to the next phase of construction. THE MIDDLETON BUILDING CODE REQUIRES THAT A CERTIFICATE OF OCCUPANCY BE ISSUED BY THE BUILDING INSPECTOR PRIOR TO THE OCCUPANCY OR USE OF THE BUILDING. THIS ALSO COVERS USING A BUILDING FOR STORAGE OR MOVING ITEMS INTO THE BUILDING.