Department of Public Works & Engineering
Building Code Enforcement Branch
PLUMBING AND IRRIGATION SYSTEM
PERMIT APPLICATION
This is a permit application for Plumbing and Irrigation Systems within the city limits of Houston, Texas. Carefully complete all necessary information.
PROJECT NUMBER: _________________________________ |
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DATE: ____________________________ |
CLASS OF WORK: |
Residence |
Apartments |
Commercial |
Industrial |
Other __________________________ |
CONTRACTOR: ___________________________________________________________ |
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TELEPHONE: ______________________ |
Company Name
JOB SITE ADDRESS: ______________________________________________________________________________________________________________
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Please Print |
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City |
State |
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Zip Code |
PRESENT OCCUPANCY: ___________________________________ |
PROPOSED OCCUPANCY: _____________________________________ |
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TOTAL NUMBER OF FIXTURES: _________ |
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Manholes: |
__________ |
Sample Well: |
__________ |
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Interceptors (Gallons):__________ |
COST $ |
_________ |
Water Heaters: __________ |
Water Service: |
__________ |
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Vaccum Breaker: |
__________ |
COST $ |
_________ |
Miscellaneous: __________ |
Ground in for Shell Building: __________ |
Sprinkler Heads: |
__________ |
COST $ |
_________ |
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Special Fees: (Nonrefundable) |
Opening in Street: |
__________ |
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Miscellaneous: |
__________ |
COST $ |
_________ |
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Roadbore: |
__________ |
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COST $ |
_________ |
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Storm Water Drainage: |
Catch Basin/Junction Box: _________ |
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Connection: |
__________ |
COST $ |
_________ |
Manholes: |
__________ |
Roofdrains: |
__________ |
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Miscellaneous: |
__________ |
COST $ |
_________ |
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Gas Meters: |
__________ |
Gas Appliances: |
__________ |
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Med Gas (# of Openings):_______ |
COST $ |
_________ |
Gas Openings: |
__________ |
Miscellaneous: |
__________ |
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Temp Gas: |
__________ |
COST $ |
_________ |
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Sanitary Sewer Connection Charge: __________ |
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COST $ |
_________ |
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Fee for Issuing Each Permit or Receipt: |
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COST $ |
27.52 |
NOTE: Minimum Fee on Any Permit $79.99 + Administration Fee $27.52 = Total Minimum Permit Fee $107.51
SEWER CONNECTION |
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Sewer Assessment Fee: |
Paid: _____________ |
Due: __________________ |
Project Number: __________ |
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WATER SUPPLY: |
City: _____________ |
Water District: ___________ |
Private Well: __________ Other: ___________ |
*To be located in ROADWAY, BETWEEN PROPERTY LINE AND CURB, ALLEY, EASEMENT, PRIVATE PROPERTY |
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Size of trench to be opened in street: |
Length: __________ft. |
Width ___________ft. Paved with: ____________________________________ |
The undersigned binds _________________________________________to defend at _____________________________________own cost and expenses any suit or
suits, action or actions, claim or claims for damages which may be sustained against the City of Houston for any loss, cost, expense or damage charged or imposed upon it by reason or granting said permit and further agrees to keep in good repair for refilling and resurfacing necessitated by the excavation covered by this application for a period of one year.
NOTE: - It is also understood and agreed that the permit to be granted shall be granted subject to the right of the City of Houston, or of any person, firm or corporation entitled thereto to use that part of such street, alley, or other public place for any purpose for which said street, alley, or other public place may be lawfully used; and, provided, further. that the granting of said permit for the purpose of locating or placing any pipe, conduit, duct, tunnel or other structure shall not be construed to grant any person or corporation any fixed or vested right in such location, but all of same shall be taken subject to the right of the City of Houston, or any other person, firm or corporation entitled thereto to lay or place its pipe or pipes, conduits or other structures in or under such portion thereof over, under or across such pipe, conduits, ducts or other structures as may have been laid without cost or change being enacted by the prior location for such use; and it is also understood and agreed that all persons receiving permits to put pipes, conduits, ducts, or other structures, under the surface of any public street, alley or other public place in the City of Houston, thereby obligate and bind themselves to move or change the location of their said pipes, conduits, ducts or other structures whenever required or instructed to do so by the City of Houston, and failure to do so or interference with any person, firm, or corporation in the matter of moving their pipe, conduit, or other structures under any public street, alley or sidewalk, shall constitute an offense and be subject to the penalties provided by ordinance.
Materials used shall be of “approved” type. Plumbing work shall be installed in accordance with the City Ordinances regulating construction in the City of Houston. No alternates or additions shall be made in the Plumbing system without the required permits.
LICENSEE’S AGENT ________________________________________________________
(SIGNATURE)
ADVANCE PAY ACCOUNT NO. ____________________ |
_________________________________________________________________________ |
(IF APPLICABLE) |
(PLEASE PRINT LICENSEE’S NAME) |
(NUMBER) |
Form No: CE-1020 rev 01/01/2015 |
(832) 394-8870 |
Public Works & Engineering |
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