Mechanical Permit Application - roseville-mi.gov

1 Plumbing Permit Application city of roseville , Building department ( ) 29777 Gratiot, roseville MI 48066 Phone (586) 445-5450 Fax (586) 445-5478 Date _____ Job Address _____ Property Owner _____ Phone # _____ Address _____ city _____ State ____ Zip Code _____ Contractor Information: Company Name _____ Phone Number _____ Applicant's Signature _____ _____ Item Description Standard Item Fee No. Total Registration, Master/Contractor ____ _____ Application Fee, Residential ____ _____ Application Fee, Commercial 5 ____ _____ Sewers Sanitary Up to 6 .. ____ _____ Sanitary 8 .. ____ _____ Sanitary 10 .. ____ _____ Sanitary 12 .. ____ _____ Sanitary 14 .. ____ _____ Crock to Iron/Fernco .. ____ _____ Residential Sewer Repair .. ____ _____ Storm/Conductor/from Bldg,First ____ _____ Each Additional .. ____ _____ Fixture First ____ _____ Each Additional ____ _____ ____ _____ Commercial Laundry ____ _____ ____ _____ Drain, ____ _____ Drinking ____ _____ Food Waste ____ _____ ____ _____ Laundry ____ _____ Laundry ____ _____ ____ _____ Lift ____ _____ Roof ____ _____ Shower ____ _____ ____ _____ Sink, 3 ____ _____ Skupper system, ____ _____ Soda ____ _____ ____ _____ Interceptor(oil,sand,grease,etc) ____ _____ ____ _____ Waste ____ _____ Water ____ _____ Water ____ _____ Water Treatment ____ _____ * Application Fee added to ALL PermitsItem Description Water Distribution/Service _ Fee No.

2 Total 15 .00 ____ _____ 1 ____ _____ 1 ____ _____ 2 ____ _____ 2 ____ _____ 3 ____ _____ 4 ____ _____ Over 4 ____ _____ Specialty Piping Medical gas, vacuum, air, etc First 100 .. ____ _____ Additional 100 .. ____ _____ Medical Gas Bulk ____ _____ Vacuum Pump, Air Compressor ____ _____ Special Equipment Backflow preventers 1 .. ____ _____ 2 .. ____ _____ 3 .. ____ _____ Over 3 .. ____ _____ Special ____ _____ Each _____ Inspections Overtime (per contract).._____ _____ Inspection _____ Special (work started early, etc) _____ Special _____ Re-inspection .. ____ _____Miscellaneous _____ ____ _____ Total *Minimum Permit Fee $ (DOES NOT INCLUDE REGISTRATION FEE) Section 23a of the State Construction Code Act of 1972, Act No. 230 of the Public Acts of 1972, being Section of the Michigan Complied Laws, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure.

3 Violators of Section 23a are subject to civil fines. [ Application Revised: 03/31/2017]