Form 1230 (4.3.20) 

Plumbing  Permit No. _______ 

CITY OF BRIDGEPORT, BUILDING DEPARMENT  APPLICATION FOR PLUMBING PERMIT

Building  Permit #_________

This Section To Be Completely Filled Out By Applicant 

HOLD HARMLESS/RELEASE City of Bridgeport and Bridgeport Building Department requires that permittee shall indemnify and hold‐harmless "City/Department", it's employees and agents and  release both  from any and all claims on actions brought by  third parties  for  injuries or damages of property  in  connection with granting of  this permit and work  to be performed  there under. Permittee may be  required  to  insure against such claims in amounts appropriate to meet such obligation. City/ Department shall have the right to review and specify  such amount and scope of coverage as it may deem appropriate for activities conducted under this permit.  

I HEREBY MAKE APPLICATION FOR A PERMIT TO DO PLUMBING WORK‐IN ACCORDANCE WITH THE BUILDING CODE‐IN A BUILDING AS HEREINAFTER DESCRIBED: 

Address of Work  Date Nearest Cross St  Owner  Address Owner Address        City/Town      State:        Zip: Use of Building  Frame       Masonry       New       Old       AdditionRemarks 

LOCATION FIXTURES  B  1st  2nd  3rd  4th  5th  6th  7th  8th  9th  10th  11th  12th Toilets Lavatories Baths Stall Showers Sinks Hot Water Heater 

PLUMBER MUST RECEIVE A PERMIT BEFORE COMMENCING WORK. Estimate of value $   Licensed Contractor:  Receipt No.   Signature  Fee   Business Address  

CT State License No.     Phone  

Permit No._____________       APPLICATION FOR FIRE PROTECTION PERMITSprinklers 

Dry   Wet Pipe  Schedule    Hydraulically CalculatedSystem Demand: PSI:                                       GPM:No. of heads:      New         Relocated

Standpipes No: and size of risers:  No. of Stories:  

Other Systems  C02   Halon  Chemical   Other

Remarks 

PERMIT MUST BE ISSUED BEFORE COMMENCING WORK. Estimate of value $   Licensed Contractor:  Receipt No.   Signature  Fee   Business Address  

CT State License No.     Phone  

Permit No: Permit: Address of Work: Date: Nearest Cross St: Owner: Address: Use of Building: Frame: OnMasonry: OffNew: OffOld: OffAddition: OffBToilets: 1stToilets: 2ndToilets: 3rdToilets: 4thToilets: 5thToilets: 6thToilets: 7thToilets: 8thToilets: 9thToilets: 10thToilets: 11thToilets: 12thToilets: BLavatories: 1stLavatories: 2ndLavatories: 3rdLavatories: 4thLavatories: 5thLavatories: 6thLavatories: 7thLavatories: 8thLavatories: 9thLavatories: 10thLavatories: 11thLavatories: 12thLavatories: BBaths: 1stBaths: 2ndBaths: 3rdBaths: 4thBaths: 5thBaths: 6thBaths: 7thBaths: 8thBaths: 9thBaths: 10thBaths: 11thBaths: 12thBaths: BStall Showers: 1stStall Showers: 2ndStall Showers: 3rdStall Showers: 4thStall Showers: 5thStall Showers: 6thStall Showers: 7thStall Showers: 8thStall Showers: 9thStall Showers: 10thStall Showers: 11thStall Showers: 12thStall Showers: BSinks: 1stSinks: 2ndSinks: 3rdSinks: 4thSinks: 5thSinks: 6thSinks: 7thSinks: 8thSinks: 9thSinks: 10thSinks: 11thSinks: 12thSinks: BHot Water Heater: 1stHot Water Heater: 2ndHot Water Heater: 3rdHot Water Heater: 4thHot Water Heater: 5thHot Water Heater: 6thHot Water Heater: 7thHot Water Heater: 8thHot Water Heater: 9thHot Water Heater: 10thHot Water Heater: 11thHot Water Heater: 12thHot Water Heater: BRow7: 1stRow7: 2ndRow7: 3rdRow7: 4thRow7: 5thRow7: 6thRow7: 7thRow7: 8thRow7: 9thRow7: 10thRow7: 11thRow7: 12thRow7: BRow8: 1stRow8: 2ndRow8: 3rdRow8: 4thRow8: 5thRow8: 6thRow8: 7thRow8: 8thRow8: 9thRow8: 10thRow8: 11thRow8: 12thRow8: BRow9: 1stRow9: 2ndRow9: 3rdRow9: 4thRow9: 5thRow9: 6thRow9: 7thRow9: 8thRow9: 9thRow9: 10thRow9: 11thRow9: 12thRow9: BRow10: 1stRow10: 2ndRow10: 3rdRow10: 4thRow10: 5thRow10: 6thRow10: 7thRow10: 8thRow10: 9thRow10: 10thRow10: 11thRow10: 12thRow10: Estimate of value: Licensed Contractor: Receipt No: Signature: Business Address: Permit No_2: Dry: OffWet Pipe: OffSchedule: OffHydraulically Calculated: OffC02: OffHalon: OffChemical: OffOther: OffEstimate of value_2: Licensed Contractor_2: Receipt No_2: Signature_2: Business Address_2: Owner Adress: City/Town: State: Zip: Fixtures - Other Row 1: Fixtures - Other Row 2: Fixtures - Other Row 3: Fixtures - Other Row 4: CT License No: Standpipes No and size of risers: No: of Stories:

PSI: GPM: Relocated: New heads: Other System: Remarks: Fee: Fee_2: Ct License: Phone: