1 Job Data
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Borough*
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Block
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Lot
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House No.*
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Street Name*
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Permit No*
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Job No. (if different from permit No.)
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Document No.*
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Permit Type (Check One Only)*
PL SP SD LAA (formerly ARA) | |
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2 Permit Applicant data
(Details of applicant who obtained the permit)
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Last Name*
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First Name*
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M.I.
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Business Name*
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Fax No.*
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Bus. No.*
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Address*
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City*
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State*
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Zip*
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License Number *
LMP LFSC |
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Applicant E-Mail
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3 Inspection data
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Inspection/test scheduled for*
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Time
8:00am 8:30am 9:00am 9:30am 10:00am 10:30am 11:00am
11:30am 12:30pm 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm |
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Floors/Apts*
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Meeting Place*
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4 Notice ( Select One Worktype ONLY: PL, SP, SD ) Plumbing (PL)
System Inspections: | Underground | Roughing | Finish | Sprinkler - PL | | | | Water/Sanitary - PL | | | | Storm - PL | | | | Gas - PL | | | | Type of Test(s): | | Water Storm | | | | Gas | | | |
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Sprinkler (SP)
System Inspections: | Underground | Roughing | Finish | Sprinkler - SP | | | | Type of Test(s): | | Dry Pipe Valve | | | |
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Standpipe (SD)
System Inspections: | Underground | Roughing | Finish | Fire Standpipe - SD | | | | Alarm System 64/09 | | | | Type of Test(s): | | Fire Pump | | | | Hydrostatic 63/09 | | | |
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Additional Information/Comments:
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5 Gas Meters/Risers Data
(check all applicable to this inspection. Include gas usage for each listed
meter(s)/riser(s))
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No. of Meters
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Locations(s) (Floor/Apt. for this inspection)
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No. of Risers
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Locations(s) (Floor/Apt. for this inspection)
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Notice for Plumbing Self-Certification
