:: Commercial Plumbing Application ::
:: Construction Code Authority ::
1075 Suncrest Dr, Lapeer, MI 48446
Phone:810-667-0420~Fax: 810-667-2952
COMMERCIAL PLUMBING JOB LOCATION
Job Address:                                     City:                        Zip:                             Municipality:
Job Between What Roads:                                                                                   Side of Road Job is On:
APPLICANT INFORMATION
Company Name:                                                                        Licensee Name:
Federal ID#                                                      MESC #                                         Workman's Carrier
License #                                                    DOB or Dri. Lic #                                    Fax #
Email Address:                                                                              Phone Number:
General Contractor on Job Site or Project Name:
Section 23a of the State Construction Code Act of 1972, Act No. 230 of the Public Acts of 1972, being
Section 125, 1523a of the Michigan Compiled 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. Violators of Section 23a are subject to civil fines.
By entering your name, you electronically acknowledge that you have read and accept this permit
application.

Application Date:                                                           Contractor's Signature:
JOB INFORMATION-Fill in all the appropriate information
Job is:
Or Just Installing:
If Other Please List Below:                                                                            If Other Please List Below:
Commercial Base Permit Fee       $162.00
Enter # of Items to be Installed-Multiply by $9.00 Each- Enter Total at Right
Fixtures, Water Connected Appliances                          Sub-Soil, Floor Drains


Connection to Building-Drains, Sewers                                      Thrust Blocks


Stacks-Soil, Waste, Vent, or Combined            Medical Gas Piping x .25 per ft
Enter # of Items to be Installed-Multiply by $43.00 Each-Enter Total at Right
Back Flow Preventers                                            Sumps, Ejectors, Manholes


Catch Basins                                                                            Water Hydrants


Oil Interceptors                                                                          Grease Traps
Indoor/Outdoor Lines/Drains- Multiply Out and Enter Total at Right
Water Lines


Storm Sewer


Sanitary Sewer


Trench Drains
Feet x .50 =


Feet x .50 =


Feet x .50 =


Feet x .50 =
Plan Review Fee Per Hour $81.00


Code Compliance Inspections-Additional-Reinspections $81.00


Yearly License Administrative Fee $15.00


Installation Started Without Permit Being Obtained- $100.00 Administrative Fee
TOTAL DUE:
Make check payable to C.C.A. or Construction Code Authority
Credit Cards Accepted; Please call C.C.A 810-667-0420
Surcharge Fee of 3.5% will be applied to Credit Cards


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