Plumbing Permit Application

Code Enforcement Department

Work Information

To complete the paper version of this form click here

All Plumbing installation and repairs must comply with the International Plumbing Code and International Residential Code. The applicant must be a Master Plumber registered with the Commonwealth of Pennsylvania as a Home Improvement Contractor to perform residential work. Commercial and new home plumbers must have a Township of Springfield Master Plumber License. All work requiring excavation must be in accordance with OSHA Standard; CFR-1926.650-.651-.652

Job Address *

City *

State *

Zip *

Is excavation required *

Yes No

Job Type *

Residential Commercial

Describe in detail the work to be performed

Estimated Cost *

Permit Fee *

Date Work will Commence

Units

State Surcharge

Fee Calculation

Parties Involved

Property Owner Name *

Owner Phone Number *

Owner Cell Phone *

Owner Address *

Owner Email *

City *

State *

Zip *

Plumbing Contractor Name *

Contractor Phone Number *

Contractor Cell Phone *

Contractor Address *

Contractor Email *

City *

State *

Zip *

Master Plumber License Num *

Issuing Authority *

PA Reg Num *

Use the Drawing Tool to Sign the Form in the Box Below

Applicant Signature

Applicant Email Address *

Date Signed *

Excavation Checklist

(To be Completed by a Competent Person)

Site Address *

City *

State *

Zip *

Date

Time

Competent Person

Soil Type

Soil Classification

Excavation Depth

Excavation Width

Type of Protective System Used

Indicate for each item: Yes - No - or N/A for not applicable

1. General Inspection of Jobsite:

Excavations, adjacent areas, and protective systems inspected by a competent person daily before the start of work. *

Competent person has the authority to remove employees from the excavation immediately. *

Surface encumbrances removed or supported. *

Employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation. *

Hard hats worn by all employees. *

Spoils, materials, and equipment set back at least two feet from the edge of the excavation. *

Barriers provided at all remotely located excavations, wells, pits, shafts, etc. *

Walkways and bridges over excavations four feet or more in depth are equipped with standard guardrails and toeboards. *

Warning vests or other highly visible clothing provided and worn by all employees exposed to public vehicular traffic. *

Employees required to stand away from vehicles being loaded or unloaded. *

Warning system established and utilized when mobile equipment is operating near the edge of the excavation. *

Employees prohibited from going under suspended loads. *

Employees prohibited from working on the faces of slopes or benched excavations above other employees. *

2. Utilities:

Utility companies contacted and/or utilities located. *

Exact location of utilities marked. *

Underground installations protected, supported, or removed when excavation is open. *

3. Means of Access and Egress:

Lateral travel to means of egress no greater than 25 feet in excavations four feet or more in depth. *

Ladders used in excavations secured and extended three feet above the edge of the trench. *

Structural ramps used by employees designed by a competent person. *

Structural ramps used for equipment designed by a registered professional engineer (RPE). *

Ramps constructed of materials of uniform thickness, cleated together on the bottom, equipped with no-slip surface. *

Employees protected from cave-ins when entering or exiting the excavation. *

4. Wet Conditions:

Precautions taken to protect employees from the accumulation of water. *

Water removal equipment monitored by a competent person. *

Surface water or runoff diverted or controlled to prevent accumulation in the excavation. *

Inspections made after every rainstorm or other hazard-increasing occurrence. *

5. Hazardous Atmosphere:

Atmosphere within the excavation tested where there is a reasonable possibilty of an oxygen deficiency, combustible, or other harmful contaminant exposing employees to a hazard. *

Adequate precautions taken to protect employees from exposure to an atmosphere containing less than 19.5% oxygen and/or to other hazardous atmospheres. *

Ventilation provided to prevent employee exposure to an atmosphere containing flammable gas in excess of 10% of the lower explosive limit of the gas. *

Testing conducted often to ensure that the atmosphere remains safe. *

Emergency equipment, such as breathing apparatus, safety harness, and lifeline, and/or basket stretcher readily available where hazardous atmospheres could or do exist. *

Employees trained to use personal protective and other rescue equipment. *

Safety harness and lifeline used and individually attended when entering bell bottom or other deep confined excavations. *

6. Support Systems:

Materials and/or equipment for support systems selected based on soil analysis, trench depth, and expected loads. *

Materials and equipment used for protective systems inspected and in good condition. *

Materials and equipment not in good condition have been removed from service. *

Damaged materials and equipment used for protective systems inspected by a registered professional engineer (RPE) after repairs and before being placed back into service. *

Protective systems installed without exposing employees to the hazards of cave-ins, collapses, or threat of being struck by materials or equipment. *

Members of support system securely fastened to prevent failure. *

Support systems provided to ensure stability of adjacent structures, buildings, roadways, sidewalks, walls, etc. *

Excavations below the level of the base or footing supported, approved by an RPE. *

Removal of support systems progresses from the bottom and members are released slowly as to note any indication of possible failure. *

Backfilling progresses with removal of support system. *

Excavation of material to a level no greater than two feet below the bottom of the support system and only if the system is designed to support the loads calculated for the full depth. *

Shield system placed to prevent lateral movement. *

Employees are prohibited from remaining in shield system during vertical movement. *

Payment Information

Payment of fees for this application will be requested via email once your submission has been reviewed.  Please verify that emails from donotreply@springfielddel.co are not sent to your spam/junk mail folder.  The email will contain a link to this form allowing you to make a secure payment by credit card.  The amount shown below is an estimated amount and may be adjusted once your submission is reviewed.

Payment Amount Due

Plumbing Permit Application

Code Enforcement Department

Work Information

Parties Involved

Excavation Checklist

Payment Information

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