QES Management System

Issue Date: 6/07/2017

Plumbing Works Application – no fire service

Application to carry out single/multi unit commercial, multi unit residential or mixed development

The following form is for applicants carrying out plumbing works for sewerage, water and recycled water connections for single/multi unit commercial, multi unit residential or mixed developments without a proposed fire service.

For services that include a fire service please use the “Plumbing Works Application – with fire service” application form. For single residential plumbing works please use the “Single Residential Application” application form.

All relevant details on this application must be completed and all relevant Plans, Documents and Information must be submitted with the application to be assessed. Failure to do so will result in the application being rejected and returned, which may result in unnecessary delays.

Please allow a MINIMUM of 20 working days for the application to be reviewed and an assessment sent

Application Fee (non-refundable): $ 466.95 Note: Additional fees may apply following the assessment

Please submit your application by e-mail (preferred) or by post:

City West Water's details / Office Use Only
Email: / / Received Date:
Mail: / Locked Bag 350, Sunshine 3020 / CWW Reference No:
Internet: / citywestwater.com.au
Phone: / 1300 299 228

Section 1 - Property details

Lot No: Unit: / Street number: / Street name:
Suburb: / Postcode:
Nearest cross street: / Melways Ref:

Section 2 - Owner/s details

Owner/ s Name:
Lot No: Unit: / Street address:
Suburb: / Postcode:

Section 3 - Applicant’s details (Please note these details will be used for all correspondence related to this application)

Company name:
Contact name (must be provided):
Address: Postcode:
Phone: / Mobile: Email:
Signed: / Date:

Section 4 - Plumber’s details

Company name: Plumber’s name: License number:
Address: Postcode:
Phone: / Phone:
By signing this application form I do so as the owner (or authorised by the owner to make this application). I will therefore be responsible to meet all City West Water’s requirements including ensuring the security of the water meter(s) and will obtain all appropriate permits prior to any works beginning. I also acknowledge that should/when a meter(s) be/is installed as a result of this application then appropriate service charges will apply.

Section 5 – Description of Works

Please describe the actual development and works being undertaken (NOTE – AS A FIRE SERVICE IS NOT PROPOSED All excavation, backfilling, council permits and traffic management is to be organised by CITY WEST WATER):
IMPORTANT: Please complete all details below and refer to the “List of Items” on page 3 of this application outlining the type of plans and information required which you must provide with your application. Failure to supply all information required may result in delays in processing your application.
Development Type: / Multi-Unit Residential Single/Multi Commercial or Industrial Mixed Multi Residential & Commercial
Required Drinking Water Service: / Size / Flow rate / Qty.
Service Tapping details / mm / L/s
General Main Water Meter / mm / L/s
Check Meter (for Units / Apartments Residential) / mm
Check Meter (for Commercial / Retail / Shops / Offices / Warehouses) / mm
Details of existing Water Service/s / mm
Existing water meter Number/s
Backflow Prevention
The installation of the appropriate Backflow Prevention Devices for Drinking and Recycled Water Services at the Main Metering Assemblies are mandatory. It is your option that these are to be provided and installed by:
Property Owner / Developer Licensed Plumber (costs WILL NOT be included in City West Water’s assessment conditions)
City West Water (costs WILL be included in City West Water’s assessment conditions)
The backflow prevention device(s) must be installed at the time of the new water connection. Note: The installation of appropriate
Backflow Prevention Device(s) is MANDATORY on all water connections as per AS:2845.
Required Recycled Water Service (where available): / Size / Flow rate / Qty.
Tapping details / mm / L/s
Main Water Meter / mm
Check Meters (for Units) / mm
PLEASE REFER TO THE TABLE BELOW TO ASSIST YOU IN DETERMING THE GENERAL SERVICE SIZE FOR THE PROPERTY AS A GUIDE ONLY :
Water Service Tapping Size / Number of Units / Dwellings
20mm / 1
25mm / Up to 3
32mm / Up to 8
40mm / Up to 17
50mm / Up to 45
80mm and Greater / Refer to a Hydraulic Consultant
List of Items required to be submitted with the plumbing application when applicable:
Full set of Hydraulic Plans (for Sewer & Water) Site Plan Plan of Subdivision
Architectural Plans Ground Anchors Other
Basement plans & works method statement
Number and Type of Fixtures --- (Refer to “Fixture Table” Page 4. This applies ONLY to Commercial / Industrial Developments)
Sewer Related Works (Tick if Applies):
Connecting to existing Sewer Connection Point
Requiring a New Sewer Connection Point
Constructing of a New Sewer Maintenance Hole / Maintenance Shaft / Maintenance Chamber / Inspection Shaft
Discharge of Trade Waste - separate application is required, refer to this link https://www.citywestwater.com.au/business/trade_waste/food/trade_waste_application_form.aspx :
Black-water/Grey-water Treatment
Storm / Rain-water Recycling

Protection of City West Water Assets:

This is not an application to build over an easement. If any proposed structure is located over a City West Water easement or located within one metre of a City West Water asset, a Build Over Easement application is required to be submitted and approved prior to City West Water issuing its consent to connect.

For a Build Over Easement application refer to the following link: https://www.citywestwater.com.au/documents/build_over_easement.doc

Note: all structures must maintain 1.0 metre clearance from all water mains (refer to Build Over Easement Guidelines - https://www.citywestwater.com.au/documents/guidelines_for_proposed_works_over_assets.pdf).
Fixture Table
SEWER – Type Of Fixture / Total Number of Existing Fixtures / Total Number of Fixtures Abolished / Total Number of New Fixtures / Net Total of Fixtures
BATHROOM GROUP
BASIN
TOILET (WATER CLOSET)
BATH
URINAL
SHOWER
CLOTHES WASHING MACHINE
DISHWASHER
SINK (pot or utility)
CLEANER SINK
LAB SINK
SLOP/STOP HOPPER
LAUNDRY TROUGH
ABLUTION TROUGH
URINAL
other code not listed above
other code
By completing this form you are supplying personal information to City West Water – Read City West Water’s privacy statement at http://www.citywestwater.com.au/privacy_statement.aspx

Section 6 - Payment – Price $466.95

Please advise the name and full details you wish to appear on the invoice:
Credit card details – BLOCK LETTERS PLEASE
Title: Mr Mrs Ms Miss Other
Cardholder’s Name:
Address: / Postcode:
Card Type: Visa MasterCard
Card Number: / Expiry date:

Document FOR-60 Rev 16 Page 4/5