QES Management System
Issue Date: 11/07/2016
City West Water
Application Form
Plumbing work for drinking water, sewerage, and recycled water
Non-residential developments orresidential developments greater than 10 lots
Application fee: $457.25 (non-refundable)
Minimum assessment time: 20 business days ensuring all information has been provided
Please return completed application and supporting documents by post or email to:
City West Water
Address Locked Bag 350, Sunshine 3020Phone 1300 299 228
Email Website
Applicant’schecklist - checklist and form must be filled out in full
Applicant’s name:
Be aware that the application will take a minimum of 20 business days to process.
By completing this application you are providing personal information to City West Water. Read City West Water’s privacy statement at:
The application has been filled out and signed by the owner or their authorised representative.
All fields in the application form have been filled in.
All relevant plans and information are attached to the application form. This includes:
site plan
fire services plan
full set of hydraulic plans (for sewer and water)
architectural plans
plan of subdivision
number and type of fixtures (for commercial/industrial developments only, see table at end of form)
pump curves and pump information (where applicable).
Payment of the relevant application fees.
I declare and acknowledge that I have submitted the attached application in its entirety in accordance with the above checklist. I further acknowledge that if the application is incomplete it will be returned and not considered lodged with City West Water.
Print name………………………………………………………………………………………… Signature………………………………………………………………………………………….. Date………………………….
Multi-unit non-residential developments and residential developments greater than 10 lots
The information required in this application form must be completed in full and all relevant plans and information must be submitted with the application.
Application Fee (non-refundable): $ 457.25 (additional fees will apply following assessment)
Minimum assessment time: 20 business days
Property details
Lot No: Level / Unit: / Street number: / Street name:Suburb: / Postcode:
Nearest cross street: / Melways Ref:
Development type
Residential – greater than 10 lotsMixed development
Non-residential multi unit
Non-residential single lot
Internal alteration only
Applicant’s detailsPreferred method of correspondence: Email Mail
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.
Company name:Primary contact name (must be provided):
Address: Postcode:
Phone: / Mobile: Email:
Signed: / Date:
Plumber’s details
Drainer’s name : / Phone number: / Licence number:Water connection:
Plumber’s name : / Phone number: / Licence number:Recycled water connection (where available):
Plumber’s name : / Phone number: / Licence number:Description of Works
Please describe the actual development and works being undertaken:Plumbing work
Required Drinking Water Service: / Size / Flow rate / Qty.Service tapping details / mm / L/s
Fire service (hydrant – sprinklers – hose reel) / mm / L/s
Fire service design standard/s (e.g. 2118.1)
General main water meter / mm / L/s
Check meters (for units) / mm
Details of existing water service/s (to remove yes/no or to retain yes/no) / mm / mm
Existing water meter number/s
Required Recycled Water Service (where available): / Size / Flow rate / Qty.
Tapping details / mm / L/s
Main water meter / mm
Fire Services Related Works (Tick all that are applicable):
Booster fire cabinet/s
Hydrants
Fire sprinkler system
Hose reels
In line pumps (for fire services and/or general services
Water holding tanks
Fire service design standard/s (e.g. 2118.1):
(mandatory if fire service required)
Sewer Related Works (tick all that are applicable):
Connecting to existing sewer connection point
Connecting to a proposed new sewer connection point
Discharge of trade waste (separate application is required – apply via )
Black-water/grey-water treatment
Storm / rainwater recycling
Protection of City West Water Assets:
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 the ‘consent to connect’ being given.
Note: all structures must maintain a 1.0 metre clearance from all water mains (refer to Build Over Easement Guidelines):
Please refer to checklist for items to be submitted with this application.For commercial/industrial developments only – include number and type of fixtures as per table
Fixture Unit Rating AS 3500.2 – General Design Requirements for Sanitary Plumbing Systems (for commercial/industrial development only)
Fixture / Existing Fixtures / Fixture Unit Rating / Abolished Fixtures / New Fixture Units Added / Office Use Only
WC / 4
Urinal / 1
Sink / 3
Basins / 1
Shower / 2
Baths / 4
Trough / 3
Cleaner Sinks / 1
Bed Pan Sterilisers / 4
Double Bowl Sink / 3
Double Pot Sink / 5
Other
Other
Total Fixture Units
______
Payment details
Cost: $457.25 payable by credit card or cheque (credit card preferred)
Please advise the name 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:
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