Fill - Free fillable Department of Community and Economic Development (City of Green Bay) PDF form

City of Green Bay

Department of Community and Economic Development

RESIDENTIAL BUILDING PERMIT INFORMATION

This is a packet of Building, Electrical, Plumbing, and HVAC permit applications you must complete to obtain the

permits necessary to remodel or add to your single family home or build a garage. You will not need all of the forms in

this packet depending on who is performing the work.

The Project Permits Application (the top form) must be completed for all projects. Fill out the form as well as you

can and leave blank any areas you do not understand. Staff can help complete the form when you submit the packet for

review.

The Cautionary Statement (the 2

form) must be signed and dated if the homeowner is acting as the general

contractor or doing any work on the project.

There are two Electrical permit applications (the 3

& 4

form); one is the Licensed Electrical Contractor’s permit

form and the other is the Homeowner’s Electrical permit form. If you are using an electrical contractor, please have

the contractor fill out this permit and return it to you to submit with the application packet. If you own and live in the

house and plan on doing the electrical work yourself, please contact a City electrical inspector at 920-448-3300 before

filling out the Homeowner’s Electrical permit and submit it with the application packet.

The 5

& 6

forms are the Licensed Plumbing Contractor’s and the Homeowner’s Plumbing permit forms.

Like the electrical permits, if you are hiring a plumbing contractor he must fill out the permit and return it to you. If

you, as the owner and occupant, are doing the plumbing work, complete the Homeowner’s Plumbing permit form and

submit it with the application packet. Contact a City plumbing inspector (920-448-3300) if you have any questions.

The 7

& 8

forms are the Licensed Heating Contractor’s and the Homeowner’s Heating permit forms. Again,

if using a licensed contractor he must fill the form out and return it to you. If you, as the owner and occupant, are doing

the HVAC work, complete the Homeowner’s Heating permit form and submit it with the application packet. Contact a

City HVAC inspector (920-448-3300) if you have any questions.

An Erosion Control permit form is also included and, if required by the Erosion Control Permitting Process flowchart,

must be submitted with an Erosion Control Plan.

You will only need electrical, plumbing, or HVAC permits if that type of work is associated with your project. If you are

not doing electrical, plumbing, or HVAC work you will not need those permits.

You may also need to submit building, electrical, plumbing, and HVAC plans when you bring the permit package in. If

you are doing work outside the house (addition, new garage, etc.) a site plan may be required. Please tell us the scope

of your project when you pick up the permit packet and we will be able to explain what information to submit.

The total permit packet at the time of submittal must contain the Project Permits Application, the Cautionary

Statement, any plans required, and an electrical, plumbing, and HVAC permit if that work is being done. All forms

must be filled out and signed prior to issuance of permits.

If you have any questions concerning these permits, please contact the Department of Community and

Economic Development at (920) 448-3300 and ask for a Building, Electrical, Plumbing, or HVAC

Inspector.

I:\DeptData\Planning\Inspection Division\Forms\Fillable\Packet-ResidentialBuildingPermitInformation.pdf

100 North Jefferson Street, Room 608, Green Bay, Wisconsin 54301-5026

(p) 920.448.3300 (f) 920.448.3426 greenbaywi.gov

(Rev 12/16)

PROJECT PERMITS

APPLICATION

All fields must be completed before permit will be processed.

Project Address

Parcel #

Project #

Property Owner

Contractor

Name Name

Company

(if applies)

Company

Address

City, State, Zip

Phone #

Current Land Use, Flood Plain & Zoning (check which applies)

Land Use: 2-Family Multi-Family # of units ____ Commercial (describe) _______________

Vacant Lot

1-Family

Zoning: R-1 R- 2 R-3 RR OR NC

D C-1 C-2 C-3 L1 G1 BP PI CON TND

Flood Plain: Yes

Base Flood Elevation (BFE)_____

Addition Alteration Repair Move Raze (demolish)

Change-of-use

Project Scope:

New

Area: Finished Unfinished Total Bldg:

Description of Project :

Estimated Cost of Construction $

 Erosion Control # _________

City  SBD $___________

Plan Approvals

PLBG Plan

SWR Plan

Foot & Found Only #_______ City

 Building Plan

 HVAC Plan

 Site Plan

# _________  City  SBD $___________

# _________ $___________

Contractors (UDC Numbers Required): DCC # DCQ #

 BLDG -

Bldg Fee

 ELEC –

Elec Fee

 HVAC –

Hvac Fee

 PLBG –________# of Fixtures

Plbg Fee

 SWRS –

 Water Fee $_____

 Storm Fee $_____

Assessment $_____

 Sanitary Fee $_____

Assessment $_____

Swrs Fee

 CERTIFICATE OF OCCUPANCY

C.O.

Addl. Fee

Double Fee

 DOUBLE FEE PERMIT [s.15.07(b)] If application for a building permit has not been obtained prior to commencement of

the job, applicable permit fee shall be doubled.

Application Signature The applicant certifies that information submitted herein is accurate; agrees to comply with the Wisconsin

Administrative Code, Municipal Ordinance, and with the conditions of this permit; and understands that permit issuance creates no legal

liability, expressed or implied, on the Department or Municipality.

Signature of Applicant Date

Class Code Census Receipt No. Total Fee

Reviewed By

Credential #

White - Office

Yellow - Applicant

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one business day

in advance. Final inspections are required for all projects.

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

www.greenbaywi.gov

(assigned by City)

Erosion Ctrl

 EROSION CONTROL

 ADDITIONAL PERMITS (Sprinklers #_____, Curb Cut, Flood Plain, Temp. Occupancy, Etc.)

(Please List)

(Rev 1/20)

(check all that apply)

Height

#_______

City

#_______ City

SBD $__________

For Office Use Only

www.greenbaywi.gov

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

CAUTIONARY STATEMENT

TO PROPERTY OWNERS

OBTAINING BUILDING PERMITS

101.65(1r) of the Wisconsin Statutes requires municipalities that enforce the Uniform

Dwelling Code to provide an owner who applies for a building permit with a statement

advising the owner that:

If the owner hires a contractor to perform work under the building permit and the

contractor is not bonded or insured as required under s. 101.654(2)(a), the following

consequences might occur:

(a) The owner may be held liable for any bodily injury to or death of

others or for any damage to the property of others that arise out

of the work performed under the building permit or that is

caused by any negligence by the contractor that occurs in

connection with the work performed under the building permit.

(b) The owner may not be able to collect from the contractor damages

for any loss sustained by the owner because of a violation

by the contractor of the one- and two-family dwelling code or

an ordinance enacted under sub. (1)(a), because of any bodily

injury to or death of others or damage to the property of others

that arises out of the work performed under the building permit or

because of any bodily injury to or death of others or damage to the

property of others that is caused by negligence by the contractor

that occurs in connection with the work performed under the

building permit.

_____________________________________________________

Owner Signature

White – Office Yellow – Owner/Agent

__________________________

Date

(Rev 12/16)

click to sign

signature

click to edit

Two-Family

NATURE OF WORK (check all that apply):

 Swimming Pool

 Alteration

 Remodeling

Repairs

Sign

 Addition

Detached Garage

Hot tub/spa

Other ____________

JOB DESCRIPTION:

(REQUIRED)

_______________________________________________

Signature (Master Electrician Responsible For Work)

(REQUIRED)

___________________

Date

INSPECTOR STATEMENT: I hereby certify the work completed as of date signed complies with applicable codes.

____________________

Date

_________________________________________________

Inspector Signature

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

LICENSED

CONTRACTOR

ELECTRICAL PERMIT

Check box for Online Payment

The information below must be provided for notification of project number and permit fee. This information is

required to make payment on-line.

Educational

Other

Multi-Family

Number of Units

Manufacturing

Phone _________________

Fax ________________

________

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one

business day in advance. Final inspections are required for all projects.

CONTRACTOR STATEMENT: I hereby certify that the above wiring upon completion will be in compliance with

the applicable federal, state, and local electrical codes and utility service rules.

“ENERGIZING THE DESCRIBED WIRING WILL IN NO WAY CREATE A HAZARD”

State of WI Electrical Contractor Certification # _____________ and WI Master Certification # _______________

Email ____________________________

(Rev 6/20)

www.greenbaywi.gov

All fields must be completed before permit will be processed.

Project Address: __________________________________________________

Owner's Name: __________________________________________________

Owner's Email: Phone #:

Electrical Contractor: ______________________________________________

Contractor's Address: ______________________________________________

Contractor’s Email: ________________________________________________

Contractor’s Phone #: ___________________ Cell #: _____________________

Value of work: ___________________________________________________

Single-Family

Commercial

OCCUPANCY (check appropriate box):

Name: ________________________________________

Address: ________________________________________

Phone #: ________________________________________

Email: ________________________________________

Check one:

What type of wiring method(s) do you intend to use (i.e. Romex, EMT, PVC, direct buried cable)?

In the left column, state the size wire you intend to use and, in the corresponding column on the right, state the

size over current device you intend to use to protect that wire:

Wire Size & Type

Over Current Device Size

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

HOMEOWNER’S

APPLICATION FOR

ELECTRICAL PERMIT

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

Addition to existing building

Detached garage

Swimming pool

Other ________________________________________

Provide a sketch of the work you intend to do that shows the location of all electrical outlets (i.e.

switches, receptacles, lights, etc.)

Briefly describe the electrical work you intend to do:

Application Approved By:

to inspection date needed. Final inspections are required for all projects.

Date: ____________________________

Electrical Inspector

All fields must be completed before permit will be processed.

www.greenbaywi.gov

AFFIDAVIT: I hereby certify that I am the owner of the above described premises located in Green Bay, Brown

County, and that I occupy such premises solely as a residence, in accordance with the Homestead Act of the laws of the

State of Wisconsin. I further declare that if the permit is granted, the electrical work will be performed by myself in

accordance with State and City regulations. Failure to do so will subject me to penalties described in the State and City

Ordinances.

Owner's Signature: _________________________________

(REQUIRED)

NOTE: Duplexes, condos, and other similar dwelling units, which are physically attached to other dwelling

units, are not single-family dwellings. The City electrical code allows homeowners to do wiring in existing

single-family dwellings only.

Before insulating or covering any walls containing any wiring, call the Community and Economic Development

Department for a rough-in inspection. At that time, all grounding splices should be made up permanently.

When the job is completed, call for a final inspection prior to occupancy.

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one business

day in advance. Final inspections are required for all projects.

(Rev 6/20)

Date: _________________________________

Value of Work: $__________________



www.greenbay.wi.gov

LICENSED CONTRACTOR

PLUMBING PERMIT

(INTERNAL)

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

All fields must be completed before permit will be processed.

Project Address:

Owner's Name:

Phone #: Owner's Email:

Plumbing/Utility Contractor:

Contractor’s Address:

Contractor's Email:

Contractor's Phone #:

Value of Work:

I hereby make application for a permit for the following described sewer/plumbing work at the above location.

General Interior Plumbing

Total Number of Fixtures

Total Number of Appliances

Total Number of Appurtenances

Total Count

Description of Work:

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one business

day in advance. Final inspections are required for all projects.

Contractor's Signature:

Master Plumber Credential #

Check box for Online Payment

The information below must be provided for notification of project number and permit fee. This information is required to make

payment online.

Phone

Fax

Excerpt from City of Green Bay Plumbing Code:

Section 16.06 Permit must be procured before starting work: If any work regulated by the Plumbing Ordinance for which a permit is required

is commenced without a permit first having been obtained thereof, double the permit fee herein prescribed shall be paid when a permit finally

is obtained. Payment of any fee mentioned in this Section, however, shall in no way relieve any person of the penalties that may be imposed for

violation of the Plumbing Ordinance.

(Rev 6/2020)

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

www.greenbaywi.gov

___________________________________________________________

Owner’s Signature

____________________

Date

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at

least one business day in advance. Final inspections are required for all projects.

The City of Green Bay hereby permits the above-described plumbing work to be performed at

the address stated above, subject to all laws and regulations of the City of Green Bay and the State of

Wisconsin.

By: ___________________________________________________

Plumbing Inspector

Date

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

HOMEOWNER’S

APPLICATION FOR

PLUMBING PERMIT

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

(Rev 6/20)

All fields must be completed before permit will be processed.

Name:

Address:

Phone #:

Email:

Value of Work: $

Description of work:

Number of fixtures roughed in for and/or installed: __________ ($7.00/fixture, $50.00 minimum permit fee)

Application is hereby made to do the above-described plumbing work at the premises named above.

Issuance of the permit is based on §145.06(4)(a) of the State Code allowing a property owner to

perform plumbing work in a one-family building owned and occupied (per SPS 382.10(2) of the State Code)

by him or her as his or her home.

AFFIDAVIT: I hereby certify that I am the owner of the above-described premises located in

Green Bay, Brown County, and that I occupy such premises solely as a residence, in

accordance with the Homestead Act of the laws of the State of Wisconsin. I further declare that if the

permit is granted the plumbing work will be performed by myself in accordance with State and

City regulations. Failure to do so will subject me to penalties described in the State and City

Ordinances.

www.greenbaywi.gov

FURNACE: Gas ___________ Electric __________ Oil __________ Forced Air __________

AIR CONDITIONER: Forced Air __________ Central Air __________

BOILER: Steam _______ Hot Water ________ Res ________ Industrial ________ Commercial _______

SPACE HEATER: Type __________ Unit __________

Class __________

Contractor’s Signature: ___________________________________ Credential # _____________________

Check box for Online Payment

The information below must be provided for notification of project number and permit fee. This information is

required to make payment on-line.

Phone ___________________ Fax _____________________

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

LICENSED

CONTRACTOR

HEATING PERMIT

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at least one

business day in advance. Final inspections are required for all projects.

Email ________________________

(Rev 6/20)

All fields must be completed before permit will be processed.

Project Address:

Owner's Name:

Phone #:Owner's Email:

Heating Contractor:

Contractor's Address:

Contractor’s Email:

Contractor's Phone #:

Unit Price: Value of Work:

I hereby make application for a permit for the following described heating work at the above location.

Check all that apply:

www.greenbaywi.gov

___________________________________________________________

Owner’s Signature

_____________________

Date

To schedule an inspection, submit an online Inspection Request or call (920) 448-3300 at

least one business day in advance. Final inspections are required for all projects.

The City of Green Bay hereby permits the above-described heating work to be performed at the

address stated above, subject to all laws and regulations of the City of Green Bay and the State of

Wisconsin.

By: __________________________________________________

Heating Inspector

Date

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

HOMEOWNER’S

APPLICATION FOR

HEATING PERMIT

This section for City use only

Project #:

Permit Code:

Permit Fee:

Parcel #:

Receipt #:

Date:

(Rev 6/20)

All fields must be completed before permit will be processed.

Name:

Address:

Phone #:

Email:

Value of Work: $

Description of work:

Application is hereby made to do the above-described heating work at the premises named above. Issuance

of the permit is based on SPS 305.70 of the State Code allowing a property owner to perform heating

work in a building owned and occupied by him as his home.

AFFIDAVIT: I hereby certify that I am the owner of the above-named premises located in Green Bay,

Brown County, and that I occupy such premises solely as a residence in accordance with the

Homestead Act of the laws of the State of Wisconsin. I further declare that if the permit is granted

the heating work will be performed by myself in accordance with State and City regulations.

Failure to do so will subject me to penalties described in the State and City Ordinances.

(Rev 01/17)

Department of Community

and Economic Development

100 N. Jefferson Street, Rm 608

Green Bay, WI 54301-5026

(920) 448-3300 - phone

(920) 448-3426 - fax

inspmail@greenbaywi.gov

Small Site General Instructions: Submit this application and erosion control plan demonstrating compliance with Ch. 34,

Green Bay Municipal Ordinance and/or Ch. SPS 321.125, Uniform Dwelling Code, for sites covering less than one acre and/or one-

or two-family residential construction prior to commencing land-disturbing construction or land-development activity to Room 610.

Large Site General Instructions: Submit application and erosion control plan demonstrating reasonable compliance with Ch. 34, Green

Bay Municipal Ordinance, for sites one acre or greater in size prior to commencing land-disturbing construction or land-development

activity to Room 610.

Excavation within Public Rights-Of-Way General Instructions: Submit this application and erosion control

plan demonstrating compliance with Ch. 34, Green Bay Municipal Ordinance for land disturbances covered within section 34.04(1)

(a) 1. 4,000 SF; 4. 100 LF of drainage conveyance impacts; 6. 300 LF of underground utility work; and/or 7. 100 CY or

greater of excavation volume prior to commencing land-disturbing construction or land-development activity to Room 300.

Address/Street of land-disturbing activity:

Parcel #:

Zoning District: Project #:

Site #

APPLICANT

Property Owner

General Contractor

EROSION CONTROL CONTRACTOR

Name Name

Company Company

Address Address

City, State, Zip City, State, Zip

Phone Phone

Email Email

Description of Activity:

Start

End ______________

Erosion Control Plan: (provide 3 copies) *Must demonstrate compliance with Ch. 34, Green Bay Municipal Ordinance and/or Ch. SPS 321.125

UDC, including but not limited to all of the following:

1. Application

2. Property legal description

3. Existing site map / plan

4. Final site map / plan

5. Site construction plan

6. Soil loss prediction tool / spreadsheet

7. Erosion & Sediment Control Plan Statement (Narrative description of who, what,

when, where, how things will be completed on the proposed site(s)).

Applicant Signature: ______________________________________________________________________ Date: ________________________

Following sections to be completed by the City of Green Bay

Plan Approval: Permit is void unless signed by the Erosion Control Specialist.

Erosion Control Plan reviewed and approved by Erosion Control Specialist:___________________________________ Date:____________________

Permit Issuance:

1. Duration – This erosion control permit shall remain valid for a period of 180 days or for the length of the building permit, whichever is longer. The

Erosion Control Specialist or designated representative may extend the period one or more times for up to an additional 180 days, and may require

additional erosion control measures as a condition of the extension if necessary to meet the requirements of this ordinance.

Permit Expiration Date: __________________________________

2. Surety Bond - As a condition of approval and issuance of the permit, the Public Works Director may require the applicant to deposit a surety bond or

irrevocable letter of credit to guarantee a good faith execution of the erosion control plan.

Surety Bond Amount $ __________________________________ Date Filed: _______________________________________

3. Conditions of Approval - This permit approval requires the applicant to:

a. Notify the Erosion Control Specialist / designated representative at least 48 hours before commencing any land-disturbing construction or land-

development.

b. Notify the Erosion Control Specialist / designated representative of completion of any erosion control measures within seven days after their

installation.

c. Obtain permission in writing from the Erosion Control Specialist / designated representative prior to modifying the erosion control plan.

d. Install all erosion control measures as identified in approved erosion control plan.

e. Maintain all road drainage systems, storm water drainage systems, control measures, and other facilities identified in erosion control plan.

f. Repair any siltation or erosion damage to adjoining surfaces and roadways resulting from land-developing construction or land-disturbing activities.

g. Inspect the construction erosion control measures after each rain of 0.5" or more and at least once each week and make needed repairs.

h. Allow the Erosion Control Specialist / designated representative to enter the site for the purpose of inspecting compliance with the erosion

control plan or for performing any work necessary to bring the site into compliance with the erosion control plan.

i. Keep a copy of the approved erosion control plan on the site.

j. Submit weekly inspection reports to the Erosion Control Specialist via e-mail at erosioncontrol@greenbaywi.gov

Failure to comply with any of these conditions may subject the permittee to corrective action, fines, and/or revocation of the permit at

permittees sole expense.

Permit Issued By: __________________________________________ Date:___________________________________

EROSION CONTROL

PERMIT APPLICATION

www.greenbaywi.gov

Raze Site Fill Site Excavation Site

Construction Site

Acres

Same as Applicant

(Rev 01/17)

Erosion Control Permitting Process

For Land Disturbing Projects Outside of the Public Rights-of-Way

Inspection Intake

Time and date stamp upon

receipt of complete application.

Is there any land disturbance? Yes

Disturbance meet

the following?

34.04(1)(a)1.

34.04(1)(a)2.

34.04(1)(a)3.

34.04(1)(a)4.

34.04(1)(a)5.

34.04(1)(a)6.

34.04(1)(a)7.

See Page 2.

Non-Permitted

Activity

Fill out 34.08 Performance

Standards Sign-Off Sheet

No Permit or E/C

Plan Required

Yes

PERMIT REQUIRED.

Inspection sends to Erosion Control Specialist for further

processing. Time and date stamped upon receipt by ECS.

<1 Acre disturbance? ≥1 Acre disturbance?

Large Site Erosion Control

Permit Application Required

Small Site Erosion Control

Permit Application Required

Review the Erosion Control Plan submitted to Inspection Department in accordance

with 34.11 under standards in 34.09, pursuant to 34.10(3). Review and comment to be

completed within 15 days of City’s initial receipt of complete application.

Comment/Resubmit

Erosion Control

Plan Approved

ECS signs off on

the application.

Approved Plan Sent to Inspection

Permit Issued by Inspection

(Rev 01/17)

APPLICABILITY AND JURISDICTION

34.04(1)(a)1. Those involving grading, removal of protective ground cover or vegetation, excavation,

land filling, or other land-disturbing construction activity affecting a surface area of 4,000 sq. ft. or more.

34.04(1)(a)2. Those requiring a subdivision plat or certified survey approval or the construction of

1- and 2-family residential dwellings or commercial, industrial, or institutional buildings on lots of

approved subdivision plats.

34.04(1)(a)3. Those requiring a certified survey approval or the construction of houses or

commercial, industrial, or institutional buildings on lots of approved certified surveys.

34.04(1)(a)4. Those involving street, highway, road, or bridge construction, enlargement, relocation,

or reconstruction.

34.04(1)(a)5. A construction site, which has 100 linear feet or greater of land disturbance to a

highway, street, driveway, swale, ditch, waters of the state, wetland, protective area, or other non-

agricultural drainage facility which conveys concentrated flow. Wetlands shall be delineated in

accordance with s. NR 103.08(1m).

34.04(1)(a)6. Those involving the laying, repairing, replacing, or enlarging of an underground pipe,

wire, cable, or facility for a distance of 300' or more.

34.04(1)(a)7. A construction site which has 100 cubic yards or greater of excavation volume, filling

volume, or some combination of excavation and filling volume.

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