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: $__________________
click to sign
signature
click to edit
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