Fillable Electric Permit Application (City of South Bend)

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Electric Permit Application (City of South Bend)

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U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

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ST. JOSEPH COUNTY/SOUTH BEND BUILDING DEPARTMENT
125 S. LAFAYETTE BLVD. SUITE 100
SOUTH BEND, INDIANA 46601
Phone: 574-235-9554/Fax: 574-235-5541
APPLICATION FOR ELECTRICAL PERMIT
PERMIT #: BD ________________________ DATE: _________________________
PLEASE COMPLETE THE CHART BELOW, NOTING THE QUANTITY OF EACH ITEM ON THE LEFT,
AND CALCULATING THE FEES ON THE RIGHT. FIND OUR FEE SCHEDULE AT THE LINK BELOW:
https://southbendin.gov/wp-content/uploads/2018/07/Fee-Schedule-2020.pdf
Qty. Description Amount Fees Owed
Temporary Services (All Amperages)
Switchboards & Panel Boards (Sub Panels)(new & Replaced)
60 amp.________________
100 amp.________________
200 amp.________________
400 amp.________________
600 amp.________________
Over 600 amp. Up to 2,000 amp.________
Over 2,000 amp.__________
Circuits, each (new and replaced)
Horsepower (machinery) Total hp__________
Back-up Generator: 10 Kv or less _______ Over 10 Kv________
Pool wiring and/or bonding
Repair, extension, and/or maintenance of wiring
Reset, Relocation, and Reconnection
Other:
MINIMUM PERMIT FEE: $40.00
Total:
It is hereby certified that the work herein called for is in accordance with the provisions of the
Electrical Codes of St. Joseph County and the City of South Bend, Indiana.
Electrical Contractor:_________________________________________________________
(Please list Company Name, how licensed within our jurisdiction)
Phone Number: _________________________________________________________
Solar *Table with description above must still be completed
*See Fee Schedule for permit fees
AEP Work Order Number:
PROPERTY ADDRESS: ____________________________________________________________
OWNER NAME:______________________________ PHONE:_____________________________
MAILING ADDRESS:______________________________________________________________
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Electric Permit Application (City of South Bend)

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Completed 16 July 2020

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