Fillable Electrical Permit Application (City of South Bend)

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Electrical Permit Application (City of South Bend)

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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
DATE:_______________________________ PERMIT NO._________________________
TOWNSHIP:__________________________ ZONING:_____________________________
OWNER NAME:______________________________ PHONE:_____________________________
MAILING ADDRESS:______________________________________________________________
PROPERTY LOCATION:_______________________________________________________________
__________________________________________________________________________________
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:_________________________________________________________
Phone Number:_____________________________________________________________
*
Solar
See Fee Schedule for permit fees
AEP Work Order Number: ______________________________________________
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Electrical Permit Application (City of South Bend)

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Completed 16 July 2020

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