Fillable PERMIT #: BD (City of South Bend)

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PERMIT #: BD (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 HVAC PERMIT
DATE:
PHONE:
PERMIT #: BD
PROPERTY ADDRESS:
OWNER NAME:
MAILING ADDRESS:
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
*PROVIDE CFM’s PER SYSTEM, NOT TOTAL
Qty.
Description
Amount
Fees Owed
Furnaces: Gas: Oil:
BTU's:
Electric(kw)
Air Conditioner(s): Tons:
EMI
airblowers:
Ventilating and Exhaust System: CFM's
Ventilating Commercial Hoods: CFM's
Refrigeration: Hsp:
Rooftop Combination: Tons:
Heat Pump: BTU input Tons:
Water
Source:
Boilers: BTU's Water: Steam:
VAV box w/coil/Thru-Wall Combination Heat/Air
Air Handler: CFM's:
Ducts and register: No. of openings:
Back-up generator-gas line: 10 Kv or less: Over 10 Kv:
Gas Reconnection: Gas Outlet(s):
Woodburning stoves
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
Mechanical Codes of St. Joseph County and the City of South Bend, Indiana.
Mechanical Contractor:
(Please list Company Name, how licensed within our jurisdiction)
Phone Number:
*See Fee Schedule for permit fees
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PERMIT : BD (City of South Bend)

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Completed 16 July 2020

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