Fillable Plumbing Permit Application (City of South Bend)

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Plumbing 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 PLUMBING PERMIT
DATE:_______________________
PERMIT#:BD__________________________
PROPERTY ADDRESS:__________________________________________________________
OWNER'S NAME:______________________
PHONE:________________________
MAILI
NG 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-c
ontent/uploads/2018/07/Fee-Schedule-2020.pdf
Qty. Description Amount Fees Owed
Plumbing fixtures/drains/traps:________________________
Backflow Protection
Building Sewer: Under 100'__________ Over 100'__________
Building Water: Under 100'__________ Over 100'__________
Water Softener(s)
Drain within building for rainwater system
Water Heater(s)
Gas Reconnection__________ Gas outlet(s)__________
Repair or alteration of drainge or vent piping
Drywells
Lawn Sprinkler Systems
Fire Protection Sprinkler system/Number of Heads:____________
Gas Tank(s) and Pump(s)
Back-up generator-gas line: 10 Kv or less_____ Over 10 Kv______
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 Plumbing
Codes of St. Joseph County and the City of South Bend, Indiana.
Plumbing Contractor:_________________________________________________________
(Please list Company Name, how licensed within our jurisdiction)
Phone Number: _____________________________________________________________
**See Fee Schedule for permit fees
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Plumbing Permit Application (City of South Bend)

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Completed 16 July 2020

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