License



WINDBER BOROUGH

Application for Contractor License

1401 Graham Avenue

Windber, PA 15963

1. NAME ______________________________________________________________________________

ADDRESS ______________________________________________________________________________

__________________________________________________________

City State ZIP

PHONE ___________________________

2. LICENSE CLASSIFICATION: ( ) General ( ) Plumbing ( ) Electrical

( ) Excavation ( ) Masonry ( ) Mechanical

( ) Demolition ( ) Paving ( ) Other __________________

3. PLEASE NOTE: If a Partnership, name all member of the partnership

If a Corporation, name the President, Vice-President, Secretary, and Treasurer.

NAME TITLE RESIDENCE ADDRESS

________________________________ ______________ ______________________________

________________________________ ______________ ______________________________

________________________________ ______________ ______________________________

________________________________ ______________ ______________________________

4. NUMBER OF EMPLOYEES: Full Time ______ Part Time ______

5. TAX ID NUMBER _________________________ PA.Certification No.:________________________

6. LIABILITY INSURANCE and WORKERS COMPENSATION

You must accompany with this application a copy of your Certificate of Insurance, or it will not be accepted. (This information can be faxed to our office.) Fax No. (814) 467-7354

❖ Please also note, only if you DO NOT have employees, and therefore are not required to carry Worker’s Compensation Insurance, the following affidavit stating that you have no employees must be notarized prior to the receipt of this application.

The undersigned swears or affirms that he/she is not required to provide Worker’s Compensation Law for one of the following reasons indicated:

( ) Contractor with no employees

( ) Contractor prohibited by law from any individual to perform work pursuant to this contractor

license unless contractor provides proof of insurance to Windber Borough

Signature of Applicant _____________________________________________

Date ________________

Subscribed and sworn to before me this __________ day of __________, 20____

Signature of Notary ______________________________________________

My Commission expires _____________________

7. Windber Borough has adopted the following Ordinances and Codes, and they are available at the Borough Office for your review:

❖ Windber Borough Zoning Ordinance

❖ Windber Subdivision and Land Development regulations

❖ Windber Borough Ordinances

❖ Flood Plain Management Ordinance

❖ National Electric Code

❖ Uniform Construction Code of Pennsylvania.

❖ International Code Council Codes

Contractor licenses must be renewed on a yearly basis. The time period covered by the license runs from January 1st to December 31st of the year that a license is purchased. All licenses expire on December 31St.

The Uniform Construction Code requires that a certificate of occupancy be issued for each building permit that is obtained. You must call for an inspection when the job is completed.

THIS APPLICATION MUST BE ACCOMPANIED BY A REGISTERED FEE OF

FIFTY ($50.00) DOLLARS.

CHECKS PAYABLE TO Windber Borough

(You will receive 2 vehicle decals for the $50.00 fee. For extra decals add $1.00 for each.)

Decals must be displayed on company vehicle(s)

Applicant Signature _________________________________________________________

Title ___________________________________ Date _____________________

________________________DO NOT WRITE BELOW THIS LINE__________________________

Amount Paid __________ Paid ~ Check # ________

Cash ________

Number of Decals Issued (2) __________ ___ Extra Decals

License (approved) (disapproved) __________, 20______

Signature __________________________________________

Windber Borough Official

Attention licensed COMMERCIAL contractors of Windber Borough

Any contractor that performs commercial work or any new home builder is required to be licensed by the local municipality as they were previously. (In municipalities that required them).

Your 2016 Windber Borough contractor license expires on December 31, 2016. You may not work in the Borough beginning in January until you renew your contractor license. (Borough Ordinance 098-2)

❑ Enclosed is a renewal application for 2017.

❑ You must furnish the Borough with a Certificate of Insurance for General Liability and Workman’s Compensation. The Certificate holder should be Windber Borough, 1401 Graham Ave. Windber, PA. 15963. This information may be faxed to (814) 467-7354

❑ If you have no employees and are not required to carry Workman’s Compensation, you must check the appropriate space and have the form notarized.

❑ Renewal may be done by stopping by the office, or by mail.

❑ You will be furnished with 2 stickers for your $50.00 fee; additional stickers will be $1.00 each. A sticker must be placed on each vehicle. Some of you have neglected to place a sticker on your vehicles. This makes it very difficult to identify you especially if your vehicle does not have the company name on it. (Suggestion: These stickers are not of the highest quality or durability. Rather that sticking them on an outside window; tape them to the inside of a rear or side window. This saves the window from the mess from the old sticker.

❑ Fee for license is $50.00. Make check payable to Windber Borough.

❑ Should you ever have any questions concerning permits, fees, code requirements, inspections, etc., please feel free to contact this office at 467-9014.

Thank you for choosing to work in Windber Borough.

-----------------------

Borough

License # _________

Year: ____________

Complete both sides of this form.

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