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.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
Related searches
- nevada state business license fee
- state of nevada license lookup
- nevada teaching license lookup
- temporary teaching license florida
- state of nevada insurance license lookup
- license verification california
- business license in clark county
- verify medical license in pennsylvania
- nevada department of insurance license lookup
- nevada educator license lookup
- ohio department of education license lookup
- nevada professional license lookup