Fillable Printable Wireman Licence Application Form - Idaho

Wireman Licence Application Form - Idaho

E-SPEC CON APPL 1 6/24/2015

_________________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

Meridian, Idaho 83642

Phone: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

APPLICATION FOR ELECTRICAL SPECIALTY CONTRACTOR LICENSE

● To qualify for the Electrical Specialty Contractor exam an applicant must:

▪ Be or employ an Idaho licensed Electrical Specialty Journeyman in the same category

as the Electrical Specialty Contractor who has held such license for a minimum of

two (2) years.

▪ Be the representative for the exam or a full-time supervisory employee of the

corporation, company, etc.

▪ Submit a completed application (included).

▪ Pay the $15 (non-refundable) application fee.

● Upon application approval:

▪ Exam information will be sent to the applicant.

● Upon passing the exam an applicant must:

▪ Submit proof of $300,000 Liability Insurance and Worker’s Compensation Insurance

or a statement of exemption for Worker’s Compensation (if applicable).

▪ Pay the $125 license fee.

Please Note: If an applicant does not take the exam within 60 days of approval,

he/she must reapply.

E-SPEC CON APPL 2 6/24/2015

THIS SECTION TO BE COMPLETED BY A NOTARY PUBLIC

State of _______________________

The above individual appeared before me this _______day of _______, 20______.

NOTARY SEAL: ______________________________

Signature of Notary Public

Commission Expires: _______________

_________________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

Meridian, Idaho 83642

Phone: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

APPLICATION FOR ELECTRICAL SPECIALTY CONTRACTOR LICENSE

*Check your form of business:

Individual _____ Social Security Number: _______________________________________________________

Other Legal Entity _____ Employer Identification Number_________________________________________

(Provide documentation from the Idaho State Secretary of State)

*Company Name: _____________________________________________________________________________

*Mailing Address: ____________________________________________________________________________

*City: ________________________________________________ *State: _________ *Zip Code: ____________

*Contact Phone Number(s): _____________________________________________________________________

*E-Mail Address: ______________________________________________________________________________

*Check the type of Electrical Specialty Contractor license you are applying for:

____ Elevator, Etc. ____ Limited Energy ____ Refrig, Htg, & Air Cond

____ Sign ____ Irrigation Sprinkler ____ Outside Wireman (Lineman)

____ Manufacturing/Assembling ____ Well Driller/Pump Installer ____ Photovoltaic (Solar) Installer

Note: This application must be signed in both places.

*Employer Identification Number/Social Security Number: _________________________________________________________

Supervising Specialty Journeyman Information: I certify I am a full-time employee and I am responsible for supervision of electrical installations

made, by the above listed company. I have been employed as a licensed specialty journeyman for a period of not less than two (2) years and I am available

during working hours to carry out the duties of supervising specialty journeyman.

*___________________________________________________________________________________________________________

Supervising Specialty Journeyman (Please Print) Signature Idaho Spec. Journeyman License Number

Note: Verification of either two years of employment as a licensed specialty journeyman or verification of four years of experience in the specialty category

applied for must be included (See page 3).

Representative Information: I certify I am a full-time supervisory employee of the above listed company. I am not currently designated

by any other company to be their representative.

*___________________________________________________________________________________________________________

Representative for Exam (Please Print) Signature Social Security Number

*Required Field

_________________________________________________________________________________________________

E-SPEC CON APPL 3 6/24/2015

THIS SECTION TO BE COMPLETED BY A NOTARY PUBLIC

State of ___________ County of ___________

The above individual appeared before me this ______ day of _______, 20______.

NOTARY SEAL: _________________________________

Signature of Notary Public

Commission Expires: ________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

Meridian, Idaho 83642

Phone: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

EMPLOYER'S VERIFICATION FORM FOR SUPERVISING SPECIALTY ELECTRICIAN

(Please submit a separate form for each employer)

SELF-VERIFICATION WILL NOT BE ACCEPTED

Applicant Name: ____________________________________________ License Number: _____________

Verified Dates: _________________________________________________________________________

From: (month/day/year) To: (month/day/year)

Total Hours Worked: ______________

Detailed Description of the type of work performed: ______________________________________________

_________________________________________________________________________________________

______________________________________________________________________________________

Employer/Contractor: ________________________________________ License Number: ______________

Address: _______________________________________________________________________________

City: ________________________________________________ State: _____________ Zip: ___________

Telephone Number: ___________________________ E-Mail: ___________________________________

______________________________________________________________________________________

Employer’s Authorized Signature

_________________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

E-SPEC CON APPL 4 6/24/2015

1090 East Watertower Street, Suite 150

Meridian, Idaho 83642

Phone: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

AUTHORIZED SIGNATURES FOR CONTRACTOR LICENSE

Completion of this form allows the license-holder to designate a maximum of two authorized individuals who will be allowed

to conduct transactions (sign permits, schedule/cancel inspections, etc.) under this contractor’s license.

_______________________________________________________________________________________

Printed Name of 1

Designee Signature

_______________________________________________________________________________________

Printed Name of 2

Designee Signature

I understand that I am responsible for updating the above information in writing to the Division of Building Safety. As

the owner of this license I am responsible for all fees, purchases or fines that accrue to this license as a result of my

actions or those of the individual(s) named above.

________________________________________________________________________________________

Signature of Licensee Date

________________________________________________________________________________________

DBA License Number

Proof of $300,000 Liability Insurance and Worker’s Compensation Insurance must be received by the Division of Building

Safety. If you are exempt from Worker’s Compensation Insurance your signature is required on the statement below before

your license can be issued.

STATEMENT OF EXEMPTION FOR WORKER’S COMPENSATION

I qualify as an exempt employer for Worker’s Compensation Insurance:

Signature: ____________________________________________________________ Date: _______________

______________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

E-SPEC CON APPL 5 6/24/2015

Meridian, Idaho 83642

Phone: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

The following (IDAPA 07.01.04014) shall be considered as electrical specialties, the practice of which shall require a specialty

license:

Elevator, Dumbwaiter, Escalator or Moving Walk Electrical Licenses:

Any person qualifying for and having in his possession a current elevator electrical license may install, maintain, repair, and

replace equipment, controls, and wiring beyond the disconnect switch in the machine room of the elevator and pertaining

directly to the operation and control thereof when located in the elevator shaft and machine room. He shall be employed by a

licensed elevator electrical contractor and his installation shall be limited to this category. The holder of such specialty license

may not countersign a contractor’s license application as supervising journeyman except for work within his specialty. (4-9-79)

Sign Electrical Licenses:

Any person qualifying for and having in his possession a current sign electrical license may install, maintain, repair, and

replace equipment, controls, and wiring on the secondary side of sign disconnecting means; providing the disconnecting means

is located on the sign or within sight therefrom. He shall be employed by a licensed sign electrical contractor whose

installations shall be limited to this category. The holder of such specialty license may not countersign a contractor’s license

application as supervising journeyman except for work within his specialty. (3-15-02)

Manufacturing or Assembling Equipment Electrical Licenses:

a) A licensed specialty manufacturing or assembling equipment electrician must be employed by a licensed specialty

manufacturing or assembling equipment contractor in order to work in this category. The holder of a specialty license in

this category may not countersign a contractor's license application as supervising journeyman except for work within this

specialty. (4-5-00)

b) Any person licensed pursuant to Paragraph 014.03.a. of these rules may install, maintain, repair, and replace equipment,

controls, and accessory wiring, integral to the specific equipment, on the load side of the equipment disconnecting means.

Electrical service and feeder are to be installed by others. The licensee may also install circuitry in modules or fabricated

enclosures for the purpose of connecting the necessary components which individually bear a label from a nationally

recognized testing laboratory when such equipment is designed and manufactured for a specific job installation. All wiring

completed shall meet all requirements of Title 54, Chapter 10, Idaho Code, all rules promulgated pursuant thereto, and the

most current edition of the National Electrical Code. (7-1-94)

c) Subsection 014.03 of these rules does not apply to a manufacturing or assembling equipment electrician installing electrical

wiring, equipment, and apparatus in modular buildings as that term is defined in Section 39-4105, Idaho Code. Only

journeyman electricians and electrical apprentices, employed by an electrical contractor, may perform such installations. (3-

30-07)

Limited Energy Electrical Licenses:

a) Limited energy systems are defined as fire and security alarm systems, class 2 and class 3 signaling circuits, key card

operators, nurse call systems, motor and electrical apparatus controls and other limited energy applications covered by the

NEC. (7-1-99)

b) Limited energy systems do not include, and no license of any type is required for, the installation of landscape sprinkler

controls or communication circuits, wires and apparatus that include telephone systems, telegraph facilities, outside wiring

for fire and security alarm systems which are used for communication purposes, and central station systems of a similar

nature, PBX systems, audio-visual and sound systems, public address and intercom systems, data communication systems,

radio and television systems, antenna systems and other similar systems. (7-1-99)

c) Unless exempted by Section 54-1016, Idaho Code, any person who installs, maintains, replaces or repairs electrical wiring

and equipment for limited energy systems in facilities other than one (1) or two (2) family dwellings shall be required to

have a valid limited energy electrical license and must be employed by a licensed limited energy specialty electrical

contractor or electrical contractor. The holder of a specialty license may only countersign a contractor’s application as a

supervising journeyman for work within his specialty. (7-1-98)

___________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

Meridian, Idaho 83642

E-SPEC CON APPL 6 6/24/2015

Ph: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

Irrigation Sprinkler Electrical Licenses:

Any person qualifying for and having in his possession, an irrigation system electrical license may install, maintain, repair and

replace equipment, controls and wiring beyond the disconnect switch supplying power to the electric irrigation machine. The

irrigation machine is considered to include the hardware, motors and controls of the irrigation machine and underground

conductors connecting the control centers on the irrigation machine to the load side of the disconnecting device. Disconnect

device to be installed by others. All such installations performed by individuals under this subsection shall be done in

accordance with the applicable provisions of the National Electrical Code. He shall be employed by a licensed electrical

contractor whose license is contingent upon the granting of a specialty electrical license to an employee and whose installations

shall be limited to this category. The holder of a specialty license may not countersign a contractor’s license application as

supervising specialty journeyman except for work in his specialty. (1-1-92)

Well Driller and Water Pump Installer Licenses:

All such installations performed by individuals under this subsection shall be done in accordance with the applicable provisions

of the approved National Electrical Code. He shall be employed by a licensed well driller and water pump installer electrical

contractor whose installations shall be limited to this category. The holder of such specialty license may not countersign a

contractor’s license application as supervising specialty journeyman except for work in his specialty. Any person currently

licensed in this category may perform the following types of installations: (1-14-87)

a) Single or three (3) phase water pumps: install, maintain, repair and replace all electrical equipment, wires, and accessories

from the pump motor up to the load side, including fuses, of the disconnecting device. Disconnecting device to be installed

by others.

(4-6-05)

b) Domestic water pumps, one hundred twenty/two hundred forty (120/240) volt, single phase, sixty (60) amps or less: Install,

maintain, repair and replace all electrical equipment, wires, and accessories from the pump motor up to and including the

disconnecting device. (7-1-98)

c) Temporarily connect into a power source to test the installations, provided that all test wiring is removed before the installer

leaves the site. (1-14-87)

d) Individual residential wastewater pumping units. Install, maintain, repair and replace all electrical equipment, wires, and

accessories from the pump motor up to and including the disconnecting device for systems that serve one-family, two-

family, or three-family residential installations. (4-11-06)

Refrigeration, Heating and Air Conditioning Electrical Licenses:

All such installation, maintenance, and repair performed by individuals under this subsection shall be done in accordance with

applicable provisions of the National Electrical Code. He shall be employed by a licensed electrical contractor whose license

shall be covered by this category. The holder of such specialty license may not countersign a contractor’s license application as

a supervising specialty journeyman except for work in his specialty. Any person currently licensed in this category may

perform the following types of installations, which installations shall be limited to factory-assembled, packaged units: (9-17-85)

a) Heating Units (single phase): install, repair, and maintain all electrical equipment, wires, and accessories from the unit up to

the load side, including fuses, of the disconnecting device. Disconnecting device to be installed by others. (9-17-85)

b) Refrigeration, Air-Conditioning Equipment and Heat Pumps (single phase): install, repair, and maintain all electrical

equipment, wires, and accessories from the unit up to the load side, including fuses, of the disconnecting device.

Disconnecting device to be installed by others. (9-17-85)

c) Refrigeration, Air-Conditioning and Heating Systems (three (3) phase): install, maintain, and repair all electrical equipment

and accessories up to the load side, including fuses, of the disconnecting device. Disconnecting device to be installed by

others.

(9-17-85)

___________________________________________________________________________________________

STATE OF IDAHO DIVISION OF BUILDING SAFETY

1090 East Watertower Street, Suite 150

E-SPEC CON APPL 7 6/24/2015

Meridian, Idaho 83642

Ph: 800-955-3044

Fax: 877-810-2840

dbs.idaho.gov

Outside Wireman (Lineman) Electrical License:

All such installation, maintenance, and repair not exempt under the provisions of Section 54-1016, Idaho Code, performed by

individuals under this subsection shall be done in accordance with the applicable provisions of the National Electrical Code.

The licensee shall be employed by a licensed electrical contractor whose license shall be covered by this category. The holder

of such specialty license may not countersign a contractor’s license application as a supervising specialty journeyman except

for work in his specialty. Applicants for this license class shall provide documentation of having completed an electrical

lineman apprenticeship program or similar program approved by the U.S. Department of Labor, Office of Apprenticeship. Any

person currently licensed in this category may perform the following types of installations: (4-7-11)

a) Overhead distribution and transmission lines in excess of six hundred (600) volts. (4-7-11)

b) Underground distribution and transmission lines in excess of six hundred (600) volts. (4-7-11)

c) Substation and switchyard construction in excess of six hundred (600) volts. (4-7-11)

Photovoltaic (Solar) Installer License:

All such installation, maintenance, and repair not exempt under the provisions of Section 54-1016, Idaho Code, performed by

individuals under this Subsection shall be done in accordance with the applicable provisions of the National Electrical Code.

The license holder shall be employed by a licensed electrical contractor whose license shall be covered by this category. The

holder of such specialty license may not countersign a contractor’s application as a supervising specialty journeyman except for

work in his specialty. Applicants for this license class shall provide proof of photovoltaic installer certification by the North

American Board of Certified Energy Practitioners (NABCEP) or equivalent. Any person licensed in this category may perform

the following types of installations: (3-29-12)

a) Solar Photovoltaic DC Systems: Install, maintain, repair, and replace all electrical equipment, wires, and accessories up to

and including the inverter. (3-29-12)

b) Solar Photovoltaic micro-inverter/AC Systems: Install, maintain, repair, and replace all electrical equipment, wires, and

accessories up to and including the AC combiner box. (3-29-12)