Contractor License

Contractor License

Concrete/Excavation/Plumbing
Application is hereby made for a permit to carry on the trade or business of Plumbing, Concrete, and Excavation work in the City of Dickinson, North Dakota, the for the period beginning on January 1st of each year and ending on December 31st of the same year.
Type of License*

Plumbing WorkConcrete WorkExcavation Work
Type of Business*

Sole ProprietorshipPartnershipCorporation
Sole Proprietorship
Applicant Name*

First NameLast Name
Email*
example@example.com
Business Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #*
Please enter a valid phone number.
Email*
example@example.com
Partnership
Business Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone #*
Please enter a valid phone number.
Partner Name*
Partner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Partner Phone #*
Please enter a valid phone number.
Partner Email*
example@example.com
Corporation
Corporation Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #*
Please enter a valid phone number.
Email*
example@example.com
Name of Officer or Agent Signing this Application*

First NameLast Name
Plumbing License Information
North Dakota Plumbing License Number*
Issue Date*
Expiration Date*
Copy of ND Plumbing License*

Cancelof
Name of Company that holds Surety or Cash Bond Company in the sum of $1,000 *
Copy of Surety or Cash Bond in the sum of $1000*

Cancelof
Concrete License Information
North Dakota State Contractor's License*
Date of Issue*

MonthDayYear
Date
Expiration Date*

MonthDayYear
Date
Copy of ND Contractor's License *

Cancelof
Name of Company that holds your Surety or Cash Bond in the sum of $5,000 *
Filed with the City Provide Copy
Copy of Surety Bond*

Cancelof
Name of Company that holds your Liability Insurance in the Sum of $100,000*
Filed with the City Provide Copy
Copy of Certificate of Liability Insurance*

Cancelof
CONTRACTOR STAMP REQUIREMENT: The CONTRACTOR shall mark in each 3,000 square feet of pavement, every 100 LF for continuous pours of new curb and gutter and/or sidewalk, every curb and gutter and/or sidewalk patch done per lot and each driveway by stamping the CONTRACTOR’S name, address, and year in which the pavement was constructed. The stamped letter should be 1 inch high and ¼ inch deep. CONTRACTOR’S stamp must be approved by the ENGINEERING Department prior to the beginning of construction. CONTRACTOR shall be responsible for changing the date on the stamp each year.
Excavation License Information
North Dakota State Contractor's License #*
Date of Issue*

MonthDayYear
Date
Expiration Date*

MonthDayYear
Date
Copy of ND State Contractor's License*

Cancelof
Will you be installing or repairing sewer/water?*

YesNo
North Dakota Water & Sewer Installer's License # or Master Plumber (if installing sewer and water)
with the State Plumbing Board
Date Issued

MonthDayYear
Date
Date Expires

MonthDayYear
Date
Copy of ND Water & Sewer Installers License or Plumbing License (if installing water/sewer):

Cancelof
Name of Company that holds your Surety or Cash Bond in the sum of $25,000*
Filed with City
Copy of Surety Bond*

Cancelof
Name of Company that holds your Liability Insurance in the Sum of $100,000*
Copy of Certificate of Liability Insurance*

Cancelof
The applicant hereby agrees to faithfully abide by all ordinances and regulations of the City of Dickinson which may apply to the above mentioned trade or business, or any amendments to ordinances or regulations which may be passed or adopted during the term of the permit herein applied for, which may affect the said permit.
Signature*

Clear
Date*

MonthDayYear
Date

License Fee*

Applicable License

$100.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Contractor License

Sole Proprietorship

Partnership

Corporation

Plumbing License Information

Concrete License Information

Excavation License Information