Contractor Registration Form

Business Name *

Employer Federal or State ID Number *

First Name *

Last Name *

Address *

City *

State *
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip *

Phone *

Alternate Phone

Email *

 

Add File

If the Worker's Compensation or Liability insurance policy expires, lapses, or is canceled by the end of the calendar year for which registration has been accomplished with the City, or if the applicant changes the coverage to a different policy or company, the applicant is responsible to submit a new copy of the certificate of insurance coverage to the Bureau of Codes the office/City of Williamsport.
Registration fee is $ 80.00 for one year, $ 120.00 for two years and $ 175.00 for three years annually (January 1 to December 31). Checks and money orders can be made payable to "The City of Williamsport".

Any registrations applied for after January 1 WILL NOT BE PRORATED.
Effective July 1, 2009, ALL contractors/plumbers who perform residential and commercial work MUST register with the State of Pennsylvania and provide a copy of your State Registration Certificate to the Bureau of Codes Office to continue to perform work in the City of Williamsport.

Any registration filed, may be suspended at any time by the Bureau of Codes for violation of the ICC, UCC, Statewide Building Code, Zoning Ordinance, Property Maintenance Code or any other ordinances and codes, including loss of insurance coverage and failure to pay the Business Privilege Tax.
Any person, company, corporation or individual who shall violate the provisions of the Contractors Licensing Ordinance, shall upon conviction thereof in a summary proceeding, be fined not less than fifty ($50.00) dollars nor more that six hundred ($600.00) dollars and cost of prosecution for each offense. In default of payment thereof, shall undergo imprisonment in the Lycoming County Prison for a period of time not exceeding thirty (30) days. Each day or portion of day a Contractor works without having a valid registration shall be considered a separate offense.

My signature and initials on this registration constitutes I have read the above information on this application and verifies that the statements provided herein are true and that I am subject to the penalty of 18 P.A.C.S.A 4904 relating to unsworn falsifications to authorities.
Applicant Signature: