Application for Contractor’s License

SOUTH WAVERLY BOROUGH
OFFICE OF CODE ENFORCEMENT
2523 Pennsylvania Avenue
South Waverly, PA. 18840
swb@southwaverlyborough.org
570-888-2125 FAX 570-888-7173

Attached is the Contractor’s Application for working in South Waverly Borough.

The annual fee is $50. Checks should be made out to the South Waverly Borough. The permit year runs from January 1 through December 31st. The fee is not prorated if you apply later in the year. However, permits applied and paid for from December 1, on are credited through the end of the following year. The application must be applied for annually. We will make a mass mailing at the end of the year for the next year and currently registered contracts will get renewal application forms.

Certificates of Liability and Worker’s Compensation are required. Most insurance company will fax or email directly to us once certificates has been requested by client. You may want to request they continue to send us your updated certificates automatically if you plan on working throughout the year in South Waverly Borough. Copies of certificates of liability ($300,000 or more) and worker’s compensation insurance (if applicable) should list the South Waverly Borough as the certificate holder. Please use the following address:

South Waverly Borough
2523 Pennsylvania Avenue
South Waverly, Pa. 18840

Please include all names the person or Company may be recognized under on the certificates of insurance. This will expand your coverage to all variations of your company’s names including your personal name.

Companies engaged in roofing as a part of their businesses must have the insurance company note that on the certificate as well.

The second page needs to be notarized after indicating whether you do or do not carry workers compensation insurance.

Your insurance companies may fax certificate directly to our office at the number below. Thank you and have a great day.
Jesse Harris
Code Office Coordinator
570-888-2125 Ext 1.
570-888-7173 FAX

 

 

 

 

 SOUTH WAVERLY BOROUGH
OFFICE OF CODE ENFORCEMENT
Email – swb@southwaverlyborough.org

2523 Pennsylvania Ave. Office 570-888-2325
South Waverly, PA. 18840 FAX 570-888-7173

DOCUMENT VERIFICATION APPLICATION FOR CONTRACTOR

Date: _____________________ Phone Number: _______________ Cell Number: _____________________
Name of Contractor or Business: _________________________________________________________________
DBA(s): ______________________________________________________________________________________
PA State Registration # ______________________ Have you registered yet? www.attorneygeneral.gov to register
(Home Improvement Contractors Only)
Name of Contact Person: ________________________________________________________________________
Address: _________________________________________, City, State and Zip: ___________________________
E-mail Address: ________________________________________________________________________________
Type of Work Performed: _______________________________________________________________________
Number of Years as Contractor: __________________________________________________________________
Do You Sub Out Parts of Jobs? ____________ If So, What: ___________________________________________
Drivers License Number of Owner/Contact Person: ___________________________________________________
What Other Contractors License/Permits do you hold? ________________________________________________
Have you ever been refused a permit or had a similar Contractors Permit revoked or suspended within two years prior to the date of this application? _____________________ if yes, please explain: _______________________
__________________________________________________________________________________________
Have you been convicted of any crimes, offenses or violations relating to your work or contracts as a contractor within the two years prior to the date of this application? ___________ if yes, please explain ___________________
__________________________________________________________________________________________
Are there any unsatisfied civil judgments against you alleging that you failed to complete a job or improperly performed a contract? _________________ if yes, please explain ______________________________________
__________________________________________________________________________________________
Please list the last three jobs done. Include property owner’s name and phone number and type of work performed.
1. ___________________________________________________________________________________
2. ___________________________________________________________________________________
3. __________________________________________________________________________________

I do hereby certify that the information contained in this application is correct to the best of my knowledge and agree that the information in this application shall be available to the public for inspection. It is understood that all construction in the Borough of South Waverly will comply with the International Code Council’s (ICC) International Building Code 2009 (IBC2009) as adopted by the South Waverly Borough Council.

______________________________ _______________________________________________________
(Date) (Signature)

WORKER’S COMPENSATION AFFIDAVIT
(This section must be completed in the presence of a Notary Public)

(For contractors with no employees)

I, ________________________________________, DO AFFIRM THAT I WILL NOT EMPLOYE/HIRE ANY OTHER PERSON(S) FOR THE PROJECTS (S) FOR WHICH I AM SEEKING A CONTRACTORS PERMIT.

After receipt of the contractors permit, if I employ any other person(s), I will notify the Code Enforcement Office and provide proof of Worker’s Compensation coverage with three (3) working days.

I understand that failure to comply will result in a stop work order being executed for the project I am undertaking and that such order may not be lifted until proper coverage is obtained and proof is presented, as provided by Section 302 (c) (40) of the Act of June 2, 1915 (P.L. 736) known as the Pennsylvania Workman’s Compensation Act, reenacted and amended June 21, 1939, and amended December 5, 1974, and amended July 2, 1993.

(For contracts with employees)

I, _________________________________________, DO AFFIRM THAT I DO HAVE WORKER’S COMPENSATION COVERAGE FOR THE EMPLOYEES THAT WILL BE WORKING FOR/WITH ME ON THE PROJECTS(S) FOR WHICH I AM SEEKING A CONTRACTORS PERMIT. I FURTHER AFFIRM THAT I HAVE PROVIDED THE SOUTH WAVERLY BOROUGH CODE ENFORCEMENT OFFICE WITH A COPY OF THAT COVERAGE.

On this, the ________ day of ____________________, year __________, before me, a Notary Public, the undersigned officer, personally appeared ___________________________________________________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledge that he/she is executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.

Sworn to and subscribed before me this

________ Day of ________________, year ____________

_______________________________________________
Notary Public

My commission expires: ____________________________

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