Reinstatement Of License Form For Licensees Who Were Previously Sub-Licensees
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1State Board of Examiners of Plumbing,
Heating & Fire Sprinkler Contractors
1109 Dresser Court, Raleigh, NC 27609
(919) 875-3612
Reinstatement of License
(for Licensees who were Previously Sub-Licensees)
_________
LICENSE #
Name__________________________________________________________________
Address __________________________________________________________________________________________
You previously were renewed as a sub-licensee under a qualifier for a company. Your license was renewed at the discounted
rate. In order to become a qualifier or put your license back in your individual name, you must reinstate your license by paying
the remaining $100 license fee. The licensee must sign the completed form in the space provided. Make check(s) and/or
money order(s) payable to “State Board of Examiners” and mail this form and your payment to: State Board of Examiners,
1109 Dresser Ct., Raleigh, NC 27609.
*A late processing fee is required if you were removed as a sub-licensee prior to a renewal being completed for the
previous year. Along with that the full year renewal fee is due for the current year.
Please call the office if you have questions regarding this form: 919-875-3612 x 203.
1. Reinstatement of license to qualifier status
$100.00
$____________
2. *If you hold a Plumbing, Heating/A/C or Fuel Piping license
$130.00
$____________
3. If you hold a Residential Fire Sprinkler Installation Contractor license
$130.00
$____________
4. If you hold a Fire Sprinkler Installation Contractor or
Fire Sprinkler Inspection Contractor License
$130.00
$____________
or
5. If you hold a Fire Sprinkler Maintenance Technician license
Fire Sprinkler Inspection Technician not listed as sub-licensee of
Fire Sprinkler Inspection Contractor
$130.00
$____________
6. *Late processing fee
$25.00
$____________
(Required if paying after January 31, 2016)
I understand that if this reinstatement form is incomplete, is received without payment, or is not
included with payment, that my reinstatement will not be processed and will be returned to me.
Total Fees Enclosed with Reinstatement
$__________________
Licensee’s
Signature __________________________________________________
Date ___________________________
If your address address has changed, please download an address change form at
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