Multi-Year Renewal Form For Licenses Expired Prior To January 1, 2015
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1State Board of Examiners of Plumbing,
Heating & Fire Sprinkler Contractors
1109 Dresser Court, Raleigh, NC 27609
(919) 875-3612
Multi-Year Renewal form for Licenses Expired Prior to January 1, 2015
License #____________
Name__________________________________________________________________
Address __________________________________________________________________________________________
Licenses that expired 12/31/12 must be renewed no later than 12/31/15 or they will be
retired.
Please list your sub-licensees on the back of this form.
You only need to pay for years in which you did not previously pay.
License Fee 2013
$ 130.00
License Fee 2014
$ 130.00
License Fee 2015
$ 130.00
License Fee 2016
$130.00
Late Fee
$ 25.00
Continuing Education is no longer required to renew.
Forms that are not completed properly will not be processed.
To change your address or the way your license is listed, please download the Trade Name Change form:
Any change noted on this form is NOT OFFICIAL.
Please make checks/or money orders payable to the State Board of Examiners and mail to 1109 Dresser Ct Raleigh, NC 27609
1. If you hold a Plumbing, Heating/A/C or Fuel Piping license
$____________
2. If you hold a Residential Fire Sprinkler Installation Contractor license
$____________
3. If you hold a Fire Sprinkler Installation Contractor or
Fire Sprinkler Inspection Contractor License
$____________
4. If you hold a Fire Sprinkler Maintenance Technician license
$____________
5. For EACH sublicensee the fee is $30 per year
$____________
6. For EACH sublicensee who holds a technician qualification the fee is $65 per year
$____________
7. Late processing fee
$25.00
(Required by paying after January 31, 2015)(one time fee)
By signing this form I attest that all information is correct and that all licensees listed below are still actively employed and
should still be listed as sublicensees under my license number.
Total Fees Enclosed with Renewal
$__________________
Licensee’s
Signature __________________________________________________
Date ___________________________
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