Application for Certificate of Competency

Transcription

1 Building Safety Department nd Street South St. Cloud, MN (320) Fax: (320) Application for Certificate of Competency Name of Applicant: Home : City, State & Zip: Business : City, State & Zip: Home Phone: Business Phone: Examinations for licenses are held twice a year, February and July. Applications for the February exam will be accepted after August 1, but in no case later than December 31. Applications for the July exam will be accepted after March 1, but in no case later than May 31. A letter will be sent to you notifying you of the test date and time. TESTING FEES WILL BE PAYABLE AT THE TIME OF TEST: Master Mechanical Installer, Class A: $60 Master Mechanical Installer, Class B: $47 Journeyman Mechanical Installer: $29 Time and place of schools attended and studies completed: 2016

2 Chronological record of employment, together with complete information as to duties and type of work performed: Classification of Certificate of Competency for which you are applying for (Circle One): MASTER A MASTER B JOURNEYMAN INSTALLER New or retest: If retest, date you last tested with the City of St. Cloud: Current license held by the City of St. Cloud: License Number: I solemnly swear that the statements are true to the best of my knowledge and belief and affix my signature in attest thereto. Date Signature of Applicant Master Installer, Class A: PLEASE NOTE: Master A applications must have an approved burner school certificate with this application. Date Received: (City Use Only)

3 MASTER A/B AND JOURNEYMAN GAS TEST REQUIREMENTS 1. 4-years working in the HVAC trade, or 2. 1-year HVAC school and 3 years working in the trade (2-3 years of school you will only get 1 year credit) (any school credit will require copy of transcript) 3. 3 references: One from each shop, or licensed contractor, or employee, or City official, or Heating Board member (Requires it to be signed by 1 Master) 4. Need to have the Journeyman license 1-year prior to testing for a Master A or B license 5. Master A requirements: Must have successfully completed a hands on approved burner school; online courses are not approved Cleaver-Brooks Maxon Corporation Power Flame Industrial Combustion IC Burners Dunwoody Burner School Combustion & Controls Training Metro Services, Inc. or Webster Combustion CODE BOOKS Current code books can be obtained from the Minnesota Book Store, 660 Olive Street, St. Paul, MN 55155, or , or online at These books are: 2015 Minnesota Mechanical and Fuel Gas Code (2012 International Mechanical Code (IMC) and 2012 International Fuel Gas Code (IFGC) with Minnesota Amendments) and the St. Cloud City Ordinance (available on our website Government/Departments/Building Safety/Contractor Licensing/Heating Contractors/Mechanical Code Section 300:20 or at City Hall) Persons taking the Master A exam will also need to study the 2015 ASME CSD-1 Control Book (search online under ASME Boiler Controls) 2016

4 Page 1 DATE: APPLICATION FOR JOURNEYMAN MECHANICAL INSTALLER S EXAMINATION Before this application is processed all questions must be answered in their entirety and acknowledged by a notary public. There must be no variation in the name of the applicant in any part of this application. The required experience for a person to take the Journeyman Mechanical Installer s exam is 48 months full-time employment by a Heating Contractor. An applicable school credit, not to exceed 12 months, may be applied as part of the 48 month total. Exams are held twice a year, February and July. Applications for the February exam will be accepted after August 1, but in no case later than December 31. Applications for the July exam will be accepted after March 1, but in no case later than May Name 2. Home (first) (middle) (last) (number & street) (telephone #) (city) (state) (county) (zip code) 3. Education: (years) Grade School High School College Other (specify) 4. Enclosed are three reference letters. It is your responsibility to contract three persons to verify your practical experience. It is desirable that your references be licensed heating installers, master or journeyman, who are familiar with your work. This application and reference letters must be returned to this office no later than the dates specified above. Any person willfully making any false representation to the Board of Examiners in applying for a license shall be guilty of a misdemeanor. 5. Write names and addresses of all heating employers and length of employment. If more space is needed, use ordinary paper and attach it to this application. (In the event more information is needed, the Board of Examiners may request a payroll record, etc.) A. Name From To Telephone # B. Name From To Telephone #

5 Page 2 C. Name From To Telephone # 6. If you are self-employed in gas or oil burner installation, give your firm s name and address: Firm Name Telephone # 7. Are you licensed in another city? If the answer is yes, a photocopy of your current license or other evidence MUST ACCOMPANY this application. 8. Have you taken this examination before? Journeyman Exam Master Exam Date Date 9. Are you a registered apprentice? Where? If the answer is yes, a certificate of completion from your apprenticeship training program must accompany this application. The applicant, whose name is, being sworn before me declares that the foregoing statements subscribed to by him are true to the best of his knowledge and belief, and that he personally signed this application. Subscribed & sworn to before me this (signature of applicant) day of, 20 (seal) (signature of notary) TOTAL EXPERIENCE: CONTRACTOR YEARS MONTHS

6 Page 3 Reference Name Applicant s Name Telephone # Telephone # The person who signs this reference letter must fill it out in its entirety. Falsifying the information in any way is jeopardizing your license and you could be prosecuted. The above applicant is applying for a Journeyman Gas/Oil Mechanical Installer s license. 1. From your own knowledge, how many years of experience has this applicant had in the installation or servicing of gas or oil burners and heating equipment? Years Months 2. Has applicant been employed by you as an apprentice or helper at any time? Yes No 3. If so, how long? Years Months Describe briefly the applicant s experience in the installation and servicing of gas or oil burners and related equipment? This reference letter must be acknowledged by a notary public. The person, whose name is, being sworn before me declares that the foregoing statements subscribed to by him are true to the best of his knowledge and belief, and that he personally signed this application. Subscribed & sworn to before me this # (signature of reference) (license #) day of, 20 (seal) (signature of notary)

7 Page 4 Reference Name Applicant s Name Telephone # Telephone # The person who signs this reference letter must fill it out in its entirety. Falsifying the information in any way is jeopardizing your license and you could be prosecuted. The above applicant is applying for a Journeyman Gas/Oil Mechanical Installer s license. 1. From your own knowledge, how many years of experience has this applicant had in the installation or servicing of gas or oil burners and heating equipment? Years Months 2. Has applicant been employed by you as an apprentice or helper at any time? Yes No 3. If so, how long? Years Months Describe briefly the applicant s experience in the installation and servicing of gas or oil burners and related equipment? This reference letter must be acknowledged by a notary public. The person, whose name is, being sworn before me declares that the foregoing statements subscribed to by him are true to the best of his knowledge and belief, and that he personally signed this application. Subscribed & sworn to before me this # (signature of reference) (license #) day of, 20 (seal) (signature of notary)

8 Page 5 Reference Name Applicant s Name Telephone # Telephone # The person who signs this reference letter must fill it out in its entirety. Falsifying the information in any way is jeopardizing your license and you could be prosecuted. The above applicant is applying for a Journeyman Gas/Oil Mechanical Installer s license. 1. From your own knowledge, how many years of experience has this applicant had in the installation or servicing of gas or oil burners and heating equipment? Years Months 2. Has applicant been employed by you as an apprentice or helper at any time? Yes No 3. If so, how long? Years Months Describe briefly the applicant s experience in the installation and servicing of gas or oil burners and related equipment? This reference letter must be acknowledged by a notary public. The person, whose name is, being sworn before me declares that the foregoing statements subscribed to by him are true to the best of his knowledge and belief, and that he personally signed this application. Subscribed & sworn to before me this # (signature of reference) (license #) day of, 20 (seal) (signature of notary)