APPLICATION FOR CONTRACTOR REGISTRATION
APPLICANT'S NAME
COMPANY NAME
ADDRESS
CITY
FAX NOPHONE NO
ZIP CODESTATE
GENERAL CONTRACTOR*
SUSTAINABLE DEVELOPMENT AND CONSTRUCTION DEPARTMENT w BUILDING INSPECTION DIVISION
OAK CLIFF MUNICIPAL CENTER, 320 E. JEFFERSON BLVD., ROOM 118; DALLAS, TX 75203 w TEL. NO. (214) 948-4480
REV 10-16-2017
E-MAIL ADDRESS
EMAIL ADDRESS
CONCRETE/ASPHALT/PAVING
ENERGY CODE PROVIDER
GREEN BUILDING PROVIDER
GAS WELL
APPLICANT'S INFORMATION (Note: If applicant is same as contractor, leave this part blank. If applicant is not contractor, contractor's affidavit required)
APPLICANT'S SIGNATURE
DATE
GAS WELL PROVIDER
I HAVE CAREFULLY READ THE COMPLETED APPLICATION AND KNOW THE SAME IS TRUE AND CORRECT AND HEREBY AGREE THAT ALL
PROVISIONS OF THE CITY ORDINANCES AND STATE LAWS WILL BE COMPLIED WITH WHETHER HEREIN SPECIFIED OR NOT. I UNDERSTAND
THAT FAILURE TO COMPLY WILL RESULT IN MY CONTRACTOR REGISTRATION BEING SUSPENDED OR REVOKED IN ACCORDANCE WITH
SECTION 1106, SUBCHAPTER 11 OF CHAPTER 52, ADMINISTRATIVE PROCEDURES FOR THE CONSTRUCTION CODES.
CONTRACTOR NO: (OFFICE USE ONLY)
DATE:
CONTRACTOR'S NAME (INDIVIDUAL)
PLEASE CHOOSE WHICH OF THE FOLLOWING TRADES YOU ARE REGISTERING FOR. SELECT ALL THAT APPLY:
NOTE*
A General Contractor includes, but is not limited to, the following: residential general contractor, commercial general contractor, roofing contractor, fence
contractor, foundation contractor, demolition contractor and pool contractor.
Contracting companies addressed within the city limits of Dallas must provide the following:
Certificate of Occupancy Number: Home office form on file?
PLEASE SELECT ONE OF THE FOLLOWING:
NEW CONTRACTOR CONTRACTOR RENEWAL (Contractor Number: )
Yes
No
ALTERNATE PHONE NO
CONTRACTOR'S RESPONSIBLE PARTY INFORMATION (Note: This individual is deemed the responsible party having sole authority in all
matter's concerning the business, including registration renewals and the assignment and removal of agents)
ADDRESS
CITY
FAX NOPHONE NO
ZIP CODESTATE ALTERNATE PHONE NO
CONTRACTOR'S COMPANY INFORMATION
E-MAIL ADDRESS
BUSINESS ADDRESS
CITY
STATE ZIP CODE
BUSINESS FAX NOBUSINESS PHONE NO
HOME REPAIR LICENSE NUMBER, IF APPLICABLE
ANNUAL REGISTRATION OR RENEWAL FEE: $120.00
LIST ALL COMPANY PERSONNEL AUTHORIZED BY YOU TO SIGN PERMIT APPLICATIONS FOR YOUR COMPANY. AT THE TIME OF REGISTRATION,
YOU WILL ASSIGN YOURSELF AND YOUR MEMBERS A PERSONAL IDENTIFICATION NUMBER (PIN). REMEMBERING YOUR PIN NUMBER IS YOUR
RESPONSIBILITY. PIN NUMBERS MUST NOT EXCEED 9 DIGITS (NUMBERS ONLY) AND EACH MEMBER MUST HAVE A DIFFERENT NUMBER. ALL
PIN NUMBERS WILL BE REDACTED FROM OUR RECORDS AND STAFF WILL NOT BE ABLE TO RETRIEVE PIN NUMBERS. NOTE THAT WEB EDIT
ACCESS WILL USERS THE ABILITY TO ADD OR REMOVE MEMBERS ONLINE; AND THE ABILITY TO RENEW ONLINE THE
CONTRACTORSREGISTRATION ONLINE.
COMPANY STAFF MEMBER PIN
PIN
PIN
PIN
PIN
PIN
COMPANY STAFF MEMBER
COMPANY STAFF MEMBER
COMPANY STAFF MEMBER
COMPANY STAFF MEMBER
COMPANY STAFF MEMBER
MEMBER ASSIGNMENT TO CONTRACTOR'S REGISTRATION
Instructions: This page to be completed only by the contractor's responsible party and executed by the individual contractor's
named on the registration application to add and/or delete member of the business. Members have the rights to apply for permits,
pay for permits, cancel permits, reassign permits, request inspections, and pay fees on behalf of the named contractor. Members
may not renew registrations or add or remove members. Members may only be added and/or removed in writing by the named
responsible party.
COMPANY NAME
Contractor Number:
PINRESPONSIBLE CONTRACTOR'S NAME
RESPONSIBLE CONTRACTOR AUTOMATICALLY
GRANTED WEB EDIT ACCESS. SELECT WHICH STAFF
MEMBERS BELOW ARE GRANTED WEB EDIT ACCESS.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
LIST THE FOLLOWING COMPANY PERSONNEL TO BE REMOVED AS MEMBERS FROM YOUR COMPANY:
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
REMOVE STAFF MEMBER
SUSTAINABLE DEVELOPMENT AND CONSTRUCTION DEPARTMENT w BUILDING INSPECTION DIVISION
OAK CLIFF MUNICIPAL CENTER, 320 E. JEFFERSON BLVD., ROOM 118; DALLAS, TX 75203 w TEL. NO. (214) 948-4480
REV 10-16-2017
RESPONSIBLE CONTRACTOR'S SIGNATURE DATE
CONTRACTOR REGISTRATION
AFFIDAVIT
Instructions: If the contractor is not appearing in person to register then the contractor must sign the APPLICATION FOR
CONTRACTOR REGISTRATION before a notary and have this affidavit presented with the APPLICATION FOR CONTRACTOR
REGISTRATION.
State of Texas §
County of Dallas §
Before me, _____________________________________________
(notary), on this day personally appeared
____________________________________(name of contractor), known to me to be the person whose name is
subscribed to the foregoing City of Dallas Application for Contractor Registration and acknowledged to me
that he executed the same for the purposes and consideration therein expressed.
Given under my hand and seal of office this _____ day of ____________________ 20___.
_________________________________________________________
Notary Public
{Notary Public Stamp}
SUSTAINABLE DEVELOPMENT AND CONSTRUCTION DEPARTMENT w BUILDING INSPECTION DIVISION
OAK CLIFF MUNICIPAL CENTER, 320 E. JEFFERSON BLVD., ROOM 118; DALLAS, TX 75203 w TEL. NO. (214) 948-4480
REV 10-16-2017
HOME OCCUPATION
DECLARATION
The City of Dallas requires a contractor to submit proof of an established place of business. If that place of business is within the
city, a certificate of occupancy must be secured as required in the Dallas Development Code. In lieu of a certificate of occupancy,
a contractor may declare that his residence is the place of business.
Home occupation definition: an occupation that is incidental to the primary use of the premises as a residence and conducted on
the residential premises by the resident of the premises.
Company Name
(as listed on the contractor’s registration application):
Address of residence:
51A – 4.217 - A person who engages in a home occupation shall not:
use any advertisement, sign, or display relating to the home occupation on the premises;
use the street address of the premises on any advertisement, sign, or display off the premises;
employ more than one person on the premises, other than residents of the premises;
have an employee, other than residents of the premises, who works on the premises more than four hours in any given
week.
conduct any activities relating to the home occupation, including activities on any porch, deck, patio, garage, or
unenclosed or partially enclosed portion of any structure, unless conducted entirely inside the main structure;
involve more than 3 people on the premises at one time, other than residents of the premises;
generate loud and raucous noise that renders the enjoyment of life or property uncomfortable or interferes with public
peace and comfort;
sell or offer products of the home occupation at or on the premises;
generate vehicular traffic that unreasonably disrupts the surrounding residents’ peaceful enjoyment of the neighborhood;
or
generate parking congestion that unreasonably reduces the availability of on-street parking spaces on surrounding
streets.
A home occupation may not occupy more than 25 percent or 400 square feet of the total floor area of the main structure,
whichever is less.
I agree to the conditions of the home occupation as outlined below. Violation of the home occupation conditions may result in the
revocation of a contractor’s registration.
CONTRACTOR'S SIGNATURE DATECONTRACTOR'S NAME (PRINT)
SUSTAINABLE DEVELOPMENT AND CONSTRUCTION DEPARTMENT w BUILDING INSPECTION DIVISION
OAK CLIFF MUNICIPAL CENTER, 320 E. JEFFERSON BLVD., ROOM 118; DALLAS, TX 75203 w TEL. NO. (214) 948-4480
REV 10-16-2017
State of Texas §
County of Dallas §
Before me, _____________________________________________
(notary), on this day personally appeared
____________________________________(Contractor/homeowner), known to me to be the person whose
name is subscribed to the foregoing instrument and acknowledged to me that he executed the same for the
purposes and consideration therein expressed.
_________________________________________________________
Notary Public
{Notary Public Stamp}