Fillable Application for Reactivation of a Business Permit for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Application for Reactivation of a Business Permit for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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  • 11 check-boxes
  • 32 other fields

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Board of Examiners of Electrical Contractors
124 Halsey Street, 6th Floor, P.O. Box 45006
Newark, New Jersey 07101
(973) 504-6410
Application for Reactivation of a
Business Permit for an Electrical Contracting Business in New Jersey
(Permit in expired status for less than three (3) years with no changes)
This application is required pursuant to the provisions of N.J.S.A. 45:5A-13.
N.J.PermitNo.:34EB______________________________________
ExpirationDateofLastRenewal:______________________________CurrentRenewalCycle:____________________________
Pursuant to N.J.S.A. 45:5A-9,youmaynotpracticeelectricalcontractingintheStateofNewJerseyunlessanduntilyour
licensehasbeenacquiredasanewlicensee,orthelicensehasbeenrenewed,reinstatedorreactivated, andyouhavesecured
aBusiness Permit.
Please print clearly. You must answer all of the questions on this application.
Personal Information Date:__________________________
 MonthDayYear
1. FullNameofBusiness:___________________________________________________________________________________
2. NameofLicensee:_______________________________________________________________________________________
LastnameFirstname Middleinitial Maidenname(Sufx-Jr,Sr,etc.)
3. Address
Home: _____________________________________________________________________________________________
StreetorP.O.Box City State ZIPcode County
_____________________________________ ___________________________________
Hometelephonenumber(includeareacode) E-mailaddress
 Business: ___________________________________________________________________________________________
Nameofcompany Telephonenumber(includeareacode)
____________________________________________________________________________________________
Street City State ZIPcode County
_____________________________________ ___________________________________
Businesstelephonenumber(includeareacode) E-mailaddress
 Mailing:____________________________________________________________________________________________
StreetorP.O.Box City State ZIPcode County
Important:Checkoneofthethree(3)boxesabovenexttotheaddressyouwishtodesignateasyouraddressofrecord.Your
address of record is considered public information and will be posted as part of the Licensee Directories made public.Failure
todesignateanaddressofrecordwilldelaytheprocessingoftheReactivationofyourBusinessPermittopracticeElectrical
ContractingintheStateofNewJersey.
-1-
Questions for Your Response:
1. Haveyousecuredthenecessary$1,000bond? Yes No
2. HaveyouobtainedtheCerticateofGeneralLiability
InsuranceoraBankLetterofCreditintheamountof$300,000? Yes No
3. Sinceyourlastrenewalhaveyoubeenarrested,chargedor Yes No
convictedofanycrimeoroffensethat you have not already
reported to your board/committee?(Minortrafcoffenses,
suchasspeedingorparking,neednotbeprovided,butmotor
vehicleoffensessuchasdrivingwhileimpairedorintoxicated
mustbedisclosed.)
4. Sinceyourlastrenewalhasanyactionbeentakenorisany Yes No
actionnowpendingagainstyourprofessionallicenseorhave
youbeenpermittedtosurrenderorotherwiserelinquishyour
licensetoavoidinquiry,investigationoractionbyanyother
licensingauthoritythat you have not already reported to your
board/committee?
Important Documents You Must Enclose:
1. ThisApplication forReactivation,completedandsigned.
2. EncloseaCopy of your Bondintheamountof$1,000.
3. EncloseaCopy of your Certicate of General Liability Insurance or Bank Letter of Creditintheamountof$300,000.
4. EncloseacheckormoneyorderforReactivationofyourBusinessPermitintheamountof$175.00.($150.00fortheRenewal
Feeplusa$25.00LateFee.)(ApplicantsforBusinessPermitReactivationshouldunderstandthatifthesefeesarepaidwitha
personalcheck,andthecheckisreturnedbythebankduetoinsufcientfunds,thenextstepintheReactivationprocesswill
bedelayeduntilthefeesarepaid.)
Certication
“Icertifythattheinformationenteredonthisformistrueandcompletetothebestofmyknowledge,andfurtheracknowledge
that if the above information is willfully false, I am subject to punishment and/or disciplinary sanction including license
suspension/revocationortheimpositionofcivilpenaltiesasmaybeprovidedbylaw.”
____________________________________________________ _____________________________________
SignatureofLicensee Date
Submitalldocumentsto: Board of Examiners of Electrical Contractors
P.O.Box45006
-2-
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Application for Reactivation of a Business Permit for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 14 August 2020

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