Fillable Instructions for the Telecommunication Wiring Exemption Certicate (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Instructions for the Telecommunication Wiring Exemption Certicate (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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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
Instructions for the Telecommunication Wiring Exemption Certicate
To ensure expeditious approval, please provide the following.
• Application fee: $250.00 made Payable to the State of New Jersey, in accordance with N.J.A.C. 13:31-1.6.
For Individual Proprietorship/Partnership:
• A copy of the trade-name certicate led with the County Court House in the county where the business is located.
For Corporation:
• A copy of incorporation papers led with the State of New Jersey Division of Revenue/Commercial Recording.
• If it is more than one year from the date the incorporation papers were led, please submit a Certicate of Good
Standing in lieu of incorporation papers led with the State of New Jersey.
• If assistance is needed in obtaining a Certicate of Good Standing, you may call the State of New Jersey, Division of
Revenue/Commercial Recording at (609) 633-8296.
For LLC:
• A copy of the Certicate of Formation led with the Division of Revenue Commercial Recording. If the Certicate of
Formation is over one year from the date it was led, please submit a Certicate of Good Standing in lieu of the
Certicate of Formation.
• If assistance is needed in obtaining a Certicate of Good Standing, you may call the State of New Jersey, Division of
Revenue/Commercial Recording at (609) 633-8296.
Out-of-State-Corporation:
• A copy of its incorporation papers plus a Certicate of Authority to do business in New Jersey led with the
State of New Jersey, Division of Revenue/Commercial Recording.
• If it is more than one year from the date the Certicate of Authority to do business in New Jersey was led, you must
obtain and submit a new Certicate of Authority to do business in New Jersey.
• If assistance is needed in obtaining a Certicate of Good Standing, you may call the State of New Jersey, Division of
Revenue/Commercial Recording at (609) 633-8296.
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 Telecommunications Wiring Exemption
(See N.J.A.C. 13:31-4.1)
The Division is precluded by law from disclosing to the public the place of residence of licensees or applicants, without their
consent. However, you are required to provide an address that may be released to the public in our directories or in response to
other requests. If you provide your place of residence as your public address of record, we will assume that you have
consented to have that address be disclosed. If you do not consent to the disclosure of your place of residence, you should provide an
address of record other than your place of residence that may be released to the public. One of your addresses must include a street, city,
state and ZIP code.
Information that you provide on this application may be subject to public disclosure as required by the Open Public Records Act (OPRA).
(Please print clearly.)
1. _____________________________________________________________________________________________
Name of applicant / responsible representative and name of business
_____________________________________________________________________________________________
Street address (principal place of business) City State ZIP Code
___________________________________
Telephone number (include area code)
2. Type of business (check one)
a. Individual Proprietorship b. Partnership c. Corporation d. LLC
_____________ _____________ _____________ ____________
Date of formation Date of partnership Date of incorporation Date of formation
_____________
State of incorporation
3. For individual proprietorship:
_____________________________________________________________________________________________
Owner (Name in full)
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Are you a U.S. citizen? Yes No If “No,” attach proof of legal work status.
4. Partnership:
_____________________________________________________________________________________________
Partner-in-charge (Name in full)
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the partner-in-charge a U.S. citizen? Yes No If “No,” attach proof of legal work status.
List all other partners (Use additional paper if necessary.)
_____________________________________________________________________________________________
Partner (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the partner a U.S. citizen? Yes No If “No,” attach proof of legal work status.
_____________________________________________________________________________________________
Partner (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the partner a U.S. citizen? Yes No If “No,” attach proof of legal work status.
_____________________________________________________________________________________________
Partner (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the partner a U.S. citizen? Yes No If “No,” attach proof of legal work status.
5. Corporation:
_____________________________________________________________________________________________
Registered agent of the corporation (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the registered agent of the corporation a U.S. citizen? Yes No If “No,” attach proof of legal
work status.
List all other corporate ofcers (Use additional paper if necessary.)
_____________________________________________________________________________________________
Corporate ofcer (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the corporate ofcer a U.S. citizen? Yes No If “No,” attach proof of legal work status.
_____________________________________________________________________________________________
Corporate ofcer (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the corporate ofcer a U.S. citizen? Yes No If “No,” attach proof of legal work status.
_____________________________________________________________________________________________
Corporate ofcer (Name in full) Title
_____________________________________________________________________________________________
Street address City State ZIP Code
______________________________________________ _________________________________________
Date of birth Telephone number (include area code)
Is the corporate ofcer a U.S. citizen? Yes No If “No,” attach proof of legal work status.
6. Has any member of the business entity been convicted of a crime, or has any member of the business entity ever entered
a plea (other than innocent) to an alleged crime under federal or state law? (Do not include minor trafc offenses.)
Yes No If your answer to question 6 is “Yes,” please explain. (Use additional paper if necessary.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7.
Have
you ever been summoned; arrested; taken into custody; indicted; tried; charged with; admitted into pre-trial intervention
(P.T.I.); or pled guilty to any violation of law, ordinance, felony, misdemeanor or disorderly persons offense, in New Jersey, any
other state, the District of Columbia or in any other jurisdiction? (Parking or speeding violations need not be disclosed, but
motor vehicle violations such as driving while impaired or intoxicated must be.)
Yes No
If “
Yes,” provide a copy of the judgment of conviction and the release from parole or probation. Please provide a complete
explanation. (Use additional sheets of paper if necessary.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8.
The applicant certies to the following: See N.J.A.C. 13:31-4.1(c):
1. A ce
rtication that the applicant is familiar with and is in full compliance with Part 68 of the Federal Communications
Commission regulations (47 C.F.R. section 68.1 et seq.) concerning installation of telecommunications wiring and
any other applicable Federal regulations;
2.
A ce
rtification that the applicant is familiar with and will comply with applicable National Electrical
Code requirements, including, but not limited to, Article 800 (communication circuits) and the State Uniform
Construction Code Act, N.J.S.A. 52:27D-119 et seq., and its implementing rules set forth in the Uniform Construction
Code, N.J.A.C. 5:23, and that the applicant will be responsible for obtaining any required local permits and inspections
for all work;
3.
A ce
rtication that the applicant shall not perform the following work unless or until an electrical contractor’s business
permit is obtained from the Board:
i.
Wiring dened by
the National Electrical Code as service conductors (the conductors from the service point to
the service disconnecting means), feeder (all circuit conductors between the service equipment, the source of a
separately derived system, or other power supply source and the nal branch-circuit overcurrent device), and
branch circuit (the circuit conductors between the nal overcurrent device protecting the circuit and the outlets(s)).
Wiring between power supplies integral with telecommunication equipment and the telecommunication equipment
is not intended to be prohibited.
ii.
Telecommunications wiring from telecommunications equipment to power operated controlled equipment; or
iii.
Installation of work in
hazardous/classied areas as dened by Article 500 of the National Electrical Code.
Classied areas are those in which hazardous liquids, vapors, gases, dusts and ber are normally present (Division
1 locations) or may be present due to maintenance or equipment malfunction (Division 2 locations); and
4.
A certication that
the business shall not subcontract telecommunications wiring work to a person or business entity
not having a business permit or a telecommunications wiring exemption issued by the Board.
9.
The applicant understands that
this exemption may be revoked by the Board of Examiners of Electrical Contractors, in
accordance with the following paragraph (N.J.A.C. 13:31-4.1(i)):
(i)
After an opportunity to
be heard pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., a
telecommunications wiring exemption may be revoked on a showing that the exempt entity has engaged in the
unlicensed practice of electrical contracting involving non-exempt electrical work; or that the exempt entity has
a history of failure to pass local inspections or to obtain required permits; or for any reason which may serve as
a basis to suspend, revoke or deny a license to engage in electrical contracting as more particularly set forth in
N.J.S.A. 45:1-21 et seq.
AffidAvit
This afdavit is to be executed by the applicant before a notary public:
State of: _____________________________
County of: ___________________________
___________________________________ , being duly sworn, says that he or she is the entity making application for
the telecommunications wiring exemption. The applicant further stipulates that the statements contained herein are strictly
true in every respect; that he or she has complied with all the requirements of the exemption; and shall take all measures
necessary to ensure that the entity complies in all respects with the requirements and intent of the telecommunications
wiring exemption.
Each application must be sworn to before a notary public or other authorized ofcer.
_____________________________________________________________________________________________
Name of business (If a corporation, give the exact legal title.)
_____________________________________________________________________________________________
Signature of owner or ofcer (Check one title below.)
owner partner trustee receiver lessee
executor president secretary
Sworn to and subscribed before me this ____________ day of ____________________________, ____________ .
Month Year
___________________________________________ ___________________________________________
Signature of applicant Name of Notary Public (please print)
___________________________________________ ___________________________________________
My commission expires
Signature of Notary Public
Corporation Seal
Application fee: Send only a certied check, postal money order or an express money order payable to the State of New Jersey, in
accordance with N.J.A.C. 13:31-1.6. Please make sure that the application fee of $250.00 is enclosed.
Notary Seal
} ss.
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Instructions for the Telecommunication Wiring Exemption Certicate (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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