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Wisconsin Department of Safety and Professional Services (Wisconsin)

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#3137 (Rev. 10/2021)
Class Code 7630 Page i
Committed to Equal Opportunity in Employment and Licensing
Wisconsin Department of Safety and Professional Services
Mail To: P.O. Box 78780 Office Location: 4822 Madison Yards Way
Milwaukee, WI 53293-0780 Madison, WI 53705
FAX #: (608) 267-0592 E-Mail: DSPSCredTrades@wisconsin.gov
Phone #: (608) 266-2112 Website: http://dsps.wi.gov
DIVISION OF PROFESSIONAL CREDENTIAL PROCESSING
INSTRUCTIONS FOR UTILITY CONTRACTOR APPLICATION
Requirements for Credential
Per Wis. Stat. § 145.06, no person may engage in or work at plumbing in the state unless licensed to do so by the Department.
Per Wis. Stat. § 145.07(10)
, the Department shall issue a Utility Contractor license to any person who is skilled in the planning, superintending and
practical installation, within public or private premises, of piping which conveys sewage, rain water, or other liquid wastes to a legal point of disposal
and who is skilled in the design, planning, superintending and practical installation of water service piping from the street main to the immediate
inside building perimeter.
Per Wis. Admin. Code § SPS 305.97
, a person who, as a licensed Utility Contractor, installs or modifies water services, private water mains, sanitary
building sewers, storm building sewers, or private interceptor main sewers shall utilize the appropriately licensed or registered persons to install or
modify the plumbing.
AN APPLICATION IS NOT COMPLETE UNTIL ALL OF THE FOLLOWING DOCUMENTS HAVE BEEN RECEIVED:
1. Application and Fee: The fee consists of a $10 application fee and a $30 exam fee. When the exam is passed the applicant will pay a $500
prorated credential fee, based on a 4-year term from March 31
st
.
2. Qualification for Examination: A person applying for a Utility Contractor license examination shall be at least 18 years old.
3. Examination: Select an exam date on Page 2. For additional information on exam content, please view the Department website at
http://dsps.wi.gov under “PROFESSIONS” and select “Utility Contractor.”
#3137 (Rev. 10/2021)
Class Code 7630 Page 1 of 2
Committed to Equal Opportunity in Employment and Licensing
Wisconsin Department of Safety and Professional Services
Mail To: P.O. Box 78780 Office Location: 4822 Madison Yards Way
Milwaukee, WI 53293-0780 Madison, WI 53705
FAX #: (608) 267-0592 E-Mail: DSPSCredTrades@wisconsin.gov
Phone #: (608) 266-2112 Website: http://dsps.wi.gov
DIVISION OF PROFESSIONAL CREDENTIAL PROCESSING
APPLICATION FOR UTILITY CONTRACTOR LICENSE
The Department must deny your application if you are liable for delinquent state taxes, UI contributions, or child support (Wis. Stat. §§ 440.12 and 440.13).
PLEASE TYPE OR PRINT
IN INK
Your name, address, phone number, and e-mail address are available to the public. Check box to withhold street address/PO
Box, phone number, and e-mail address from lists of 10 or more credential holders (Wis. Stat. § 440.14).
Last Name
First Name
MI
Date of Birth
/
/
Address (street) (city) (state) (zip code)
Daytime Telephone Number
-
-
Social Security Number
-
-
Your Social Security Number must be submitted with your application on this form. If you do not have a
Social Security Number, you must complete Form #1051
. The Department may not disclose the Social
Security Number collected except as authorized by law.
Have you ever held a Trades credential in WI? Yes No If yes, list your credential number:
APPLICATION FEES: Please check applicable box. Make check
payable to DSPS and attach to this application. To pay by credit
card see Form #3073
.
I am seeking a Veteran Fee Waiver (for Initial Credential Fee
only, see below for further information)
Initial Credential Fee
$10.00 Application Fee
$30.00 Exam Fee
$40.00 Total Fee Attached
Reinstatement Fee (credential expired more than 4 years)
$10.00 Application Fee
$30.00 Exam Fee
$25.00 Late Renewal Fee
$65.00 Total Fee Attached
APPLICATION IS NOT COMPLETE UNTIL ALL OF THE
FOLLOWING DOCUMENTS HAVE BEEN RECEIVED:
Fee and Application (including signature on Page 2)
Is name on all credentials the same? If not, list former/maiden
name(s):
ARE YOU A VETERAN? If yes, please view the DSPS website at https://dsps.wi.gov/Pages/Professions/MilitaryLicensureBenefits.aspx for
information and eligibility requirements for veterans, service members, former service members, and their spouses.
If you qualify, are you requesting a waiver of your initial credentialing fee? Yes No
If Yes, provide copy of WI Dept of Veterans Affairs (WDVA) voucher code and list your WDVA Voucher Code #: __________________________
(You may contact the WDVA at 1-800-947-8387 or dva.wi.gov for assistance in obtaining your WDVA Voucher Code and/or documents
related to your training.)
#3137 (Rev. 10/2021)
Class Code 7630 Page 2 of 2
Committed to Equal Opportunity in Employment and Licensing
Wisconsin Department of Safety and Professional Services
TO SCHEDULE AN UPCOMING EXAM:
• Indicate a first date choice (1) and a second date choice (2) in the event one exam site is full.
• Submit the fee and this application to the Department at least 30 days in advance of the exam date chosen.
• Keep a copy of this application for your records. You may only schedule one future exam session at a time for each credential type.
• You will receive a letter from DSPS confirming your upcoming exam, including the time, date, and location of the exam.
• If you need special accommodations see information at https://dsps.wi.gov/Pages/Professions/TradesExaminationInformation.aspx
or email
DSPSCredTrades@wisconsin.gov.
Select One: A.M. (starts at 8:00 a.m.) or P.M. (starts at 1:00 p.m.)
(If taking a 2-part plumbing exam or 5-hour exam, you will be scheduled for both the A.M. and the P.M. session.)
DeForest – (new location)
Comfort Inn and Suites
5025 County Road V
DeForest, WI 53532
February 15, 2022 February 16, 2022 April 27, 2022 April 28, 2022
June 21, 2022 June 22, 2022 August 23, 2022 August 24, 2022
October 4, 2022 October 5, 2022 December 13, 2022 December 14, 2022
Pewaukee – (new location)
Ingleside Hotel
2810 Golf Road
Pewaukee, WI 53072
January 4, 2022 January 5, 2022 March 15, 2022 March 16, 2022
May 24, 2022 May 25, 2022 July 26, 2022 July 27, 2022
September 13, 2022 September 14, 2022 November 29, 2022 November 30, 2022
Eau Claire
– Sleep Inn and Suites
5872 33rd Ave, Eau Claire, WI 54703
April 12, 2022 April 13, 2022 August 9, 2022 August 10, 2022
Appleton – Doubletree by Hilton Appleton
150 South Nicolet Road
Appleton, WI 54914
January 18, 2022 January 19, 2022 March 1, 2022 March 2, 2022
May 3, 2022 May 4, 2022 July 12, 2022 July 13, 2022
September 27, 2022 September 28, 2022 November 8, 2022 November 9, 2022
Wausau – (new location)
Fairfield By Marriott
7100 Stone Ridge Dr, Weston, WI 54476
February 1, 2022 February 2, 2022 June 7, 2022 June 8, 2022
October 25, 2022 October 26, 2022
CONTINUING EDUCATION AND RENEWAL REQUIREMENTS: Please view the Department website at http://dsps.wi.gov under “PROFESSIONS”
and select “Utility Contractor.”
CERTIFICATION OF LEGAL STATUS
I declare under penalty of law that I am (check one):
A citizen or national of the United States, or
A qualified alien or nonimmigrant lawfully present in the United States who is eligible to receive this professional license or credential as defined in
the Personal Responsibility and Work Opportunities Reconciliation Act of 1996, as codified in 8 U.S.C.
§1601 et. seq. (PRWORA). For questions
concerning PRWORA status, please contact the U.S. Citizenship and Immigration Services in the Department of Homeland Security at 1-800-375-
5283 or online at http://www.uscis.gov.
Should my legal status change during the application process or after a credential is granted, I understand that I must report this change to the Wisconsin
Department of Safety and Professional Services immediately.
CONTINUING DUTY OF DISCLOSURE
I understand that I have a continuing duty of disclosure during the application process. If information I have provided in this application becomes invalid,
incorrect, or outdated, I understand that I am obliged to provide any necessary information to ensure the information on my application remains current,
valid, and truthful. I understand that credentialing authorities may view acts of omission as dishonesty and that my duty of disclosure during the
application process exists until licensure is granted or denied.
AFFIDAVIT OF APPLICANT
I declare that I am the person referred to on this application and that all answers set forth are each and all strictly true in every respect. I understand that
failure to provide requested information, making any materially false statement and/or giving any materially false information in connection with my
application for a credential or for renewal or reinstatement of a credential may result in credential application processing delays; denial, revocation,
suspension, or limitation of my credential; or any combination thereof; or such other penalties as may be provided by law. I further understand that if I am
issued a credential, or renewal, or reinstatement thereof, failure to comply with the statutes and/or administrative code provisions of the licensing
authority will be cause of disciplinary action.
By signing below, I am signifying that I have read the above statements (Certification of Legal Status, Continuing Duty of Disclosure, and Affidavit of
Applicant) and understand the obligation I have as an applicant or credential-holder should information I have provided to the Department of Safety and
Professional Services change.
Signature:
Date:
/ /
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Completed 17 February 2022

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