The Department of Labor will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability or political beliefs. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency.
INSPECTOR LICENSE FEE:
$75.00
OFFICE USE ONLY
OKLAHOMA DEPARTMENT OF LABOR
3017 N. Stiles, Suite 100
Oklahoma City, OK 73105
405-521-6100
FAX 405-521-6025
www.labor.ok.gov
Mark Costello, Commissioner
Elevator Inspector License Application
Safety Standards Division
CERTIFICATION AND SIGNATURE
I certify all statements are true to the best of my knowledge and that all work shall be done according to the State of Oklahoma elevator law, rules, and regulations adopted by the Oklahoma Department of Labor.
I also certify I am actively employed by the company I'm representing and that in the event of my leaving said firm, agree to immediately notify the Oklahoma Department of Labor.
SIGNATURE OF APPLICANT
DATE
PROOF OF ELIGIBILITY
Please see 380:70-5-3 of the Elevator Safety Law for qualifications for an inspector's license.
APPLICATION FEE
NEW
REINSTATEMENT
REPLACEMENT
RENEWAL
$75.00 - submit with application along with proof of continuing education, completed questionnaire per Rule 380:70-5-7 and proof of liability insurance per Section 3023 F.
$10.00 - submit with application.
$100.00 in addition to license fee of $75.00 with application and and proof of liability insurance per Section 3023 F. O.S. Title 59 § 3020, et seq.
APPLICATION TYPE IF NOT NEW ENTER
LICENSE NUMBER
APPLICANT INFORMATION
NAME
ADDRESS
CITY
TELEPHONE NUMBER (Include Area Code)
ZIP CODE
STATE
SOCIAL SECURITY NUMBER
EMPLOYED BY
E-MAIL
APPROVED
DENIED
INITIALS
APPROVAL ACTION
ACTION DATE
CHECK/CASH
RECEIPT #
DATE
DEO
LICENSE #
AMOUNT
$75.00 - submit with application and proof of liability insurance per Section 3023 F.
06/21/2012
U.S. CITIZENS: A valid, unexpired Driver's License or Photo-Identification Card from your state of residency; AND Birth Certificate; OR Social Security Card; OR a valid, unexpired passport; OR a W-2 form from current employer. New applicants must appear in person at an approved facility which can be found at www.labor.ok.gov or by calling 405-521-6100. NON-U.S. CITIZENS: Call 405-521-6100 for information regarding the required documentation. AFFIDAVIT OF or REGARDING CITIZENSHIP: ALL APPLICANTS MUST SIGN AFFIDAVIT Note if RENEWING: U.S. Citizens: Once eligibility has been established, all renewal license can be approved by mailing an application, fee and photocopy of the requested documentation to the Oklahoma Department of Labor. The tenth year and every tenth year thereafter you must appear in person. Qualified Aliens: State law requires the Oklahoma Department of Labor to verify immigration status (lawful presence) of all non-U.S. citizens upon license renewal. Qualified aliens are required to present, in person, documentation to establish eligibility for every renewal.
REQUIRED DOCUMENTATION:
$75.00 - submit with application and proof of liability insurance per Section 3023 F.
NEW WITNESS PERIODIC TESTING ONLY
ATTESTATION: The enclosed application, which is specific to the undersigned’s application for elevator license, reflects the following requirements outlined in the Elevator Safety Act, Oklahoma Administrative Code (OAC) 380:70-5-6. (Please initial to acknowledge your agreement.)
The undersigned, as applicant for the enclosed elevator license, shall not engage in
the sale of any service, article or device relating to elevators or conveyances of
their appurtenances covered by this Act.
In accordance with 12 O.S. 426, I state under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct.
Print Name: Name of Company:
Signature: Date:
This signed statement under penalty of perjury shall constitute a legally binding assertion that the contents of the statement to which it refers are true. If you have any questions please call the Safety Standards division at (888) 269-5353 or (405) 521-6100. Sincerely, Bettye M. Finch Director of Statistics, Safety and Licensing Enclosure(s)
