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Minnesota Department of Labor and Industry
Construction Codes and Licensing Division Application Deadline Date Billing Code
Licensing and Certification Services
12/31/2007 4832
443 Lafayette Road N
Restricted License Application Fee Amount Paid
St. Paul, MN 55155
Phone: (651) 284-5067 $30.00
Fax: (651) 284-5748 Method of Payment Check / MO #
E-mail: dli.license@state.mn.us
Website: www.doli.state.mn.us Cash Check Money Order
TTY/MRS: (651) 297-4198 Date Paid (Deposit Date)

The $30 application fee is payable to Department of Labor and Application Number Date Recorded
Industry, must accompany the application and be mailed to:
Minnesota Department of Labor and Industry Decision Decision Date Recorded
Financial Services/Plumbing Approve Deny
443 Lafayette Road N
Reason Denied
St. Paul, MN 55155

By law applicants without at least 2-years documented Checks returned for nonpayment will be charged a $30 fee
practical plumbing experience will be denied. (Minn. Stat. § 604.113, subd. 2)

Application for Restricted Plumber License

Plumbing License Required Statewide. The 2007 Minnesota Legislature extended statewide, effective December 1, 2007,
the requirement that throughout the state all persons (with few exceptions) working at the business of plumbing must be
licensed plumbers or registered plumbing apprentices. A special class of restricted plumbing licenses was created by the
Legislature that limits holders to working in cities with a population of 5,000 or less, which is available to previously unlicensed
individuals with two or more years of documented practical plumbing experience. Persons having certification as pipelayers
may perform some plumbing installation outside of buildings without a license, if properly bonded.

PRINT IN INK or TYPE your responses.

Unreadable or illegible applications will be denied. Incomplete applications will not be processed and will returned to sender.

Mark the box of the license you are applying to receive.

Document your practical plumbing experience for the license on the back of this application form.
Restricted Journeyman Plumber License Restricted Master Plumber License
Must have at least 2-Years practical plumbing experience. Must have at least 4-Years practical plumbing experience.
Engage in plumbing trade in all areas of state except cities Engage in plumbing trade in all areas of state except cities
and towns with a population of more than 5,000. and towns with a population of more than 5,000.
License must be renewed annually at Journeyman fee ($55). License must be renewed annually at Master fee ($120).
If contracting to do plumbing work, must have $25,000 bond If contracting to do plumbing work, must have $25,000 bond
filed with DLI and have required liability insurance coverage. filed with DLI and have required liability insurance coverage.
Items with * are required to process your application.

LAST NAME* FIRST NAME* MIDDLE INITIAL

ADDRESS* CITY STATE ZIP CODE*

HOME PHONE NUMBER WORK PHONE NUMBER DATE OF BIRTH DATE (mm/dd/yyyy)* SOCIAL SECURITY NUMBER*

The information you provide on this application will be used to determine if you meet the license requirements. Before a license is issued to
you, Minn. Stat. § 270.72, subd. 4, requires you to provide your social security number. The other information is required to process your
application. Failure to provide requested information may delay the processing of your application or may be grounds for denying your
application. Under Minn. Stat. § 13.41, the information that you provide on this application, except for your name and address, is private data
while the application is pending. Disclosure of this information to others may occur as authorized or required by law, including the Attorney
General’s Office, the Department of Revenue, the Department of Human Services and/or for the purpose of verification and investigation.
Once you are licensed, the information (except for your social security number) becomes public data and will be part of the agency’s
permanent records.
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD 651-297-4198.
PLB 02 (8/07)
 Application for Restricted Plumber License
Documentation of Practical Plumbing Work Experience
Applicants for restricted master and journeyman plumber licenses must provide documentation of their practical plumbing work
experience earned prior to making application to qualify for a restricted license. DLI’s plumbing bond and plumber’s apprentice
records will be used, as necessary, to validate claims of practical pluming experience.

Restricted Master Plumber: Applicant must show four (4) years practical plumbing experience.
Restricted Journeyman Plumber: Applicant must show two (2) years practical plumbing experience.

Applicants with four (4) years documented practical plumbing experience may apply for the Restricted Journeyman Plumber
license and are not required to apply for the Restricted Master Plumber license. Applicants must, however, choose a restricted
license and submit the completed application by December 31, 2007.

Qualification: Contracting for Plumbing Work

Practical plumbing experience claimed as “contracting for plumbing work” will only qualify for those years that were covered by
a $25,000 plumbing code compliance bond properly filed with the State of Minnesota pursuant to Minn. Stat. § 326.40.

I filed a plumbing bond pursuant to Minn. Stat. § 326.40 in the following years while owning or working for the identified
plumbing business (es). I claim those years contracting for plumbing work and ask that DLI verify my bond filings.
Calendar Year Plumbing Company Name Bond number Date Bond Filed

Qualification: Practical Plumbing Experience as Registered Plumber’s Apprentice

Practical plumbing experience claimed for work in Minnesota since July 1, 1987, which is not qualified as “contracting for
plumbing work,” will only qualify for those years the applicant was properly registered as a Plumber’s Apprentice.

I am or have been registered as a Plumber’s Apprentice with the State of Minnesota

and claim the hours reported annually for the following registration number. PA

I am or have been registered as a Plumber’s Apprentice in a voluntary Joint Plumbers Apprenticeship Program and claim
the recorded hours worked and have attached written verification from the joint apprenticeship program.

Qualification: Practical Plumbing Experience – Pre 07/01/1987 in Minnesota and Out-of-State

Practical plumbing experience claimed for work in Minnesota before July 1, 1987 and outside the state of Minnesota shall be
verified by affidavit.

I claim practical plumbing experience for plumbing work performed in Minnesota before July 1, 1987 equal to ( two
years / four years (select one)) as demonstrated on the attached affidavit form(s).

I claim practical plumbing experience for plumbing work performed outside the state of Minnesota equal to ( two years /
four years (select one)) as demonstrated on the attached affidavit form(s).

Certification
I certify all of the information submitted in this application and any attachments are true and complete, that this license prohibits
me from performing plumbing work in cities and towns with populations exceeding 5,000 according to the most recent U.S.
Census, and that by becoming a Restricted Master Plumber the annual license fee will equal the Master Plumber license fee
($120) and that by becoming a Restricted Journeyman Plumber the annual license fee will equal the Journeyman Plumber
license fee ($55).

PRINT NAME SIGNATURE OF APPLICANT DATE