____________________________________				____________________
Signature								Date

			For Office Use Only: 					
Application Accepted By: 			Plans Checked By 				Approved for Permit By 	
Date: 			Date: 				Date 			
Plan Check Fee: 				Permit Fee: 					
Type of Const.: 				Zoning District: 					
Occupancy Class: 		Max. Occupancy Load (if applicable): 		Fire Sprinklers Required: 	
							Yes 	or 	No 	
No of Dwelling Units (if applicable): 	No. of Rooms 		No. of Bathrooms or Restrooms: 	Off-Street Parking Spaces: 	
Electrical Plans Checked By: 				Plumbing Plans Checked By: 			
Mechanical Plans Checked By: 				Fire Protection or Fire Alarm System Plans Checked By: 	
Date: 				Date: 						
TDLR Registration # (if required) 				Asbestos Survey (if required): 			
					Yes 		or 	No 		
Proof of Energy Code Compliance (if required): 		Engineered or Architect Plans: 			
ResCheck Form 	or 	ComCheck Form 		Yes 		or 	No 		
Notes or Special Conditions: 										

		

CITY OF PETERSBURG

ITEMS TO BE INCLUDED WITH THIS REGISTRATION: 
1.	A COPY OF YOUR CURRENT STATE LICENSES. 
2.	A COPY OF YOUR CURRENT STATE REQUIRED MINIMUM LIABILITY 
INSURANCE. 
3.	MINIMUM REGISTRATION FEE: $30.00 (Payable to the City of Petersburg) 
	BUSINESS NAME: 	_ 
	MAILING ADDRESS: 	 
	REGISTRANT'S NAME: 	 
	LICENSE NUMBER: 	EXPIRATION DATE:	 
	EMAIL: 	_ 
	REGISTRANT'S NAME: 	 
	LICENSE NUMBER: 	EXPIRATION DATE: 	 
	EMAIL: 	 
	REGISTRANT'SNAME: 	
	LICENSE NUMBER: 	EXPIRATION DATE: 	 
	EMAIL: _____________________________________________________________________________	_ 

PHONE NUMBER: 

1524 Main Street, Petersburg, TX  79250   •   Telephone (806) 667-3461   •   Fax (806) 667-3461 
WWW.PETERSBURGTX.COM

	OFFICE: 	
 
	MOBILE: 	
 
	MOBILE: _____________________________________________	_
 
FAX: _________________________________________________	_
 
	OTHER: 	
Sec. 3.03.033 Contractor registration 
No person shall erect, construct, enlarge, alter, repair, remove, improve, convert or demolish any 
roof or roof structure for which a permit is required within the corporate limits of the city until 
such person has registered with the city and has made, executed and delivered to the building 
official a permit surety bond and a certificate of insurance in accordance with the following: 
	(1) 	Permit surety bond. 
(A) Contractors are required to obtain a good and sufficient corporate 
surety bond or permit surety bond, in the amount shown in table
 3.03.033 payable to the city for the use and benefit of either the city or 
the property owner for damages as a result of any act or neglect of the 
principal or his agents or employees; or by reasons of failure to repair 
any defective work, material or installation; or for failure to pay any fees 
or other charges due the city; or for failure to remedy any defects or 
faulty workmanship or material within the time prescribed by the building 
official for the completion of such remedial work, without additional cost 
to the person for whom the work was done; and guaranteeing 
compliance with the requirements of the applicable construction codes of 
all work installed by the principal, his agents or employees. 
(8) Claim upon such bond may be filed by either any person damaged 
by reason of the principal's failure to perform his obligations under the 
bond, or the city for violation of applicable construction codes. 
(C) Suspension or revocation of the registration of the principal shall 
not by itself affect the liability of either the principal or the surety on such 
bond. 
(2) Certificate of insurance. Contractors are required to maintain liability 
insurance and shall provide a certificate of insurance showing the levels of 
liability insurance coverage in accordance with table 3.03.033. 

(3) Homestead exemption. A homeowner for which a homestead 
exemption has been given for his/her property intended for the permit and 
said homeowner is acting as his/her own roofing contractor. 
Table 3.03.033 

Contractor Categories 	State License 	City 	Annual City 	License and 	General 	
	or Registration 	Registration 	Registration 	Permit Surety 	Liability 	
	Required 		Fee 	Bond 	Insurance 	
Commercial Roofing 	No 	Yes 	$30.00 	$20,000.00 	$300,000.00 	
Contractor 						
Residential Roofing 	No 	Yes 	$30.00 	$20,000.00 	$100,000.00 	
Contractor