PLUMBING AFFIDAVIT OF EXPERIENCE
This form is to be completed by and signed by the employer (must be typewritten or printed legibly in ink). The form must be filled in completely or it will be rejected. If the answer is “none” or “does not apply,” please state “none” or “n/a.”
BUSINESS NAME:
LICENSE NUMBER & STATE OF ISSUE:
BUSINESS ADDRESS:
BUSINESS PHONE: BUSINESS EMAIL:
EMPLOYEE NAME: DATE OF HIRE:
CO APPRENTICE NUMBER OR SSN: DATE OF TERMINATION:
TOTAL TIME WORKED (Specify Hours or Months): Hours Months
Provide a breakdown of the experience in hours OR months of total time worked in each area: TYPE OF EXPERIENCE
HOURS
MONTHS
SUPERVISOR INFORMATION
Residential
Commercial SUPERVISOR NAME:
Industrial
LICENSE NUMBER: SUPERVISOR NAME:
Other (Explain in detail on a separate sheet)
TOTALS (cannot exceed total time indicated above)
STATE:
LICENSE NUMBER:
0.00
STATE:
0.00
I hereby certify that the statements on this affidavit and any attachments are true and accurate to the best of my knowledge. I understand that under § 12-23-118(I), C.R.S., providing false information is grounds for denial, suspension, or revocation of an electrical contractor registration.
Signature of Master Plumber for, or any signatory authority of, the Plumbing Contractor or Approved Training Director
Date
Printed Name of Master Plumber for, or any signatory authority of, the Plumbing Contractor or Approved Training Director
Job Title
WORK EXPERIENCE REQUIREMENTS AND DEFINITIONS
Plumbing Experience Requirements: Residential Plumber – 3,400 hours of practical experience Journeyman Plumber – 6,800 hours of practical experience Master Plumber – 8,500 hours of practical experience Definition of Plumbing according to § 12-58-102(5)(a), C.R.S.: “Plumbing” includes the following items located within the building or extending five feet from the building foundation to the first joint, excluding any service line extending from the first joint to the property line: All potable water supply and distribution pipes and piping, all plumbing fixtures and traps, all drainage and vent pipes, all building drains, including their respective joints and connections, devices, receptacles, and appurtenances, and all medical gas and vacuum systems in health care facilities.
Construction Work Experience: Letters of verification must reflect the number of hours or months that you have worked for each employer in each classification that applies to you. One month must equal a minimum of 163 hours of work. The total hours or months submitted for each employer must equal the months required for the level of plumber licensing. 1. Residential: Include new construction, remodeling and additions to buildings for residential occupancy. Also include plumbing installation in one, two, three, and four-family dwellings, which do not extend more than two stories above ground. 2. Commercial: Include new construction remodeling and additions to stores, office buildings, gas stations, theaters, warehouses, hospitals, and other buildings and facilities of a similar nature.
