Form DBPR HR-7017 "Application for Certified Elevator Inspector Registration" - Florida

What Is Form DBPR HR-7017?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBPR HR-7017 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

ADVERTISEMENT
ADVERTISEMENT

Download Form DBPR HR-7017 "Application for Certified Elevator Inspector Registration" - Florida

Download PDF

Fill PDF online

Rate (4.6 / 5) 35 votes
DBPR HR-7017
APPLICATION FOR CERTIFIED ELEVATOR INSPECTOR REGISTRATION
Application begins on page 2
Congratulations on your decision to register your license or certification! The Department of Business and Professional
Regulation’s (DBPR) Division of Hotels and Restaurants (H&R) is ready to assist you through the licensing and regulatory
process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. We are a resource you can use to see that your new business
operates within the requirements of the law.
This packet contains the legal requirements for your license or certification. It is very important that you familiarize
yourself with this information before you begin operating. If you have questions, or need any clarification, please contact
the DBPR Customer Contact Center at 850.487.1395 or go online to www.MyFloridalicense.com/DBPR/elevator-safety/.
In addition to working with us to meet the state requirements, it is very important that you also contact local officials
regarding any city and county requirements to register as a new business.
We wish you the best of luck and success in your venture.
LICENSE INFORMATION
A Certified Elevator Inspector (CEI) is a natural person registered with and authorized by the division to construct, install,
inspect, maintain, or repair any vertical conveyance, after having properly acquired the qualified elevator inspector (QEI)
credential as prescribed by the American Society of Mechanical Engineers (ASME) (s. 399.01(13), F.S.). The QEI must
be in good standing (s. 399.17, F.S.).
Good standing means the QEI credential was not suspended, revoked, or otherwise disciplined by the issuing body, or
allowed to expire or lapse.
APPLICATION REQUIREMENTS
Complete DBPR HR-7017 Application for Certified Elevator Inspector Registration.
Submit a copy of valid qualified elevator inspector (QEI) credential issued by and in good standing with an
organization meeting the QEI credential standards prescribed by the ASME.
Submit proof of comprehensive general liability insurance in a minimum amount of $100,000 per person and
$300,000 per occurrence, meeting the requirements of Rule 61C-5.007(6), F.A.C.
Please send your completed application and documentation to:
Department of Business and Professional Regulation
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-1013
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
Rule 61C-5.007, F.A.C.
Page 1 of 3
DBPR HR-7017
APPLICATION FOR CERTIFIED ELEVATOR INSPECTOR REGISTRATION
Application begins on page 2
Congratulations on your decision to register your license or certification! The Department of Business and Professional
Regulation’s (DBPR) Division of Hotels and Restaurants (H&R) is ready to assist you through the licensing and regulatory
process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. We are a resource you can use to see that your new business
operates within the requirements of the law.
This packet contains the legal requirements for your license or certification. It is very important that you familiarize
yourself with this information before you begin operating. If you have questions, or need any clarification, please contact
the DBPR Customer Contact Center at 850.487.1395 or go online to www.MyFloridalicense.com/DBPR/elevator-safety/.
In addition to working with us to meet the state requirements, it is very important that you also contact local officials
regarding any city and county requirements to register as a new business.
We wish you the best of luck and success in your venture.
LICENSE INFORMATION
A Certified Elevator Inspector (CEI) is a natural person registered with and authorized by the division to construct, install,
inspect, maintain, or repair any vertical conveyance, after having properly acquired the qualified elevator inspector (QEI)
credential as prescribed by the American Society of Mechanical Engineers (ASME) (s. 399.01(13), F.S.). The QEI must
be in good standing (s. 399.17, F.S.).
Good standing means the QEI credential was not suspended, revoked, or otherwise disciplined by the issuing body, or
allowed to expire or lapse.
APPLICATION REQUIREMENTS
Complete DBPR HR-7017 Application for Certified Elevator Inspector Registration.
Submit a copy of valid qualified elevator inspector (QEI) credential issued by and in good standing with an
organization meeting the QEI credential standards prescribed by the ASME.
Submit proof of comprehensive general liability insurance in a minimum amount of $100,000 per person and
$300,000 per occurrence, meeting the requirements of Rule 61C-5.007(6), F.A.C.
Please send your completed application and documentation to:
Department of Business and Professional Regulation
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-1013
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
Rule 61C-5.007, F.A.C.
Page 1 of 3
DBPR HR-7017 – Application for Certified Elevator Inspector Registration
STATE OF FLORIDA, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road, Tallahassee, FL 32399-1013
Phone: 850.487.1395 – Email:
www.MyFloridaLicense.com/contactus/
Internet :
www.MyFloridalicense.com/DBPR/elevator-safety/
Please direct questions about this application to the Department of Business and Professional Regulation’s Customer
Contact Center at 850.487.1395.
Section 1 – Qualifications
Qualified Elevator Inspector (QEI) Number (required):
QEI Expiration Date:
QEI Issued by:
Insurance Provider (Attach copy of certificate of general liability insurance):
Section 2 – Personal Information (MA)
Note: This address will be designated as the "address of record" for the license.
* Under the Federal Privacy Act,
Social Security Number (REQUIRED)*
disclosure of Social Security Numbers
is
voluntary
unless
specifically
required by Federal statute. In this
Last Name
First
Middle
Suffix (Jr., III, etc.)
instance, social security numbers are
mandatory pursuant to Title 42 United
States Code, Sections 653 and 654;
and sections 409.2577, 409.2598 and
Birth Date (MM/DD/YYYY)
559.79,
Florida
Statutes.
Social
Security numbers are used to allow
efficient screening of applicants and
Street Address or Post Office Box
licensees by a Title IV-D child support
agency to assure compliance with
child
support
obligations.
Social
Security
numbers
must
also
be
City
recorded on all professional
and
occupational license applications and
will be used for licensee identification
pursuant
to
the
Personal
Florida County
State
Zip Code (+4 optional)
Responsibility and Work Opportunity
Reconciliation Act of 1996 (Welfare
Reform Act), 104 Pub.L.193, Sec 317.
Country
E-Mail Address (Optional)
Phone Number
Section 3 – License Location Information (LL)
Note: This address will be designated as the physical location address for this license.
Street Address
City
Florida County
State
Zip Code (+4 optional)
Country
E-Mail Address (Optional)
Phone Number
Section 4 – License Mailing Information (LM)
Note: This address will be used by the department for all mailings to the licensee, including the license and license renewal notices.
Routing Name (
)
e.g., Office Manager, contact name
Street Address or Post Office Box
City
Florida County
State
Zip Code (+4 optional)
Country
E-Mail Address (Optional)
Phone Number
2018 January
Rule 61C-5.007, F.A.C.
Page 2 of 3
DBPR HR-7017 – Application for Certified Elevator Inspector Registration
Section 5 – Employment Information
Business/Firm Name
Street Address or Post Office Box
City
Florida County
State
Zip Code (+4 optional)
Country
Section 6 – Signature
All certified elevator inspectors must register with the division, provide proof of a valid QEI credential in good standing,
and provide proof of insurance as specified in division rule to maintain their certified elevator inspector (CEI) license
registration in good standing.
I acknowledge that:
1. A certified elevator inspector license registration expires December 31 each year.
2. The certified elevator inspector license registration may only be renewed by the division upon receipt of an
annual registration form, proof of a valid QEI credential in good standing, and proof of comprehensive
general liability insurance coverage as specified by division rule.
3. I must be licensed as a certified elevator inspector before I may construct, install, maintain, repair, or inspect
an elevator in Florida.
4. I must maintain my qualified elevator inspector credential in good standing throughout the license year. I
understand that if I fail to maintain my QEI credential in good standing the division will not renew my CEI
license registration.
SECTION 559.79(2), Florida Statutes: Each application for a license or renewal of a license issued by the Department of
Business and Professional Regulation shall be signed under oath or affirmation by the applicant, or owner or chief
executive of the applicant without the need for witnesses unless otherwise required by law.
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand
that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of
perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that
falsification of any material information on this application may result in criminal penalty or administrative
action, including a fine, suspension or revocation of the license.
Signature
Date
Complete the application and mail it with the required supporting documents to the address on this form. Please
use the entire 9-digit zip code in the address above to ensure proper handling.
2018 January
Rule 61C-5.007, F.A.C.
Page 3 of 3
Page of 3