Safety and Buildings Division Forms

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Recent forms changes.  

Credential Application Forms (Licenses, Certifications, and Registrations)

  * Complaint Explanation: This complaint process is for asking that S&B staff members follow-up problems you feel are related to an S&B administrative code program.  [See list of programs.]  This process is not the avenue to give comments about S&B staff members.  If you have a compliment or a complaint about an S&B staff person, please contact that person's supervisors.  S&B staff members and their supervisors are listed here.  

Amusement Rides / Ropeways
** SBD-211 Amusement Ride / Ropeways Injury Report (R03/08), PDF file, Word file
** SBD-5292 Amusement Ride Registration (R12/07), PDF file, Word file
** SBD-7620 Amusement Ride Route Schedule (R12/07), PDF file, Word file
** SBD-7620a Amusement Ride Listing (R12/07), PDF file
** SBD-10818 Amusement Ride Application for Plan Review (R6/06) PDF file, Word file
** SBD-10867 Affidavit of Compliance (N12/07) PDF file, Word file

Blasting
Blaster Class 1 (PDF) Application
Blaster Class 2 (PDF) Application
Blaster Class 3 (PDF) Application
Blaster Class 4 (PDF) Application
Blaster Class 5 (PDF) Application
Blaster Class 6 (PDF) Application
Blaster Class 7 (PDF) Application
** Request for Storage of Explosives in a Community, SBD-6772 (R2/02), PDF file, Word file.
** Notice of Blasting in the Community SBD-7336 (R8/99) PDF file, Word file
** Notice to Begin Operation (Pit and Quarry) SBD-6736 (R4/99), PDF file, Word file

  Boilers and Pressure Vessels
- Inspection -
    Boiler/Pressure Vessel Inspector (PDF) Application
    ** SBD-37 Application for the National Board Boiler Inspector Commission/Endorsement Examination (R05/06), PDF file
    ** SBD-4341 Inspection Report and Orders (Continued) (R5/04), PDF file, Word file
    ** SBD-10663-E Boiler Regulated Object Inspection Report (R06/04) front, PDF file, Word file
    ** SBD-10663-E Blr Boiler Regulated Object Inspection Report (R06/04) back, PDF file, Word file
    ** SBD-10663-E UPV Unfired Pressure Vessel Regulated Object Inspection Report (R04/04) front, PDF file, Word file
    ** SBD-10663-E UPV Unfired Pressure Vessel Regulated Object Inspection Report (R04/04) back, PDF file, Word file

- Owner/Contractor -
    ** SBD-5204 Power Piping/Welded Refrigeration Piping Installation Registration (R12/06) PDF file, Word 97 file
    ** SBD-6314 Boiler and Unfired Pressure Vessel Registration (R12/06) PDF file, Word file
    ** SBD-10759 Hobby Boiler Inspection Checklist (R2/03), PDF file, Word file
    ** SBD-10789 Boiler and Pressure Vessel Accident Report (R9/07), PDF file, Word file
    ** Safety Valve Test Log, PDF file, Word file

  Commercial Buildings
    Commercial Building Inspector (PDF) Application   
    HVAC Contractor (PDF) Application
    HVAC Qualifier (PDF) Application
** List of Delegated Municipalities 

** Commercial Buildings Plan Review Worksheets and Checklists

  ** Link to federal site for software for downloading, http://www.energycodes.gov.
- COMcheck-EZ, federal Department of Energy software approved in Wisconsin for showing compliance with thermal envelope requirements ONLY (Lighting and HVAC portions are not acceptable. Note COMcheck-Plus is not acceptable.) COMcheck is used for commercial buildings or high-rise (>3 stories) multi-family buildings.
- REScheck, another software application from DOE, is now used for low-rise multi-family (3 dwellings or more, 3 stories or less). (Within REScheck, a user should choose the code option of "2000 IECC" as the code type.)
- Another option within REScheck is to choose the code option of "Wisconsin." One- and two-family building envelope compliance can be demonstrated. 

  Electrical
   Beginner Electrician (PDF) Application
   Commercial Electrical Inspector (PDF) Application 
   Electrical Contractor (PDF) Application
   Electrical Contractor Restricted (PDF) Application
   Journeyman Electrician (PDF) Application
   Master Electrician (PDF) Application
   UDC Electrical Inspector (PDF) Application
** Request for Electrical Inspection, Training, or Plan Review, SBD-10822 (R01/07), PDF file, Instructions for SBD-10822, PDF file, (Sample completed [farm] project description, PDF file.)

  Elevators
    Elevator Apprentice PDF Application
    Elevator Apprentice-Restricted PDF Application
    Elevator Contractor PDF Application
    Elevator Helper PDF Application
    Elevator Inspector PDF Application
    Elevator Mechanic PDF Application
    Elevator Mechanic-Restricted PDF Application
    Lift Apprentice PDF Application
    Lift Helper PDF Application  
    Lift Mechanic PDF Application

** SBD-2E Safety and Governor Test (R07/05) PDF file, Word file
** SBD-3E Periodic Hydraulic Elevator Test (R07/05) PDF file, Word file
** SBD-6E Periodic Escalator Test (R01/07), PDF file, Word file 

** SBD-22 Elevator Application for Review (R8/07) PDF file, Word file
** Instructions for Elevator Application for Review, PDF file, Word file

** SBD-10663 Escalator Regulated Object Inspection Report (N1/05) Front PDF file, Word file, Back PDF file, Word file
** SBD-10782 Elevator / Escalator Accident Report (N06/04), PDF file, Word file
** Elevator Inspection Checklist, (R7/05), PDF file, Word file

Fire Prevention
** SBD-11 Wisconsin School District Record of Fire / Tornado / Other Evacuation Drills (R04/08), PDF file
** SBD-8009 Fire Prevention Program Supplies Form (R03/08) PDF file
** SBD-8568 WIFRS Incident Field Notes (R3/05) PDF file
** SBD-10615a (R03/08) Detailed Fire Prevention Report ("Northwoods") PDF file

  Fire Protection Systems (Also see "Safety Services" below)
    Automatic Fire Sprinkler Contractor (PDF) Application
    Automatic Fire Sprinkler Contractor-Maintenance (PDF) Application
    Automatic Fire Sprinkler Fitter-Maintenance (PDF) Application
    Automatic Fire Sprinkler System Apprentice (PDF) Application
    Automatic Fire Sprinkler System Tester (PDF) Application
    Journeyman Automatic Fire Sprinkler Fitter (PDF) Application
** SBD-118 Buildings, HVAC, Fire Protection Application for Review (R2/03) PDF file, Word file
 Instructions for Application for Review SBD-118 (R06/04) PDF file, Word file
** SBD-10717 Combination water calc worksheet for home plumbing system and 13D fire protection system (R8/02) PDF file, Word file
** SBD-10719 Fire Protection Plan Review Agent Application Form (N3/01), PDF file, Word file

  Gas Systems
** SBD-4341 Inspection Report and Orders (Continued) (R5/04), PDF file, Word file
** SBD-6038 Gas Systems Installation Application (LPG, LNG, CNG, NH3, H2) (R12/06), PDF file, Word file.
** SBD-9656E Gas Systems Certificate of Installation PDF file, Word file
** SBD-10633-E AmmStor Gas Systems Regulated Object Inspection Report (R06/04) front, PDF file, Word file
** SBD-10633-E AmmStor Gas Systems Regulated Object Inspection Report (R06/04) back, PDF file, Word file
** SBD-10786 Anhydrous Ammonia Systems Accident Report (R9/07), PDF file, Word file
** SBD-10789 Gas Systems Accident Report (R9/07), PDF file, Word file.
** Gas Systems Plan Submittal Procedures, PDF file, Word file

  Manufactured/Mobile Home Titling
** SBD-10687 Manufactured Home Title Application and Instructions (R4/08), PDF File, Word File
** SBD-10688 Indemnity Statement PDF File, Word File
** SBD-10693 Statement of Transfer of Manufactured Homes to an Heir or Surviving Spouse (R7/06), PDF File, Word File
** SBD-10696 Statement of Manufactured Home Transfer (R10/05), PDF File, Word File
** SBD-10697 Statement of Intent  PDF File, Word File
** SBD-10698 Name Change/Correction Statement (R10/05), PDF File, Word File
** SBD-10699 Substantiation for Manufactured Homes Titling or Retitling by Repossession Security Agreement (R10/05), PDF File, Word File
** SBD-10700 Trustee's Statement for Certificate of Title (R10/05), PDF File, Word File
** SBD-10702 Landlord Lien (R10/07), PDF File, Word File
** SBD-10752 Manufactured Home/Owner Record Information Request (R10/05), PDF File, Word File
** SBD-10773 Statement of Consent to Purchase, Under 18 Years Old (R10/05), PDF file, Word File

Manufactured Home Communities, Dealers, Sellers
    Manufactured Home Installer (PDF) Application
    Manufactured Home Manufacturer (PDF) Application
** SBD-5524-EMH Manufactured Home Communities Reimbursement of State Fees from Agents to Department of Commerce (R11/07), PDF file, Word file
** SBD-10675 Manufactured Home Community License Application (R03/08), PDF file, Word file, Instruction
** SBD-10676 Manufactured Home Dealer License Application (R5/05), PDF file, Word file, Instructions, PDF file
** SBD-10676SSI Manufactured Home Dealer Program Description (R7/05), PDF file, Word file
** SBD-10677 Manufactured Home Dealer - Salesperson License Application (R7/05), PDF file, Word file
** SBD-10678 Manufactured Home Dealer Financial Statement (R7/05), PDF file, Word file
** SBD-10679 Manufactured Home Dealer Bond (R7/05), PDF file, Word file
** SBD-10681 Manufactured Home Dealer Business Facilities Affidavit (N7/00), PDF file, Word file
** SBD-10685 Manufactured Home Dealer Service Agreement (N10/00), PDF file, Word file
** SBD-10701 Manufactured Home Community Inspection Report (R4/06), PDF file, Word file
** SBD-10784 Manufactured Home Tax State For Out-Of-State Dealers (R10/05), PDF file, Word file
** SBD-10807C Manufactured Home Purchase Contract (N5/06), PDF file, Word file 
** SBD-10807O Manufactured Home Offer to Purchase (N8/05), PDF file, Word file
** SBD-10807S Manufactured Home Purchase Schedules (legal paper size) (N7/05), PDF file, Word file
** SBD-10808 Consignment/Listing Agreement for Sale of Manufactured Home (N7/05), PDF file, Word file
** SBD-10809 Used Home Disclosure Statement (N7/05), PDF file, Word file
**Agent Change Form P2407 (R2/06) PDF file, Word file

  Mechanical Refrigeration
    Refrigerant Handling Technician (PDF) Application
- Owners/Contractors -
    ** SBD-34-E Mechanical Refrigeration Installation Registration (R12/06) PDF file, Word file
    ** SBD-5204 Power Piping/Welded Refrigeration Piping Installation Registration (R10/02) PDF file, Word file
    ** SBD-10788 Mechanical Refrigeration Accident Report (R9/07), PDF file, Word file

- Inspectors -
    ** SBD-4341 Inspection Report and Orders (Continued) (R5/04), PDF file, Word file
    ** SBD-10633-E MechRefrig Mechanical Refrigeration Regulated Object Inspection Report (R06/04) front, PDF file, Word file
    ** SBD-10633-E MechRefrig Mechanical Refrigeration Regulated Object Inspection Report (R06/04) back, PDF file, Word file

   Mine Safety/Blasting
** SBD-6772 Request for Storage of Explosives in a Community (R2/02), PDF file, Word file
** SBD-7336 Notice of Blasting in the Community (R8/99) PDF file, Word file
** SBD-6736 Notice to Begin Operation (Pit and Quarry) (R4/99), PDF file, Word file
 
One- and Two-Family Dwellings (UDC)
    Dwelling Contractor (PDF)  Application
    Dwelling Contractor -Restricted (PDF) Application
    Dwelling Contractor Qualifier (PDF)  Application 
    UDC Construction Inspector (PDF) Application
    UDC Electrical Inspector (PDF) Application
    UDC HVAC Inspector (PDF) Application
    UDC Inspection Agency (PDF) Application
    UDC Plumbing Inspector (PDF) Application
** SBD-5518 One- and Two-Family (UDC) Energy Worksheet (R10/01) PDF file, Word file
     Completed Example of One- and Two-Family (UDC) Energy Worksheet PDF file Word file
  ** SBD-5823 Wisconsin Uniform Building Permit Application (R01/08) Word file, PDF file
** SBD-5824 Wisconsin Uniform Building Permit Card (R1/08)  PDF file, Word file
** SBD-6025 Inspection Report and Notice of Non-Compliance (R6/05) PDF file, Word file
** SBD-6072 One- and Two-Family Dwelling Permit to Start Construction (R2/00) PDF file, Word 
** Materials for the Uniform Dwelling Code Program are ordered from state Document Sales
** Materials for the Manufactured Dwellings Program are ordered from state Document Sales, PDF order form
** SBD-10837 Erosion and Sediment Control Field Guide - 2006 (N02/06), PDF file
** Optional Makeup and Combustion Air Worksheet, PDF file
** DNR's Standard Erosion Control Plan Worksheets, DNR WT-458-96, PDF file

*** REScheck is a software application that can be downloaded from the federal Department of Energy. A Wisconsin version is an option within REScheck and is used for Wisconsin one- and two-family dwelling design. Link to federal site for software for downloading, http://www.energycodes.gov/

  Plumbing (List of plumbing Agent Municipalities)  
    Commercial Plumbing Inspector (PDF) Application
    Cross Connection Control Tester (PDF) Application 
    Journeyman Plumber (PDF) Application
    Journeyman Plumber Restricted Appliance (PDF) Application
    Journeyman Plumber Restricted Service (PDF) Application   
    Master Plumber (PDF) Application
    Master Plumber Restricted Appliance (PDF) Application
    Master Plumber Restricted Service (PDF) Application
    Pipelayer (PDF) Application
    Plumbing Apprentice (PDF) Application
    Plumbing Learner Restricted Appliance (PDF) Application
    Plumbing Learner Restricted Service (PDF) Application
    POWTS Inspector (PDF) Application
    POWTS Maintainer (PDF) Application 
    UDC Plumbing Inspector (PDF) Application
    Utility Contractor (PDF) Application
** SBD-6154 Plumbing Application for Review and Cross Connection Control Assembly Registration (R02/08) PDF file, Word file, AND information on submittal of alternate plumbing systems, PDF file and Word file.
** SBD-6479 Water Calculations Worksheet Pg. 1 (R8/02) PDF file, Word
** SBD-6479 Water Calculations Worksheet Pg. 2 (R11/98) PDF file, Word
** SBD-7966 Plumbing Standard and Product Review Application (R7/07), PDF file, Word file
** SBD-9927 Cross Connection Control Device Performance Test (R5/04) PDF file, Word file
** Order multi-ply paper copies of Cross Connection Test Reports from state Document Sales (800-362-7253 or 608-264-9419)
** Order Cross Connection Device Identification Tags from S&B's Christine Severson
** SBD-10717 Combination water calc worksheet for home plumbing system and 13D fire protection system (R8/02) PDF file, Word file
** SBD-10754 Double Check/DC Detector Performance Test (R11/07) PDF file, Word file
** SBD-10766 Cross Connection Control Assembly Removal Notice (N3/03), PDF file, Word file
** SBD-10793 Soil Evaluation - Storm (R2/05), PDF file
** SBD-10837 Erosion and Sediment Control Field Guide - 2006 (N02/06), PDF file

  Pools
If you would like to schedule a plan review appointment by e-mail, our scheduling address is: planschedule@commerce.state.wi.us.
** SBD-9720 Compliance Statement (01/02) PDF file, Word file
** SBD-9808 Public Swimming Pools Application for Review (R05/06) PDF file, Word file
** SBD 10606 Public Swimming Pools Compliance Statement (R03/03) PDF file, Word file
 
Private Onsite Wastewater Treatment Systems (POWTS)
    Journeyman Plumber (PDF) Application
    Journeyman Plumber Restricted Service (PDF) Application
    Master Plumber (PDF) Application
    Master Plumber Restricted Service (PDF) Application
    Pipelayer (PDF) Application
    Plumbing Apprentice (PDF) Application
    Plumbing Learner Restricted Service (PDF) Application
    POWTS Inspector (PDF) Application
    POWTS Maintainer (PDF) Application 
    Soil Tester (PDF) Application
** SBD-6153 Sanitary Permit Submittal Summary (R12/02) PDF file, Word file

** SBD-6232 Materials Order form has been discontinued.  All of the POWTS forms that had been ordered via SBD-6232, except the SBD-6499 - Sanitary Permit Card, can be downloaded free here on the Web and printed.  S&B will no longer provide printed copies of those downloadable forms.  SBD-6499 can be ordered from the Green Bay S&B office, 2331 San Luis Place, Green Bay, WI 54304.  920-492-5601.
** SBD-6398 Sanitary Permit Application (submit to county) (R1/07), PDF file, Word file;

Form-fillable versions of SBD-6398, PDF file, Word file  (Download the form-fillable versions to your computer and save them for repeated use.   S&B does not provide help with using the form-fill versions.)
** SBD-6412 Soil Saturation Determination Report (R6/01) PDF file Word file
** SBD-6710 POWTS Inspection Report (R3/01), PDF file, Word file
** SBD-7987 Soil Saturation Determination Report (Hydrograph Method) (R02/02), PDF file, XLS file
** SBD-8330 Soil Evaluation Form (R7/00), PDF file, or a form-fillable version of the form PDF file (instructions for form-fill).
** SBD-10577 POWTS Application for Review (R02/08) PDF file, Word file 
** SBD-10842 Application for Registration of Privies Serving State-Owned Facilities (R07/07), PDF file, Word file

  Private Sector Safety Support  (Wisconsin Private Sector Safety regulations are enforced by the federal Occupational Safety and Health Administration.)
** SBD-6894 Hazardous Chemicals in the Workplace? Poster (02/06), PDF format, HTML format
** SBD-9301 Public Employee Safety and Health Poster (02/06), PDF format, HTML format
** SBD-10710 Summary of Work-Related Injuries and Illnesses (R01/06), PDF file, Word file
** Order forms for Determination of Exposure to Blood/Body Fluids (WKC-8165) from state Document Sales (800-362-7253 or 608-264-9419)

  Public Sector Safety Support
** SBD-11 Wisconsin School District Record of Fire / Tornado / Other Evacuation Drills (R04/08), PDF file
** SBD-6894 Hazardous Chemicals in the Workplace? Poster (02/06), PDF format, HTML format
** SBD-9301 Public Employee Safety and Health Poster (02/06), PDF format, HTML format
** SBD-10710 Summary of Work-Related Injuries and Illnesses (R01/06), PDF file, Word file
** Order forms for Determination of Exposure to Blood/Body Fluids (WKC-8165) from state Document Sales (800-362-7253 or 608-264-9419)
 
Rental Weatherization
    Rental Weatherization Inspector (PDF) Application
    Information to satisfy provisions of the Rental Weatherization Program is described here.
** SBD-5524 Agreement for Designation as Department of Commerce Agent  R4/08 PDF file, Word file
** SBD-7114A Certificate of Compliance (R10/01), PDF file, Word file (The Word file is form-fillable, meaning you can save it to your computer system, fill it out electronically, then print or save.)
        Replacement of a Certificate of Compliance, PDF file
** SBD-9171 How to Satisfy the Provisions of a Stipulation (R6/05) PDF file
** SBD-9171W How to Satisfy the Provisions of a Waiver (R9/01) PDF file
** SBD-10647 Building Performance Worksheet (R6/08) PDF file, Word file
** SBD-7115 Stipulation - Rental Unit Energy Efficiency Standards (R04/08) PDF file, Word file
** SBD-7116 Waiver - Rental Unit Energy Efficiency Standards (R04/08) PDF file, Word file
** SBD-7313-E Weatherization Field Inspection Report (R4/08) PDF File, Word file (The Word file is form-fillable, meaning you can save it to your computer system, fill it out electronically, then print or save.)
** SBD-7314 Material Order Form for Weatherization Agents Only, PDF file
** Inspector materials for the Rental Weatherization Program are ordered from state Document Sales, PDF order form
** SBD-9890X Petition for Variance (R12/03) PDF file, Word file
** SBD-10708 Order Form for Satisfaction of Compliance for Stipulation or Waiver, or for Previous Certification (R04/08) PDF file, Word 97 file
** How to Transfer the Responsibility of a Stipulation During the First 12 months, PDF file, Word file

  Soil Erosion
    Soil Erosion Inspector (PDF) Application    
There are three ways to register or submit information to satisfy the "Notice of Intent" concerning soil and sediment control provisions of Comm 60, Commercial Building Code
1. The preferred, easiest and most efficient method - Use the S&B WebSite - More Information 
2.SBD-10376 Notice of Intent, Commercial Buildings Construction Site, Soil Erosion Control, In Lieu of Web Submittal (R05/2007) PDF file, Word file.  This form is the equivalent of the Web submittal, with a $100 additional fee for using the paper version.
3. SBD- 10857 (N05/2007) Notice of Intent, Plan Summary Review for Custom Erosion and Sediment Control Plans, PDF file, Word file.  This form is used when the project plans are custom-designed and do not use of the Web or paper RUSLE based calculations/ code appendices. 

**  The Erosion Control and Post Construction Stormwater Management checklist, a tool to help develop a code-compliant plan prior to submitting a Notice of Intent, PDF file

** SBD-10520 Notice of Termination of Coverage of Storm Water Discharges (R03/05) PDF file, Word file
** Change of Property Ownership, Commercial Buildings Construction Sites, Notice of Termination/Notice of Intent, SBD-10854 (N01/07) PDF file, Word file
** SBD-10837 Erosion and Sediment Control Field Guide - 2006 (N02/06), PDF file
** DNR's Standard Erosion Control Plan Worksheets, DNR WT-458-96, PDF file

Universal Soil Loss Equation for Construction Sites, Excel worksheet.  Download and save the worksheet to your computer and use it to estimate soil loss from sheet and rill erosion.  (It is not used for gully erosion.)  Variables are entered by the user or are automatically calculated.  There is a "Help Page" button leading to descriptions of the fields.  This new tool (June 2006) is still being perfected.  If you have questions, comments, or suggestions, you can direct them to S&B Soil Erosion Control Program Manager, Lynita Docken, 608-785-9349, Ldocken@commerce.state.wi.us

  Wisconsin Fund   See brochure explaining the Wisconsin Fund.
These forms (used only by government agencies) are separate pages in the two formats: PDF file, Word file
Eligible Applicant List, SBD-9166 (R.2/05);
Government Unit Application, SBD-9161 (R.2/05);
Grant Worksheet, SBD-9167 (R.2/05);
Payment Claim Worksheet, SBD-9165 (R.2/05);
Request for Payment, SBD-9164 (R.2/05)

  Some materials for the Rental Weatherization and Uniform Dwelling Code Programs in the Safety and Buildings Division are now being distributed by the state Document Sales agency.  S&B will continue to have free electronic copies of most of the items (UDC online forms) (RW online forms).  (The division does not mandate use of multi-ply forms.  Photo copies are acceptable.)
   Consolidating the distribution at Document Sales will maintain the timeliness and efficiency of the service for customers in the face of declining staff in S&B.
   For the UDC, Doc Sales will handle paper copies of building permit seals, application forms, display cards, inspection reports, energy worksheets, permits to start, violation cards, and several informational brochures.
   For RW, Doc Sales will handle compliance stamps and forms, inspection forms, and a brochure.
Explanations of how to order from Doc Sales are included with the UDC and RW material order forms, which are among the electronic forms on the S&B WebSite, http://commerce.wi.gov/SB/SB-DivForms.html.

County Web sites || City/Town/Village Web sites || State Portal || Licensing and Permitting || Build Your Business

Email this page's manager, Todd Taylor, ttaylor@commerce.state.wi.us or 608-267-3606

The Department of Commerce Safety and Buildings Division is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact us, 608-266-3151, TTY 608-264-8777, or ttaylor@commerce.state.wi.us