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Application Fee: $80 (license period: expires 1 year from date of approval)
Please do not fill out and submit this form unless you are a mechanical contractor and are certain it is required or you have been asked by city staff. If you are unsure, please call 651-638-2043.
Note: The license shall not be valid until a Certificate of Insurance (COI) is furnished showing workers' compensation coverage (workers compensation insurance requirements may be waived if the applicant is self-employed) and liability coverage in the amount of $300,000 per person, $300,000 per occurrence, $500,000 per accident and $100,000 per property damage.
Please submit current certificate/coverage using the file upload on this form.
Must be a physical address: no P.O. boxes.
(Not the insurance agent)
Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business or engage in any activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Minnesota Statues, Chapter 176. If the required information is not provided or is falsely stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry. A valid workers' compensation policy (if applicable) must be kept in effect at all times by employers as required by law.
(Not the name of the insurance agent)
I certify that the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify that I am authorized to sign on behalf of the business.
Minnesota Department of Labor and IndustryP.O. Box 64228St. Paul, MN 55164Department of Labor and Industry website
Licensing and Certification ServicesEmail Licensing and Certification ServicesPhone: 651-284-5034Fax: 651-284-5743
Some or all of the information that you are asked to provide on this form is classified by state law as either private or confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data. Confidential data is information that generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to comply with MN Statute § 270c.72, which requires the city to provide the MN Department of Revenue with federal tax identification numbers, state tax identification numbers and social security numbers for all professions, occupations, trades and businesses licensed by the city or whose license is registered with the city. You are legally required to provide this information. If you refuse to supply the information, your license application may be delayed or denied. Persons or entities authorized by law to receive this information include city staff members whose job requires them to access in order to process your application, law enforcement officers who are implementing the New Brighton Crime-Free Housing Program and other initiatives as well as the MN Department of Revenue.
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