Certification Examination Application (Page 2 of 2) in pdf

STEP 5: Select the exam(s) you wish to take.

Starting Time 8:00 a.m.

Starting Time 10:30 a.m.

SELECT ONLY ONE

□ B1 Residential Building Inspector

$199

□ B2 Commercial Building Inspector

$199

□ R3 Residential Plans Examiner

$199

□ B3 Building Plans Examiner

$199

□ E1 Residential Electrical Inspector

$199

□ E2 Commercial Electrical Inspector

$199

□ M2 Commercial Mechanical Inspector

$199

□ E3 Electrical Plans Examiner

$199

□ M3 Mechanical Plans Examiner

$199

□ M1 Residential Mechanical Inspector

$199

□ P1 Residential Plumbing Inspector

$199

□ P2 Commercial Plumbing Inspector

$199

□ P3 Plumbing Plans Examiner

$199

□ FG Fuel Gas Inspector

$199

□ 66 Fire Inspector I

$205

□ 67 Fire Inspector II

$205

□ FE Cert Portable Fire Extinguisher Technician

$199

□ F3 Fire Plans Examiner

$199

□ RF Residential Fire Sprinkler Inspector

$199

□ FK Pre-engineered Kitchen Fire Extinguishing System Tech

$199

□ 79 Residential Energy Inspector/Plans Examiner

$199

□ FN Pre-engineered Industrial Fire Extinguishing System Tech

$199

□ 64 Property Maintenance and Housing Inspector

$199

□ 77 Commercial Energy Inspector

$199

□ C1 Coastal and Floodplain Construction Inspector

$199

□ 78 Commercial Energy Plans Examiner

$199

□ GC IgCC Inspector/Plans Examiner w/ASHRAE 189

$199

□ 14 Permit Technician

$199

□ CE Commercial Energy Inspector/Plans Examiner w/ASHRAE 90.1 $199

□ 75 Zoning Inspector

$199

□ CA Commercial Fire Alarm Inspector

$199

□ 21 Accessibility Inspector/Plans Examiner

$199

□ CN Commercial Fire Alarm Plans Examiner I

$199

□ CR Commercial Fire Alarm Plans Examiner II

$199

□ CS Code Specialist

$130

□ CF Commercial Fire Sprinkler Inspector

$199

□ MM Management Module

$130

□ CP Commercial Fire Sprinkler Plans Examiner

$199

□ FC Fire Codes and Standards

$130

□ MG Legal Module

$130

□ BC Building Codes and Standards

$130

□ G1 Green Building—Residential Examiner

$199

STEP 6: Enter your billing information.

Billing Information

Name: _____________________________________________________________________________________________________________

Mailing Address: _____________________________________________________________________________________________________

City: ____________________________________________________________________

State: _________ ZIP: _______________

(____) _____________________________

(____) ____________________________

Business Telephone Number

Fax Number

$_______________

Full payment must be submitted with all applications.

Total Amount::

Method of Payment Provided:

□ Check/Money Order

□ Visa □ MasterCard □ American Express □ Discover □ Bill to ICC account number:

(Payable to ICC)

Name as it appears on credit card: _________________________________________________________________________

Signature: ____________________________________________________________________________________________

Credit Card Number

Expiration Date:

Month

Year

STEP 7: Sign your application, attesting all information entered is true.

I have a copy of the current ICC National Certification Examination Information Bulletin. (If you do not have a copy of the Bulletin, go to

certification or call: 1-888-422-7233, ext. 5524.)

I hereby certify that I am the person indicated above, that all the information I have given herein is true and complete to the best of my knowledge, and that

any false statement will be cause for voiding this application and/or subsequent certification.

I acknowledge receipt of the Code Council Certification Code of Ethics (located in the Information Bulletin and at certification) and agree to

comply with these professional standards for the term of my active certification. I agree that failure to comply with these standards may be cause for sus-

pension or revocation of my certification.

I further certify that I understand the secure and confidential nature of the examination, and will not reveal the contents of the examination to anyone. I here-

by affirm that I will abide by the rules of the examination that are found in the Code Council National Examination Information Bulletin.

Signature: ____________________________________________________________________ Date: ______________________________________

Printed Name: _________________________________________________________________