Application For Renewal Of The Inspector Of Structure Certificate - Department Of Business And Industry
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2STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
2501 East Sahara Avenue, Suite 102 * Las Vegas, NV 89104-4137 *(702) 486-4033
e-mail: realest@red.nv.gov
APPLICATION FOR RENEWAL OF THE
INSPECTOR OF STRUCTURE CERTIFICATE
RENEWAL FEE: $250.00
*LATE FEE: $125.00
♦ Renewal will be accepted by postmark up to midnight of the below expiration date. Licensees applying for renewal after
midnight of the below expiration date must remit renewal fee, late penalty reinstatement form 639 and fees.*
♦ Payment in the form of cash, check, or money order made payable to the Nevada Real Estate Division is accepted. Credit cards
are accepted for in person transactions.
♦ Copy of current insurance must be submitted.
APPLICANT NAME (Please print) _____________________________________________________________
CERT. NUMBER: IOS._____________________________ EXPIRATION DATE: ______/______/20______
The two year renewal of an Inspector of Structures certificate must include twenty (20) hours of
approved continuing education. Include 3 hours of safety, 2 hours of 645D Nevada law, 15 hours in
general inspector courses.
CURRENT RESIDENT ADDRESS,
(This will not update the business address on your certificate)
__________________________________________________________________________________________
No. Street & apt number
__________________________________________________________________________________________
City, State, Zip Code
___________________________
______________________________________________________
Telephone Number Area Code
Email Address (Real Estate Division use only)
REQUIRED: Please check one box:
YES NO
Have you been arrested, charged, or convicted of a misdemeanor, gross misdemeanor, or felony
within your renewal period?
If the answer is yes, you are required to attach a written explanation and appropriate court documents.
IMPORTANT FOR ALL LICENSEES
Pursuant to NAC 645D.195, the following statement MUST be answered and signed. Your application for the
issuance or renewal of this license will be denied if you do not indicate on the statements which of the provisions
apply to you.
I AM NOT SUBJECT to a court order for the support of a child.
I AM SUBJECT to a court order for the support of one or more children and I am IN COMPLIANCE with that
order or a plan approved by the District Attorney or other public agency enforcing the order for the repayment of the
amount owed in that order.
I AM SUBJECT to a order for the support of one or more children and I am NOT IN COMPLIANCE with that
order or a plan approved by the
I herby certify under penalty of perjury that the answers contained in this statement are true and correct. I understand
that if I am subject to a court order for support of one or more children and I am not in compliance with that order or
a plan, my application for a license, certification or renewal of a license or certification will be denied.
I further certify that I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to
the conduct of Inspector of Structures in the State of Nevada.
Signature of Applicant: ____________________________
Date: ______/_____/20______
07/03/14
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