Form Cc0195 - Residential Building Contractor Residential Remodeler Contractor Business License Renewal -Minnesota Department Of Labor And Industry
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1Minnesota Department of Labor and Industry
Construction Codes and Licensing Division
Licensing and Certification Services - Residential
443 Lafayette Road North
St. Paul, MN 55155
Mailing Address:
Residential Building Contractor
PO Box 64217
Residential Remodeler Contractor
St. Paul, MN 55164-0217
BUSINESS LICENSE RENEWAL
E-Mail:
dli.license@state.mn.us
Web Site:
License Fee is Non-Refundable
Directions:
Cash Is NOT accepted by Mail or Walk-In
Phone:
(651) 284-5034
If Gross Annual Receipts are less than $1 million
$565.00*
SPACE IN BOX FOR OFFICE USE ONLY
If Gross Annual Receipts are $1 million to $5 million
$665.00*
Account Numbers
STK
If Gross Annual Receipts are greater than $5 million
$765.00*
License 632422
B42RCLIC
Recovery 632425
B42RCRECV
*A $80.00 late fee is due if the renewal is received by DLI after the
PCK
CCK
MO
DLI Deposit Date
expiration date per Minn. Stat. § 326B.092; subd. 3
NOTICE: Pursuant to Minnesota
Statute § 604.113, checks returned for
DID YOUR LEGAL BUSINESS STRUCTURE CHANGE?
nonpayment will be charged a $30
If YES, you must submit a new license application
service charge and may subject the
issuer to additional civil penalties.
Avoid Processing delays by submitting your application online at
Application Number
Bus License Number:
https://secure.doli.state.mn.us/license/intro.aspx
FEDERAL TAX ID NUMBER (FEIN) (Tax # call: 1-800-829-4933)
MINNESOTA TAX ID NUMBER (Tax # call: 651-282-5225)
BUS LICENSE NUMBER
If the applicant is an individual proprietor (sole proprietor) or a one-member
SOCIAL SECURITY NUMBER
limited liability company they must provide a Social Security Number.
LEGAL BUSINESS NAME OF CONTRACTOR (CORP, LLC, LLP)
FULL LEGAL NAME OF INDIVIDUAL PROPRIETOR (IP) OR PARTNERS (PT)
DBA NAME (Doing business as name / assumed name – if applicable)
DBA NAME (Doing business as name / assumed name – Required)
PHYSICAL BUSINESS STREET ADDRESS (PO Box is not acceptable)
CITY
STATE
ZIP CODE
BUSINESS MAILING ADDRESS (PO Box is acceptable - if applicable)
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER (public)
OTHER TELEPHONE NUMBER
E-MAIL ADDRESS
QUALIFYING PERSON REG NO
LEGAL LAST NAME (including suffix)
FIRST NAME
MI
THIS RENEWAL FORM MUST BE SUBMITTED ALONG WITH ALL OF THE FOLLOWING REQUIRED DOCUMENTS
LICENSE FEE – $565.00 if gross annual receipts are less than $1 million; $665.00 if gross annual receipts are $1 million to $5 million; or $765.00 if gross
annual receipts are greater than $5 million. A $80.00 late fee is due if the renewal is received by DLI after the expiration date.
MN Secretary of State (SOS) Business Registration Verification – Include a computer screen print of the ACTIVE SOS Business Record Detail
screen with your license renewal forms. Except for individuals and partnerships doing business under their own true full legal first and last name(s), all
businesses and assumed names (DBA) must be registered with the Office of the Secretary of State. Please visit MN SOS
to verify registration or call 651-296-2803 or 1-877-551-6767 for questions about your SOS business registration renewal or filing status
Disclosure of Business Owners, Partners, Officers and Members Form - All owners, partners, shareholders, and members owning more than 10
percent in the business must be disclosed. Key officers responsible for the day-to-day operations of the business entity being licensed, certified, or
registered must be disclosed. A missing or incomplete disclosure will cause the application to be deficient and delay processing.
Certificate of Insurance (Liability) – The Certificate of Insurance MUST BE COMPLETED BY THE INSURANCE AGENT and SUBMITTED WITH THIS
RENEWAL. The ACORD 25 (2010/05) certificate of insurance is acceptable otherwise your insurance agent may complete the DLI Certificate of Insurance
available at
Workers’ Compensation Certificate of Compliance – The Certificate of Compliance with Minnesota Workers’ Compensation Laws MUST BE
COMPLETED AND SUBMITTED WITH THIS RENEWAL. Pursuant to Minn. Stat. § 176.215, Subd. 1, you may be required to have workers’ compensation
insurance coverage. Questions about who is required to have workers’ compensation insurance coverage may be answered at 651-284-5032. This form
can be found at
Qualifying Person Designation Form – The Qualifying Person Designation Form MUST BE COMPLETED AND SUBMITTED with this renewal form..
Qualifying person registration information can be found by searching by an individual’s first and last name at the DLI License Lookup feature:
https://secure.doli.state.mn.us/lookup/licensing.aspx
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