Safety and Buildings Division Forms

  * 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 Program Forms
** SBD-211 Amusement Ride / Ropeways Injury Report (R11/08), PDF file, Word file
** SBD-5292 Amusement Ride Registration (R12/08), PDF file, Word file
** SBD-7620 Amusement Ride Route Schedule (R11/08), PDF file, Word file
** SBD-7620a Amusement Ride Listing (R11/08), PDF file
** SBD-10818 Amusement Ride Application for Plan Review (R12/08) PDF file, Word file
** SBD-10867 Affidavit of Compliance (R11/08) PDF file, Word file

Blasting Program Forms
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 Program Forms
  - Inspection -
Boiler/Pressure Vessel Inspector (PDF) Application
** SBD-37 Application for the National Board Boiler Inspector Commission/Endorsement Examination (R08/08), 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
** Hydronic Heating Boiler Checklist (R07/08), PDF file, Word file
** Steam Heating Boiler Checklist (R07/08), PDF file, Word file
** Unfired Pressure Vessel Checklist (R07/08), PDF file, Word file
** ASME-Sect. 1 Power Checklist (R07/08), PDF file, Word file
** Power Piping Checklist ASME B31.1 (R07/08), PDF file, Word file

-   Owner/Contractor -
** SBD-5204 Power Piping/Welded Refrigeration Piping Installation Registration (R08/08) PDF file, Word file (To purchase printed forms, contact state Document Sales. See Web catalogue; choose "Department of Commerce" link on second page Table of Contents.)
** SBD-6314 Boiler and Unfired Pressure Vessel Registration (R07/08) PDF file, Word file (To purchase printed forms, contact state Document Sales. See Web catalogue; choose "Department of Commerce" link on second page Table of Contents.)
** SBD-10787 Boiler and Pressure Vessel Accident Report (R9/07), PDF file, Word file
** National Board Initial Boiler Certification Report Form C-1, NB405, Rev 0, PDF file
** Safety Valve Test Log, PDF file, Word file

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

  ** 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, interior and exterior lighting requirements ONLY (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 "2006 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 Program Forms
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 (R7/09), PDF file,
Instructions for SBD-10822, PDF file, (Sample completed [farm] project description, PDF file.)

  Elevators / Conveyance Systems Program Forms
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

-- Here is a document which explains the use of various S&B elevator forms - PDF file

** SBD-2E Safety and Governor Test (R09/09) PDF file, Word file
** SBD-3E Periodic Hydraulic Elevator Test (R07/09) PDF file, Word file
** SBD-Cat5E Conveyance Category 5 Periodic Tests (R09/09) PDF file Word file
** SBD-6E Periodic Escalator Test (R03/09), PDF file, Word file

** SBD-22 Elevator Application for Review (R11/08) PDF file, Word file ("form-fillable")
** Instructions for Elevator Application for Review, PDF file, Word file

** SBD-10663 Elevator Regulated Object Inspection Report (R8/06) (Front - PDF file, Word file) (Back - PDF file, Word file)

** SBD-10782 Elevator / Escalator Accident Report (R10/08), PDF file, Word file ("*form-fillable")
** Elevator Inspection Checklist, (R7/05), PDF file, Word file

Fire Prevention Program Forms
** SBD-11 Wisconsin School District Record of Fire / Tornado / Other Evacuation Drills (R11/08), PDF file
** SBD-8009 Fire Prevention Program Supplies Form (R11/09) 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 System Program Forms (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 (R3/09), 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

  Fire Safe Cigarettes
** SBD-10887 Fire Safety Performance Manufacturer Certification (R03/09), PDF file

  Gas System Program Forms
** SBD-4341 Inspection Report and Orders (Continued) (R5/04), PDF file, Word file
** SBD-6038 Gas Systems Installation Application (LPG, LNG, CNG, NH3, H2) (R10/08), PDF file, Word file.

** SBD-10633-E AmmStor Gas Systems Regulated Object Inspection Report (R06/04) (Front - PDF file, Word file) (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 Program Forms
** SBD-10687 Manufactured Home Title Application and Instructions (R10/09), PDF File, Word File
** SBD-10688 Indemnity Statement (R10/09) PDF File, Word File
** SBD-10693 Statement of Transfer of Manufactured Homes to an Heir or Surviving Spouse (R10/09), PDF File, Word File
** SBD-10696 Statement of Manufactured Home Transfer (R08/09), 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 (R10/09), PDF File, Word File
** SBD-10702 Landlord Lien (R1/09), 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
** SBD-10883 Permission to Pick Up Title (N11/08), PDF file
** SBD-10885 Acknowledgement of Manufactured Home Title Surrender (N01/09) PDF file

Manufactured Home Communities, Dealers, Sellers Program Forms
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 (R11/08), PDF file, Word file
** SBD-10675 Manufactured Home Community License Application (R03/09), 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 (R3/09), 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 Program Forms
Refrigerant Handling Technician (PDF) Application

- Owners/Contractors -
** SBD-34-E Mechanical Refrigeration Installation Registration (R12/06) PDF file, Word file (To purchase printed forms, contact state Document Sales. See Web catalogue; choose "Department of Commerce" link on second page Table of Contents.)
** SBD-5204 Power Piping/Welded Refrigeration Piping Installation Registration (R08/08) PDF file, Word file (To purchase printed forms, contact state Document Sales. See Web catalogue; choose "Department of Commerce" link on second page Table of Contents.)
** SBD-10788 Mechanical Refrigeration Accident Report (R9/07), PDF file, Word file

- Inspectors -
  ** SBD-4341 Inspection Report and Orders (Continued) (R8/06), 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
** Refrigeration Checklist (R7/08), PDF file, Word file
** Refrigeration Piping Checklist ASME B31.5, PDF file, Word file

  Mine Safety/Blasting Program Forms
** 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) Program Forms
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-5823 Wisconsin Uniform Building Permit Application (R10/08) 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
** SBD-8028 Wisconsin Buildings Product Review Application (R2/08) PDF file, Word file
** UDC materials order form for state Document, PDF file
** Manufactured Dwellings Program materials 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. Use this link to read some important points about REScheck 4.2.2 before going to federal site for software downloading: http://www.energycodes.gov/

  Plumbing Program Forms (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

Information on submittal of alternate plumbing systems, PDF file and Word file

** SBD-6479 Water Calculations Worksheet (R04/09)
PDF file, Excel Worksheet, Instructions PDF file

** SBD-9927 Cross Connection Control Device Performance Test (R3/09) 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)

** Affadavit of Plumbing Testing, SBD-10605 (R3/09) PDF file, Word file
** Order Cross Connection Device Identification Tags, SBD-10771, 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
** SBD-10881 Air Admittance Valve Test Report (N09/08), PDF file, Word file

  Pool Program Forms
If you would like to schedule a plan review appointment by e-mail, our scheduling address is: planschedule@commerce.state.wi.us.

  Private Onsite Wastewater Treatment Systems Program Forms (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 (R10/08) PDF file, Word file

Sanitary Permit Card SBD-6499 can be ordered from the S&B Green Bay office.

** SBD-6398 Sanitary Permit Application (submit to county) (R2/09), PDF file, Word file;
** 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-10842 Application for Registration of Privies Serving State-Owned Facilities (R10/08), PDF file, Word file

Public Sector Safety Support Program Forms
** SBD-6894 Hazardous Chemicals in the Workplace? Poster (02/06), PDF file
** SBD-9301  Public Sector Employee Safety and Health Poster (02/06), PDF file
** SBD-10710 Summary of Work-Related Injuries and Illnesses (R09/08), 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 Program Forms
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 (R11/08), PDF file, Word file (*"form-fillable")
** Replacement of a Certificate of Compliance, PDF file
** SBD-7115 Stipulation - Rental Unit Energy Efficiency Standards (R11/08) PDF file, Word file
** SBD-7116 Waiver - Rental Unit Energy Efficiency Standards (R11/08) PDF file, Word file
** Procedures for filling out stipulation and waiver forms (R11/08) PDF file
** SBD-7313-E Weatherization Field Inspection Report (R11/08) PDF File, Word file (*"form-fillable")
** Material order form for Inspectors, PDF file
** SBD-9171 How to Satisfy the Provisions of a Stipulation (R10/08) PDF file
** SBD-9171W How to Satisfy the Provisions of a Waiver (R11/08) PDF file
** SBD-9171T How to Transfer the Responsibility of a Stipulation During the First 12 Months or a Waiver During the First 24 Months (R11/08) PDF file
** SBD-9890X Petition for Variance (R12/03) PDF file, Word file
** SBD-10647 Building Performance Worksheet (R9/08) PDF file, Word file
** SBD-10708 Order Form for Satisfaction of Compliance for Stipulation or Waiver, or for Previous Certification (R12/08) PDF file, Word file

Soil Erosion Program Forms
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 (R12/08) PDF file, Word file (Form only to be used when online NOI registration is not functioning.)

** 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
** SBD-10854 Notice of Termination / Notice of Intent, Change of Property Ownership, Commercial Buildings Construction Sites 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 Program Forms 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 (R10/08);
Payment Claim Worksheet, SBD-9165 (R.2/05);
Request for Payment, SBD-9164 (R.2/05)

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, TDD Relay dial 711 in Wisconsin or 800-947-3529, or ttaylor@commerce.state.wi.us