Ensuring the quality and safety of water systems, backflow assembly testers play a crucial role in maintaining public health. To operate in this capacity, testers must navigate the initial registration and subsequent renewal processes as outlined in the Backflow Tester Registration form. This document stipulates that new applicants provide a duly completed original form, their current Backflow Tester's pocket license, an approved photo ID, and the registration fee of $120.00, payable to the "City of Dallas," in person at the designated office. Renewals can be processed both in-person and online, but still require the same comprehensive documentation and fee, with the additional step of notarization for those submitting remotely. It's crucial to note that the Backflow Tester Certificates of Registration are tied to the expiration of the State License, necessitating annual renewal to maintain validity. This registration not only legitimizes the tester's capacity to work within Dallas but also emphasizes the importance of accurate, up-to-date information for both the initial application and any subsequent amendments, underlining the tester's sole authority to sign permits or validations for backflow testing. The structured outline and requirements aim to ensure a straightforward process, yet underscore the fundamental responsibility held by backflow testers in safeguarding water quality standards.
| Question | Answer |
|---|---|
| Form Name | Backflow Tester Registration Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dallas backflow registration, city of dallas backflow contractor, backflow license dallas, coppell tx backflow tester registration |
BACKFLOW ASSEMBLY TESTER
REGISTRATION
NEW RENEWAL
Contractor #
MUST BE COMPLETELY FILLED OUT IN ORDER TO BE ACCEPTED FOR REGISTRATION
ORIGINAL REGISTRATION: The licensed Tester must personally appear at 320 E. Jefferson Room 105 and furnish (1) This original form completed, (2) Their Current Backflow Tester’s pocket license, (3) An approved photo identification, (4) Payment of $120.00. Please make checks payable to “City of Dallas”.
RENEWAL REGISTRATIONS: May be processed in person at any Building Inspections office or
(1)All documents listed above are required for each registration renewal, (2) If not registering in person, this document must be notarized, (3) Payment of $120.00. Please make checks payable to “City of Dallas”.
Please note: Backflow Tester Certificates of Registration provided for in the code, expire annually upon the expiration date of the State License. Pursuant to the City Code, application is hereby made for registration as a Backflow Tester Contractor.
All Information Must Be Complete (Please Do Not Use Same)
Backflow Tester Information
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Expiration Date:_____ /__ _ /______ |
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If company is located within the city limits of Dallas, please provide the certificate of occupancy number:
C.O. #
The Licensed Backflow Tester is the only person authorized to sign permits or validations to perform backflow test.
Name |
PIN # (LIMIT TO 4 DIGITS OR LESS) |
(TESTER)
I DO DEPOSE AND SAY THE ABOVE INFORMATION IS TRUE AND CORRECT.
SIGNED X
Signature of Responsible License Holder
Registration Clerk/Notary Public: |
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(Must Be Signed by Registration Clerk or Notarized) |
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Any changes or corrections to this information must be submitted on this
same form and marked as amended. A $30.00 record change fee shall apply.
Revised: 09/30/2015