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West Virginia Office of Miners' Health Safety and Training

Independent Contractor

Certificate of Approval Extension Application
Last revised:  04/23/14 01:44 PM


Please read carefully the instructions and if you have questions, contact one of our offices or use the contact link below to email your question.

Please keep in mind that NO EXTENSIONS for the new year will be ISSUED BEFORE January 1.


This year,  the Office of Miners' Health, Safety and Training is providing PDF forms for extensions - these are forms with fields that you can complete. You will need a current version of the Adobe Reader (see the link below) in order to complete the application. The Application and General Information forms have been combined into one PDF Document.

1. Click on the link for the Application and Extension Package (below).

2. Complete the form (all pages).  Your WV MHS&T Permit Number is critical for your application to be processed properly. Not sure of your permit number? View a status list of all current  permits here: WV Permits Listings
Verify your Permit Number before you enter data!

3. Once the form is complete you will need to print it out (you can save a copy to your hard drive if you want a digital copy). There is "print this form" button at the bottom of the last page.

4. The completed form must be signed and dated by a company official.  We must have a legal signature of a company official on the form.

5. The completed form may be mailed or faxed to our Charleston Office (304-558-6091).  The address and fax number is on the Application.  You have the option to email the completed PDF form if you have a digital signature, or you can scan the signed document and send it as an email attachment to the Email addresses below.

6. Your permit fee of $100 may be paid on-line Use this link to pay your Extension fee

7. Penalty Assessments may also be paid on-line Use this link to Pay Penalty Assessments

Download the current version of  Acrobat Reader  adobe button 

2014 Independent Contractor Certificate of Approval Extension Application Package (non fill-able form)

2014 Independent Contractor Certificate of Approval Extension Application  
(
fill-able form - although you can complete this form, it cannot be sent electronically.  It must be printed out.)

Contractors:     

Numerical, and A through J
304-957-2316 or email Tina.L.Estep-Bowles@wv.gov
304-558-6091 (fax)

K through Z
304-957-2313 or email Leona.J.Wehrle@wv.gov
304-558-6091

 

 

 


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