Skip to main content

Industrial Commission of Arizona

0
  • Home
  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
    • Meetings
      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
Industrial Commission of Arizona Logo
Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

Follow Industrial Commission of Arizona on:

Main menu

  • Home
  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
    • Meetings
      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
  • Home
  • Request for Boiler Certificate Form

Request for Boiler Certificate Form

Instructions

An owner, user or licensed contractor must request a Certificate Inspection prior to installing or reinstalling a boiler or a fired pressure vessel in the State of Arizona in accordance with R20-5-408, R20-5-404B, and R20-5-419. This form may be used to make this request.

The following provisions must be met or the request will not be accepted:

  1. The boiler or fired pressure vessel must be constructed in a manner which meets the standards of the Arizona Administrative Code, Boiler Rules: R20-5-404 or R20-5-418 (R20-5-418 requires a variance request).
  2. The owner, user or licensed contractor shall have on-site the Manufacturer's Data Report for the boiler and/or fired pressure vessel, comply with the clearances requirements stipulated in A.A.C. R20-5-404B3.
  3. Clearance requirements for boiler sides not requiring access may be waived, but must meet manufacturer's documented minimum clearance/installation requirements.
  4. The installer holds a current contractor's license issued pursuant to Chapter 10, Title 32, ARS §32-1122, which authorizes the licensee to install boilers or fired pressure vessels.


This form must be completed in its entirety.  Failure to do so may cause a delay in processing. It can be submitted online or it can be submitted to ADOSH by mail, fax, or hand-delivery.

Printer-Friendly Form

PDF icon New Install Reinstall form (1).pdf

Related Forms

Report a Fatality or Severe Injury Form
Notice of Alleged Safety or Health Hazards Form
Discrimination / Whistleblower Complaint Form
Consultation Request Form
ADOSH Training Request Form
Application for Permit to Install or Alter Elevator Form
Elevator Inspection (PEI) New Application
Request for Boiler Repair Form
Request for Boiler Certificate Form
Boiler Inspector (PBI) Renewal Application
Compliance Assistance Request Form
VPP Pre-Screening Form
SHARP Application Form

Official Website of the State of Arizona

phoenix map

Contact Us:

Phoenix Office
800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

tucson map

Contact Us:

Tucson Office
2675 E. Broadway Blvd
Tucson AZ 85716
520-628-5188

 

 

Arizona State Seal

Footer Nav

  • Statewide Policies
  • Site Map
  • The Ombudsman-Citizens Aide helps citizens to resolve ongoing issues with State Agencies