ADOSH Request for Boiler Certificate Form

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.