"Inspection Request" - North Carolina

Inspection Request is a legal document that was released by the North Carolina Department of Labor - a government authority operating within North Carolina.

Form Details:

  • Released on January 1, 2020;
  • The latest edition currently provided by the North Carolina Department of Labor;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the North Carolina Department of Labor.

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Boiler Safety Bureau
1101 Mail Service Center
INSPECTION REQUEST
Raleigh, NC 27699-1101
Phone: 919 - 707 - 7918
Phone: 919-807-2760
Fax: 919-807-2762
N.C. Department of Labor
Boiler.safety@labor.nc.gov
o
o
o
NEW INSTALLATION
REINSPECTION
FOLLOW-UP
INSTALLER’S
DATE INSPECTION
NAME:
IS REQUIRED:
INSTALLER’S
INSTALLER’S
CONTACT NAME:
CONTACT PHONE:
OWNER’S NAME AND MAILING ADDRESS:
USER’S NAME AND PHYSICAL ADDRESS:
OWNER’S
USER’S
CONTACT NAME:
CONTACT NAME:
OWNER’S
USER’S
CONTACT PHONE:
CONTACT PHONE:
OWNER’S
USER’S
E-MAIL:
E-MAIL:
YEAR
MANUFACTURER
STAMP MAWP
USE
SIZE
SPECIFIC LOCATION IN FACILITY
o
o
o
o
o
INVOICE TO:
OWNER
USER
HAS A LOCAL PERMIT BEEN ISSUED?
YES
NO
NOT APPLICABLE
COMMENTS:
Note 1: This report must be submitted to the Boiler Safety Bureau no less than ten (10) days prior to operation.
Note 1: This report must be submitted to the Boiler Safety Bureau no less than ten (10) days prior to operation.
Note 2: Exemptions listed in G.S. 95-69.10(b) include, but are not limited to (1) private residences and apartments of less than 6 families and
(2) hot water supply boilers and potable water heaters not exceeding 200,000 BTUs input or 120 gallon storage capacity. Hydronic
Note 2: Exemptions listed in G.S. 95-69.10(b) include, but are not limited to (1) private residences and apartments of less than 6 families and
(2) hot water supply boilers and potable water heaters not exceeding 200,000 BTUs input or 120 gallon storage capacity. Hydronic
heating boilers are not excluded.
heating boilers are not excluded.
Note 3: Indicate object size by pounds steam/hr, Btu/hr, Kw/hr, boiler horse power, gallons storage capacity, cubic feet storage capacity,
Note 3: Indicate object size by pounds steam/hr, Btu/hr, Kw/hr, boiler horse power, gallons storage capacity, cubic feet storage capacity,
or diameter X length.
or diameter X length.
Note 4: If this object is used, do not use this form. Please submit a “Used boiler/pressure vessel installation request” from our “Forms” tab.
Reset Form
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1/20
IV.14.1932 6/16
Boiler Safety Bureau
1101 Mail Service Center
INSPECTION REQUEST
Raleigh, NC 27699-1101
Phone: 919 - 707 - 7918
Phone: 919-807-2760
Fax: 919-807-2762
N.C. Department of Labor
Boiler.safety@labor.nc.gov
o
o
o
NEW INSTALLATION
REINSPECTION
FOLLOW-UP
INSTALLER’S
DATE INSPECTION
NAME:
IS REQUIRED:
INSTALLER’S
INSTALLER’S
CONTACT NAME:
CONTACT PHONE:
OWNER’S NAME AND MAILING ADDRESS:
USER’S NAME AND PHYSICAL ADDRESS:
OWNER’S
USER’S
CONTACT NAME:
CONTACT NAME:
OWNER’S
USER’S
CONTACT PHONE:
CONTACT PHONE:
OWNER’S
USER’S
E-MAIL:
E-MAIL:
YEAR
MANUFACTURER
STAMP MAWP
USE
SIZE
SPECIFIC LOCATION IN FACILITY
o
o
o
o
o
INVOICE TO:
OWNER
USER
HAS A LOCAL PERMIT BEEN ISSUED?
YES
NO
NOT APPLICABLE
COMMENTS:
Note 1: This report must be submitted to the Boiler Safety Bureau no less than ten (10) days prior to operation.
Note 1: This report must be submitted to the Boiler Safety Bureau no less than ten (10) days prior to operation.
Note 2: Exemptions listed in G.S. 95-69.10(b) include, but are not limited to (1) private residences and apartments of less than 6 families and
(2) hot water supply boilers and potable water heaters not exceeding 200,000 BTUs input or 120 gallon storage capacity. Hydronic
Note 2: Exemptions listed in G.S. 95-69.10(b) include, but are not limited to (1) private residences and apartments of less than 6 families and
(2) hot water supply boilers and potable water heaters not exceeding 200,000 BTUs input or 120 gallon storage capacity. Hydronic
heating boilers are not excluded.
heating boilers are not excluded.
Note 3: Indicate object size by pounds steam/hr, Btu/hr, Kw/hr, boiler horse power, gallons storage capacity, cubic feet storage capacity,
Note 3: Indicate object size by pounds steam/hr, Btu/hr, Kw/hr, boiler horse power, gallons storage capacity, cubic feet storage capacity,
or diameter X length.
or diameter X length.
Note 4: If this object is used, do not use this form. Please submit a “Used boiler/pressure vessel installation request” from our “Forms” tab.
Reset Form
Submit
1/20
IV.14.1932 6/16