Form DIC4320 "Installation or Weld Repair Application" - Ohio

What Is Form DIC4320?

This is a legal form that was released by the Ohio Department of Commerce - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2022;
  • The latest edition provided by the Ohio Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DIC4320 by clicking the link below or browse more documents and templates provided by the Ohio Department of Commerce.

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Download Form DIC4320 "Installation or Weld Repair Application" - Ohio

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Installation or Weld Repair Application
Filing Fee: $100 Per Boiler
Checks Payable to: Treasurer, State of Ohio
Email completed form to:
com.boilers@com.ohio.gov
Payment Portal: icportal.com.ohio.gov
Choose one of the following:
Submission Date:
 A.) New Boiler Installation
 B.) Boiler Welded Repair
Estimated Completion Date:
Number of Boilers Being Installed
Boiler Being Repaired State ID#
CONTRACTOR INFORMATION:
C
Contractor Registration #
Contractor Certificate Expiration Date
Company Name
Address
Building/Apartment/Hall/etc.
City
State
Zip
Email
Phone
LOCATION OF BOILER INSTALLATION OR REPAIR:
Property Name
Building/Apartment/Hall/etc.
Exact Address
Contact Name
City
State
OHIO
Zip
Email
Phone
Current Boiler Inspecting Agency (Check One)
State of Ohio
Insurance (Company)
BOILER OWNER INFORMATION:
Name
Contact Name
Address
Building/Apartment/Hall/etc.
City
State
Zip
Email
Phone
NEW BOILER(S) INFORMATION:
Boiler Type
Manufacturer
National
Serial or Model #
Year
Leave Blank
Board #
Built
Contact Person (Print)
Email
Phone
Bureau of Operations & Maintenance – Boilers
Phone 614-644-2223
6606 Tussing Road Reynoldsburg, OH 43068-9009
Fax 614-644-2428
Form Number DIC 4320
TTY/TDD 800-750-0750
An Equal Opportunity Employer and Service Provider
com.ohio.gov
Date Updated: 4/2022
Installation or Weld Repair Application
Filing Fee: $100 Per Boiler
Checks Payable to: Treasurer, State of Ohio
Email completed form to:
com.boilers@com.ohio.gov
Payment Portal: icportal.com.ohio.gov
Choose one of the following:
Submission Date:
 A.) New Boiler Installation
 B.) Boiler Welded Repair
Estimated Completion Date:
Number of Boilers Being Installed
Boiler Being Repaired State ID#
CONTRACTOR INFORMATION:
C
Contractor Registration #
Contractor Certificate Expiration Date
Company Name
Address
Building/Apartment/Hall/etc.
City
State
Zip
Email
Phone
LOCATION OF BOILER INSTALLATION OR REPAIR:
Property Name
Building/Apartment/Hall/etc.
Exact Address
Contact Name
City
State
OHIO
Zip
Email
Phone
Current Boiler Inspecting Agency (Check One)
State of Ohio
Insurance (Company)
BOILER OWNER INFORMATION:
Name
Contact Name
Address
Building/Apartment/Hall/etc.
City
State
Zip
Email
Phone
NEW BOILER(S) INFORMATION:
Boiler Type
Manufacturer
National
Serial or Model #
Year
Leave Blank
Board #
Built
Contact Person (Print)
Email
Phone
Bureau of Operations & Maintenance – Boilers
Phone 614-644-2223
6606 Tussing Road Reynoldsburg, OH 43068-9009
Fax 614-644-2428
Form Number DIC 4320
TTY/TDD 800-750-0750
An Equal Opportunity Employer and Service Provider
com.ohio.gov
Date Updated: 4/2022