Tdlr Form 002Blr PDF Details

As many of you already know, the Tdlr Form 002Blr is an essential form for those who are creating a business in the state of Colorado. This document must be completed and submitted to your local government office before you can legally establish and operate a business. It’s important to familiarize yourself with this document as soon as possible so that you can understand any legal requirements related to making sure your venture remains compliant and meets all relevant regulations. In this blog post, we’ll be taking a deeper dive into understanding the purpose of Tdlr Form 002Blr, what it entails, how to complete it properly, and much more!

QuestionAnswer
Form NameTdlr Form 002Blr
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesblr002 tdlr boiler texas form

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TEXAS DEPARTMENT OF LICENSING AND REGULATION

Compliance Division - Boiler Program - 920 Colorado - Austin, TX 78701

P.O. Box 12157 • Austin, Texas 78711 • (800)722-7843(512)539-5707 • fax (512)539-5687

E-mail address: boilers@license.state.tx.us Web site: www.license.state.tx.us

APPLICATION FOR CERTIFICATE OF AUTHORIZATION TO

REPAIR, SET AND SEAL SAFETY APPLIANCES

Chief Inspector

Texas Department of Licensing and Regulation

P. O. Box 12157

Austin, Texas 78711

For Chief Inspector

Use Only

Approved _______

Not Approved ________

The owner/operator named below hereby attests that it can repair, set and seal safety and safety relief valves on boilers covered by the Texas Boiler Law and is prepared to demonstrate this activity within the following scope:

Location:

Shop

Field

Shop and Field

 

Special Processes:

Machining

Welding

NDE

Heat Treatment

ASME Code Section:

I

IV

VIII, Div. 1

 

Test Media:

Air

Gas

Steam

Liquid

 

 

 

 

 

and makes application for

initial issuance

renewal of the owner/operator Certificate of Authorization.

In consideration of receipt of the owner/operator Certificate of Authorization we hereby agree that the Certificate shall be used exclusively for valves on boilers encompassed by the Texas Boiler Law at the location(s) listed below. Further, it is agreed that the Chief Inspector or his designated representative may make audits or unannounced visits as necessary to assure compliance with the requirements of the Texas Boiler Law and associated rules.

OWNER/OPERATOR NAME

_________________________________________________________________________________________________________________________________________________________________

Company or corporate name, department, division, etc.

PHYSICAL LOCATION

MAILING ADDRESS

___________________________________________________________________________

___________________________________________________________________________

Street address or closest intersection

Address

___________________________________________________________________________

___________________________________________________________________________

City, State, Zip Code

City, State, Zip Code

LIST ON BACK OF THIS FORM ADDITIONAL LOCATIONS

FOR CERTIFICATE OF AUTHORIZATION TO BE ISSUED.

AUTHORIZED REPRESENTATIVE

___________________________________________________________________________

___________________________________________________________________________

Print or Type Name

Signature

___________________________________________________________________________

___________________________________________________________________________

Title

Date

_________________________________________________________________________________________________________________________________________________________________

Telephone number/fax/e-mail**

P.O. BOX 12157 AUSTIN, TEXAS 78711 ( 512) 539 - 5707 ( 800) 722 - 7843 FAX ( 512) 539 - 5687

EMAIL ADDRESS: BOILERS@LICENSE.STATE.TX.US I NTERNET ADDRESS: W W W .LICENSE.STATE.TX.US

**The Department will add your email address to the Boiler Program email notification list, which automatically provides information from the Department on matters affecting the Boiler Program. Your email address is confidential pursuant to the Texas Public Information Act and the Department will not share it with the public. See additional information at the following link http://www.license.state.tx.us/newsletters/TDLRnotificationLists.asp

TDLR FORM 002BLR 7/08

ADDITIONAL LOCATIONS FOR CERTIFICATE OF AUTHORIZATION TO BE ISSUED

(1)________________________________________

(10)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(2)________________________________________

(11)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(3)________________________________________

(12)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(4)________________________________________

(13)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(5)________________________________________

(14)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(6)________________________________________

(15)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(7)________________________________________

(16)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(8)________________________________________

(17)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code

(9)________________________________________

(18)_______________________________________

Street address or closest intersection

Street address or closest intersection

__________________________________________

__________________________________________

City, State, Zip Code

City, State, Zip Code