Boiler License Application 200130
State of New Hampshire
Department of Labor
PO Box 2076
Concord, NH 03302-2076
http://www.nh.gov/labor
Phone: 603-271-2585 Email: B.E.Inspection@dol.nh.gov Fax: 603-271-2668
Boiler Inspector License Application
Check one
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□ Initial Application □ Annual Renewal □ Reinstatement □ Change of Address
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Last Name First Name Middle Initial
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Home Mailing Address City State Zip Code
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Email Address Cell Phone Number Home Phone Number
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Business Name (Company you work for) Federal ID Number
___________________ _______________________A□ IS□ _________________________
NH Inspector Number National Board Commission Number
National Board License
Expiration Date
Select additional National Board endorsements, if appropriate:
“R”□ “B”□ “N”□ “I”□ “NS”□ “C”□ “NSC”□ “NSI”□ “O”□
Renewal Fee: $20.00 New Application Fee: $30.00 Reinstatement Fee: $30.00
All applications must be accompanied by a copy of the National Board Credential.
Please make check payable to, “Treasurer, State of New Hampshire”. Application fees are not refundable.
Submit completed application along with payment to:
Department of Labor
Inspection Division
PO Box 2076
Concord NH 03302-2076
___________________________________________________ _____/_____/_____
Signature Date
