Read FS 09132 Appl for Registration as a Contractor 07.10.pmd text version

Technical Standards and Safety Authority

14th Floor - Centre Tower 3300 Bloor Street West Toronto, Ontario M8X 2X4 Fax: 416.231.4903 Customer Service: 1.877.682.8772

Application for Registration in Ontario as a Contractor

Technical Standards and Safety Act

For Office Use Only

www.tssa.org

Clear Form

Fee (non-refundable): $452.41 (13% HST included) For each type of registration * HST Registration No.: 891131369 Please make cheque or money order payable to the Technical Standards and Safety Authority. Mail this form and your payment to the above address.

Name of Company

Print Form

$

Registration No.

Ontario Corp. No., if applicable E-mail

Name of Person

Complete Mailing Address

Street No. Street Name Suite No.

Town/City

Province

Postal Code

Telephone No.

If you are a fuels certificate holder, provide the Certificate No.

If your business location address is different from your mailing address, please complete this section

Street No. Street Name Suite No.

Town/City

Province

Postal Code

Telephone No.

1. Type(s) of work - Check appropriate box(es) a) Heating Fuels Contractor Fuel oil (O. Reg. #213/01) Gaseous Fuels (O. Reg. #212/01) Liquid Propane (O. Reg. #211/01) b) c) Petroleum Contractor (O. Reg. #217/01) Compressed Gas Contractor (O. Reg. #214/01) 3. 1. 2.

* Note

It is mandatory to apply for separate registrations, according to the applicant's type of work, classified as a), b), or c). This fee includes pro-rated portion of inspection fee to cover a periodic inspection completed once over a three-year cycle. An inspection has to be performed to complete the registration process. For further information, please see our Website at: http://www.tssa.org/fuels/faq_compliance_audit.asp

You are required by law to notify TSSA of any change of information. The information is collected under the authority of Ontario's Technical Standards and Safety Act. I have read the Act under which I am applying for registration and understand my duties and obligations, as they apply to me and my employees. I certify that the information I have provided in this application is true. Please Print

Name of Owner/Operator Signature

FS 09132 (08/10)

Month

Day

Year

Please Print & Sign before returning to TSSA

Information

FS 09132 Appl for Registration as a Contractor 07.10.pmd

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FS 09132 Appl for Registration as a Contractor 07.10.pmd