AB-29 (Side A) 2009-01

APPLICATION FOR CERTIFICATE OF AUTHORIZATION PERMIT

Pursuant to Pressure Equipment Safety Regulation AR49/2006, Section 12

Company Name: Mailing Address: Telephone No.: ( E-Mail: Site/Shop Address: Same as Mailing ; or , ) Fax No.: ( )

(For ABSA USE ONLY)

DATE RECEIVED STAMP

Please use separate sheet of paper for additional location(s) or address(s).

Person Responsible for the administration of the Quality Management System: Name & Title: New ; Renewal Tel. No.: ( ; Revision - Scope Change
)

E-Mail: ; Location Change ; Ownership Change

I (we) wish to register for the following programs (check as applicable): ; Name Change

CHECK (X) APPROPRIATE SPACES TO FULLY DESCRIBE THE SCOPE OF YOUR APPLICATION

SCOPE AUTHORIZED (Certification by ABSA Auditor)

PROGRAM DESCRIPTION 1 PRESSURE VESSELS: ASME Section VIII-I ASME Section VIII-2 ASME Section VIII-3 Miniature Vessels in accordance with CSA B51 2 BOILERS: ASME Section I Assemble ASME Section I Boilers ASME I Engineering Contractor Certification ASME Section IV 3 DIRECT FIRED HEATERS: ASME I Fired Heaters API 530 & ASME B31.3 Fired Heaters Engineering Contractor Certification Assemble Direct Fired Heaters 4 INDIRECT FIRED HEATER COILS 5 PRESSURE PIPING: ASME B31.1 Power Piping ASME B31.1 Boiler External Piping ASME B31.3 Process Piping ASME B31.5 Refrigeration Piping ASME B31.9 Building Services Piping 6 FITTINGS: A , B , C , D , E , F , H

New Const. Shop Field

Repair/Alter. Shop Field

New Const. Shop Field

Repair/Alter. Shop Field

Covered under ASME Sec. VIII-1

7 SERVICING AND SETTING OF PRVs: Please complete back side 8 PQ TESTING OF WELDERS: Please complete back side Welders ; Machine Welding Operators Shop Field Shop Field

9 OWNER/USER PROGRAM: 11 OTHER: Specify

Please submit Form AB-512A Please submit Form AB-515A

10 INSPECTION COMPANIES CERTIFICATION

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AB-29 (Side B)

Authorization currently held: (1) AQP-

Expiry Date:

(2) AQP-

Expiry Date:

AOQP-

Expiry Date: ; External clients ; H

ASVS; U ; U2 ; U3

Expiry Date: ; UM ; PP ; A

Is the certification for: Own use

ASME Code symbol stamps held or applied for: S Other certificates held: R ; VR ; API ; ISO

; Other:

Complete if Performing Qualification Testing of Welders, Machine Welding Operators:

Scope of testing: For employees of your organization; For employees of another organization Person Responsible for the Performance Qualification Testing Program: Name & Title: Telephone No.: ( ) Fax No.: ( ) E-Mail:

ABSA Welding Examiner Certificate No.: Expiry Date: Attach resume of the qualifications of the person indicated above and all other persons who will conduct performance qualification tests.

Complete if Servicing and Setting Pressure Relief Valves

MEDIUM AIR LIQUID STEAM Set Valves from NPS of kPa. to NPS in-situ using the system fluid to a maximum pressure SCOPE OF SERVICE APPLIED From NPS To NPS SCOPE AUTHORIZED (ABSA use only) From NPS To NPS

By signing my name, I declare that the information provided on this application is true and correct and I confirm that I am aware of ABSA's fees as outlined in the attached schedule "3 YEAR CERTIFICATION PROCESS AND FEES". Applicant: Name of Company Officer
(Please Print)

Title:

Signature of Company Officer:

(This application will expire one year from the date of submission.)

Date:

Application Fee $1,045 is included. The application fee is non-refundable and is required for first time applicants and for renewal applications. If this is an application for renewal you may provide us a purchase order and we will invoice you for the fee. Payment made by: P.O. # Visa ; MasterCard No. FOR ABSA USE ONLY The Quality Management System for which (Company Name) seeks registration has been reviewed by ABSA Safety Codes Officer and the following recommendation is made: Certificate to be issued not to be issued (refer to attached report) Expiry Date: New Expiry Date: OR provided Credit Card Information below OR Debit Cheque

(Signature of ABSA Safety Codes Officer)

(Date)

Registration No.: AQP-

AOQP-

ASVS-

The information you provide is necessary only for the administration of the programs as required by the Alberta Safety Codes Act and Regulations in the Boiler Discipline.

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AB-29 Attachment

3 YEAR CERTIFICATION PROCESS AND FEES

the pressure equipment safety authority

All Certificate of Authorization Permit renewals require submission of a new application for recertification approximately 6 months before expiry. The certification is renewed upon successful demonstration of the implementation of the quality program. Fees for Initial Certification, Interim Audits and Renewal of Certification are payable pursuant to the 'Fee Schedule for Delegated Functions' (Effective January 1, 2009) and the Boilers Delegated Administration Regulation (Alta. Reg. 32/2002). Cheques are payable to ABSA . Mailing Address: ABSA Quality Systems Certification Program 9410 20 Avenue Edmonton, Alberta T6N 0A4 Edmonton (780) 437 9100 Calgary (403) 291-7070 Red Deer (403) 341-6677 Grande Prairie (780) 538-9922 Lethbridge (403) 394-1011 Medicine Hat (403) 529-3514 Fort McMurray (780) 714-3067 Fees

Certification Process 1 NEW PROGRAM CERTIFICATION: First meeting between ABSA QSCP Representative and the applicant to discuss ABSA requirements for registration of a new QMS, Safety Codes Act & Regulations and applicable Codes and Standards is held at no charge. If the applicant decides to initiate the certification process, he/she is required to: (i) Submit the Application Form (Form AB-29). (ii) Non-refundable Application fee. QMS review: - QMS Manual Review: A review of the manual will by conducted by an ABSA auditor. QMS Implementation Review: An ABSA auditor will witness the implementation of the QMS to evaluate conformance and will prepare an audit report.

No charge

$1,045.00

Min. 4 hours @ $136.00/hr. Additional hours @ $136.00/hr.

Travel

Time $136.00/hr. & expenses per ABSA policy. Km @ current ABSA charge. $136.00/hr.

Documentation review: Documentation review of the outstanding items (if any). Certificate of Authorization Permit: Upon successful review of the implementation of the program, a Certificate of Authorization Permit will be issued. 2 PERIODIC AUDIT: Audit of the System ABSA may schedule Periodic Audit(s) to verify continued compliance to the QMS. Audits may be conducted once or twice within the tenure (normally 3 years) of the certification or as deemed necessary to confirm compliance. The ABSA auditor will witness the implementation of the QMS to evaluate conformance and will prepare an audit report.

$136.00/Program

Min. 4 hours @ $136.00/hr. + expenses. Additional hours @ $136.00/hr.

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AB-29 Attachment

Certification Process
Travel:

Fees
Time $136.00/hr. & expenses per ABSA policy. Km @ current ABSA charge.

RENEWAL OF THE CERTIFICATE

Application Form: Submit an Application Form (AB 29) and non-refundable Application Fee to initiate the certification renewal process. QMS review: - QMS Manual Review: A review of the manual will by conducted by an ABSA auditor. QMS Implementation Review: An ABSA auditor will witness the implementation of the QMS to evaluate conformance and will prepare an audit report. $1,045.00

Min. 4 hours @ $136.00/hr. + expenses. Additional hours @ $136.00/hr. Time $136.00/hr. & expenses. Km @ current ABSA charge. $136.00/hr. $136.00/Program

Travel

Documentation review: Documentation review of the outstanding items (if any). Certificate of Authorization Permit: Upon successful review of the implementation of the program, a Certificate of Authorization Permit will be issued. 4 AUDIT CANCELLATION POLICY Notification for audit cancellation must be received 5 business days prior to the audit schedule date.

Failure to provide sufficient notice may result in minimum charge of 4 hours @ $136/hr plus any committed travel expenses associated with the scheduled audit.

CHANGE TO THE SCOPE OF THE CERTIFICATION Change to the scope of certification may require an audit to certify a company for additional scope items. Companies who wish to revise scope of the existing certification must apply using an AB-29 Form. CHANGE OF LOCATION Change of location may require re certification process similar to (3) above. Submit an Application Form (AB 29) to initiate the re-certification process.

Application Fee is not required.

Fees chargeable per (3) above except Application Fee is not required.

CHANGE OF OWNERSHIP (No Name or Location change) Change of ownership may require audit of the facilities. Contact the nearest ABSA office to discuss it with a QSCP Representative. Issuance of new Certificate of Authorization Permit.

Fees chargeable per (3) above.

CHANGE OF COMPANY NAME

(No Ownership or Location change) Change of company name will require issuance of a new Certificate of Authorization Permit. Fees chargeable per (3) above except Application Fee is not required. $136.00/Program
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DUPLICATE CERTIFICATE