Fill - Free fillable Petition for Waiver or Variance from a Boiler (Office of the Chief Information Officer) PDF form

Petition for Waiver or Variance from a

Boiler or Pressure Vessel Rule

Notice: A waiver may not suspend the requirements of the statute. A waiver suspends the

requirements of a rule for the specific circumstances if an identified person. If you seek

blanket authorization to install objects in unidentified locations, please file a petition for

rulemaking instead of this form.

You may wish to consult an attorney before completing this document. For more

information, please read the boiler board’s rules on waivers and variances at 875 Iowa

Administrative Code Chapter 81.

Your name: _____________________________________________________________

Your title: _______________________________________________________________

Name of the organization you represent, if applicable: ____________________________

Your phone number: ______________________________________________________

Your e-mail address: ______________________________________________________

Your address: ___________________________________________________________

_______________________________________________________________________

State ID No. of boiler or pressure vessel: ______________________________________

Are the requirements you wish to have waived specifically mandated by statute? If yes, the

board does not have authority to waive the requirements.

Yes No

Does this petition relate to a pending contested case or other legal proceeding? If so, the

petition must be filed in that proceeding.

Yes No

Please indicate whether this is a request for a temporary waiver or a permanent waiver.

Temporary Permanent

If this is a request for a temporary waiver, please give the desired end date for the waiver.

__________________________

10-07

1

If this is a request for a permanent waiver, do you believe a temporary waiver would be

infeasible?

Yes No

If yes, please describe why you believe a temporary waiver would be impracticable.

________________________________________________________________________

Describe and cite to the rule or rules you wish the board to waive.

________________________________________________________________________

Describe the exact waiver or variance desired, including scope.

_______________________________________________________________________

10-07

2

10-07

3

Describe how complying with the rule would impact the building.

_______________________________________________________________________

Describe how complying with the rule would impact your activities in the building.

_______________________________________________________________________

Describe how complying with the rule would impact your business or other organization.

_______________________________________________________________________

Provide any additional facts, data and arguments that you believe show complying with the

rule would create an undue hardship.

________________________________________________________________________

Will substantially equal protection of the public health, safety, and welfare be provided if the

waiver is granted.

Yes No

If you marked yes, please describe exactly how the protection will be provided.

________________________________________________________________________

Do you believe a waiver would prejudice the substantial legal rights of any person.

Yes No

10-07

4

10-07

5

If you marked no, please describe why not.

________________________________________________________________________

Describe previous contacts with the Iowa Division of Labor or any other governmental

agency regarding the boiler or pressure vessel at issue.

________________________________________________________________________

10-07

6

Provide any information you have regarding how the board has handled similar requests in

the past.

________________________________________________________________________

Provide the name, address and telephone number of any person, entity, public agency or

governmental body that might be affected by this waiver.

________________________________________________________________________

Provide the name, address, and telephone number of anyone with relevant knowledge

regarding the variance or waiver request.

________________________________________________________________________

If an attorney is handling this variance request for you, provide the attorney’s name, address

and telephone number.

________________________________________________________________________

Mail this form with copies of any supporting

documents you want the board to consider

to:

Boiler and Pressure Vessel Board

Iowa Division of Labor

1000 East Grand Avenue

Des Moines, Iowa 50319-0209

The information provided in this petition is

true and accurate to the best of my

knowledge. I hereby authorize persons with

information relevant to this variance request

to release information to the board.

___________________________________

Your signature

__________________________________

Date

10-07

7

Fill Online, Printable, Fillable, Blank Petition for Waiver or Variance from a Boiler (Office of the Chief Information Officer) Form

Related forms

Fillable Petition for Waiver or Variance from a Boiler (Office of the Chief Information Officer)

Fill Online, Printable, Fillable, Blank Petition for Waiver or Variance from a Boiler (Office of the Chief Information Officer) Form

Related forms

First 20 documents completely FREE!