Application for Boiler & Pressure Vessel Special Inspector Commission

Payment Information

Upon submission please send your payment of $55.00 to DIAL.  Please include your case number generated upon submission on the check sent to DIAL.

Mailing Address

Department of Inspections, Appeals, & Licensing
Boiler & Pressure Vessel Inspection Bureau
6200 Park Ave.
Suite 100
Des Moines, IA 50321

Application Type

New

  • You have never been issued an Iowa Special Inspector Commission.
  • You were issued an Iowa Special Inspector Commission while you were employed at a different company.
  • Your were issued an Iowa Special Inspector Commission in the past but did not renew the commission.

Renewal

  • Your were issued an Iowa Special Inspector Commission in the past year and are employed at the same company (no employment status change).

Applicant Details

Applicant Name

Title

Applicant Mailing Address

Applicant Contact Info

Applicant Photo

One file only.
15 MB limit.
Allowed types: gif, jpg, jpeg, png.
Please include a photograph of the applicant from mid-chest up.

Employer Information

Employer Name

Employer Address

Manager Information

Manager Name

Title

Manager Title

Manager Contact Information

Commission Information

National Board Inservice Commission #

Please include a scan and/or photo of the front of your National Board IS Commission card.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, pdf, doc, docx, zip.

Previous Iowa Commission #

I understand and agree to the following:

  • I will notify the Chief Boiler Inspector within 30 days of any change to the information in this form or its attachments.
  • As a new applicant I will schedule a meeting with the Chief Boiler Inspector to discuss Iowa law and the responsibilities, expectations, and requirements as a special inspector.
  • I have read and understand Iowa Code Chapter 89 and Iowa Administrative Rules Chapters 90-96.
  • I agree to apply all the applicable requirements identified in the Iowa Code, Administrative Rules, and all Adopted Codes to each inspection I perform.
  • I will submit copies of of my completed report of inspection to the Chief Boiler Inspector within 14 days of completing the inspection.
    • The inspection comments section of the report shall be a narrative style, fully identify all aspects of the inspection performed, equipment room and object conditions, any violations or recommendations identified, and a determination of the code compliance of the object and equipment room based upon the information gathered during the inspection.
    • If the inspection report is rejected by the Chief Boiler Inspector, I will review the rejected report, the comments submitted by the Chief Boiler Inspector, make any corrections necessary, and resubmit the report for review with rejection comments that fully communicate the action taken within 14 days of the rejection.
  • I agree to receive and accept any official notice(s) or mailings from the Boiler & Pressure Vessel Inspection Bureau at either of the addresses identified in this form.
  • I understand the Boiler & Pressure Vessel Inspection Bureau may deny this application or revoke my commission if I make false, misleading, or fraudulent statements within this application or it's attachments. 
  • I further understand that the Boiler & Pressure Vessel Inspection Bureau may revoke my commission if I do not hold a National Board Inservice Commission or for any reason listed in Iowa Administrative Rules.
  • I understand my Iowa Special Inspector Commission is null and void if I do not maintain my National Board Inservice Commission.

By completing and submitting this form for review, I am certifying that all the information provided on the form and attachments is true and accurate.

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