Minnesota Special Application

Minnesota Department of Labor and Industry Financial Services/Code 443 Lafayette Road North St. Paul, MN 55155

DATE APPLIED FOR

OWNERS NAME

ADDRESS

LOCATION NAME

ADDRESS

CONTACT PERSON

REGISTERED PROFESSIONAL ENGINEER

ADDRESS

Reset

Minnesota Special Application

PHONE NO CITY

PHONE NO CITY TITLE REGISTRATION NUMBER CITY

FAX NO

STATE

ZIP CODE

FAX NO

STATE

ZIP CODE

STATE

ZIP CODE

Note: The RPE must be familiar with and have experience in boiler/pressure vessel construction.

TYPE OF VESSEL (Boiler, Pressure Vessel)

ORIGINAL MANUFACTURER

SERIAL NUMBER

YEAR BUILT

SIZE

NB NUMBER

MAXIMUM ALLOWABLE WORKING PRESSURE AT TEMP (F) MINIMUM DESIGN METAL TEMPERATURE (F)

AT PSI

MANDATORY HOLD POINTS: (BY State of Minnesota Inspector) CONFIRM MATERIALS REVIEW CALCULATIONS REVIEW DRAWINGS INSPECT FIT UP WITNESS FINAL PRESSURE TEST STAMPING

DATE DATE DATE DATE DATE DATE

INSPECTORS NAME MINNESOTA SPECIAL NUMBER ASSIGNED DATE APPLIED REMARKS

STATE COMMISSION NUMBER LOCATION OF DATA PLATE

The data plate must contain the Minnesota Special Number, MAWP @ Tempf., thickness, MDMT @ PSI, and Date. CAIS 19.WP (3/08)

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download