875—81.5(17A,89) Content of petition. The required form for a petition for waiver or variance is available on the board’s website at iowaboilers.gov. A petition for waiver shall include the following information where applicable and known to the petitioner:
	81.5(1) The name, address, and telephone number of the entity or person for whom a waiver is being requested; the case number of or other reference to any related contested case; and the name, address, and telephone number of the petitioner’s legal representative, if any.
	81.5(2) A description of and citation to the specific rule from which a waiver is requested.
	81.5(3) The specific waiver requested, including the precise scope and duration.
	81.5(4) The relevant facts that the petitioner believes would justify a waiver under each of the four criteria described in rule 875—81.3(17A,89). This statement shall include a signed statement from the petitioner attesting to the accuracy of the facts provided in the petition and a statement of reasons that the petitioner believes will justify a waiver.
	81.5(5) A history of any prior contacts between the board, other departments or agencies of the state of Iowa, or political subdivisions and the petitioner relating to the boiler or pressure vessel affected by the proposed waiver.
	81.5(6) Information regarding the board’s action in similar cases.
	81.5(7) The name, address, and telephone number of any public agency or political subdivision which might be affected by the granting of a waiver.
	81.5(8) The name, address, and telephone number of any entity or person who would be adversely affected by the granting of a petition.
	81.5(9) The name, address, and telephone number of any person with knowledge of the relevant facts relating to the proposed waiver.
	81.5(10) Signed releases of information authorizing persons with knowledge regarding the petition to furnish the board with information relevant to the petition for waiver.
	81.5(11) The state boiler identification number of the relevant object.
[ARC 9082B, IAB 9/22/10, effective 10/27/10; ARC 3635C, IAB 2/14/18, effective 3/21/18]