Form BPVC-003 "Application for Stationary, Power and Refrigeration Engineer, Boiler and Special Operator License" - New Jersey

What Is Form BPVC-003?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2020;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
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  • Fill out the form in our online filing application.

Download a printable version of Form BPVC-003 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

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Download Form BPVC-003 "Application for Stationary, Power and Refrigeration Engineer, Boiler and Special Operator License" - New Jersey

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BPVC-003. Rev 2.2020
BPVC-003. Rev 2.2020
INSTRUCTIONS
FOR COMPLETING APPLICATION FOR ORIGINAL OR UPGRADE LICENSE
NOTE: APPLICANTS SHALL ONLY PROVIDE INFORMATION THAT IS LEGAL AND THAT IS LEGITIMATE
SECTION A
8. Enter the municipality where you reside.
1. Please print your first name and then your last
9. Enter the county of the municipality.
name.
10. Enter your date of birth.
2. *Enter a valid email address.
11. Under the requirements of N.J.S.A. 34:7-2 and 2.1,
3. Enter your home mailing address.
an applicant must be a citizen of the US or have
4.
Enter a phone number where you can be reached.
declared an intention of becoming a citizen.
5. Enter the city where you currently are residing.
12. Select an exam location. If possible, you will be put
6. Enter the state where you are now living.
in the test site you selected. See document “List of
7. Enter the zip code of the city in which you are
Examination Test Sites”.
currently residing.
*Email Address: The Mechanical Inspection Bureau of Boiler and Pressure Vessel Compliance (MIBBPVC) is asking all
applicants to supply a valid email address. Providing an email address will allow the MIBBPVC to provide you with dates
and notifications regarding your application approval status, and notifications concerning test results, etc. You will also be
able to request information and receive responses.
SECTION B
1. Indicate the license classification and grade you are requesting based upon your eligibility. (Example: Boiler operator low pressure; 2C
Refrigeration, 1C Power Engineer)
2. If you currently have a Stationary, Power, Boiler Operator or Refrigeration license in the State of New Jersey check YES and fill out the
rest of this section.
SECTION C
In this statement of experience section, you shall list the actual operating experiences obtained for the classification and grade requested
for an original or upgrade license. Only pertinent, applicable, and full-time experience shall be listed. This experience shall have been
completed within seven years of submitting this application. Failure to indicate experience will result in rejection of the application. (See
N.J.A.C. 12:90-8.2(c) for eligibility details). Incomplete or outdated applications shall not be accepted.
SECTION D
List the details of the equipment operated as listed. Failure to complete the required information could result in rejection of the application.
(See N.J.A.C. 12:90-3.3 to 3.10 and N.J.A.C. 12:90-8.2 to 8.13 for eligibility details). NOTE: The “burner-input capacity” must be used for the
purpose of determining the capacity of the equipment used for proof of eligibility.
SUBMITTAL OF APPLICATION
If this is your first license in New Jersey, forward the nonrefundable application fee of $200 with your application. If you are applying for an
upgrade or additional classification, the nonrefundable fee to submit is $160. The check or money order should be made payable to the
Commissioner of LWD and be attached to the original application and mailed to address below. If you decide to email the application, you
must also send the original or upgrade application along with your check. All checks must be sent by regular or express mail. CASH IS NOT
ACCEPTED. Every applicant must ensure all the of the required documents are submitted to the MIBBPVC. The estimated processing time for an
application is 4 to 6 weeks. If the application is approved, the applicant will be notified when and where to appear for examination.
This license application package (LAP) has several forms that will require completion: (1) “Applicant Endorsement Verification”, (2) “Management
Endorsement Verification”, (3) Engineer’s Endorsement Verification”, (when applicable). NOTE: Electronic completion of the forms is allowed
as well as accepted forms of validated electronic digital signatures for the applicant, engineer and manager. Each of the forms has
instructions on how they should be completed. Every applicant must ensure they have submitted all of the required documents to the MIBBPVC.
The documents must be returned to the address below but can also be emailed to BPVRCompliance@dol.nj.gov. Emailing the documents is the
fastest way and will allow the MIBBPVC to communicate with you if there is any reason you must be contacted. Any incomplete documents
will slow the application review process and failure to provide all necessary supportive information could cause the application to be
rejected.
If you have been deemed ineligible for any reason, you will receive a notification.
Failure to appear for an
examination could result in cancellation of the application. Once you submit your application and fee there is no refund if you are not
approved to take the test. Proof of identity in the form of a photo I.D. will be required at the time of examination. All questions should be
directed to (609) 292-2345; by fax to (609) 984-1577 or by email to the address shown above. The license application and fee should be
sent by regular mail carrier to:
New Jersey Department of Labor and Workforce Development
Division of Public Safety and Occupational Safety & Health
Mechanical Inspection Bureau of Boiler and Pressure Vessel Compliance
P.O. Box 392
Trenton, NJ 08625-0392
Phone: (609) 292-2921
Fax: (609) 984-1577
Email:
BPVRCompliance@dol.nj.gov
This application for license is a legal binding document. The applicant shall provide only legal and valid information. Falsification of any information found on this application, could lead to criminal
prosecution.
BPVC-003. Rev 2.2020
ORIGINAL AND UPGRADE APPLICATION
STATIONARY/POWER/REFRIGERATION ENGINEER
BOILER AND SPECIAL OPERATOR LICENSE
NEW JERSEY DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
DIVISION OF PUBLIC SAFETY & OCCUPATIONAL SAFETY & HEALTH
$200.00
MECHANICAL INSPECTION BUREAU OF BOILER AND PRESSURE VESSEL COMPLIANCE
P.O. BOX 392
$160.00
TRENTON, NJ 08625-0392
$80.00
DATE EXAMINED
RECALL
PPD
DNA
1
Date Rec’d:
1
Date Ret’d:
2
Date Rec’d:
Note: PPD = Postponed on Date indicated DNA = Did Not Appear on Date Indicated
Applicant Number on Exam Roster
Reader/Interpreter Requested: ⎕Yes ⎕No
2
Date Ret’d:
If “Yes” Valid Affidavit Must Be Attached to the
Application for Review and File.
3
Date Rec’d:
Affidavit Record No.
3
Date Ret’d:
Reinstate App.
Yes
No Initials/Date:
Cancel App.
Yes
No Initials/Date:
_____________________
LICENSE ISSUED:
YES
NO LICENSE NUMBER ISSUED:
CLASSIFICATION/GRADE:
TEST LOCATION:
____
(Applicant: D
N
W
A
T
L
)
O
OT
RITE
BOVE
HIS
INE
SECTION A
PLEASE PRINT OR TYPE ONLY LEGAL INFORMATION
1
2
Name:
Email Address:
3
4
Home Address:
Phone Number:
5
6
7
City:
State:
Zip Code
8
9
10
Municipality:
County:
Date of Birth:
11
Are you a U.S. Citizen?
Yes
No (If No, provide proof of your intention to become a citizen in accordance with N.J.S.A. 34.7-2.1)
12
Exam Locations:
NPT
KEW
PSV
RD
TR
VL
BRT
WCW (Please check the exam location where you desire to be tested.
(NOTE: If you do not pick a test location, one will be assigned based on your home address. (Please see the List of Examination Test Sites)
T
;
NOTE:
HIS APPLICATION IS A LEGAL DOCUMENT
FALSIFICATION OF ANY SECTION COULD LEAD TO CRIMINAL PROSECUTION
SECTION B
1
The classification and grade requested
. See N.J.A.C. 12:90-8.3
2
If you currently hold a State of New Jersey Stationary, Power, Refrigeration Engineer or Boiler Operator’s license complete this following:
A
Applicant currently has license number
which expires on
.
B
C
Classification and grade
.
License held for
year(s)
months.
BPVC-003. Rev 2.2020
SECTION C
S
E
TATEMENT OF
XPERIENCE
C
D
E
F
G
*Title Served in
Experience Gained
Begin Date
End Date
Total
A
B
While Experience
Indicate Type of Plant:
of
of
Experience
Company where
Address & City Where
Gained with
Power, Cogen, Steam,
Experience
Experience
Years or
Experience Gained
Equipment Located
Company
Hot Water or
Gained
Gained
Months
Refrigeration
*NOTE: T
S
A
M
B
S
T
E
N.J.A.C. 12:90-3.3 to 3.10 and N.J.A.C. 12:90-8.2 to 12:90-8.13
ITLE
ERVED
S
UST
E
PECIFIC
O
LIGIBILITY IN
SECTION D
EQUIPMENT OPERATED MUST SATISFY CLASSIFICATION REQUIREMENTS & OPERATING ELIGIBILITY
PART 1 – Identify the Equipment – (This is the equipment located at Section C above where hands-on training was obtained)
A
NJ Jurisdiction Number(s) of Equipment Which Requires a License: (MANDATORY)
The jurisdiction number starts with the letters NJ – Example: NJ012345-07H (The Jurisdiction Number is found on the Certificate of
Inspection in the upper left-hand corner.) This number must also be affixed to the equipment.
NJ
NJ
NJ
NJ
NJ
NJ
(Note: Only Applicable in New Jersey. Include NJ Jurisdiction Number of All Interconnected Equipment Comprising the System; Number in Top Left Corner of Certificate of Inspection)
B
C
Mfg. of Equipment (Boiler, Fired PV, HRSG, Prime-Mover, Cogen. or Refrig. Plant):
Total Found in Plant:
D
E
Total Interconnected Input Capacity of Equipment
Btu/hr, kW-input, lbs/hr
(Circle the Rating)
F
G
H
Safety Valve(s) Setpoint:
psi
Safety Valve(s) Capacity:
lbs/hr or Btu/hr
I
J
K
(Total) MAWP of Equipment:
psi.
Operating Pressure:
psi.
Type of Fuel Burned:
PART 2 – Gas Turbine and/or Steam Turbine Details (if applicable) - Complete this Part if Your Plant is Cogeneration and/or Steam Turbine(s) in the Plant
A
B
C
Cogeneration Plant Output: _______________ (kW of Generator)
Fuel:__________
Heat Rate:________________ Btu/kWh
D
E
F
Turbine HP/Throttle Capacity:
Use: ________________
Steam Pressure: _____________ psig
G
H
st
Condensing Turbine – 1
Stage and Exhaust press.
Psig or
in. Hg.
Noncondensing Turbine – Backpressure
psig. Temp.
PART 3 – Refrigeration System
Refrigeration Plants Must Also Complete this section:
(NOTE: *Obtain from the Equipment Manufacturer or ANSI/ASHRAE Standard 34)
C
A
B
*Refrigerant number:
*Refrigerant Safety Group:
*System Classification
(Ex: R-22)
(Ex: A1, B2, A3)
(Ex: Direct, Indirect)
E
F
D
Tons of Refrigeration Cap:
Tons
Refrigeration System Use :
Compressors in System:
IMPORTANT: The following 8-documents are considered part of the LAP (License Application Package) mentioned in the instructions. Items
Nos. 2), 3), 4), and 5) are mandatory documents that must be sent to the MIBBPVC along with the nonrefundable application fee. You will
only need to provide Item No. 6) and 7) if you obtain a passing score on your examination (Do Not Send a Photo or Signature unless you
are notified). It is the applicant’s responsibility to complete this application and they should seek out help doing so if needed to avoid
unnecessary delays. Item No. 5) is not needed for low-pressure boiler operator applicants unless, they received documented hands-on training
from an Engineer licensed by the MIBBPVC. Item No. 8) is the Boiler, Pressure Vessel and Refrigeration Rules and must be kept by the applicant.
Every applicant must understand that all the documents used for the purpose of determining the eligibility of an applicant are legal documents
where all information you complete and present shall be valid and true.
 License Application
 License Application
 Applicant Endorsement Verification
 Management
Instructions
Endorsement
Verification
 Engineers Endorsement
 When you pass the Test provide
 List of Test Sites.
 N.J.A.C. 12:90
Verification (when needed)
a Passport Style Photo 2” x 2” and
your handwritten signature.
BPVC-003. Rev 2.2020
APPLICANT ENDORSEMENT VERIFICATION
ORIGINAL AND UPGRADE APPLICATION
STATIONARY/POWER/REFRIGERATION ENGINEER
BOILER AND SPECIAL OPERATOR LICENSE
Proper Processing of an Application Requires the Completion of all Information
I
A
DENTIFY THE
PPLICANT
Applicant Name: _____________________________________
The purpose of the Applicant’s Endorsement Verification is to confirm the experience of the applicant for the equipment found in
the specified Stationary, Power, or Refrigeration Plants. Completion of the license application requires you to validate that you
received the necessary training, gained the experience and that you meet the qualifications at the location specified in Section C
for the equipment detailed at Section D. The training you received must be real and shall have been recorded within a logbook as
required under the provisions of N.J.A.C. 12:90-3.10. The duration of the training must meet or exceed the established provisions
specified at N.J.A.C. 12:90-8.4 through 12:90-8.13. The MIBBPVC requires you to provide a valid, properly completed logbook
as proof that your training, was done in accordance with the regulations. The logbook must show details regarding your hands-on
training, including the duration of time you spent in the boiler room, along with the appropriate signatures. The MIBBPVC shall
conduct a review of the logbook, License Application, the Management and Engineer Endorsement Verification forms as
appropriate. Failure to provide the requested documents or to meet the established regulatory provisions for eligibility, may cause
your original or upgrade license application to be rejected.
W
H
– The State of my Experience and the Details of the Equipment in Section C and D of the
ORK
ISTORY
original or upgrade application is a true representation of my employment history and experience gained. It can
Applicant Initial
be substantiated by my employer.
H
-O
T
– I attest that the organized hands-on training was provided to me by my employer at the
ANDS
N
RAINING
location and time period presented on the original and upgrade license application. I confirm that the training is
documented in a logbook as required by N.J.A.C. 12:90-3.10 and that the logbook copy presented is a true
Applicant Initial
representation and record of my training as the applicant requesting a license.
NOTICE: Applicant must be at least 18 years old to obtain a boiler operator’s license. No applicant under 17 years old will be
scheduled for an exam.
I hereby attest to meeting or exceeding the established licensing requirements and have achieved the necessary experience
and qualifications as set forth in New Jersey Administrative Code (N.J.A.C.) 12:90 eligibility requirements for examination
at N.J.A.C. 12:90-8.4 through N.J.A.C. 12:90-8.13 at my employer’s business location detailed in Section C of the
application.
I understand that any invalid or erroneous information submitted by me for an original or upgrade application shall be
considered an act of fraud, which pursuant to New Jersey Statutes Annotated (N.J.S.A.) 2C:21-1 is Criminal Forgery and
is a Crime of the Third Degree. Also, in accordance with N.J.S.A. 34:7-26, any person who shall violate any provisions of
the Act on Licensing of Operating Engineers and Fireman shall be liable to a penalty of not less than $500.00 nor more
than $5,000.00 per day for each violation.
As the duly noted applicant, I hereby upon oath duly administered, declare that all the information and details provided
are a valid representation of my acquired experience, qualifications and training as specified by the MIBBPVC under the
provisions of N.J.A.C. 12:90-8.4 through N.J.A.C. 12:90-8.13.
Subscribed and sworn to before me
Legible Written Signature/Date or an Acceptable Electronic Digital Signature
this
day of
2
(Note: Applicant Signature must be legible)
Notary Public Stamp/Signature
Applicant Endorsement Verification Form
BPVC-003. Rev 2.2020
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