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Minnesota Department of Labor and Industry

Financial Services/Code
443 Lafayette Road North
St. Paul, MN 55155

HIGH PRESSURE PIPING LICENSE APPLICATION, EXAMINATION AND AFFIDAVIT INSTRUCTIONS


License Examination Requirements

Please PRINT IN INK or TYPE your responses. Applications will be denied for illegible or unreadable applications.

The Minnesota pipefitter examination has two parts: 1) documented experience, and 2) a written test.

Only applications who pass the documented experience part of the examination may take the written test. Applicants who fail
the documented experience part of the examination may not take the written test.

Application Instructions

Basic applicant information: ALL information in this section is mandatory in order to process the application.

• Applicant’s last name, first name and middle initial.


• Applicant‘s mailing address (street or post office box) city, state and zip code.
• Applicant’s social security number
• Area code and telephone number of Applicant.
• Area code and Fax number of Applicant, if you have one.
• Applicant’s date of birth (month, day, year).

License Information Instructions

If you are applying for a Journeyman license check the box and list your Pipefitter Apprentice number and Pipefitter Trainee
Registration number. If you are applying for a Contractors license check the box and list your Journeyman pipefitters license
number, if applicable.

If you were a Registered Apprentice check the appropriate box. If yes, fill in the years and months as an Apprentice, and the
years and months experience with high pressure piping systems.

If you were a Registered Trainee check the appropriate box. If yes, fill in the years and months as a Trainee, and the years and
months experience with high pressure piping systems.

If you were a Journeyman Pipefitter check the appropriate box. If yes, fill in the years and months as a Journeyman, and the
years and months experience with high pressure piping systems.

Applicant signature and date are required.

Name and address of the Registered Apprenticeship program you completed. You must submit a copy of your apprenticeship
completion certificate or your apprenticeship indenturement card.

List Employer name, address and dates employed.

Proof of High Pressure Piping Experience

In order to pass the experience part of the examination, applicants must submit written proof of the required years of
experience in the installation and/or construction of high pressure piping as a registered pipefitter trainee, registered apprentice,
or journeyman pipefitter as prescribed in Minnesota Rules, Chapter 5230, Steamfitter Rules and Codes for Power Piping
Systems.

The written proof of high pressure piping experience is submitted on affidavits. The affidavits must be filled out by your current
employer and/or your previous employers and indicate the amount of time served at the pipefitting trade, as defined in
Minnesota Rules, Chapter 5230. The affidavit should be signed by a Minnesota licensed pipefitting contractor that you worked
for and include that person’s license number. For experience acquired in other states or jurisdictions, the affidavit should be
signed by the appropriate contractor and include any state or jurisdiction license information.

Affidavits must cover the minimum time requirements: 4 years for journeyman; 5 years for contractor. No credit is given for
time that is not certified by your affidavits.

CAIS HPP-11.WP (7/05) over


Required Information

It is essential to provide the specific information regarding high pressure piping work and the dates the work was done.

Definition: High pressure piping in Minnesota means any system of piping hot water or other medium used for
heating that exceeds 30 P.S.I. gauge and 250 degrees F, or any system of high pressure steam or ammonia
piping.

The application and affidavit experience must be consistent with this definition. Additional information regarding experience may
be presented on the reverse side of the affidavit or on a separate sheet of paper.

Examples of entries on affidavits include the following:

Applicant helped install 125 psi steam piping at (Project) from (Date) to (Date)

Installation of Ammonia refrigeration piping at (Project) from (Date) to (Date)

Project Type of Work Performed by Applicant Dates of Employment


From: To:

XZY Alcohol Plant Helped install 125 psi steam piping 8-98 5-99

It is recommended that you obtain a code book (Minnesota Rules, Chapter 5230, High Pressure Piping and Code for Power
Piping Systems) before you make application for licensing. It sets forth the licensing requirements and may be used as a study
guide. A copy may be obtained from the Minnesota State Bookstore, 660 Olive Street, St. Paul, MN 55155.
Metro: 651-297-3000. MN Tool Free: 1-800-657-3757. TTY Metro: 651-282-5077. TTY MN Toll Free: 1-800-657-3706

Application Fees

$120 - Journeyman pipefitter individual competency examination and license fee.

$270 - Contracting pipefitter individual competency examination and license fee.

Applications fees are not refunded. It is important that your affidavits are complete and specific in showing your actual high
pressure work experience. Affidavits must be fully completed, notarized, and returned to our office with the appropriate fee and
application form.

Applications must be received fifteen (15) days prior to examination.

BEFORE MAILING YOUR APPLICATION ALONG WITH YOUR FEE, PLEASE NOT THE FOLLOWING:

All licenses require submission of both application and affidavit(s).

Application:

• All mandatory information is fully completed.


• Proper fee submitted via check or money order payable to Department of Labor and Industry. Do not send cash.
• Applications must be received 15 calendar days prior to exam.

Affidavits:

• Notarized properly with a current commission expiration date.


• Fully completed.
• Required total amount of time shown with specific dates of employment indicated.

This material can be provided in different forms, such as large print, Braille or audiotape, if you call (651) 284-5080 or (651) 297-4198/TTY.
Minnesota Department of Labor and Industry Reset
Financial Services/Code
443 Lafayette Road North APPLICATION FOR PIPEFITTER’S LICENSE
St. Paul, MN 55155
Please PRINT IN INK or TYPE your responses. Unreadable or illegible applications will be denied. Items with * are required to
Please submit completed application, affidavit, if required, and appropriate fee to the above address. process your application.
LICENSE NUMBER (If applicable) SOCIAL SECURITY NUMBER*

LAST NAME * FIRST NAME * MIDDLE INITIAL

ADDRESS *

CITY STATE ZIP CODE *

AREA CODE AND PHONE NUMBER AREA CODE AND FAX NUMBER DATE OF BIRTH *

EXAMINATION INFORMATION* Applying for: Journeyman $120 Contractor $270


RETEST If yes, you do not need to complete Pipefitter Apprentice Number Pipefitter Trainee Registration Number
YES the remainder of this application
Were you a . . . Years as Years experience with high pressure piping systems
Registered Apprentice yrs mos yrs mos
Registered Trainee yrs mos yrs mos
Journeyman Pipefitter yrs mos yrs mos

I VERIFY THAT ALL INFORMATION IS CORRECT* DATE *


SIGNATURE OF APPLICATION X

Name of Registered Apprenticeship Program you completed


Address of Registered Apprenticeship Program you completed
Please submit a copy of your apprenticeship certification of your apprenticeship indenturement card.
Employer Employer Address Phone Number Dates Employed
From: To:

From: To:

From: To:

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From: To:

From: To:

The information you provide on this application will be used to determine if you meet the license requirements. Before a license is issued to
you, M.S. § 270.72, subd. 4, requires you to provide your social security number. The other information is required to process your
application. Failure to provide the requested information may delay the processing of your application or may be grounds for denying your
application. Under M.S. § 13.41, the information that you provide on this application, except for your name and address, is private data while
the application is pending. Disclosure of this information to others may occur as authorized or required by law, including the Attorney
General’s Office, the Department of Revenue, the Department of Human Services, and/or for the purpose of verification and investigation.
Once you are licensed, the information (except for your social security number) becomes public data and will be part of the agency’s
permanent records.

This material can be provided in different forms, such as large print, Braille or audiotape, if you call (651) 284-5080 or (651) 297-4198/TTY.

CAIS HPP-06.WP (3/07)


Office Use Only Approve Deny Inspectors Initials

REASON(S) DENIED:
WRC = WRONG SIGNATURE ILL = ILLEGIBLE OR UNREADABLE
NOA = NO APPLICATION SUBMITTED NOS = NO SIGNATURE ON APPLICATION
NOF = NO FEE SUBMITTED CIP = COMPLETE IN PENCIL
ANS = AFFIDAVIT FORM NOT SUBMITTED ANN = AFFIDAVIT NOT NOTARIZED
ICT = INSUFFICIENT CREDITED TIME NOR = NOT ORIGINAL AFFIDAVIT (copies of faxes not accepted)
IDA = INVALID DATES ON AFFIDAVIT OTH = OTHER

Office Use Only Application Number Date Paid

Amount Paid Check Number Money Order Number

Interagency Payment Purchase Order Number (state agencies only)


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

Please PRINT IN INK or TYPE your responses. Please submit completed affidavit along with application to the above address.
APPLICANT LAST NAME FIRST NAME MIDDLE INITIAL

ADDRESS AREA/PHONE NO.

CITY STATE ZIP CODE

NAME OF COMPANY BUSINESS LICENSE NUMBER

COMPANY ADDRESS AREA/PHONE NO.

CITY STATE ZIP CODE

NAME OF CONTRACTING LICENSE HOLDER (if applicable) LICENSE NUMBER (if applicable)

Application applying for: Journeyman Contractor


How long has the applicant been continuously employed by you on high pressure piping as defined in Chapter 5230
yrs mos
Describe the applicant’s experience in the practical installation of High Pressure Piping, as defined in 5230.0250 of the
Minnesota High Pressure Piping code. List specific high pressure piping projects, work performed by the applicant and dates
of continuous employment.
Project Type of Work Performed by Applicant Dates of Employment
From: To:

From: To:

From: To:

From: To:

From: To:

Continue on back Has the applicant been employed by you as an apprentice pipefitter? Yes No

Subscribed and sworn to before me this _____ day of _______________________, 20 ___

by ______________________________________________________________________
(Name of Affiant)

Signed ___________________________________________________________________ _______________________________


(Notary) (Stamp)

The information provided on this form is used to determine if the applicant meets the license requirements. The requested information is
required to process your application. Failure to provide the requested information may delay the processing of license application or may be
grounds for denying your application. Under M.S. § 13.41, the information that you provide on this form, except for the applicant’s name and
address, is private data while the application is pending. Disclosure of this information to others may occur as authorized or required by law,
including the Attorney General’s Office, the Department of Revenue, the Department of Human Services, and/or for the purpose of verification
and investigation. Once the applicant is licensed, the information becomes public data and will be part of the agency’s permanent records.

This material can be provided in different forms, such as large print, Braille or audiotape, if you call (651) 284-5080 or (651) 297-4198/TTY.
CAIS HPP-07.WP (8/04)
Project Type of Work Performed by Applicant Dates of Employment
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CODE BOOK ORDER FORM

PREPAYMENT REQUIRED

Please send me the following publications:

Boiler and Power Boat Rules, $10.00 each


(3-19) (includes M.S. 183.375-183.62) $
High Pressure Piping Rules and Code for Power Piping
Systems, $11.00 each
(3-66) (includes M.S. 326.46 – 326.52) $

Sub-Total $
(up to $15.00 remit $3.00;
$15.04 - $25.00 remit $5.00;
$25.01 - $50.00 remit $7.00;
$50.01 - $100.00 remit $10.00;
over $100 call for rates) Shipping/Handling $

New Sub-Total $

6.5% MN Sales Tax


(7% for St. Paul Residents) $

Total $

Send to:
Name

Company

Street Address

City State Zip Code

Check enclosed payable to: State of Minnesota

Charge to: MasterCard / Visa / American Express / Discover


Card Number Expiration Date Authorized Signature

Return to:
Minnesota Bookstore
660 Olive Street
St Paul, MN 55155

Phone No:
651-297-3000
1-800-657-3757

CAIS 23.WP (8/06)