Asbestos Project Designer Application

              3017 N. STILES, OKLAHOMA CITY, OKLAHOMA 73105 ∙ www.laobr.ok.gov ∙ PHONE: (405)521-6464 ∙ FAX (405) 521-6016
Revised 07/19/2012 Toll Free Number (888) 269-5353 Page 1 of 3 Oklahoma Department of Labor
Mark Costello
COMMISSIONER OF LABOR
ASBESTOS
PROJECT DESIGNER APPLICATION
EW NEW RENEWAL LICENSE #
1. Applicant’s Name
2. Home Address
3. City
4. State
5. Zip
6. Date of Birth
7. Social Security Number
8. Phone
8. Hair Color
9. Eye Color
10. Weight
11. Height
12. Doing Business as:
13. At The Address of:
14. City
15. State
16. Zip
17. Company Phone
18. Company Contact Person
FOR OFFICE USE ONLY
Date
DEO
Receipt No.
License No.
Asbestos Admin Approval/Date Type of Payment
1 2 3
#
Endorser
3017 N. STILES, OKLAHOMA CITY, OKLAHOMA 73105 ∙ www.laobr.ok.gov ∙ PHONE: (405)521-6464 ∙ FAX (405) 521-6016
Revised 07/19/2012 Toll Free Number (888) 269-5353 Page 2 of 3 Do you currently hold any other Oklahoma Asbestos Licenses? YES NO
If yes, please indicate the type of license and the license number: CHECK TYPE LICENSE LICENSE NUMBER
CHECK TYPE LICENSE LICENSE NUMBER
Supervisor
Worker
Mgmt. Planner
Inspector
ALL APPLICANTS MUST SUBMIT THE FOLLOWING:
1. A copy of your current drivers license or state issued photo identification card.
2. Copy(s) of current refresher training class*
3. Provide social security card, birth certificate, valid unexpired passport or W-2 form.
NEW APPLICANTS MUST ALSO SUBMIT THE FOLLOWING, IN PERSON:
1. Copies of Original AHERA Project Designer training class and all subsequent refresher courses.*
2. Provide current drivers license or state issued photo identification card.
3. Provide social security card, birth certificate, valid unexpired passport or W-2 form.
4. Affidavit regarding citizenship.
NEW APPLICANTS MUST ALSO SUBMIT THE FOLLOWING:
1. Copies of Official Transcript of diploma/degree in architecture, engineering or industrial hygiene (or an equivalent)
OR
2. Degree of Equivalence application (see above NOTE)
NOTE: If applicant does not have the required degree/diploma, please fill out a Degree of Equivalence application form and submit it with this application for approval.
* Training must have been provided by an educational institution, government agency or labor union and must have been accredited by the U.S. Environmental Protection Agency.
Education Information
List schools attended and applicable training received. Provide additional information on a separate sheet if necessary.
High School Name_____________________________________ Year of Graduation __________
(submit copy of GED if appropriate) City______________________________________ State___________
College or
University
Location
(City/State)
From: Mo/Yr
To:
Mo/Yr
Diploma or
Degree
Major
Subjects
Total Credit Hrs
3017 N. STILES, OKLAHOMA CITY, OKLAHOMA 73105 ∙ www.laobr.ok.gov ∙ PHONE: (405)521-6464 ∙ FAX (405) 521-6016
Revised 07/19/2012 Toll Free Number (888) 269-5353 Page 3 of 3 If applicant is the employee of a political subdivision of the State of Oklahoma and agrees to perform any AHERA Inspection or Management Planning services on behalf of that employer only, applicant is EXEMPT and no fee is required. Otherwise, applicant is considered NON-EXEMPT and a fee of $500.00 is required.
Select One: EXEMPT NON-EXEMPT
I hereby authorize the above named educational institutions to release verification of completion of the AHERA Inspector/Management Planner courses presented in this license application.
I further affirm, upon my oath, to follow Title 40 of the Oklahoma Statutes, Section 450 through 456 as amended, and the Abatement of Friable Asbestos Materials Rules OAC 380, Chapter 50. I understand that a violation of any law or rule may subject my license to be suspended or revoked, or may subject me to cease and desist orders, injunctive measures, and criminal penalties for criminal violations.
I, upon my oath, do state that the above information is a true statement, and further state that I am not under any type of disciplinary action, including license revocation or suspension, by any State or political division thereof, or by the United States government, for any illegal or improper activity, civil or criminal, involving asbestos-containing material.
Applicants Signature Date
OAC 380:50-5-12. of the Abatement of Friable Asbestos Materials Rules states: Licensing of AHERA Project Designers.
Licensing requirements for AHERA Project Designers are as follows: (1) Preparation of plans and/or specifications for response actions for asbestos-containing materials in any facility under the jurisdiction of Title 40, Sections 450 through 456 shall be performed only by persons who are licensed as AHERA Project Designers by the Oklahoma Department of Labor. (2) AHERA Project Designers shall have met all requirements for accreditation for Asbestos Abatement Contractor or Project Designer, and in addition, shall have a bachelor's or advanced degree in architecture, engineering, or industrial hygiene, or an equivalent combination of education, training, and experience as determined by the Commissioner. (3) Applications shall be submitted on forms prescribed by the Commissioner. (4) The license fee shall be Five Hundred Dollars ($500.00) per year. If the applicant holds a current AHERA Management Planner license, there shall be no additional fee charged. (5) The license shall be issued in the name of the individual applicant. (6) The license shall be issued for a period not to exceed one year and shall expire concurrently with the initial Asbestos Contractor or Project Designer training and subsequent Project Designer refresher training. There will be no grace period wherein a Project Designer will be allowed to work with an expired license. (7) Any Project Designer who has not taken the required AHERA Project Designer refresher training course within two years of the previous initial Contractor or Project Designer training or Project Designer refresher course, shall repeat the initial Project Designer training requirements of OAC 380:50-6-6 and 380:50-6-11.
OAC 380:50-6-6 of the Abatement of Friable Asbestos Materials states:
Training Requirements:
Training requirements are as follows: (1) Training shall be supplied by an EPA or DOL accredited, educational institution, labor union, or government agency, or from a private vocational education provider licensed by the state where it operates (pursuant to 70 O.S.§ 21-103 within the state of Oklahoma) and approved by EPA or an EPA approved governmental agency. (2) Training providers must have EPA approval or approval by a State that has an approved Model Accreditation Plan (MAP) that is as stringent or exceeds the minimum requirements of the EPA MAP. (3) The AHERA Project Designer's course shall be no less than three days in length and shall include: lectures, demonstrations, a field trip, course review and a written examination. (4) Asbestos Abatement Project Designer training courses shall consist of the training required in OAC 380:50-6-6 and 380:50-6-11. (5) In addition to the training required for an AHERA Project Designer, persons seeking accreditation or licensure must also have a minimum of a bachelor's or advanced degree in architecture, engineering or industrial hygiene or an equivalent combination of education, training and experience as determined by the Commissioner of Labor.