STATE OF IOWA

DEPARTMENT OF COMMERCE

UTILITIES BOARD

IN RE:
(company name) / DOCKET NO. P-

PETITION FOR RENEWAL OF PIPELINE PERMIT

COMES NOW , Petitioner and pursuant to Iowa Code chapter 479 (20 ) states:

I

Petitioner is a corporation existing under the laws of the State of . It is authorized to transact business in the State of Iowa. Its principal office is at .

II

On the day of , the Iowa Utilities Board issued Permit No. to

(Name and address of Company to which the permit was granted.)

to construct, operate and maintain a pipeline for the transportation of natural gas and for such purpose to construct, reconstruct, repair or locate its pipes, pumps, pressure apparatus or other stations, devices or equipment used in and on such line.

III

The pipeline is approximately miles in length.

IV

A legal description of the pipeline route is provided as Exhibit "A", attached and incorporated by reference.

V

A map showing the pipeline route, including all road, railroad, and stream crossings and other pertinent features is provided as Exhibit "B", attached and incorporated by reference.

VI

The engineering features, materials and manner of construction of said pipeline are shown on Exhibit "C", attached and incorporated by reference.

VII

A showing that the financial accountability of the Petitioner conforms to the provisions of Iowa Code chapter 479 is provided in Exhibit "D", attached and incorporated by reference.

VIII

Attached as Exhibit "F" and incorporated by reference is (1) a statement of the purpose of the project and a description of how the services rendered by the pipeline will promote the public convenience and necessity; (2) a general statement covering each of the following topics: the nature of the lands, waters, and public or private facilities crossed; the possible use of alternative routes; the relationship of the proposed pipeline to present and future land use and zoning ordinances; and the inconvenience or undue injury which may result to property owners as a result of the pipeline; and (3) for an existing pipeline, the year of original construction and a description of any amendments or reportable changes since the permit or latest renewal permit was issued.

WHEREFORE, Petitioner requests:

1. The Utilities Board consider and take appropriate action in the matter of this petition for renewal of permit and requests that proper notice be prepared for publication. Petitioner will make available to the public a map of the route, a copy of which is attached to this Petition, and requests the notice for publication state: (Indicated which)

a. A map showing the proposed route is published with the notice; or,

b. A map of the proposed route may be obtained free of charge by calling
- - ,

or by writing to:


2. The Petitioner be granted a Renewal Permit for a period of twenty-five (25) years beyond the expiration date of the permit described above, pursuant to Iowa Code chapter 479, and all the rights, privileges, orders, limitations and restrictions of the original permit be renewed with the granting of a Renewal Permit.

Dated this day of , 20 .

(Company)

By

(Signature)

(Name - printed)

(Title)

AFFIDAVIT

STATE OF
COUNTY OF / } / ss:

I, , state under oath that I am

of Petitioner named above and that I have

(Official Title)

authority to execute this instrument and that I have read the Petition, know the

contents, and that the statements are true and correct.

(Signature of Affiant)

Subscribed and sworn to before me by ,

this day of , 20 .

Notary Public

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Instructions For Filing A Petition For Renewal Of Pipeline Permit

This form is to be used when filing a petition for renewal of permit for an existing intrastate natural gas pipeline.
Rules regarding filing a petition for permit for intrastate gas pipelines and underground gas storage are found in 199 IAC chapter 10. General filing rules are found in 199 IAC chapter 7. Rules regarding electronic filing with the Iowa Utilities Board are found in 199 IAC chapter 14.

The petition and exhibits must be filed with the Iowa Utilities Board by uploading a document or collection of documents into the Iowa Utilities Board’s electronic filing system at https://efs.iowa.gov/efs/. (Petition filings in cases where the initial petition was filed prior to January 2, 2009, will continue to be filed on paper, instead of electronically. See 199 IAC 14.4(2).)

Until June 30, 2009, filers must provide the Board with one paper copy of each document that is filed electronically. See 199 IAC 14.8(2) and “Order Extending Requirement To Provide Paper Copy of Electronic Filings” issued March 30, 2009.

If any map, drawing or oversized document cannot be printed on 11x17 inch or smaller-sized paper in legible and usable form, an original plus four paper copies must be filed in addition to the electronic copy. See 199 IAC 14.8(1).

Any paper copies required must be mailed or delivered to the address below: (See 199 IAC 7.4(2)b.)

Executive Secretary

Iowa Utilities Board

1375 E. Court Ave., RM 69

Des Moines, Iowa 50319-0069

See the rules for additional details and exceptions to the general requirements described above.

If you have any questions, phone Donald Stursma at 515-725-7352 or Jeffrey O'Neal at 515-725-7341, or send e-mail to or .

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