Fillable Commonwealth of Massachusetts Application for Variance from State Fuel Gas Code Post-Installation

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Commonwealth of Massachusetts Application for Variance from State Fuel Gas Code Post-Installation

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Commonwealth of Massachusetts
OFFICE OF CONSUMER AFFAIRS
DIVISION OF PROFESSIONAL LICENSURE
Board of State Examiners of Plumbers and Gasfitters
1000 Washington Street, Suite 710 - Boston, Massachusetts 02118
APPLICATION FOR VARIANCE FROM STATE FUEL GAS CODE
POST-INSTALLATION
$86.00 application fee – Check payable to Commonwealth of Massachusetts
(DO NOT USE THIS APPLICATION IF THE VARIANCE IS SOUGHT FOR NEW/FUTURE WORK)
(1) APPLICANT INFORMATION
(The licensed plumber/gas fitter responsible for the work performed must complete this application)
NAME: TEL: FAX:
ADDRESS: CITY/TOWN: STATE: ZIP:
TITLE OR
POSI
TION: EMAIL:
(2) PRESENT OWNER INFORMATION (Do not complete this block if it is the same as block (1)
NAME: TEL: FAX:
ADDRESS: CITY/TOWN: STATE:  ZIP:
TITLE OR POSITION: EMAIL:
3) VARIANCE LOCATION INFORMATION
NAME OF PROPOSED OR CURRENT OCCUPIER OF BUILDING:
ADDRESS: CITY/TOWN: TEL:
(4) OTHER INFORMATION
ENGINEER: LICENSE # TEL: PENDING
CONTRACTOR: LICENSE # TEL: PENDING
GAS FITTER/PLUMBER  LICENSE # TEL: PENDING
GAS PERMIT NUMBER: PENDING
NAME OF PLUMBING/GAS INSPECTOR: TEL:
THE PLUMBING/GAS INSPECTOR WAS INFORMED OF THIS VARIANCE REQUEST ON:
NEW CONSTRUCTION: RENOVATION
ALTERATION
APPLICABLE CODE SECTION(S):
3529,'('$7(6:+(1121&203/,$17:25.:$63(5)250(':
Board of State Examiners of Plumbers & Gas Fitters – Page 2 of 3
(5) VARIANCE REQUEST INFORMATION
NOTE: Variances after the fact shall be granted only if a hardship can be established which would have justified the variance
if sought prior to the work being performed. EXPLAIN BELOW:
IF ADDITONAL SPACE IS NEEDED ENCLOSE SHEET(S) WITH THIS APPLICATION
6) MANDATORY CERTIFICATIONS Applicants for a variance for completed work must initial the following certifications:
INITIAL HERE
I certify that I was responsible for the work outlined in this request for a variance.
I certify that the work performed violates specific provisions of M.G.L. c. 142 and/or 248 CMR as cited by
the inspector in writing which, I am providing to the Board.
I certify that I understand how the provisions of M.G.L. c. 142 and/or 248 CMR have been violated and
that I will ensure all my future work will conform to those requirements
I certify that the non-compliant work was unintentionally non-compliant due to a condition that I could not
have reasonably foreseen.
I certify that I notified the inspector immediately when the work was discovered to be non-compliant and
ceased all non-compliant work since that time.
I certify that the non-conforming work is subject to immediate removal if the Board, in its discretion,
rejects this application.
By checking this box - I hereby certify under pains and penalties of perjury that the information entered on this
application request, including supporting documentation, is true and accurate and is filed in accordance with Chapter 142,
section 13 of the General Laws and 248 CMR, the Massachusetts State Fuel Gas Code. I certify that, other than work
referenced in this request, all other work performed prior to this request for a variance meets the requirements of 248
CMR. I also certify that I understand that this is a request for the Board to allow an exception to the requirements of the
Massachusetts State Fuel Gas Code and does not constitute an appeal of an inspector’s decision.
____________________________________________ Date of Application:
Signature of Applicant
Board of State Examiners of Plumbers & Gas Fitters – Page 3 of 3
IMPORTANT NOTES
FAILURE TO ADHERE WITH NOTE 2 WILL PLACE THE VARIANCE IN A HOLD STATUS
. If necessary, attach supporting information / documentation to this application and deliver or mail to the Board Office.
. $86.00 application fee (non-r
efundable) – Check or money order payable to Commonwealth of Massachusetts.
. Variances are customarily heard on the last Wednesday of every month. Notification will be sent.
. Copies of state gas code regulations (248 CMR) are available at the State Bookstore, Room 116, State House,
Boston, MA 02113. Call 617 727-2834 for current cost plus mailing charge.
. The applicant must file a copy of the Board’s approval for this variance request with the local Plumbing and/or Gas
I
nspector prior to the c
ommencement of any gas fitting work.
. T
his application is for variances (exceptions to the Code), not appeals. If the applicant disagrees with the application
of the Code as decided by the inspector, the applicant must file an appeal for instead (deadlines apply).
[ This completes the online process, please print and sign the application ]
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Commonwealth of Massachusetts Application for Variance from State Fuel Gas Code Post-Installation

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Completed 22 May 2020

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