BOARD OF STATE EXAMINERS OF PLUMBERS & GAS FITTERS – PAGE 2 of 2
(5) VARIANCE REQUEST INFORMATION – NOTE:
EXPLAIN THE ESTABLISHED HARDSHIP WARRANTING A WAIVER
IF MORE SPACE IS NEEDED, ATTACH
ADDITIONAL SHEET(S) TO 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 ac curate and i s filed in accordance with Chapter 142, section 13 o f the General Laws and 248 C MR, the
Massachusetts State Plumbing Code. I certify that all work performed prior to this request for a variance meets the requirements of 248 CMR and that
I am only seeking a variance for work that has not yet commenced. I also certify that I understand that this is a r equest for the Board to allow
an exception to the require
ments of the Massachusetts State Plumbing Code and does not constitute an appeal of an inspector’s decision.
____________________________________________ DATE OF APPLICATION:
SIGNATURE OF APPLICANT
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-refundable) – Check or money order payable to Commonwealth of Massachusetts.
. Variances are customarily heard on either the first or last Wednesday of every month. Notification will be sent.
. Copies of state plumbing 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 Inspector prior
to commencing any work.
. This 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 form instead (deadlines apply)
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THIS COMPLETES THE ONLINE PROCESS, PLEASE PRINT AND SIGN THE APPLICATION
