Commonwealth of Massachusetts
Division of Professional Licensure
Board of State Examiners of Plumbers and Gasfitters
1000 Washington Street, Suite 710, Boston, MA 02118-6100
Forms available at http://www.mass.gov/dpl/boards/pl
PHONE: 616 727-9952 FAX: 617 727-6095 www.mass.gov/dpl/boards/pl
CODE MODIFICATION PROPOSAL APPLICATION
APPLICANT INFORMATION
______________________________________________ ________________________________________
Name Address
City/Town State Zip Code
Telephone Facsimile E-mail
(1) Request
Check one only:
Revise existing text CODE SECTION
: ______________________________
Adopt new text CODE SECTION
: ______________________________
Delete and substitute new text CODE SECTION
: ______________________________
Delete text entirely CODE SECTION
: ______________________________
(2) Proposal Criteria
Note 1: On a separate sheet, provide a response for each question regardless of whether or not it applies to the
proposed code change.
Note 2: Be sure to use corresponding question numbers for your response(s).
Note 3: Provide supporting documentation for the following:
1. Provide an explanation for adopting this proposal, and if not adopted any problem(s) that may result?
2. Will the adoption of this proposal protect the health, safety, welfare and security of the general public, if
so, how?
3. Will the adoption of this proposal impact small business, if so, state the impact?
4. What impact will the adoption of this proposal have on local plumbing and/or gas fitting inspectors
5. Does this proposal address known field problems that are not addressed in the current code, if so how?
6. Will the adoption of this proposal have any adverse impact on the public, if so, how?
7. Will the adoption of this proposal help to conserve vital resources in any way, if so how?
8. Will the adoption of this proposal require the Board to approve a new material, technology, installation
method prior to implementation?
9. Will the adoption of this proposal impact the industry relative to cost of complying with the code, if so
how?
10. Does this proposal discriminate against the use of materials, products, methods, or systems, if so how?
