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36-272 (4) NAHB National Research Center IThorstensen Laboratory 400 Prince George's Blvd. 66 Littleton Road :Upper Marlboro,MD 20772-8731 Westford,MA 01886 (plastic bathroom fixtures and Tel 508-692-8395 cultured marble only) Tel 301-249-4000 Underwriters Laboratories,Inc. 333 Pfingsten Road National Automatic Merch. Assoc. Northbrook,IL 60042 20 N. Wacker Drive - Tel 214-271-1208 Chicago,I1 60606-3102 Tel 312-346-0370 United State Testing Co.,Inc. Tulsa Division National Sanitation Foundation 1341 No. 108th East Avenue 3475 Plymouth Road Tulsa, OK 74116 P. O. Box 1468 Tel 918-437-8333 Ann Arbor,MI 48105 Tel 313-769-8010 Universal Laboratory,Inc. 2633 South Garland Avenue National Testing Labs, Inc. Garland,TX 75041 6151 Wilson Mills Road (plb. and cultured marble) Cleveland, OH 44143 Tel 214-271-1208 (drinking water only) Tel 216-449-2525 U S Analytical Labs 600 S. State College Blvd. Omni Test Labs,Inc. Fullerton, CA 92631 5465 SW Western Avenue-Suite M (plb. products and cultured marble) Beaverton, OR 97075 Tel 714-773-9151 Tel 503-643-3788 Warnock Hersey PS/Pittsburgh Testing Laboratory Div. 8431 Murphy Drive 850 Poplar Street Middleton, WI 53562 Pittsburgh, PA 15220 (gas products only) Tel 412-922-4000 Tel 608-836-4400 RADCO (Resources, Applications Warnock Hersey Professional Design and Controls, Inc.) Services, Limited 3220 East 59th Street 211 Schoolhouse Street Long Beach, CA 90805 Coquitlam, B. C. V3K 4X9 (gas products only) (plb. prod. only) Tel 604-520-3321 Tel 310-272-7231 Water Control Laboratory Smith Emery Company 106 South Street 781 East Washington Blvd. Hopkinton, MA Los Angeles, CA 90021 (water vending machines only) (plb. products only) Tel S08-43S-6824 Tel 213-749-3411 Water Quality Association Spectrum Labs,Inc. 4151 Naperville Road 301 W. County Rd. E-2 Lisle, IL 60532 St. Paul MN 55112 (water and waste water only) (drinking water,waste water treatment and Tel 708-505-0160 vending machines) Tel 612 633 0101 Terralab,Engineers International 11. O. Box 57025 Salt Lake City, IJT 84157 Tel 801-262-2332 applahs 11 10 9� NATIONAL TESTING LABORATORIES ACCEPTABLE TO THE COMMONWEALTH OF MASSACHUSETTS American Gas Association Labs 8501 East Pleasant Valley Road Eastern Analytical Laboratory,Inc. Cleveland, Ohio 44131 149 Rangeway Road Billerica,MA 01862 Applied Research Laboratories (water and waste water only) 5371 N. W. 161st Street Tel 617 272 5212 Miami, FL 33014 Tel 305-624-4800 ETL Testing Laboratories,Inc. Boycote Industrial Testing,Ltd. Industrial Park 2350 South Seventh Street Cortland, NY 13045 St. Mo. 63104 1, (plb. prod.water chemistry, Factory Mutual Research Corp. metals and ceramics) 1151 Boston-Providence Turnpike Tel 314-771-7111 Norwood,MA 02042 BR Laboratories,Inc. Gabriel Laboratories, LTD 15161 Triton Lane 1421 N. Elston Avenue Box 1249 Chicago, IL 60622 Huntington Beach, CA 92647 (chemical analysis of organic compounds) (plb. fixtures only) Tel 714-891-0206 Tel 312-486-2123 Broward Testing Laboratories, Ltd Gas and Mechanical Labs, Inc. 4416 N. E. 11th Avenue 3230 Mines Avenue Fort Lauderdale, FL 33334 Los Angeles, CA 90023 954-776-7238 - 1-800-458-3330 (plb. products only) Tel 323-262-1185 Building Technology Research Lab. Stevens Institute of Technology IAMPO Research and Testing,Inc. Castle Point Station 20001 Walnut Drive South Hoboken, NJ 07030 Tel 201-420-5311 Walnut CA 91789-2825 Tel 909-595-8449 California State University Center for Irrigation Technology Lehigh Testing Laboratories, Inc 308 308 West 5370 No. Chestnut Avenue Basin Road Fresno, CA 93740-0018 New Castle, DE 19720 water flow apparatus only) Tel 302-328-0500 Tel 209-278-2066 Massachusetts i\laterials Research, Inc. Canadian StandardsAssociation 241 West Boylston St 178 Rexdale Boulevard West Boylston, nlA 01583 Rexdale, Ontario M9W 1R3 Tel 508-835-6262 Center for Advanced Materials-U of Ufa Lowell One University Avenue Lowell, MA 01845 (copper pipe, tubing and fittings) Tel 30£-934-3540 MASSACHUSETTS BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS APPLICATION FOR PRODUCT APPROVAL Ten (10) items per application * $50 per application up to ten (10) applications Tenth application unlimited ($500.00 Maximum) Product Name: Model No: Description of product: Product Name: Model No: Description of product: Product Name: Model No: Description of product: Product Name: Model No: Description of product: Product Name: Model No: Description of product: * A Diskette must be submitted if seeking approval of more than ten (10) items. MASSACHUSETTS BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS APPLICATION FOR PRODUCT APPROVAL Must submit fee,payable to the Commonwealth of Massachusetts, with this application when forwarding to the Board Office Ten (10) items allowed per application $50 per application up to ten 10) applications Tenth application unlimited ($500.00 Maximum) Product Name: CULTURED MARRr F Model No: Description of product: MAN MADE MARBLE CONSISTING OF POLYESTER REqTN., rRi1,SHFr) T,Ij4E,-,T0NE AND PIGMENTS MOLDED INIQ COUNTERTOPS, SINK S. AND TUBS. Product Name: STARSTONE Model No: Description of product: N12-N :14ADE DENSIF IED COUNTER TOPS AND SINKS CONSISTING OF 'OLYESTER RESIN AND ALUMINIUM TRIHYDRATE Product Name: Model No: Description of product: Product Name: Model No: Description of product: Product Name: Model No: Description of product: List National Testing Organization acceptable to the Commonwealth of MA which have listed this product. (see attached list) Organization Product Name and Model Certification Date Report No. List principle performance and/or safety standards(s) with which your product complies. Orig. Iss. Std. Std.Iden. Code/No. Title of Standard Date of Standard List brochures installation instructions maintenance manuals or other pertinent information submitted to support this application. li(°��r� ����;�'�� 1 ► V�� �L� � ��,Qa���CT�� ���C7CY'iV%"pJ Does your product me-Ef the Massachusetts State Fuel Gas and Plumbing Codes: (CMR 248 1.00-7.00) as amended? Yes ✓— No NOTICE Effective as of 4/1/87 products are first reviewed by the board subcommittee. Their recommendations are voted on by the full board. A product receives a provisional one year approval.Manufacturer must request extension of approval prior to the expiration date. Extensions are granted provisionally for three years; presence not required at Board Meeting.Codes as amended are available from the State Book Store(617-727-2834) for current price including postage fee. A copy of this application (fee non-refundable) and all referenced information and attachments shall be provided to all nine 9 Members of the Board. FAILURE TO COMPLY WILL RESULT IN LACK OF ACTION BY BOARD. Date This is to verify that on 19 �� a copy of this application and all pertinent literature on our product was mailed to the Executive Secretary and the eight(9) individual Board Members.Required fee, test reports, and application were mailed to the Board Office located at the Division of Registration,Rm. 1511, 100 Cambridge St.,Boston,MA 02202. It is understood that filing this application does not constitute approval in and of itself. It is further understood that I may be requested to rovide additional information in person or in writing to demonstrate the product to the Board. i Signature of App Ica Please print Applicant's Name itIe Date BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS Room 1511, Leverett Saltonstall Building, 100 Cambridge Street Government Center, Boston, Massachusetts 02202 617-727-9952 Application for Plumbing or Fuel Gas Product Approval FEES LISTED ON PROD UCT SHEET. Please indicate type: Plumbing X Gas Combination PLEASE NOTE: The Application will be placed on an agenda at the direction of the Chairman and Executive Secretary. Notifications/Correspondence to be mailed to: Manufacturer Manufacturer's Rep. X (check one) Manufacturer Manufacturer's Representative Name BOLFING BROS. MARBLE INC. 'Name VICTOR SHIBLEY _ Address18407 TELGE RD. Address 6 BIG WOOD City/State CYPRESS, TX City/State WESTFIELD, MA Zip 77429 Zip 01085 _ Telephone 281-351-7195 Telephone 413-568-1836 Contact Person 19IL BOLFING Contact Person VICTOR SHIBLEY Title PRESIDENT Title List Jurisdiction (State Localities) that have approved this product Jurisdiction Contact Person Address Telephone prodapp 07/97 Page Two Manufacturer's Request for Product Approval Please Note: Diskette Application In order to expedite your product approval request, we will need a diskette 3-1/4" or 5-1/2" of a flat file in ASCII format of all applications with more than 10 model numbers. Record layout is Fixed-Width fields; the data must be able to be read by tools found within MS Office version 4.3. (ASC III means a straight TXT file comma de-limited) The data must be presented in the following order: Field Starting Column Length Product Type (P [Plumbing], G [Gas], or C [Combination]) 1 1 Product Name 2 50 Model Number/Designation 52 50 Description 102 255 Category 357 50 Class 407 50 Material 457 50 Dimensions 507 50 Configuration 557 50 The last five (5) fields are optional at this time (Category through Configuration). If you do not have information for these fields, leave them blank on the diskette. Please label the diskette with the Manufacturer's name and date. A printout of the diskette showing products must accompany the application for approval. Separate files are required for each application. Please provide a separate diskette for each file being submitted. If you are unable to provide a diskette to us, you must send a letter to the Executive Secretary explaining why you cannot provide said information. _ Please call the Board office at (617) 727-9952 with any questions or concerns. PLEASE CHECK FOR VIRUSES BEFORE SUBMITTING TO BOARD OFFICE pdctapp 7/97 The Commonwealth of Massachusetts F w Division of Registration d Leverett SaltonstallBuildrng, Government Center 100 Cambridge Street,Boston 02202 Board of State Examiners of Plumbers and Gasfitters MANUFACTURER'S REQUEST FOR PRODUCT APPROVAL Enclosed you will find the Massachusetts Board of State Examiners of Plumbers and Gas Fitters' application for plumbing or fuel gas product approval. PLEASE NOTE: THE FEE SIGNED APPLICATION AND REQUIRED TEST RESULTS ARE TO BE MAILED TO THE BOARD OFFICE LOCATED IN ROOM 1511 100 CAMBRIDGE STREET, BOSTON, MA 02202. Your application will not be processed without authorized signature. Upon signing the enclosed application, you are stating that a copy of all corresponding information has been forwarded to each Board Member and the Executive Secretary as listed below CHAIRMAN Louis C. Stifano, 111 Willis Avenue, Medford, MA 02155 MEMBERS Frederick P. Barker, Jr., P. E., Department of Public Health, Oral Health- 5th Floor- 250 WashingtonSt., Boston, MA 02108 Rudolph Banks, 661 Bay St., Springfield, MA 01109 Edward F. Cruz, 137 South Main St., West Bridgewater, MA 02379 James E. Curry P. E., Jr., 1035 Westford Avenue, Lowell, MA 01851 Robert S. McKinnon, 428 Massapoag St., Sharon, MA 02067 George M. Murphy, 30 Merrill Road, Watertown, MA 02172 David W. Healey, Esq. , 125 Winnifred Road, Brockton, MA 02401 William T. Callahan, 49 Walnut Street, Newtonville, MA 02160 EXECUTIVE SECRETARY Louis J. Visco, 38 Locust St., Winthrop, MA 02152 The Board now has a separate application for Lacoratory Approval. If this application is necessary please call the Board office and reques- one.