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.