Board of State Examiners of Plumbers and Gas Fitters ... and Gas Fitters Licensure ... based on the...

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Board of State Examiners of Plumbers and Gas Fitters

Licensure Candidate Information

Gas Fitters and LP Gas Installer

November 12, 2011 Introduction: This Bulletin details the requirements as well as the process for achieving licensure. Candidates are eligible for the examination when their application and supporting documentation are approved. In order to be approved for examination by the Commonwealth of Massachusetts, Division of Professional Licensure, Board of State Examiners of Plumbers and Gas Fitters as a Master Gas Fitter, Journeyman Gas Fitter, or LP Gas Installer, candidates must have the required apprenticeship experience and education. The Board has contracted with PSI to process applications and to conduct the examinations. Hence there are many references to PSI in this Bulletin.

Commonwealth of Massachusetts Division of Professional Licensure Board of Plumbers and Gas Fitters

1000 Washington St., 7th Floor Boston, MA 02118

Phone: 617.727.9952

Frequently Asked Questions and Answers:

1. Where are the examinations given? See Part I- () Preparing for Examination.

2. Who is responsible for documenting my apprenticeship

hours? Part II – (Page 4 Apprentice Work Experience).

3. What types of examinations are given? What will I be tested on? See Preparing for examination (Page 1) and Examinations (Page 5).

4. Are there special testing accommodations for

candidates with disabilities? See Part II –(Page 3) Americans with Disabilities Act.

5. What is the examination process? What are the fees for

the examinations? See Examination Process (Page 2) and Fees Part V - (Page 10)

6. What is the passing score for each part of the two-part

examination? See Part V- (Page 3) Examinations.

7. What materials are allowed in the examinations? None, all examinations are closed book. See Part III – (Page 5)

8. When will I be notified that I have passed or failed an

examination? See Part V - (Page 7) Scores.

9. How can I get help on Reviewing Questions-See Part I- (Page 4) Request for

Review of Questions Making an Appeal- See Part I- (Page 4) Examination

Appeal Reviewing Scores- See Part I- (Page 3) Review of Examination Score Refunds and Penalties- See Part IV- (page 9)

10. When am I considered licensed to work in the

business of plumbers and gas fitters. You are considered licensed when:

a. You have received notice of a passing score

on each part of your examination and;

b. You have in your possession a printed, photo license issued from the Board or a temporary license.

11. When will the examinations be based on NEW code

editions or amendments? All examination items are based on the edition of the plumbing and gas fitters code currently in effect.

Preparing for an Examination

Part I. General: The examinations are administered at the PSI examination centers listed below:

Auburn 48 Sword St, Unit 204

Auburn, MA 01501 Going South on Southbridge ST/MA-12, turn right on Sword St.

Boston

56 Roland St., Suite 211 Washington Crossing

Charlestown, MA 02129 From North: Take I-93 South. Exit 28 – Boston/Sullivan Sq./Charlestown. Merge into Mystic Ave. Take I-93S Ramp to Boston/Sullivan Sq./Charlestown (take ramp do not get on highway). Make slight left turn on to Maffa Way. Make slight right turn on to Cambridge Street. At first traffic light, make left on to Carter Street. Turn right on to Roland Street. End at 56 Roland Street (Building on left, parking lot on right). Enter through North lobby. From South: Take I-93 North. Exit 28 - Rt 99/Sullivan Sq./Somerville. Make left on to Cambridge St. At first traffic light, make left on to Carter Street. Turn right on to Roland Street. End at 56 Roland Street (Building on left, Parking lot on right). Enter through North lobby. Site is also accessible by Public Transportation to Sullivan Square. The Orange Line and many buses stop here. Walking from Sullivan Station: Make a right on to Cambridge Street. About 1/4 mile on the left is

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Carter Street (will pass a Dunkin Donuts and Hess Gas station on left). Turn right on Roland St. Enter through North Lobby.

Fall River

218 South Main St, Suite 105 Fall River, MA 02721

From the North take Rte. 24S to 79S. Take Route 138S Exit. Bear right off exit. Go left at first traffic light. Take left at the second traffic light (top of hill) onto So Main St. 218 is 2 blocks down on the right. Parking: Go past 218 SO Main to 2nd light. Take right. Take another right at next traffic light. Third St parking Garage is on your right. From the East 195 West. Take 138 S / Ma 79 S exit 5 toward N Tiverton RI ( .3 miles). Follow Route 138 S toward N Tiverton RI (.1 miles). Merge right. Take Broadway Exit. Turn left at 1st light on Columbia St. Turn left at 2nd light to So Main St. Site is 2 blocks on the right.

Lawrence 1 Ballard Way, Suite 104

Lawrence, MA 01843

From the North take Rte. I-93 S to Exit 45, River Rd./S. Lawrence. Take the ramp toward River Rd./S Lawrence. Take a slight right onto River Rd. River Road becomes Andover St. Turn right onto Ballard Rd. Turn left onto Ballard Way. There is a sign for N-Tek, Inc. on the right. Turn left into the parking lot marked "Still Water Place, Ballard Way". PSI is located in the first suite on the left beneath Yellow Book and the Asian Center office.

From the South take I-93 N to Exit 45, River Rd./ S. Lawrence. Take the River Rd. ramp toward River Rd./ S. Lawrence. Turn left on River Rd. River Rd. becomes Andover St. Turn right onto Ballard Rd. Turn left onto Ballard Way. There is a sign for N-Tek, Inc. on the right. Turn left into the parking lot marked "Stillwater Place, Ballard Way".

Springfield 1111 Elm Street, Suite 32A West Springfield, MA 01089

Going East on Mass Pike (Rt. 90). Take Exit 4 - West Springfield/Holyoke. Turn right on West Springfield/Rt. 5 South. Continue on Rt. 5 approximately two miles. Turn right on Elm St. - immediately after Showcase Cinemas. Office is approximately 1/4 mile on the right. Going West on Mass Pike (Rt. 90). Take Exit 4 - West Springfield/Holyoke. Follow as above. Going South on Rt. 91. Take West Springfield/Route 5 Exit. Continue on Rt. 5 for approximately 1/2 mile. Turn right on Elm St. - immediately after Showcase Cinemas. Office is approximately 1/4 mile on the right. Going North on Rt. 91. Take West Springfield/Route 5 South Exit. Continue on Rt. 5. Follow as above.

On the day of the examination, you should arrive at least 30 minutes before your appointment. This extra time is for sign-in, identification, and familiarizing yourself with the examination process. If you arrive late, you will not be admitted to the examination site and you will forfeit your examination administration fee.

Part II.

Type/Class of Licenses: Massachusetts requires all applicants to pass an examination

for the following categories of licensure: Master Gas Fitter, Journeyman Gas Fitter, LP Gas Installer.

Taking Consecutive Examinations: As a matter of preference, you may choose to sit for both

parts of an examination on the same day. Applicants who choose to take both parts will immediately continue onto the second part of the examination. Once you enter a second part of an exam you will not be able to return to the first. You must complete one part of the examination in order to proceed to the next part.

Separate Examination Dates: As a matter of preference, you may choose to sit for only

one part of your examination and then return on another date to take the next part of your examination.

Part III.

Re-examination: Applicants who have failed an examination or part thereof

MUST wait 10-days from the last examination date to sit for reexamination.

Mail or call: PSI Examination Services

3210 E Tropicana Ave Attn: MA PL Las Vegas, NV 89121

(800) 733-9267 Fax (702) 932-2666 www.psiexams.com

NOTE 1. See Required Renewal of Application Forms Part V (Page 7).

Applicants may not take the exam more than six times without Board approval.

Part IV.

Identification of Candidates: You must provide 2 forms of identification. One must be a VALID form of government issued identification (driver’s license, state ID or passport), which bears your signature and has your photograph or a complete physical description. The other must have your signature and preprinted legal name. All identification must match the Examination Registration Form and your Registration Confirmation Notice.

Note: If you cannot provide the required identification, you must call (800) 733-9267 at least 3 weeks prior to your scheduled appointment to arrange a way to meet this security requirement. Failure to provide all of the required identification at the time of the examination without notifying PSI is considered a missed appointment, and you will not be able to take the examination.

The Examination Process

Part I.

Eligibility and Examination Registration: Eligibility for examination is to be determined by the Board

of State Examiners and its’ vendor, PSI.

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When your application has been approved, PSI will email or mail you an Examination Authorization Notice, along with information about scheduling your examination. Please allow 3 weeks for processing your application.

NOTE 1. Prior to taking examination: It is the applicant’s responsibility to immediately notify PSI, in writing of any change in information on your previously submitted application.

If your application is deemed incomplete or unqualified, PSI will return your original application, any additional documentation, examination fee and MA license fee to you for completion. Enclosed will be a notice explaining why your application could not be approved.

Part II.

Americans with Disabilities Act (ADA): All examination centers are equipped to provide access in accordance with the Americans with Disabilities Act (ADA) of 1990, and every reasonable accommodation will be made in meeting a candidate’s needs. Applicants with disabilities or those who would otherwise have difficulty taking the examination must fill out the form at the end of this Candidate Information Bulletin and fax to PSI (702) 932-2666.

Part III.

Admission/ Security to the Examination Area: The following security procedures will apply during the examination:

Cell phones, pagers, and guests are not allowed in the examination site. This policy is strictly enforced.

No smoking, eating, or drinking will be allowed in the examination site.

Copying or communicating examination content is a violation of PSI security policy and State Law. Either will result in the disqualification of examination results and may lead to legal action.

Any individual papers that are not part of a paper-back, ring-binder, spiral binder or loose leaf binder type of book, or part of a multi-paged CMR, MGL, UL, or NFPA document as described in this section MUST be removed prior to entering the examination area. Failure to comply with this may result in disqualification and forfeiture of all fees.

NOTE 1. Please see the following section for a list of “items that may be used as an aid during an actual examination” NOTE 2. Items not on this list are not allowed in the examination area.

Part IV.

Items allowed/ used as an aid during an actual examination Calculator- only non-programmable, non-printing,

silent, battery-operated, non-alphabet keys. During the examination – only writing on the scrap

paper that is provided by PSI will be allowed during the exam.

Part V.

Scores: Your scores will be based on the number of questions you answered correctly. A passing score is a MINIMUM of 70% on each part See Examinations (pages 5-6). At the end of the examination all candidates will receive a

printed Score Report. Veterans as defined in clause forty-three of section seven of

chapter four shall be granted a credit of five percent to each part of the examination. DD214 must be submitted with application.

Score Report: If you did not pass the examination, a Score Report will

indicate your overall score and the number of questions answered correctly on each major section of the examination. This information may help you prepare for reexamination.

This detail is not shown on your Score Report if you received a passing score.

If for some reason the Score Report can not be printed after you have completed your examination, PSI will mail such report within 10-days of your examination date.

Reviews and Appeals

Part I.

Candidate Comments: If during the test you believe that a test question needs

clarification, you MUST submit your comments and concerns to PSI while at the test center. You may submit your comments by typing them into the desktop computer's "Comment" button on the keyboard. Comments will be analyzed by PSI examination development staff. While PSI does not respond to individuals regarding these comments, all substantive comments are reviewed. If an error affecting examination scores is discovered as a result, which occurs very rarely, the examination scores of all affected candidates will be automatically adjusted.

Review of Examination Score: An Examination Score report shall be given to candidates,

on site, for no additional charge after completing their respective examination or part thereof. Your Examination Score report will state whether you have passed or failed and explain what part(s) of your examination you failed,

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showing your strengths and weaknesses in content areas. It will also inform you of your right to review the questions that you answered incorrectly on your examination. A request to review examination questions shall be made to PSI within 30-days from the date of examination. See Review of Question in the following section.

NOTE 1. If you need an extra copy of your Examination Score Report - such a request must be made within 30-days of the date of examination at no cost to you. After 30-days, you can write to PSI to request a duplicate of your score report for up to 1 year after your examination. The fee for a duplicate score report is $15. Money Order or cashier’s check ONLY.

Important: If an appeal, review of questions or review of score results in a change of score from failing to passing, candidates will be required to update their application to show any changes in information in their initial application. See Part V Required Renewal of Application Forms on page 7. Request for Review of Questions: Failing candidates will review their examination in a

secure environment and may challenge any questions or answers that they feel should be eliminated, changed, or given credit.

A Request for a Review of Questions shall be made to PSI

within 30-days from your examination date or the date you received your score. Failure to make such a request within the time allotted may jeopardize your right to review the examination questions.

Candidates may register for the examination review via

Automated Telephone, Internet, Mail or Fax and Pay by VISA, Mastercard, cashier’s check, company check or money order. Personal checks are not accepted. The fee for this service is the same as the cost of reexamination. See Reexamination Fees on Page 10.

During the review you will be presented with the

questions you answered incorrectly and the correct answer to those questions. The purpose of the review is to allow you to self-research the question to determine why the answer you selected was incorrect. If you feel that there is an error in the question, you may comment about the question during the review by writing down comments on the Test Question Review sheet.

All comments together with a copy of the challenged test

questions will be submitted directly to PSI’s test development staff for review. PSI will contact you within 20 business days if your status changed from fail to pass, and a new score report will be issued. Most test questions are determined to be correct as presented on the examination, so do NOT wait for a response before preparing for and scheduling for re examination.

You are not permitted to take any notes outside of the review sessions. Please call (800) 733-9267 with any questions. Examination Appeal: If after an exam review PSI maintained their failing score

and you still disagree with their findings you may file an

appeal before the Board. The appeal shall be made in writing to the Board of Plumbers and Gas Fitters within 30-days of the date on your rejection notice from PSI. In your appeal you must state the items/questions that are to be reviewed. Failure to make such a request within the time allotted may jeopardize your right to an appeal. Mail To:

Commonwealth of Massachusetts Division of Professional Licensure Board of Plumbers and Gas Fitters

1000 Washington St., 7th Floor Boston, MA 02118

Phone: 617.727.9952

Part II.

Applications for Examination: Applications for examination may be requested from PSI.

Such request may be made by phone, fax, mail (postal services). Additionally, all applications may be downloaded, e-mailed as an attachment and or printed from the Board’s and PSI’ s web sites:

www.mass.gov/reg/boards/el/forms.htm www.psiexams.com

PSI Examination Services 3210 E Tropicana Ave Las Vegas, NV 89121

(800) 733-9267 Fax (702) 932-2666

Out of state applicants must first contact the Board office for pre-approval.

Scheduling:

1. Once applications are approved, candidates are responsible for contacting PSI to schedule an appointment to take the examination. For the fast and convenient test scheduling, PSI recommends candidates schedule their exams online by accessing PSI’s registration website at www.psiexams.com 24 hours a day.

2. You may also schedule your examination touch- tone phone 24hours a day at (800) 733-9267. To schedule with a PSI registrar, call Monday through Friday, between 7:30 am and 8:00 pm and Saturday, between 11:00 am and 5:00 pm, Eastern Time. If space is available in the examination site of your choice, you may schedule an examination 1 day prior to the examination date of your choice, up to 7:00pm ET. PSI will make every effort to schedule the examination site and time that is most convenient for you. Please be prepared to offer alternate examination appointment choices.

Work Experience: Master Gas Fitter Applicants for a master gas fitter’s license shall have had a Massachusetts journeyman gas fitter’s license for not less than one (1) year. Journeyman Gas Fitter Journeyman Gas Fitter who became an Apprentice prior to 9-1-2008

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Every applicant for a journeyman gas fitter’s license shall have worked for not less than 2 years in Massachusetts as a registered gas fitting apprentice in compliance with the provisions of Section 3A of Chapter 142 of the General Laws before being eligible to take the examination. He/she must also have completed 150 hours of a day or night study in a gas fitting theory course at a state, municipal, or private school accredited by the Massachusetts State Department of Education or approved by the Board of State Examiners of Plumbers and Gas Fitters. An applicant having qualifications for examination other than those specified herein may be admitted for examination as a journeyman by a majority vote of the Board. Journeyman Gas Fitter who became an Apprentice after 9-1-2008 Every applicant for a journeyman gas fitter’s license shall have worked for not less than 3 years in Massachusetts as a registered gas fitting apprentice in compliance with the provisions of Section 3A of Chapter 142 of the General Laws before being eligible to take the examination. He/she must also have completed 330 hours of Tier curriculum study in a gas fitting theory course at a state, municipal, or private school accredited by the Massachusetts State Department of Education or approved by the Board of State Examiners of Plumbers and Gas Fitters. An applicant having qualifications for examination other than those specified herein may be admitted for examination as a journeyman by a majority vote of the Board. LP Gas Installer Applicants for an undiluted liquefied petroleum gas installer’s License shall have worked for not less than 2 years in Massachusetts as an undiluted liquefied petroleum gas installer in training before being eligible to take the examination. He/she must also have completed not less than 220 hours of Tier curriculum study in an undiluted liquefied petroleum gas installer course at a state, municipal, or private school accredited by the Massachusetts State Department of Education or approved by the Board of State Examiners of Plumbers and Gas Fitters.

Part III.

Examinations: Examinations are CLOSED BOOK, computer generated and

two parts. Examination scores are stand alone scores, i.e. each part of the examination is independent but necessary. Candidates who fail one part of an examination are only required to retake the part of the examination that they failed. However, all candidates are required to sit and pass each part of the examination for licensure. Passing scores are valid for ONE YEAR ONLY.

MASTER GAS FITTER (PART I - WRITTEN) Scope of Work A gas fitter having a regular place of business and who, by himself or journeyman gas fitters in his employ, performs gas fitting work, subject to inspection and in compliance of any law, rule, or regulation pertaining to same.

# of Questions % Required to Pass

Time Allowed

60 70 120 minutes

Content Outline

Subject Area # of

Items

General Regulations, Inspections, and Permits 7

MGL 142 Administrative (Sections 3 through 11 - 248 CMR)

Safety and Excavation

Gas Piping, Equipment, and Appliances 38

Design, Material, and Components

Inspection Testing and Purging

Underground Installation

CSST

Gas Piping Regulators

Combustion Air

Specific Equipment

Equipment Testing and Adjustment

Modifications (Sections 4 and 5 - 248 CMR) Gas Equipment over 400,000 btus (Section 7 – 248 CMR)

Venting 15

Positive/Non Positive

Natural Draft

Chimneys

Sizing

Proper Materials Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later editions of references as they become available. For Code questions, the examination will be based only on the edition of the Codebook that is listed. The following references are NOT allowed in the examination center: 248 CMR 1.00 – 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code.

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NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm

MASTER GAS FITTER (PART II - PRACTICAL) Scope of Work A person who himself does any work in plumbing and gas fitting, subject to inspection under any law, rule, or regulation.

# of Questions % Required to Pass Time Allowed

20 70 80 minutes

Content Outline

Subject Area # of Items

Gas Piping 7

Gas Venting 8

Combustion, Dilution, and Ventilation Air 5

Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later editions of references as they become available. For Code questions, the examination will be based only on the edition of the Codebook that is listed. The following references are NOT allowed in the examination center:

248 CMR 3.00 – 7.00 and 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code. NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269-9101, (617) 770-3000, www.nfpa.org Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm

JOURNEYMAN GAS FITTER (PART I - WRITTEN) Scope of Work A person who himself does any work in gas fitting, subject to inspection under any law, rule, or regulation.

# of Questions % Required

to Pass Time Allowed

60 70 120 minutes

Content Outline

Subject Area # of

Items






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CSST


Combustion Air

Specific Equipment



Venting 15


Natural Draft

Chimneys

Sizing

Proper Materials Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later editions of references as they become available. For Code questions, the examination will be based only on the edition The following references are NOT allowed in the examination center: 248 CMR 1.00 – 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code. NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the

end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm

JOURNEYMAN GAS FITTER (PART II - PRACTICAL) Scope of Work A person who himself does any work in plumbing and gas fitting, subject to inspection under any law, rule, or regulation.


20 70 80 minutes

Content Outline


Gas Piping 7

Gas Venting 8

Combustion, Dilution, and Ventilation Air 5

Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later editions of references as they become available. For Code questions, the examination will be based only on the edition of the Codebook that is listed. The following references are NOT allowed in the examination center: 248 CMR 3.00 – 7.00 and 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code. NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269-9101, (617) 770-3000, www.nfpa.org

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Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm

LP GAS INSTALLER (PART I - WRITTEN) Scope of Work A person who does any work in installing, connecting ,and moving from place to place undiluted liquefied petroleum gas salamanders, space heaters, and related equipment used in buildings under construction.


50 70 100 minutes

Content Outline

Subject Area # of

Items








CSST


Combustion Air

Specific Equipment



Venting 14


Natural Draft

Chimneys

Sizing

Proper Materials Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later editions of references as they become available. For Code questions, the examination will be based only on the edition of the Codebook that is listed. The following references are NOT allowed in the examination center:

248 CMR 1.00 – 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code. NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org

LP GAS INSTALLER (PART II - PRACTICAL) Scope of Work A person who himself does any work in plumbing and gas fitting, subject to inspection under any law, rule, or regulation.


15 70 60 minutes

Content Outline


Gas Piping 7

Gas Venting 8

Reference List All the reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge, or general industry practices. Except for Codebooks, you can use later

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editions of references as they become available. For Code questions, the examination will be based only on the edition of the Codebook that is listed. The following references are NOT allowed in the examination center: 248 CMR 3.00 – 7.00 and 11.00 Massachusetts Uniform State Plumbing Code, 2005, Massachusetts Board of State Examiners of Plumbers and Gas Fitters, State of Massachusetts General Laws, General Provisions Governing the Conduct of Plumbing and Gas Work Performed in the Commonwealth: Introduction to the Massachusetts Modifications; Amendments to 2002 Edition of ANSIZ233.1 – NFPA 54; Massachusetts Code for Gas Utilization Equipment in Large Boilers; Uniform State Plumbing Code. NFPA 54 National Fuel Gas Code, 2002, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269-9101, (617) 770-3000, www.nfpa.org Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm NFPA 58 Liquefied Petroleum Gas Code, 2001, National Fire Protection Association, 1 Batterymarch, Quincy, MA 02269- 9101, (617) 770-3000, www.nfpa.org Code of Federal Regulations - 29 CFR Part 1926 (OSHA), 2008 or 2011, Superintendent of Documents, PO Box 371954, Pittsburgh, PA 15250-7954, 888-293-6498, http://www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1 OR Code of Federal Regulations - 29 CFR Part 1926 Selections by PSI, 2008 or 2011, 3210 E Tropicana, Las Vegas, NV 89121, (800) 733-9267, www.psiexams.com, (See order form at the end of the Candidate Information Bulletin.) All items are based on either the 2008 or 2011 editions. State of Massachusetts Dig Safe Rules, 220 CMR 99.00, www.digsafe.com/documents/09-24update/MassLaw- 9_17_04wrules.pdf

MGL Chapter 142: Supervision of Plumbing, http://www.mass.gov/legis/laws/mgl/gl-142-toc.htm

Part IV.

Penalties and Refund Policies for all Examinations: 1. Failure to appear- Any candidate who fails to appear for

an examination shall forfeit ALL fees paid in connection with that examination.

2. Failing Examination- Any candidate who fails an

examination cannot sit for re-examination for a period of ten (10) days from the date of last examination or for a time period as specified by the Board.

3. Rescheduling- You may cancel and reschedule an

examination appointment without forfeiting your fee if your cancellation notice is received 2 days before the scheduled examination date.

Note: A voice mail message is not an acceptable form of cancellation. Please use the internet, automated telephone system, or call PSI and speak to a Customer Service Representative. 4. Illness- If you are too ill to take an examination on the

scheduled date, you may submit a letter from your doctor or hospital substantiating your illness (on their letter head) or any other documentation that PSI and or the Board could use in determining your illness.

5. Weather- In the event of severe weather, PSI reserves the

right to cancel any and all scheduled examinations. In such event PSI will attempt to contact each applicant that day via telephone to reschedule your examination at your earliest convenience. If they are unable to contact you at that time, they will send a written notice to reschedule the next business day.

Part V. First Time Candidate Fees: Applicants must pay the fee by VISA, Mastercard, cashier’s check or money order only, payable to PSI.

*Initial PSI Fee Per

Candidate

**PSI Application Processing

Fee

Examination Administration Fee

***MA License Application Processing

Fee

Master Gas Fitter $181 $70 $80 $31 Journeyman Gas Fitter $166 $55 $80 $31 LP Gas Installer $181 $70 $80 $31 *Fee is a sum of all fees broken down at right **PSI Application Processing Fee is good for one year. If you do not test within one year, you must pay this fee again. ***MA License Application Processing Fee is non-refundable.

***MA

License Fee

Master Gas Fitter $97 Journeyman Gas Fitter $52 LP Gas Installer $52

***The MA License Fee is charged to the candidate at the Test Center upon passing the examination. Please be prepared to pay this fee in order to obtain your license. Payment may only be in the form of VISA, Mastercard, Money Order, Cashier's Check or Company Check. Cash and Personal Checks are not accepted. Please make the Money Order, Cashier’s Check, or Company Check, payable to PSI.

Re-exam Candidate Fees: Applicants for reexamination must pay the fee by VISA, Mastercard, cashier’s check, company check or money order only, payable to PSI.

*Total PSI Re-exam Fee Per

Candidate Master Gas Fitter $80 Journeyman Gas Fitter $80 LP Gas Installer $80

* Fee is a sum of all fees broken down at right. Re-exam Fees are non-refundable.

All fees and completed forms shall be sent to: PSI Examination Services

Attn: MAPL 3210 E Tropicana Ave Las Vegas, NV 89121

VISA, Mastercard, cashier’s check, company check or money order only

The Commonwealth of Massachusetts

DIVISION OF PROFESSIONAL LICENSURE BOARD OF STATE EXAMINERS OF PLUMBERS AND GAS FITTERS

1000 Washington Street, Suite 710 – Boston, Massachusetts 02118-6100

IMPORTANT NOTICE FOR CANDIDATES WITH DOCUMENTED MEDICAL CONDITIONS

Qualified applicants for examination who are physically impaired or challenged by medical conditions documented by a Doctor / Physician may receive upon written request other Board authorized dispensation or distinct services. The applicant must enclose with the examination application, the written request of the medical information regarding any impairment; (physical or learning).

CHECKLIST FOR APPLICANTS

MASTER GAS FITTER The following must accompany your application for examination:

Journeyman Gas Fitter must provide proof of at least 1,700 hours of practical work experience over a period of not less than one year submitted on the “STATEMENT OF EXPERIENCE” form located on page C. (Photostats of these statements are unacceptable and will be returned.)

Journeyman Gas Fitter must provide proof of completing 50 hours of gas fitting theory or proof of completion of the 110 hour Tier 3 gas fitting program. (School completion certificates may be submitted but will not be returned)

VETERANS: Must submit a clear legible copy of your DD form 214. (Status determined by legislation)

OUT OF STATE/COUNTRY APPLICANTS

The Board of State Examiners of Plumbers and Gas Fitters does not have reciprocity with any other state. Please refer to the current Board policy on our website at: www.mass.gov/dpl/boards/pl for more details.

NOTE

It is the sole responsibility of the applicant to be certain that all of the instructions as outlined in all of the informational notices supplied with this application are followed. National Assessment will notify only those applicants who meet Board requirements.

The Commonwealth of Massachusetts DIVISION OF PROFESSIONAL LICENSURE

BOARD OF STATE EXAMINERS OF PLUMBERS AND GAS FITTERS 1000 Washington Street, Suite 710 – Boston, Massachusetts 02118-6100

MASTER GAS FITTER EXAMINATION APPLICATION

1. Name Last First Middle Email

2. Permanent Address Number Street Apartment Number

City/Town State Zip Code

3. Date of Birth Place of Birth

4. Maiden Name/Other Name

5. Home Phone Work Cell

6. Social Security Number (Required) Pursuant to G.L. c.62C, s. 57A, the Division of Registration is required to obtain your social security number and forward it to the Department of Revenue. The Department of Revenue will use your social security number to ascertain whether you are in compliance with the tax laws of the Commonwealth.

7. List any licenses/certifications you hold in another state or country of foreign jurisdiction and the state or jurisdiction from which the license/certificate was originally issued. Please attach a Record of Standing from each state or jurisdiction in which you are licensed/certified indicating the status of your license and any relevant disciplinary information

8. Has any disciplinary action been taken against you by a licensing/certification Board located within the United States or any foreign jurisdiction? Yes No

If you answered yes, please provide a detailed description. (use a separate sheet if necessary)

9. Are you the subject of pending disciplinary actions by a licensing board located in the United States or any other country or foreign jurisdiction? Yes No


A

10. Have you every voluntarily surrendered or resigned a professional license to a licensing or certification board in the United

States or any other country or foreign jurisdiction? Yes No If you answered yes, please provide a detailed description. (use a separate sheet if necessary)

11. Have you ever applied for and been denied a professional license in the United States or any other country or foreign jurisdiction? Yes No If you answered yes, please provide a detailed description. (use a separate sheet if necessary)

12. Have you ever been convicted of a felony or misdemeanor in the United States or any other country or foreign jurisdiction other than a traffic violation for which a fine of less than $100.00 was assessed? Yes No


The Board is certified by the Criminal History Systems Board [ID# MAREG G] to access data about convictions and pending criminal cases. Those records and other Federal and professional records may be checked as part of your licensing process. No records are automatic disqualifiers; you will be given an opportunity for a limited appearance before the Board.

13. I certify, under pains and penalties of perjury, that the information I have provided pursuant to this application for licensure is

truthful and accurate. I understand that failure to provide accurate information may be grounds for the Massachusetts Board of Registration of Plumbers and Gas Fitters to deny me the right to sit as a candidate or the suspend or revoke a license issued to me in accordance with Massachusetts Law. I further attest that, pursuant to G.L. C.62C, S. 49A., to the best of my knowledge and belief, I have filed all State tax returns and paid all State taxes required by law.

Signature of Applicant Date

Subscribed and sworn to, before me, this day of 20 Notary Signature My commission expires

.

B

2” x 2” passport photograph

Please attach a photograph

taken no longer than six months ago.

NOTARIAL SEAL

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 02118-6100

STATEMENT OF EXPERIENCE AND EDUCATION

FOR MASTER GAS FITTER EXAM TO THE BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS: In connection with my application for a master gas fitter license, I submit the following verification of education and experience:

THE FOLLOWING IS TO BE COMPLETED BY THE APPLICANT

Type or Print Name Clearly First Middle Last Residence

Number Street City or Town Zip Code

Journeyman Gas Fitter Registration Number and Date of Issue Number Original Date of Issue

THE FOLLOWING IS TO BE COMPLETED BY SCHOOL OFFICIALS

Subject to the rules set forth in Section 4 of Chapter 142 of the General Laws, I subscribe to and vouch for the statement made by:

Name of Applicant: (Type or Print Clearly) Address

Name of School Address

From To Date of Enrollment Date of Completion of Course or Graduation During that time, the student successfully completed the following (check one) which meets the requirements of 248 CMR 11.00

110 hour Tier 3 Third Year Lesson for Journeyman Gas Fitter Licensure

50 hours of Gas Fitting Theory

Name of Designated School Official – Type or Print Title Signature of Designated School Official Date Name of Plumbing or Instructor – Type or print Master License Number Signature of Plumbing or Instructor School Phone Number


C

VISA, Mastercard, cashier’s check, company check or money order only. Credit card (MasterCard or VISA) payment accepted for phone or fax review/re-exam registrations only. MC Visa

Card No:___________________________________________________________ Exp. Date:________________________________

Card Verification No:__________________

For your security, PSI requires you to enter the card identification number located on your credit card. The card identification number is located on the back of the card and consists of the last three digits on the signature strip.

Cardholder Name (Print):______________________________________ Signature:___________________________________________

Notice and Instruction sheet for CORI Acknowledgement Form

Dear Licensee: If your license application indicates that you checked “Yes” in the response to question number 12 regarding the existence of any criminal convictions, the Board will need to review your Criminal Offender Record Information (CORI) record prior to proceeding with the processing of your application. As noted on your application form, the Board is certified by the state of Massachusetts Criminal History Systems Board to receive from it and review criminal conviction and pending criminal case information. In order to do so, the Criminal History Systems Board requires that the licensee be placed on notice that a CORI check will be performed. Please complete the following CORI notification acknowledgement form and return it along with this letter and your completed application immediately to PSI. Any delay in returning this form will delay the processing of your application for examination. Upon receipt of this acknowledgement form, the Board will request and review your criminal record. If it is necessary for you to appear before the Board to answer questions regarding your CORI data, you will be notified in writing in advance. If it is not necessary for you to appear before the Board after your criminal record is requested and reviewed, the Board will continue processing your application for examination. Sincerely, Joseph A. Peluso Jr. Executive Director Board of Examiners of Plumbers and Gas Fitters Enclosure




CORI ACKNOWLEDGEMENT FORM

I acknowledge that: The Division of Professional Licensure has been certified by the Criminal History Systems Board (ID# MAREG G) to access the data about my convictions and pending criminal case data. As an applicant/licensee for , I understand that a criminal record check will be Plumbing, Gas Fitting, Electrical, other

conducted to review applicable convictions and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowledge. Applicant/Licensee Signature

APPLICANT/LICENSEE INFORMATION (PLEASE PRINT) _______________________________ ___________________________ __________________ LAST NAME FIRST NAME MIDDLE NAME ___________________________________________ MAIDEN NAME OR ALIAS (IF APPLICABLE) DATE OF BIRTH: ____________________ SOCIAL SECURITY NUMBER_________-_________-_________ (Mandatory)

ADDRESS: ______________________________________________________________________________ ___________________________________________________________________________

CHSB USE ONLY RECORD ATTACHED:________ NO RECORD:__________







JOURNEYMAN GAS FITTER The following must accompany your application for examination:

Apprentice Gas Fitter licensed prior to September 1, 2008 must provide proof of at least 3,400 hours of practical work experience submitted on the “STATEMENT OF EXPERIENCE” form located on page E. (Photostats of these statements are unacceptable and will be returned.)

Apprentice Gas Fitter licensed on or after September 1, 2008 must provide proof of at least 5,100 hours of practical work experience submitted on the “STATEMENT OF EXPERIENCE” form located on page E. (Photostats of these statements are unacceptable and will be returned.)

A copy of your high school diploma or equivalent Apprentice Gas Fitter licensed prior to September 1, 2008 must provide proof of completing 150 hours of gas

fitting theory over a period of not less than two years submitted on the “VERIFICATION OF SCHOOL” form located on page C. (School completion certificates may be submitted but will not be returned)

Apprentice Gas Fitter licensed on or after September 1, 2008 must provide proof of completing 330 hours of gas fitting theory over a period of not less than three years submitted on the “VERIFICATION OF SCHOOL” form located on page D. (School completion certificates may be submitted but will not be returned)




NOTE




JOURNEYMAN GAS FITTER EXAMINATION APPLICATION













A

10. Have you every voluntarily surrendered or resigned a professional license to a licensing or certification board in the United States or any other country or foreign jurisdiction? Yes No If you answered yes, please provide a detailed description. (use a separate sheet if necessary)









.

B




NOTARIAL SEAL




FOR APPLICANTS WHO REGISTERED AS A GAS FITTING APPRENTICE BEFORE SEPTEMBER 1, 2008*

VERIFICATION OF SCHOOL AND SHOP HOURS FOR 150 HOUR GAS FITTING PROGRAM

TO THE BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS: In connection with my application for a journeyman or master gasfitter license, I submit the following verification of schooling: Name of Applicant: (Type or Print Clearly) Address Signature of Applicant Date


Subject to the rules set forth in Section 4 of Chapter 142 of the General Laws, I subscribe to and vouch for the statement made by:


Name of School Address From To Date of Enrollment Date of Completion of Course or Graduation

During that time, the student successfully completed the following which meets the requirements of 248 CMR 11.00

hours of basic gas fitting theory for Journeyman Gas Fitter Licensure

As a full time day student who graduated with a plumbing certificate, the student successfully completed: hours of shop under the supervision of a licensed plumber or gas fitter and obtained

hours of theory

Name of Designated School Official – Type or Print Title Signature of Designated School Official Date Name of Gas Fitting Instructor – Type or print Master License Number Signature of Gas Fitting Instructor School Phone Number *Refer to 248 CMR 11.02 (3) (a)

C




FOR APPLICANTS REGISTERED AS A GAS FITTING APPRENTICE

AFTER SEPTEMBER 1, 2008*

VERIFICATION OF SCHOOL AND SHOP HOURS FOR 330 HOUR TIER GAS FITTING PROGRAM

TO THE BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS: In connection with my application for a journeyman or master gasfitter license, I submit the following verification of schooling:




Subject to the rules set forth in Section 4 of Chapter 142 of the General Laws, I subscribe to and vouch for the statement made by: Name of Applicant: (Type or Print Clearly) Address Name of School Address

From To Date of Enrollment Date of Completion of Course or Graduation

During that time, the student successfully completed the following which meets the requirements of 248 CMR 11.00

110 hour Tier 1 First Year Lesson for Journeyman Gas Fitting Licensure

110 hour Tier 2 Second Year Lesson for Journeyman Gas Fitting Licensure

110 hour Tier 3 Third Year Lesson for Journeyman Gas Fitting Licensure

As a full time day student who graduated with a gas fitting certificate, the student has also successfully completed hours of shop under the supervision of a licensed gas fitter.

Name of Designated School Official – Type or Print Title Signature of Designated School Official Date Name of Gas Fitting Instructor – Type or print Master License Number Signature of Gas Fitting Instructor School Phone Number *Refer to 248 CMR 11.02 (3) (b)

D




STATEMENT OF EXPERIENCE FOR GAS FITTERS

Erasures, Mark Overs or White Outs are Unacceptable



Apprentice Gas Fitter Registration Number and Date of Issue: Number Date of Issue

EMPLOYERS STATEMENT This is to certify that: was employed by me as a licensed Gas fitting apprentice performing supervised gas fitting from:

To Month/Day/Year Month/Day/Year (to present is unacceptable)

Total hours employed by me as a licensed apprentice performing supervised gas fitting during this time: Note: Vocational school Co-op employment hours may not be included. Company or Corporation Name Master License Number and Date Originally Issued Business Address Street City or Town Zip Code Phone

Can you produce Social Security Records for this person? Yes No If you checked NO in the box above, please explain As the employer I hereby certify that the above statements are true and are made subject to the penalties of perjury. In addition, I certify that for the entire time listed above, the applicant worked for me as an apprentice gas fitter and not as an independent contractor or a subcontractor performing non-gas fitting work.

Signature of Employing Master Gas Fitter PHOTOSTATS OF THESE SHEETS ARE UNACCEPTABLE

E


Card No:___________________________________________________________ Exp. Date:________________________________











ADDRESS: ______________________________________________________________________________ ___________________________________________________________________________








UNDILUTED LIQUEFIED PETROLEUM GAS INSTALLER

The following must accompany your application for examination:

Undiluted Liquefied Petroleum Gas Installer in training must provide proof of at least 3,400 hours of practical work experience over a period of no less than two years submitted on the “STATEMENT OF EXPERIENCE” form located on page D. (Photostats of these statements are unacceptable and will be returned.)

A copy of your high school diploma or equivalent Undiluted Liquefied Petroleum Gas Installer in training must provide proof of completing 220 hours of gas fitting

theory over a period of not less than two years submitted on the “VERIFICATION OF SCHOOL” form located on page C. (School completion certificates may be submitted but will not be returned)




NOTE




LP GAS INSTALLER EXAMINATION APPLICATION













A

10. Have you every voluntarily surrendered or resigned a professional license to a licensing or certification board in the United States or any other country or foreign jurisdiction? Yes No If you answered yes, please provide a detailed description. (use a separate sheet if necessary)









.

B




NOTARIAL SEAL




VERIFICATION OF SCHOOL AND SHOP HOURS

220 HOUR TIER LP INSTALLER PROGRAM

TO THE BOARD OF STATE EXAMINERS OF PLUMBERS AND GASFITTERS: In connection with my application for an undiluted liquefied petroleum gas Installer license, I submit the following verification of schooling: Name of Applicant: (Type or Print Clearly) Address Signature of Applicant Date


Subject to the rules set forth in Section 4 of Chapter 142 of the General Laws, I subscribe to and vouch for the statement made by: Name of Applicant: (Type or Print Clearly) Address Name of School Address From To Date of Enrollment Date of Completion of Course or Graduation During that time, the student successfully completed the following which meets the requirements of 248 CMR 11.00

110 hour Tier 1 First Year Lesson for LP Installer Licensure

110 hour Tier 2 Second Year Lesson for LP Installer Licensure

Name of Designated School Official – Type or Print Title Signature of Designated School Official Date Name of Gas Fitting Instructor – Type or print Master License Number Signature of Gas Fitting Instructor School Phone Number

C




STATEMENT OF EXPERIENCE FOR UNDILUTED LIQUEFIED PETROLEUM GAS INSTALLER

Erasures, Mark Overs or White Outs are Unacceptable



EMPLOYERS & SUPERVISORS STATEMENT

A. SUPERVISOR STATEMENT: (May be filled out by the same individual) This is to certify that: was supervised by me as an undiluted liquefied petroleum gas installer in training performing supervised LP work from:

To Month/Day/Year Month/Day/Year (to present is unacceptable)

Total hours supervised by me as a undiluted liquefied petroleum gas installer in training performing supervised LP work during this time: Company or Corporation Name LP Installer License Number and Date Originally Issued: Business Address Street City or Town Zip Code Phone

Can you produce Social Security Records for this person? Yes No If you checked NO in the box above, please explain

Signature of supervising LP Installer:

B. EMPLOYER STATEMENT: As the employer I hereby certify that the above statements are true and are made subject to the penalties of perjury. In addition, I certify that for the entire time listed above, the applicant worked for me as an undiluted liquefied petroleum gas installer in training under the supervision of a licensed LP Installer and not as an independent contractor or a subcontractor performing non-LP work.

Signature of Employer: PHOTOSTATS OF THESE SHEETS ARE UNACCEPTABLE

D


Card No:___________________________________________________________ Exp. Date:________________________________











ADDRESS: ______________________________________________________________________________ ___________________________________________________________________________


SPECIAL ARRANGEMENT REQUEST FORM

All examination centers are equipped to provide access in accordance with the Americans with Disabilities Act (ADA) of 1990. Applicants with disabilities or those who would otherwise have difficulty taking the examination may request special examination arrangements. Candidates who wish to request special arrangements because of a disability should fax this form and supporting documentation to PSI at (702) 932-2666. Requirements for special arrangement requests You are required to submit documentation from the medical authority or learning institution that rendered a diagnosis. Verification must be submitted to PSI on the letterhead stationary of the authority or specialist and include the following: Description of the disability and limitations related to testing

Recommended accommodation/modification

Name, title and telephone number of the medical authority or specialist

Original signature of the medical authority or specialist

Date_________________________________________________

Legal Name:

Last Name First Name

Address:

Street City, State, Zip Code

Telephone : ( ) __________ - _______________ ( ) __________ - ______________

Home Work

Email Address:

Check any special arrangements you require (requests must concur with documentation submitted): Reader (as accommodation for visual impairment or learning disability)

Extended Time (Additional time requested:______________)

Large-Print written examination Other____________________________________

Complete and fax this form, along with supporting documentation, to (702) 932-2666. After 4 business days, please call 800-733-9267 x6750 and leave a voice message. PSI Special Accommodations will call you back to schedule the examination within 48 hours.

DO NOT SCHEDULE YOUR EXAMINATION UNTIL THIS DOCUMENTATION HAS BEEN RECEIVED AND PROCESSED BY PSI SPECIAL ACCOMMODATIONS.

BOOKS AND MORE ARE NOW AVAILABLE AT THE PSI ONLINE STORE!

To place an order for one or more of the following items listed, you may: Call the PSI Online store toll-free at (866) 589-3088

CERTIFICATE OF ACHIEVEMENT (You must have passed the exam before ordering the certificate) Certificate of Achievement suitable for framing.

NFPA 54 National Fuel Gas Code

29 CFR Part 1926 Selections

Please note: Inventory and pricing subject to change without notice.

You may also place a checkmark next to the items that you would like to order, and fax this form to PSI (be sure to include your contact information). A Customer Service Rep will call you to place the order.

FAX to:

PSI licensure:certification Fax (702) 932-2668

Name_________________________________________________________________________________________ Address________________________________________________________________________________________ City______________________________________________________State______________________Zip________

Phone Number__________________________________________________________________________________

PSI Services LLC

3210 E Tropicana Las Vegas, NV 89121

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