HomeMy WebLinkAboutinstall oil burner 2005'ffu Comaorrututtrt. of *{oss aitus et*
Deporanant ,f 9"5fu Sof"ty
527 CMR 4.00
Form I
Application for Permit, Permit and Certificate of completion for the lnstallation or
Alteration of Fuet Oil Burning Equipment and the Stomge of Fuet Oil
@atc)
Fcc Paid:
Owncr/Occupanr Name:
[nstell4iel Addrcss:
R,:n
EJ Hcadng Unit
Bumer: ENcw
Trade Name:
@Fuei Oil E Kerosarc EI Wasrc oil
Storage Tank E New frnstrrg Location:
J Tcl fh s?/-5 7s2
Serviced Floor or Unit f
-
6,4se ruc*'t-
Capaciry:e7€ga.ls. No. of Tanls:
^EDomcstic Warcr Hcarcr E Powcr vcnr EI Orhcr
E Existing Locarion €/n e2 r
RnCh3 )€
3)Locadon:ks€/ht-zr
TyPe
Special requirenrcns (or addirional safery devices)
E osv valve pOu *. prorecled d-Sh.o Rock E Sprintlcr AFUE: E yes El
. 7{x r0a Gross Stack Tcrnp.:L/6t V&r'Combusrion Tcsc Nozzle Sizc
New Suck Tcmp.: COlTcst BrcechDrafc ,O Y-
Tel. *
Zip:L)eGL q
Sr'gruture (no Siarnp)
Smoke:o Ovcrfire Drafr ,.0 L Efficicnry rating 9o:
Address
,h;7TJ
City:
lnstaller I
Print Ndme
Inspected by:
F7%
l, the undersigned ceaify that the insrallation of fuel buming equipment has been made in accordance with M.C L. c. 148 and 52? CMR 4.00
currenrly in eifecr. Furthermore, this installation has been tested in accordance with such requirements, h now in ProPer operating condirion and
complere instrucrions as to its use and maintenance have been furnished to the person for whom the installation (or alteration) was made.
Co. Name s +C)-6?otn,,)
Once signed by the fire depaftment, this is a PERMIT e storage and use of oil burning equipment
f)rtet
WHITE CoPY: Property owner's copy; CANARY coPY: YF'D copy - Relurn when iob is completed; PINKCOPY'Ttis copy must be posted 8l installation'
(Gry or Town)
Pcrmit #'s: FD _ Bec. _ FDID* J r ,
ryp", ft)nd L(ffi r-uodct # or Size:
Op
, VxmuL
ll
.\afie Conarunatea[tfi. of *{ass atfius et*
Deporanar of 9"6fu Sof"ty
527 CMR 4.00
Form i
Application for Permit, Permit and Certilicate of completion foi the Insrrllation or
Alteration of Fuel Oil Burning Equi and the Storage of Fuet Oil
or Town)
t
@arc)
Fce Paid:L-L)
s 7s2
oEPermir #'s: FD 05-ln3 Elcc.
Rm
FDID#:
EUJ let tn
613
Owncr/Occupant Namc:
fu5reil4i611 Ad&css:
EJ Headng Unir
Burner: F l.[cw
Trade Name:
E Exlsting l.ocadon
Serviced Fioor or Unit fr
-E[bomcsric warcr Heacr E Powcr vcnt E othcr
Bx e)-2'f
g:Roah 3a6
TyPe , -._r //ctfua odcl # or Size:3ae Locarion:4-/hPV*&ss
pFucl Oil EI Kcroscnc E Wasrc oil
Storage Tank EI New frra"*^e Locadon:6lsd mc"tr-
Type:srk/Capaciry:a7.f gals. No. of Tants:
Special requiremcns (or additional safery dcvices)
E osv valvc 1&Or t" protecred E Shcct Rock E Sprinllcr AFUE: E ycs E no
Combustion Tcsc Nozzle Size
New Stack Tcrnp.: COlTcsr
Gross Suck Tcrnp.:
Breech Drafc
Smoke:Ovcrire Draft:Efficiency rzing 9o:
cordance with M.C.L. c. 148 and 527 CMR 4.00
rements, is now in proper operating condition and
rhe installation (or alteGtion) $,as made-
Date
l, the undersigned cenify that the installation o{ fuel buming equipment has been made in ac
cunently in effect. Furthermote, this installation has been tested in accordance with such requi
complete instructions as to its use and mainrenance have been furnished to the person {or whom
Co. Name s 01 n a {!.oal: I [v1 Tcl "gb - 6701
Address -t7 /0h;7T-s City:Pr'lL OEGLzip:
Installer:-S
Print Narne Sicnalrrre (no S@nP)
Once signed by the fire department, this is a PERMIT storage and use of oil buming equipment.
lnspected by:
wHtTE COPY: Prop€rty owne/s copy; CANABY COPY: YF D Copy ' neturn when iob is compleled; PIN( COPY'This copy must be posted at insttllation
lL a*-"*,&t q -.k-.-,i,.4&,
OCPANTIENT OF PU'LIC SAFETYLic. .: olL EUnfl€R TECHNICIAN
Numb.t: BU 1035tG
llrffia: 01104/t 986
Errlrr: 0liot205 ?r- m: 2919.C
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