HomeMy WebLinkAboutinstall oil burner 2005afie Cotrmtorrutea.{tfr of Mass a{tus ets
Dcporanart ,f e"bfu Sofrty
527 CMR 4.00
Form t
Application for Permit Permit and Certificate of completion for the Insullation or
Alteration of Fud Oil Burning Equl nt Storage of Fuet Oil
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(ci or Town)@
Permir #'s: FD os- tol Eec.FDID#: d lJ.I/
Owner/Occupant Name:Tcl
ln5trll i6n AddrcsS:Serviced Floor or Unit *i
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p
Ire."ting Unir EI Domestic Warcr Hcacr EI Power Vcnr E Orhcr
Bumer:Fft"'"E er:sting [.ocarion:BnseYN (l't T
Trade Name: 6 t l(ufie6 Mfg:NNO
TyPe ni,\ fivrAlll Modei # or S Pocation:Btts €n €hr
p fucr Oif E Kcroscnc E Wastc oil
Storage Tank EI Nct p e*itting Locadon:BaSe-mtnf
Type:SrEY I C:paciry:R gals. No. of Tants:
Special requiremens (or addidonal safcry devices)
E Osv valvc poif fin. grotecred E Shea Rock E Sprinkter AFUE: E ycs E no
Combusrion Tesr Nozzic Sizc Gross Suck Tcnrp.:
New Suck Tcrnp.:
Smokc:
COlTcsr Breech Drafr
Efficiency rating 9o:
I, the undersigned ccnif'y that the installation of fuel buming equipment has tleen rnade in accordance with M.G.L. c. 148 and 527 CMR 4.00
currcndy in effect. Furthermor€, this iflstallation has been tested in accordance with such requirements, is now in proper operating condition and
complete instructions as ro iG use and rnaintenance have been fumished to the perrcn fot whom the installation (or alteration) was made.
Ovcrfire Drafr
Co. Name s b n
Address,s? hth;l€r Falh City
d h 6$ 3? P-6 9t
zip RL(I
Insta er l)J
Pant Name Signaure (no {^,pl
Once signed by the fire department, this is a PERMIT for storage and use of oil buming equipment
Inspected by:Date:
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wHm COPYr Property owner's copy; CANARY COPY: YED. Copy . Retum when iob i! completed; Plt{( CoPY -This copy m0st be posted at installation
Fcc Paid: 4h, 6b
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