HomeMy WebLinkAboutoil tank install 2007?
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afiz Coruttonuteo[ti of *{us adtus etfs
Deptoranant of t rhfu. Sofetg
527 CMR 4.00
Form I
Application for Permit, Permit, and Certificate of completion for the Insallarion or
Alteration of Fud Oil Burning Equipment and the Storage of Fuel Oil
(Gry or Town)@ate)
Fee Paid:Permit #'s: FD Elcc.- FD
Owner/Occupant Name:
Insullation Address: /
El Hcarin g Unit omcstic Warcr Hearcr E Power
Tci f,
/Scrviced Floor or Unit *:
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Bumcr:dN".,tr Existing
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E other
2
Trade Name:Mfg:,<a
kA T
Type:
F Fuel oil E Kcroscne
Sorage Tanb E New
Model # or Size:€ls',4t
Type:Aatfltto//
E Wasrc oil
E- g*isting Location:rttd-g,Je-
Capaciry:2zs ga1s. No. of Tanls:
Spccial requiremcns (or additional safety dcviccs)
E osv vaivc EI Oit tile prorectcd B Sheer Rock E Sprinklcr
7{
AFUE:Elycs E no
z/33Combusrion Tcsc Noz:ic Sizc
Ncw Sack Tcmp,: CO lTcst
Gross Stack Ternp.:
Brcech Drafc/?.7%o6
Smokc:,Ot Efficiency radng 7o:sY/
l, rh€ uhdersign€d ceftifu that thc installation of fuel buming cquipment has hceo made in accordance with M.C.L. c. 148 and 527 CMR 4.00
currently in effect. Furdrermore, this installation has been testcd in accordance with such rcquircmeots, is now in proper opemting condition and
complete insEuctions a5 to its use and nraint nance have been fumished to the person for whom the installation (or alteration) was made.
Co. Name /ono,*eatiac Te[. :r ffi--w77a"2
Address City:Zi
Installer:e
Pnn, Ndme Simartre (no StanP)
department,is a PERMIT for the storage and use of oil buming equipment.
lnspected by:Date:
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WHm Copyr propedy oyfie/s copy; CANARY COPYI Y.F.D. Copy. Rdum nhen iob b complelsd; PINKCOPY-Tnl! copy mu3t be posted st installstion.
riz lot
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Location:,4 jta
0vcr6re Draft:
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Once signed by the