HomeMy WebLinkAboutinstall oil burner 2007A,.Tfiz. Comnonueoltft of fo{ass at{tus et*
Depornwtt "f Pn6fu Sofrty
527 CMR 4.00
Form i
Application for Permit, Permit, and Certilicate of completion for the Insrallation or
Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oit
(Gry or Town)
Permit#'s:FD..c"rr', Elcc.- EOIW ,. -/ 4
Owncr/Occupant Name:Tcl *t
(Dalc)
Fee Paid:
Serviced Floor or Unit #:
-
[n5rrll1gi6s
>ch
'l B^rl4 /] t<
EJ Headng Unit E Domcstic warcr Hearcr EI Fower venr E other
-
Bumer:EI Nc* E Existing [.ocarion
Trade Name:Mfg:
Type: .' Modcl * or Size:
E Fucl Oil E 6coscac E] Y/asa oil
t Locarion:
Storage Tank EI Nel* E exisdng Location:
Type:Capaciry:
Special requiremcns (or addirional safcry &vices)
gais. No. of Tants:
E osv valvc d Oi, tin. protected E Shcct Rock E Sprinllcr AFUE: E yes EI no
Gross Suck Tcrnp.:
Brcech Draft
Combusdon Test Nozzie Sizc
Ncw Suck Tcmp,: COlTcsr
Smoke:Ovcrfire Drafc Efficienry rating 7o:
le t. -Co. Name
Address tity:e. y zip
Sigaarre (no SamPl
/'lr 6' fio
Prin! Name
Once signed by therfire denarfment, this is a PERMIT for the storage and use of oil buming equipment.
Inspected by:Date:t b/) .t/07
Pr, " ?.o (
1I
i)ro/
.ol
3? 7,
l, rhe undcrsigned certify rhat rhe installation of fuel buming equipment has been made in accordance with M.G.L. c. 148 and 527 CMR 4.00
currcntly in ekect. Fonhermore, this irrstallation has becn testcd in accordance with such requitemedE, is no$, in proper operating condition and
complete inst uctions as to its use and maintenance have been fumished to the petson for whom the installation (or alteration) was made9;5 - o(o::'l l'a: iz;--
-//"./-, RJ
,l E. Pno,,"tlnstaller:
WHm Copyr property owner,s copy; CANABY C0PY: YF.o. Copy. Eetum when job is completed; PINK COPY -This copy must be posted at installalion
t
I
Tr. no: 752 0 .
MICFAEL E
18 TJULLOCK
e FREETOWN,