HomeMy WebLinkAboutinstall oil burner 2005Application for Permit, Permif and Certificate of completion for the Inssllarion or
Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oil
6 ?l 0)
(ciry or Town)arc)
permit #'s: *o5-/oJ EIcc.-..-..---.FDID*: O
Owncr/Occupant Narn", ChC, : Nohw ra *
ft5trll4ie1r Addlcss: 1D 0,AlL {.A"-
-a ^ (>a
Fec Paid: e( o
Scrviced Floor or Unit * a=_...._v_
(J Hcating Unir E Domcstic warcr Hcacr E Powcr Vcnr El Other
Q Ne', tr e*sting locadon: .^nl]il^[ f.orvn ,[1 o[ qAfage-z
TyPe 0';{.t
Bumer:
Trade Name: $r*tr" o'ru'5 *tt c4r^p,..
o Model # or Size:L el{ Locadon:,yliw (ry
{ Fucl OiI E Ksosenc E Wase oil
Stonge Tank Q X"', E Exisdng Location:
Type:Capaciry:n5 gals. No. of Tanks:
Spccial rcquiremens (or additionai safery devices)
4o f(
tr OSV Valve / ou rin grotecred tr Shcet Rock EI Sp;ntler
Combusdon Tcsr Nozzle Size t,l0 .ltUo tlJ Gross Sack Tcnrp .. 1rf0 N"l Ho
New Stack Tcrnp.:
Smoke: D
,r olo
AFUE: EI yes EI no
o
Breech Drafr .OL
o
CO lTcst rl
Efficiency adng ?o:
I, the undersigned cenifl that the installation of fuel buming equipment has tren made in accordance with M.G.L. c. 148 and 527 CMR 4.00
cunendy in effect. Furthermore, this installarion has been tested in accordance with such requirements, is now in proper operating condition and
complete instructions as to its use and flraintenance have been fumished to the perrcn for whom the insrallation (or alteration) was made.
Co. Name AC[",t Tel. *ro3 3lu -rl3l
Address &City:h,tl\,ra, n*zip oL]}q(
Installer Co
Pn'ni Ndme (no S.arnp)
Ovafi:c Drafi:4o'lo
nLlllL
lnspected by: Date:-
wHtIE COPY: Prop€rty owne/s copy; cAIAnY COPY| Y.F.0. Copy - netum when iob i! complet€d; PINK coPY 'Ihis copy must be posted at installation'
tfrz Comnonutea.ttfr. of grtass a{us et8
Deporanart ,f 9"6fu S"ftty
527 CMR 4.00
Form I
I
Once signed by the fire department, this is a PERMIT for the storage and use of oil buming equipment.
'n- a- *E,/d ,/-/(""*"1"'e'" '- Jeirirxem oF FuBLlc sArElY
Licensc: OIL BURNER TECHNICIAN
Numbsr: BU 114112
Birthdate:07/08/1970
Expir6: 07/08/2006
Restricted:00
h. not 2747.0
MARK J CORDERY
20 HOWLAND RD
BERKLEY, MA O2Z9
q/* -r,r4
Commlsslonar /
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