HomeMy WebLinkAboutnew oil burner 2001.4.Ifu Cormonanoltft. of 9l{ass aduts ets
Depo*nar ,f 9"5fu Sofrty
527 CMR 4.00
Form 1
Buraer:
- Trade Name:Mfg:
Tlpe:ci7 OIL ' Modcl # or Size:*{/f o/'l Locadon: B&seueru*
dru.tort tr Kcroscnc E Wasc oil
Storage Tan-k E Ncw d*,*,Location:
Type:#>Capaciry:27{gais. No. of Tanls:
(City or Town)@are)
Permir *'s:pp gl -06'1 6.9.FDID#: _Fec I'aid:l/ zo'oo
Owner/Occupant Name:NER,E Tcl fl:
lnsullarion Address:z z SPat 13 r-rt? n-l Scsiced Floor or Unit tr ;$ f,
Application for Permit, Permit, and Certificare of completion for the Installation or
Atteration of Fud Oit Burning tvffi"Afrt the Storage of Fuer Oil J_ZZ _o i
/tl"arirrg uoit E Domestic warcr Heatcr E Power vcnt E orhcr
/*"*EI fxisting location:
I
E osv valve EI Shect Rock E Sprinklcr AFUE: E yes E no
Combusdon Tcsr Nozzlc Sizc Gross Stack Tcrnp.:
Brcech DrafcNew Stack Tcmp.: COlTcsr
Smokc:Ovcrtire Drafr Efficicncy rati.ng 7o:
I, the undenigned certify that the installation of fuel huming equipment has been made in accordance with M.C.L. c. 148 and 527 CMR 4.00
curre.,tly in ekect. Furthermore, this installation has been tested in accordance with such requrrements, is now in prcper op€rating condition and
complete instructions as ro its use and rnaintenance have been fumished to the person for whom the installation (or alteotion) was made.
Co. Name tr Te[. #
Address ,z Ciry zip:
lnsta er:^ffi
q sqb
A^"protected
r Name OZ Signa.lrfe (no Samp)
once signed by the fire department, this is a PERMIT for the storage and use of oil buming equipment
lnspected by Date:
t r..l
BrJRnJ Al,t4
Special requirerrenB (or additional safery dcvices) N eqt fl , a , t n '
54(als
wHITE COpy: property owne/s copy; CANARY COPY: Y.F.O. Copy. Return when iob is completed; Plt'lK coPY'This copy musl be Posted at inst.llation.