HomeMy WebLinkAboutnew oil burner 2009&-\afiz Compnanaltft of !|,{tss aduts et*
Depor*wt ,f e"bfu S"f"ty
527 CMR 4.00
Form I
Application for Permit, Permit and Certificate of completion for the InsEllation or
Alteration of Fuel Oit Burning E t and e Storage of Fuet Oil
(Ci or Town)
FDro*:1)l15 I Fec PaiPermit #'s: FD
Owner/Occupant N
Insullaaon
Heating UnirK,Bumcr:
Trade Name:
Type:
I, the
compl
Co. Name
E Exlsting [ocadon:l?*""r*
Mfg:
Modci # or Size:Locarion:
Fuci Oil E Kcroscac E Wasc oil
Srorage Tank E New ,K, Locarion:thu.,*
Typc:I Capaciry:11-{gais. No. of Tanks:
tr OSV Valve Oil linc prorccted E Shc"t Rock E Sprinllcr AFUE:
%
ycs E no
Gmss Stack Tcng.:
Brcech Drafc .o
.ol Efficieac;r rating 7o:
undersiSned ce(ify that the installation of fuel buming equipment has been made in accordance with M.C L. c. 148 and 527 CMR 4.00
.tly ln effect. Furthermore, this installarion has b€en rested in accordance with such requirements, is now in proper operating condition and
ete instrucrions as to [s use and maintenance have been fumished to the person for whom the installation (or alteration) was made.
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Address City:zip:
lnstaller:/
Pnnt Nome Signalur€ (no SlanD)
Inspected by: Date:-
EI Domestic Warcr
wHITE C0PY: Property owne/s copy; CANARY COPY: YF,D. Copy ' netum when iob b comPleted; PINK coPY 'This copy musl be Posted al installalion'
'r.rn'77 3'35?f
-
Scrviccd Floor or Unit *
-E Powcr Venr E other
,Zl
Speciai requircmens (or additional safery dcvices)
once signed by the fire department, this is a PERMIT for the storage and use of oil buming equipment.
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