HomeMy WebLinkAboutnew oil burner 2017FP-056
(Rev. 1.26.2015)
Permit #'s: FD _Elec
.zfeating Unit
Burner: 4.*
9.V*r/-.-f /eVrzue,fi*rr;*
527 CMR 1.00
Section 1.12.8.2.1
Form 1
Application for Permit, Pcrmit, and Certificate of Completion for the
Installation or Alteration of Fucl Oil Burning Equipment and the Storage ofFuel Oil
(City or
A.Vr-r-r""***m "/ o>fuudr-lrrtm
Fee Paid: $<Ydet-
Domestic Water Heater
Existing Location
FDID#:
Power Ven
B^-,^ui
Serviced Floor or Unit #:
Other
Tel.#
Mfg:
Type
t
Model # or Size Nozzle size: .r- 5
Removal4u"Waste OiltoitKerosene
Storage Tank: New /E i"ting {4rr*'*
Type
Special requirements (or additional safety devices)
Capacity: 27-) gattons No. of Tanks/?r/h
-FBSv vatve
Co. Name 5",J/.{ret# 77/-NJ6,,-fbs<:fu,srAddress zip
Completion Date t7
Combustion Test: Gross Slack Temp.:47,4 Net Stack Temp /a
co,rest: //lz-Breech Draft: -o d-
Smoke: 2 Overfire Drafl: ,o /Efficiency Rating v,: RitL
l, the undersigned certify that the installation of fuel burning equipment has been made in accordance with M.G.L. Chapter 148 and 527 CMR 1.00
curently in etfect. Furthermo.e, this installation has been tested in accordance wth such requiremenls, is now in propor op€rating coodi$on aM
cornplete
lnstaller:
Address:
instructions as to its use and maintenance have been fumished to the person or whom the installation (or alt ) was
A
Ced ol (no Stanp)
City:
Once signed by the fre department, this is a PER[,11T for the storage of fuel oil and use of the oil buming equipment
ILI c,(Date 8^zs'tnApproved by:
Keep original as application. lssue duplicate as permit. This form may be photocopied
Owner/Occupant Name:
lnstallation Address:
AK
Location:
City:
Oil Line Protected