HomeMy WebLinkAboutnew oil burner 2005)
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527 CMR 4.00
Form I
Application for Permil Permit and Certificate of completion for the Installarion or
Alteration of FueI Oil Burning Equipment and the Storage of Fuel Oil
(Ciry or Town)@alc)
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Trade Name -6ecK<-t I
T19e:Modcl # or Sizc:
Capaciry:
E Domestic Warcr Hearcr Powcr Vcnt E Other
tr Exisring [.ocarion:
Mfg:
el..-ln Af(=r
E[ Fuel OiI E Kcroscne E Wasre oil
Sorage Taab E Ncw El'gxisdne Location:
L l.)Type:€-{ I gals. No. of Tants:
tr OSV Valvc {ou*"Fotected tr Shea Rock E SprinUcr
Combusrion Tcsr Nozz.lc Size 85 Oo'A Gross Stack Tcrnp.:
New Stack Tanp.: COlTcst l7- "/Brcech Draft
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6aa 456"
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Efficiency ratirg 9o:3z-'/-z-
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Smokc: O - ,O'LOverfire Draft:
I, rhe undersigned certi$ that the installarion of fuel buming equipment has been made in accordencc with M.C.L. c. 148 and 527 CMR 4.00
;;;.;;iyl; #;,. Furthermore, this installation has bcen tested in accordance with such requirements, is now io Ptop€r ope.ating condition and
."",pf"ii *,-.,1."r * ro its use ancl rnaintenance havc been fumished to the person for whom the insallation (or eltclation) was made.
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Co. Name
v(City:Addres
a\KarInstaller:
Pnnr Name
lnspected by: Date
Signadfe (no Slarp)
Scrviced Floor or Unit +:
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Locarion: =t<ls(
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Special requiremens (or additionai safcry dcvices)
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once signed by the fire department, this is a PERMIT for the storage and use of oil buming equipment.
WIIIECoPY:Propertyowne/3copy;CANARYcoPY:YF.D.copy.R.tUmwheniobi3complet€d;P|NKcoPY.Ihl!copymultbeposteda!install.tion.