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HomeMy WebLinkAboutCertificate of Compliance - Oil Burner - Certificate of Compliance - 61 JOHNSON CIRCLE 3/7/2022 Spring 2010 W4 W. 4 R Interim Form 527 CMR 4.00 — Farm 1A FP-56A (Rev.03/10) Certificate of Compliance M.G.L.'Chapter 148,Section 38J City or Town:, ctrti -- Street Name&Number: Name of Property Owner. ` This certifies that visual:inspection of the fuel supply line(s) for the aboveground heating oil storage tank was.completed.in accordance with M.G.L.Chapter 148,Section 38J(d) for the residential property identified apove,and the following equipment was observed and compliant: Each fuel supply and return line(Ifpresent)Is enclosed with a continuous non-metallic sleeve, © Each fuel supply line is equipped with an oil safety valve. 5,110 „ t 10 This visual ms ecifSm and ce,�r,tf�;f i,cy atl0Un��o fco plf�ancev� s cdril p.lee ted-on:�'Date: ` By: (Signature of OWBurnerTochnician) °s G (Print Name of oil Burner'Technici4,O) Certificate of Compotsncy#f x u�� a Upon coMplet►on of Form liA,the pzoperty,:owner shall receive a.copy of the form and a copy shall also.be. , ubmitted,to tli head afthe local fire department or a designee, This f6na can be photocopied or reproduced lit triplicate, i - ., , 4fchi ainyw C, 4fifl (t14 tlJtt4M W4111 + k"IIINIIa¢71 C.tli1 VY.19 4Y id�;�:C'W ttN .h is td c, ra �sio as t I � � �� �� a r✓��ffYlPlF r .._ Y ��f OfLiL� �i ililir �� �1