HomeMy WebLinkAboutPermit - Fuel Oil Burning Equipment 2018 - Alteration of Oil Burning Equipment - 314 CLARK STREET 3/21/2018 527 CM�� � ���
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Section I .12'8.2�1
FP-056 Form �
(Rev. 1.2U2D15) �
— Application for Permit, 9uonh, and Certificate of Completion for the
Installation or Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oil
(City or Town) (Date)
Permit#'o� FD Elec. FD0#: Fee Paid: $______
Owner/Occupant �#�
�
Installation Address:
Serviced Floor ur Unit#:
"K.,' Heating Unit [] Domestic Water Heater [� Power Vent Other .
Burner: ��Waw Existing 7_� Location:
Mfg.-
Type: ' Model#or Size; Nozzle size: 1 -��*x�0/61
eos'�, Fuel Oil E], Kerosene L) Waste Oil El Removal
Storage Tank: 01New Existing Location:
Type.* Capacity: gallons No. ofTanks.-
Special requirements (or additional safety devices)
Ej OSV valve �X Oil Line Protected
Co. Narn
Address: �ity: Zip:
Completion Date:
Combustion Test: Gross Stack Temp.- Net8tackTemp.:
CO' Test: Breech Draft:
Smoke: _�� 0verDve Draft.- � �v Efficiency Rating W
/.the undersigned uomfyma the installation o[fuel burning equipment has been made maccordance wimmoL Chapter 14m and su,oMR1
oo
currently m effect,Furthermore,this installation has been tested m accordance with such requirements,io now in proper operating condition and
complete instructions anm its use and maintenance have been furnished to the pemono/,mom the installation(or alteration)was made,/nntaUer
Print Name Cell of C#
Address:
City:
Once signed by the n=department,this is a pEnm|T for the storage mfuel oil and use of the oil uvm/ng equipment.
Approved by:
Date:
Keep original anapplication. Issue duplicate aa permit. This form may be photocopied,