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527 CtvIR. I3UARD OF FIRE PRE EN I7"ON REGULATIONS`t' `s 3 ,r "�,
MASSACHUSETTS 1ZR'E SAFETY CODE` "` a Y'
4.03: .continuedy
2rl e Corrrraorcweaftkf Massachusetts
Dtparlrrient:of Picblic,Safety
CMR 4.00 527 . .
l Form`1 .
4 Application for Permit,Permit,and Certificate of completion for the Installation or
A-Iferat'o o yel Oil Burning Equiptm t an the Storage,of Fuel Oil
(CityTown
or ) ate
Permit 9's: FD Elcc. FDIDn: Fare Paid: G y�
Owncr/Occu ant Name: /!�� ' ( Jt�t)s 7 �7 /p
Installadon Address: 00 ��; G V Serviced Floor or Unit n:
U Heating Unit ❑ Domestic Water Heater ❑ Power Vent, ❑ Other u
Bumer. ❑ New Existing Location: J �1
Trade Name: _C�4le-_'LJ Mfg:
f
Type: A Model# or Size:
tJ Fuc1.0i! ❑ Kerosene ❑ Waste oil
Storage Tank: ❑ New 13-1 fisting Location:
1
-Type: z`' Capacity: gals. No. of Tanks:
Special requirements (or additional safery devices)
Ise'OSV Valve ❑ Oil line protected ❑ Sheet Rock ❑ Sprinkler AFUE: Ll cs ❑ no
y
Combustion Test: Nozzle Size P3 4�y SS Gross Stack Temp.:
Ncw Stack Temp.: COr Test Breech Draft 7
' Smoke: y Ovcrc Draft: _C� Ef-icicncy raring %: _3 /�
fu
L the undersitned certify that the insutlation of fuel bomint equipment has bam nude in accordance with M.G.L.c. 148 and 527 CMR 4.00
eamndy in of ccL Fu hermorr-this iruullation has bocn tested in accordance with saeh roquiremenis.is now in o tin condition
PmPQ PQa t
and complete irtstrvc u to its uu and maattcnana have been fumishod-to the parson for whom the insutlacon(or alrmoon)wu made
Co. Name:
r p Address: City: ✓//// lie Zi
Installer:
!� Prior Nam[ ��� /�/« Siananrrc(m Stamp)
Once signed b�firedc ot, this is a PERMTT for the sto age and use of oil burning equipment.Inspected by• .l�ai Date:
Keep Oigiaal is application. Issue duplicate as permit. This form may be photocopied..
A •
SALEM FIRE DEPARTMENT
t
Fire Prevention Bureau
48 LAFAYETTE STREET, SALEM, MASS. 01970
�eu�-�.oe"�
Date
Certificate of Co>tnpletion - Installation or Alteration of Oil Burning E � ,
The undersigned harsh certifies that the ' pn3e>iit
/ installation (or alteration) of fuel oil burning equipment and/or
(Name of Owner) ......./�,�',.. %i9�(
storage tank and a
at(Address) • •,••• / PP1Ym8 to the installation for
S
' Floor heated
has been made in accordance with provisions of the Salem F' •..... . ..... ... y system.........................
b y
effect and
Fire Prevention Code,of Chapter 148,G.L.,and re
pertaining thereto,(Ref.527CMR4.00) �•�••��• (lst,2nd,a11)
regulations made under authority thereof now currently in
Furthermore,this installation has been tasted in accordance with such
and maintenance have been furnished requirements,is now in proper
to the person(or persons)for whom the installation a Pe operating condition and complete instructions as to its use
/� (or alterations)was made.
Name......1. r��cs�7� BURNER
Typo........ .e. i7/ Mfg. by.
.. '✓rc/��$ ....
To use not heavier than....... Mass........ Approval No. ...,v � ` .....fuel oil........ C> —C,
..........
Kind of heat......... 4-1•
F. .W.; ..................
STORAGE TANK H STEAM;F.H.A.)
Type of Tank........ 4, a V.1
C
No. of Tanks...... // ..................................:..
`'.............. I 1 New Tank
Location.......,�� ry'7•'�
Total Capacity.......��?J
ting
Note: New underground tank installations,require a plan and Form 81G to be filed. I �sddit Tank
.....
•���''''�''''•••-•••• I ]No additional storage,using
Type(automatic or manual g same tank as another unit.
control. ,AZ 7Q�7*�C
Location of automatic shut-off valve..... /.. l . .'.'''''
Location and typo of manual shut-off valve....
f ���..j ..........................
s .............
Facial requirements.
`...��Sd/ ••• .... ELECTRICAL CONTRACTOR: .....
Com / ..! 1 S fz/` —
By
• O `
Cart. !✓. . O. .!.� �.....
°f'()PmP•Rec'd. •CF ......
..� ei(written
$nature)
Permit issued.�¢ !,� iv •..........................
Issued By...oC�C+ .. ....... Address....!.`lr .....
y
Installer's Certificate of Com
petsncy No..... ... 4......
.:............... ...
DO NOT WRITE BELOW THIS LINE
•P
f
M.
Form 24 Power Burners
Date 5/23/2000
Name MAX TALCOWSKI
Location 16 PHILLIPS STREET No. of Tanks 1
Name of Burner BECKETT Mass. Approval No. AFUE
Gals. Stored 275 Kind of Heat FHW
Location of Tank BASEMENT Kind of•Oil #2
Installed by WOJCIK OIL CO. C. of C. 27,105
Inspected by INSP. PRECZEWSKI Date Approved 5/23/2000
r
POWER BURNERS
Date May 10-,195t,
Name Issac Talkowsky..
Location 16 Phillips St. 2ndr floor—
Name of Burner Deleo Kind ofHeatWarm Air
Gals. Stored 275 Cap, of Tank 275 Gals,
Location of Tank Basement Kind of Oil 2
Installed by George W. Pickering Co, C.0 . 520
Inspected 5-10-5$ Approved 5-10-58
POWER BURNERS
Date May 10,195.$,-. .
Name Il.s:sac- Talkowzk_-y
Location 16 Phillips-- Ste
1st floor-
Namne of Burner Delco '
Kind of Heat Warm Adr
Gals. Stored 275
Cap. of Tank 275 Gals.
Location of Tank Basement Kind'of Oil
�f 2 ,
Installed by George W. Pickering Go. , C.0. 520
,. Inspected 5-18-5$
Approved 5-10-58
I
.a
. a
Form 24 Power Burners
Dote 06-17-92
Nome MAX TALKOWSKY
Location 18 PHILLIPS STREET
No. of Tanks ONE
Planne of Burner BECKETT
Mass. Approval 14o.BEC788-01
Gals. Stored 275
Kind of lieot F.H.A.-
Location of Tank BASEMENT
Kind of Oil #2
Installed by GLEN- MOR FUEL OIL CO.
C. of C. f 024984
06-17-92
Inspected by
LT. FRANCIS Date Approved
F°`"'24 Power Burners
Date 2/24/99
Name MAX TALKOWSKY
Location 23 IRVING STREET No. of Tanks 1
Name of Burner CARLIN Mass. Approval No. AFUE
Gals. Stored 275 Kind of Heat FHW
Location of Tank BASEMENT Kind of Oil #2
Installed by GLEN-MOR FUEL C. of C. t 080769
Inspected by INSP. PRECZEWSKI Date Approved 2/24/99