Form 22 . M..0090RA..
i
SALEM FIRE DEPARTMENT Fee Due$10.00
? Fire Prevention Bureau Received by . . . . . . . . . . . . .
48 LAFAYETTE STREET, SALEM, MASS. 01970 Ck.# Cash
Excerpt from 527CMR4.02(2)(g), NO PERSON shall install or alter any fuel oil burner without FIRST
making application to the head of the fire department and obtaining a permit therefor.
Application for Permit to Install/Alter Oil Burning Equipment
Application is hereby made in accordance with the provisions of Chapter 148,G.L.and Regulations made under authority thereof by the undersigned for per-
mit to install/alter,for the person or persons and at the location named herein,certain equipment for the keeping,storage or use of fuel oil or flammable liquid pro-
ducts used for fuel as described below.
Ay (�
Name of Owner..�.(L.�.A.0.1con.f ofz] 9.1.3.0.............................................. Date ... . b.. ..........
Address.....I....... ......................................... ys ea �bYtem ... .................
(1 st,2nd,all)
II( ne �/�o
Name 1`��6 ........n......................................BURNER..... Mfg.by....(...lC; .�lam.... �......`^+.1�P............
Type... .la. .�e.......tz en �U. ....................... Mass.Approval No......I to 3.1.:21................................
Typeof heat...........F.0. .....................................
(D.H.W.;F.H.W.;STEAM;F.H.A.)
L STORAGE TANK
�CL.S�If� ei�I
( )New Tank Location of Tank.. .............................No. of Tanks......t{............
(X Existing Tank Type of Tank.. .I.e.�.�......................Capacity.vc..[.S.r......gals. T pe of fuel..� .....................
( J No additional storage,using same tank as another unit. ELECTRICAL CONTRACTOR.... ...ford,+(.e.Vt ...................
This application is made with full knowledge of the current requirements of the regulations governing such instal lation„which will be made in compliance
therewith.
' Comp y.. L ke+...i. ............
Appl. Rec'd.......... ...... ............ By ..... ... . .... I......
Premit Issued............................... Address a,o..Cen.l.a'I........
{Z>�^� .11. �.f✓ ............
Permit No................................... Installer's Certificate of Competency No......1....1..b.Ui.....................
A self-addressed(Installer's name and address)stamped
envelope must accompany this application.
Note: New Underground tank installations,require a plan and Form 81 G to be filed.
Form NO.22(Rev. 1 1/82) DO NOT WRITE BELOW THIS LINE