Installation or Alteraion of Oil Burning Equipment 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 b ow.
Nameof Owner..... ... .. ..... ..... .. ....................................... Date ....�.1. 0. `!+?............
. ....� ( -� c t v.►�:L. .V��/VC/�- Floor heated `
Address.... by system.......jS�...............
(1st,2nd,all)
BURNER
Name.... �. .\..................................... .... Mfg.b(y LXXJ�.(�....l.1.1 )�.. ...............
Type. ... Mass.Approval No.....6 ... ...............................
Typeof heat........r.RCl......................................
(D.H.W.;F.H.W.;STEAM;F.H.A.)
STORAGE TANK
( )New Tank Location of Tank..�`l .. en.� ..No. of Tanks..................
[ Existing Tank Type of Tank... . ....................Capacity.p�� .............gals. Type of►fuel.. 1�9...................
[ ]No additional storage,using same tank as another unit. ELECTRICAL CONTRACTOR..EC�W.O.Rd•.....1=4Qa.1.�e2...................
This application is made with full knowledge of the current requirements of the r lations governing such instal let ion„which will be made in compliance
therewith. _ fl .. ' '..q''
Appl. Rec'd...........�...:... ..... By ...... ... .. . ' >
....
Premit Issued............................... Address V.. .......... ...........
Permit No................................... Installer's Certificate of Competency No..........1..l..FU I.................
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