Fillable Commonwealth of Massachusetts Application for Certificate of Competency as Oil Burner Technician or Apprentice Oil Burner Technician

Fill Online, Printable, Fillable, Blank Commonwealth of Massachusetts Application for Certificate of Competency as Oil Burner Technician or Apprentice Oil Burner Technician Form

Use Fill to complete blank online COMMONWEALTH OF MASSACHUSETTS (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Commonwealth of Massachusetts Application for Certificate of Competency as Oil Burner Technician or Apprentice Oil Burner Technician

On average this form takes 10 minutes to complete

The Commonwealth of Massachusetts Application for Certificate of Competency as Oil Burner Technician or Apprentice Oil Burner Technician form is 2 pages long and contains:

  • 0 signatures
  • 7 check-boxes
  • 37 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised May 2017
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF FIRE SERVICES
OIL BURNER LICENSE
Please send application to:
Department of Fire Services, Boiler and Pressure Vessel Program, 1 State Rd. Stow, MA 01775-1025
APPLICATION FOR CERTIFICATE OF COMPETENCY AS OIL BURNER TECHNICIAN OR APPRENTICE OIL BURNER TECHNICIAN
IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAW CHAPTER 148 SECTION 10D
Application must be filled out in ink or printed and accompanied by the non refundable processing fee.
1. Choose the Grade of Certificate of Competency for which you are seeking to obtain:
Oil Burner Technician $75
Apprentice Technician $40
(Non-refundable processing fee)
(Non-refundable processing fee)
(Check box if applicable) I am requesting examination accommodations due to a disability that substantially limits my ability to perform
a major life activity. You must submit the Accommodations Request Form along with the required documentation as part of this
application in order for this request to be considered.
2. Full Name: _____________________________________________ Social Security Number: _____________________
(print legibly)
3. Home Address: ______________________________________________________________________________
_______
(Street) (City) (State) (Zip Code)
4. Date of Birth: _____________ Email Address: ___________________________ Phone Number: _________________
5.
Name and Address of Employer: _______________________________________________________________________
______________________________________________________________________
6. State full title of occupation: _____________________________
_____________________________________________
7. Have you ever been examined for a Massachusetts Certificate of Competency? YES, when? __________ NO
Do you hold a Massachusetts Apprentice Oil Burner Technician Certificate? YES NO
If so, list license number: ________________________ ____________________ ______________________
License number License Grade Expiration date
Pursuant to Massachusetts General Laws, Chapter 22 and 520 CMR 1.00, I certify under the penalties of perjury that to my best
knowledge and belief I have paid any and all outstanding civil fines owed to the Department which are required under Law.
________________________________________ ________________________________________
Signature of Applicant Date
AUTHORIZATION FOR RELEASE OF RMV PHOTO INFORMATION
(MASSACHUSETTS RESIDENTS ONLY)
My signature below authorizes the Department of Fire Services to electronically access my photograph from the
Massachusetts Registry of Motor Vehicles database solely for use on this license/registration.
_______________________________________________
MA- RMV photo release signature
BPV-011
Revised May 2017
8. EXPERIENCE: In the space below, please describe all experience you have working on oil burner equipment, including
brand names and length of time:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
9. I attended an oil burner course at (name of school) _______________________________________________________
10. I am also skilled in _______________________ License or degree held: _________________________________
11. I use the following instruments and equipment: (name equipment you use in line provided)
a. Tank and Tubing Test, when required _________________________________________________
b. CO2 Analysis _________________________________________________
c. Temperature Reading _________________________________________________
d. Draft Reading _________________________________________________
e. Smoke Testing _________________________________________________
PREREQUISITES: ALL OF THE FOLLOWING ITEMS MUST BE SUBMITTED WITH THIS APPLICATION IN
ORDER FOR YOUR APPLICATION TO BE PROCESSED. FAILURE TO SUBMIT ALL REQUIRED
INFORMATION AND APPLICABLE FEE PAYMENT WILL RESULT IN UNNECESSARY DELAYS.
Completed Application with home mailing address and social security number.
Attach 1" x 1.25" photo or a legible copy of a valid driver’s license
(Unless Authorization for Release of RMV Photo Information Signed-Off)
Applicants: You must be at least 18 years of age.
Check or money order payable to the Commonwealth of Massachusetts.
Revised May 2017
DESCRIPTION OF REQUIREMENTS FOR CERTIFICATE
OF COMPETENCY AS OIL BURNER TECHNICIAN
The applicant must demonstrate a thorough knowledge of the NFPA 31 -2011 Code and the Oil Burner Code
amendments in Massachusetts Regulation 527 CMR 1.00, as well as an intricate knowledge of oil burners, safety
devices, automatic, and electrical and electronic controls. Knowledge of pipefitting and heating is essential. An
applicant must also have a thorough knowledge of combustion performance testing. The applicant must pass a
strenuous written examination. Although not required, it is strongly recommended that an applicant for the certificate
should have attended classroom instruction and should have obtained an apprentice license to learn how to clean
boilers and install equipment in a safe and workmanlike manner. An applicant must also have attained the age of
eighteen years.
The apprentice certificate has no prerequisites. The only requirement is that the applicant work under the direct
supervision of a person holding a current Certificate of Competency as an Oil Burner Technician license.
Must be submitted with application:
All applicants must provide:
•
1 photo 1”x1.25”, or a colored copy of Drivers License (Unless Authorization for Release of RMV Photo Information
has been Signed-Off)
•A legible copy of a valid driver’s license,
•Application processing fee is a Non-Refundable $75.00.
•Applicants: You must be at least 18 years of age.
An official copy of 527 CMR 1.00 can be purchased online, by mail or in person from the State Bookstore, State
House- Room 116, Boston, Ma 02133. Ph: (617) 727-2834, Website: www.sec.state.ma.us. Other locations to order and
purchase in person are the Western Office of the Secretary of Commonwealth, 436 Dwight St., Springfield, Ma. 01103,
(413) 784-1376, or the Southeastern Office of the Secretary of Commonwealth, 218 South Main St.- Suite 206, Fall
River, MA 02721, (508) 646- 1374. By telephoning the current price can be obtained.
Please contact the National Fire Protection Association (NFPA) for purchasing NFPA 31 - 2011 Standard for the
Installation of Oil-Burning Equipment. www.catalog.nfpa.org/ (888) 932-5317
ADDITIONAL RESOURCE MATERIALS FOR STUDY MAY BE FOUND AT:
•
Basic Oilheat Technician’s Manual: National Oil Heat Resource Alliance (NORA), P.O. Box 314 • Watertown, MA
02471-0314 Ph: 1-866-924-1100 / Fax: 1-866-924-1200 / www.noraweb.org/
•
Residential Oil Burners: Author: Herb Weinberger, Publisher: Delmar Cengage Learning; 3 edition (September 11,
2007) ,ISBN-10: 1418073970,ISBN-13: 978-1418073978
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF FIRE SERVICES
OIL BURNER LICENSE
Please send application to:
Department of Fire Services, Boiler and Pressure Vessel Program, 1 State Rd. Stow, MA 01775-1025
BPV-011
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Commonwealth of Massachusetts Application for Certificate of Competency as Oil Burner Technician or Apprentice Oil Burner Technician

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 May 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document