Revised May 2017
INSPECTION OF BOILERS
Chapter 146: Section 6. Annual inspection; extension of time; first inspection
Section 6.
All steam boilers and their appurtenances except those specified in the following section shall be
thoroughly inspected externally and internally at least once a year. Upon written application made to it by the
owner or user of a pressure vessel or boiler, the board may, when the public interest and convenience require,
extend the time for the making of such inspection for a period not to exceed six months as the board may
determine. A district engineering inspector of the division of inspection of the
D
epartment of
Fire Services
shall perform the first inspection of
steam boilers and
pressure vessel
s
required by this chapter.
Name of Facility
Date Submitted
Facility Address
Contact Name
Engineer in Charge
Contact Person’s
Telephone Number
Contact Person’s
E-mail Address License Number.
Boiler Information
Manufacturer National Board Number
Year Built Mass Tag Number
MAWP Date of Last Inspection
Rated Capacity Certificate Expiration
Authorized Inspector Duration of Extension
Reason for Request :
Please attach a statement from the Authorized Inspector of record in regards to this request for an extension of the
Certificate of Inspection for this Boiler or Pressure Vessel. The statement must include the Mass Tag Number of the Boiler.
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF FIRE SERVICES
Certificate of Inspection Extension Request
Please forward this form via email to: holly.bartlett@state.ma.us or mail to
Department of Fire Services, Boiler and Pressure Vessel Program, 1 State Rd. Stow, MA 01775-1025
BPV-031
