STATE OF NEW HAMPSHIRE
DEPARTMENT OF SAFETY
DIVISION OF FIRE SAFETY
OFFICE OF THE STATE FIRE MARSHAL
DSFM 7 (REV. 01/15)
Copies: Original posted near burner
Fire Department
Installer
PERMIT TO INSTALL AND OPERATE OIL BURNING EQUIPMENT
To the Chief of the Fire Department:
The undersigned hereby applies for a permit to install and operate oil burning equipment in compliance
with RSA 153:5 and NFPA Standard #31 as follows:
Address: ______________________________________________________________
Type of Occupancy: _____________________________________________________
Owner: _______________________________________________________________
Address: ______________________________________________________________
Town: __________________________________ State:____________
Occupant’s Name: _______________________________________________________
Make & Serial # of oil Burner: ______________________________________________
Size & Location of tank: ___________________________________________________
Name of Installer: _______________________________________________________
Business Name: _________________________________________________________
Address: _______________________________________________________________
Telephone: ( )_______________________________________________________
____________________________________________________ __________________
Signature of Owner or Installer Date
When signed below by the Chief of the Fire Department this application may be used as a TEMPORARY
PERMIT authorizing the installation of oil burning equipment.
Permit No.:_________________ ____________________________ Chief or Designee
_____________________________Fire Department
_____________________________Date
Permission is hereby granted to operate the oil burning equipment described above which has been
inspected and found to be in compliance with the State Fire Code as adopted by the State Fire Marshal.
________________________ ______________________________________
Date Signature of Fire Chief or Designee
