Fillable The Commonwealth of Massachusetts Department of Public Safety (SELCO)

Fill Online, Printable, Fillable, Blank The Commonwealth of Massachusetts Department of Public Safety (SELCO) Form

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

The Commonwealth of Massachusetts Department of Public Safety (SELCO)

On average this form takes 10 minutes to complete

The The Commonwealth of Massachusetts Department of Public Safety (SELCO) form is 1 page long and contains:

  • 0 signatures
  • 14 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for SELCO

BROWSE SELCO (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
 
The Commonwealth of Massachusetts
Department of Public Safety
527 CMR 4.00 – Form 1
Application for Permit, Permit and Certificate of completion for the Installation or
Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oil
TOWN OF SHREWSBURY
Date _______________
Permit #’s: FD __________ Elec. __________ FDID# __________ Fee Paid __________
Owner/Occupant Name: ___________________________________________ Tel #: _________________
Installation Address: _______________________________________ Serviced Floor or Unit #: _________
Heating Unit Domestic Water Heater Power Vent Other ________________________________
Burner: New Existing Location: ______________________________________________________
Trade Name: _____________________________________________ Mfg: _________________________
Type: ___________________ Model# or Size: ___________________ Nozzle Size: __________________
Special Requirements (or additional safety devices): ____________________________________________
______________________________________________________________________________________
OSV Valve Oil Line Protected Sheet Rock Sprinkler AFUE: Yes No EF: Yes No
Co. Name: ______________________________________________ Tel #: _________________________
Address: ___________________________________ City: _____________________ Zip: _____________
Completion Date: ________________________
Combustion Test: Gross Stack Temp: _______________ Net Stack Temp: ______________
CO
2
Test: ______________________ Breech Draft: _________________
Smoke: ____________ Overfire Draft: __________________ Efficiency Rating %: ___________
I, the undersigned, certify that the installation of fuel burning equipment has been made in accordance with M.G.L. c. 148 and 572
CMR 4.00 currently in effect. Furthermore, this installation has been tested in accordance with such requirements, is now in proper
operating condition and complete instructions as to its use and maintenance have been furnished to the person for whom the
installation (or alteration) was made.
Installer: ______________________________________________________________________________
Print Name Cert of C# Signature (no Stamp)
Address: _________________________________________ City: ________________________________
Once signed by the Fire Department, this is a PERMIT for the storage and use of oil burning equipment.
Approved by: _____________________________________ Date: ________________________________
Keep Original as application. Issue duplicate as permit. This form may be photocopied.
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

The Commonwealth of Massachusetts Department of Public Safety (SELCO)

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 5 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document