Winchester
Fire Dept.
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Fuel Oil Burning Equipment
FP-056 Application & Permit
City or Town
Date
FD Permit #
Elec. Permit #
FDID #
Fee Paid ($)
Owner/Occupant Name *
Telephone *
Installation Address *
Serviced Floor or Unit #
Equipment Type *
Heating Unit
Domestic Water Heater
Power Vent
Other
Burner Information
Burner Status *
New
Existing
Location
Manufacturer
Type
Model # or Size
Nozzle Size
Fuel Type *
Fuel Oil
Kerosene
Waste Oil
Storage Tank Information
Tank Status *
New
Existing
Removal
Location
Type
Capacity (gallons)
Number of Tanks
Special Requirements (or additional safety devices)
OSV valve
Oil Line Protected
Company Information
Company Name *
Telephone *
Address
City
Zip
Completion Date
Combustion Test
Gross Stack Temp.
Net Stack Temp.
CO² Test
Breech Draft
Smoke
Overfire Draft
Efficiency Rating %
Installer Information
Installer Name *
Certificate of Competency #
Address
City
Installer Signature *
By typing my name, I agree this serves as my legally binding digital signature on this form, certifying that the installation has been made in accordance with M.G.L. Chapter 148 and 527 CMR 1.00.
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Winchester
Fire Dept.
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