Bcc 849 Form PDF Details

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QuestionAnswer
Form NameBcc 849 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesboiler inspection form, state of michigan boiler division, csd 1 boiler inspection form, michigan boiler application online payment

Form Preview Example

 

 

 

Boiler Permit Application

162/161

 

 

 

Michigan Department of Licensing and Regulatory Affairs

 

 

 

 

Bureau of Construction Codes / Boiler Division

 

 

 

 

P.O. Box 30255, Lansing, MI 48909

 

 

 

Telephone Number: 517-241-9334 Fax Number: 517-241-6301

 

 

 

 

www.michigan.gov/bcc

 

Authority:

1965 PA 290

 

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to

Completion: Mandatory

 

 

individuals with disabilities.

 

Penalty:

Permit will not be issued

 

 

 

 

 

 

 

 

 

 

IMPORTANT: A new or reinstalled boiler shall not be operated until an inspection certiicate is issued by the Boiler Division, State of Michigan. The inspection certiicate will not be issued until electrical, mechanical, and plumbing permits have had a inal inspection approval.

PIPING: Describe in detail installation of components and piping system on the back side of this application.

INSTALLATIONS: Provide a drawing showing clearance dimensions around boiler on the back side of this application and/or an attached sketch.

REPAIRS: Describe in detail the repair and/or provide a sketch of repair on the back side of this application.

This application, when approved by the Boiler Division, shall serve as a permit to install, repair, ield erect, or alter this boiler or piping as described on the application. Enclose a check made payable to the State of Michigan. Mail completed original application with 2 copies and payment to the address

listed above.

PERMIT FEE (Nonrefundable) Licensees are responsible for the permit fee. This does not include boiler inspection/certiicate fees.

$75.00

□INSTALL LOW PRESSURE BOILER

□REPAIR

□ALTER

HIGH PRESSURE - $120.00 + .05 PER FOOT OF PIPING

□ INSTALL HP BOILER AND B31.1 PIPING _____________ (PIPING FOOTAGE)

 

□ INSTALL HP BOILER

 

 

 

□ HP PIPING B31.1 _____________ (PIPING FOOTAGE)

 

 

 

 

□ FIELD ERECT BOILER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSED INSTALLER / REPAIRER’S NAME

 

LICENSE NUMBER

 

CLASS

EXPIRATION DATE

 

APPLICATION DATE

 

 

 

 

 

 

 

 

 

 

 

COMPANY NAME

 

FEDERAL EMPLOYER ID NUMBER

E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

CITY

 

STATE

ZIP CODE

 

TELEPHONE NUMBER

FAX NUMBER (Include

 

 

 

 

 

 

 

 

(Include Area Code)

Area Code)

 

 

 

 

 

 

 

 

 

 

OWNER / USER’S NAME

OWNER’S FEIN (If applicable)

 

CONTACT PERSON

 

 

 

TELEPHONE NUMBER (Include Area Code)

 

 

 

 

 

 

 

 

ADDRESS

CITY

 

STATE

ZIP CODE

 

OFFICE USE ONLY - INSPECTOR

 

 

 

 

 

 

 

BOILER LOCATION ADDRESS (If different than owner/user)

CITY

 

STATE

ZIP CODE

 

OFFICE USE ONLY - INSPECTOR NUMBER

 

 

 

 

 

 

 

 

 

 

 

NATURE OF BUSINESS

 

 

 

 

 

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE

 

 

 

 

 

 

 

 

 

 

 

□POWER

□PROCESS

□STEAM HEATING

□HOT WATER HEAT

□HOT WATER SUPPLY

 

REPAIR (162)

 

INSTALLATION (161)

NATIONAL BOARD “R” CERTIFICATE NUMBER

EXPIRATION DATE

BOILER SIZE IN

MAXIMUM DESIGN PRESSURE

 

 

 

 

LBS / STEAM HR _______________________

 

DATE OF REPAIR / ALTERATION

WELD PROCEDURE

ASME CODE SYMBOL STAMP

 

 

 

 

 

 

BTU / HR INPUT _______________________

 

 

 

 

 

 

 

MAXIMUM DESIGN PSI

HYDRO TEST PRESSURE

MANUFACTURER

 

 

 

 

 

 

LICENSED INSPECTOR

LICENSED INSPECTOR’S EMPLOYER

BOILER MODEL

 

 

 

 

 

 

 

MICHIGAN BOILER NUMBER

 

 

PREVIOUS MICHIGAN BOILER NUMBER

 

 

 

 

 

 

PROPOSED ALTERATION SUBMITTED FOR REVIEW

DATE

ESTIMATE DATE READY FOR INSPECTION

 

□ YES

□ NO

 

 

 

 

 

 

 

 

 

ORIGINAL SIGNATURE OF LICENSED INSTALLER / REPAIRER

 

DATE

 

 

 

 

 

 

 

 

BCC-849 (Rev. 10/11) Front

DESCRIPTION OF WORK BEING PERFORMED ON PERMIT

BOILER CLEARANCE

Does the boiler have the required clearances of twenty-four (24) inches as required by Rule 408.4197? □YES □ NO **If you answered “No” to the above question you will be required to submit a diagram showing the boiler clearances.

CLEARANCE DRAWING GRAPH OR REPAIR SKETCH

OFFICE USE ONLY

BCC-849 (Rev. 10/11) Back

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Completing this form will require care for details. Make sure that all mandatory fields are done properly.

1. While filling out the michigan boiler application online payment, be certain to incorporate all of the needed blanks in its associated section. This will help to speed up the work, making it possible for your details to be processed efficiently and accurately.

csd 1 boiler inspection form conclusion process detailed (step 1)

2. When this section is filled out, go to enter the applicable information in all these: INSTALLATION , NATIONAL BOARD R CERTIFICATE NUMBER, EXPIRATION DATE, BOILER SIZE IN, MAXIMUM DESIGN PRESSURE, DATE OF REPAIR ALTERATION, WELD PROCEDURE, LBS STEAM HR , BTU HR INPUT , ASME CODE SYMBOL STAMP, MAXIMUM DESIGN PSI, HYDRO TEST PRESSURE, MANUFACTURER, LICENSED INSPECTOR, and LICENSED INSPECTORS EMPLOYER.

Writing section 2 of csd 1 boiler inspection form

3. Completing DESCRIPTION OF WORK BEING, BOILER CLEARANCE Does the boiler, If you answered No to the above, and CLEARANCE DRAWING GRAPH OR REPAIR is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Step number 3 for submitting csd 1 boiler inspection form

It is easy to get it wrong when filling in the If you answered No to the above, therefore make sure to reread it before you finalize the form.

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