Form Dlt L 59 PDF Details

Navigating the complexities of boiler installations in Rhode Island requires a crucial piece of documentation known as the DLT-L-59 form, a comprehensive application that serves as the bridge between compliance and enforcement for the Department of Labor and Training's Division of Occupational Safety. This document, revised last in October 2002, is essential for any installer looking to legally fit a boiler within the state, regardless of whether it's a new or used system. It specifies the need for detailed information about the boiler, starting from the basic identification of the owner and installer to intricate details about the boiler’s make, capacity, and the safety features it will include. Additionally, the form delves into the specifics of the boiler room itself, asking for confirmation that it meets all local code requirements, including ventilation and clearance. Crucial in ensuring the safety and legal compliance of boiler installations, this documentation must be accompanied by an installation fee and, importantly, boiler drawings when submitted to the chief inspector. The penalties for non-compliance, as outlined, underscore the form’s importance in maintaining safety standards, indicating potential fines or imprisonment for failures to adhere to state laws. By mandating a thorough review and approval process before a boiler can be installed, the DLT-L-59 form exemplifies Rhode Island’s commitment to occupational safety and public welfare.

QuestionAnswer
Form NameForm Dlt L 59
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdltL59Boiler riboiler unit form

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DLT-L-59 (Rev. 10/2002)

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

Department of Labor and Training - Division of Occupational Safety

1511 Pontiac Avenue, P. O. Box 20157 Cranston, RI 02920-0942

(401) 462-8570 | www.dlt.ri.gov/occusafe/boiler.htm

BOILER UNIT

Benjamin P.Anthony Chief Inspector

Application for Permit to Install BoilerS

PERMIT #

TO BE COMPLETED BY INSTALLER PRIOR TO BOILER INSTALLATION, THEN FORWARDED TO ABOVE ADDRESS ACCOMPANIED BY INSTALLATION FEE.* BOILER DRAWINGS MUST ACOMPANY THIS APPLICATION.

1. Owner/User:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Installer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel. No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel. No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approx. Installation Date:

 

 

 

 

 

 

 

 

 

 

 

Location:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. BOILER Manufactured By:

 

 

 

 

 

 

 

 

 

 

 

Steam:

 

 

 

 

 

Circulating H.W.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New:

 

 

Used:

 

 

 

 

 

Yr. Manuf.

 

 

 

 

 

 

NB#

 

 

 

 

 

Manuf. Ser. No.

 

 

 

 

 

 

C. I.:

 

 

 

Steel:

 

 

 

 

 

Watertube:

 

 

 

 

 

 

Firetube:

 

 

 

 

 

H.W. Tank:

 

 

 

 

 

 

 

 

 

 

 

MAWP:

 

 

 

 

 

 

 

 

 

 

 

PSI

 

 

 

 

 

 

 

Min. Safety Valve Rel. Cap.

 

 

 

 

 

 

 

 

 

 

 

 

Heat Input:

 

 

 

 

 

 

BTU/Hour:

 

 

 

Steam Generating Capacity:

 

 

 

LB/Hour

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Heating Capacity:

 

 

 

 

 

 

BTU/LB/Hour:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. SAFETY APPURTENANCES INCLUDED:

 

 

Firomatic Switch:

 

 

 

 

 

 

L.W. C. O.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Safety Valve(s):

 

 

 

 

 

Remote Switch:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. BOILER ROOM:

 

 

 

 

 

 

 

 

 

New:

 

 

 

 

 

 

Existing:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Does Boiler Room meet all code requirements?

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ex. (a) Proper ventilation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(b)Three (3) foot clearances on all sides and top of boiler(s) and aceiling or piping for boilers with manholes.

(If no, use comment space at bottom to explain.)

 

 

 

 

* Each High Pressure Unit $300.00

Pipefitter Master I License Number:

 

Each Low Pressure Unit $120.00

 

 

 

CERTIFICATION

I,

 

certify that the boiler mentioned above will be installed in compliance with all state

law pertaining to boiler installations. I also recognize that failure to adhere to said state laws may result in a fine of up to $500.00 and imprisionment of up to 3 months or both, as set forth in 28-25-10 of the Rhode Island General Laws.

STATE OF RHODE ISLAND

DEPT. OF LABOR & TRAINING

BOILER UNIT

Date:

Amount:

Receipt #:

Check #:

PERMIT APPROVED BY:

INSTALLATION APPROVED BY:

DATE:

IF INSURED, BY WHOM:

COMMENTS:

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Form Dlt L 59 completion process explained (portion 1)

2. The next part would be to fill out these particular fields: MAWP, Heat Input, PSI, Min Safety Valve Rel Cap, BTUHour, Steam Generating Capacity, LBHour, Water Heating Capacity, BTULBHour, SAFETY APPURTENANCES INCLUDED, Firomatic Switch Safety Valves, LW C O Remote Switch, BOILER ROOM Does Boiler Room, Existing Yes, and New.

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