Massachusetts Form Fp 056 PDF Details

Are you looking for information about Massachusetts Form FP 056, the application for Medicaid coverage of long-term care services? Not sure where to start or what’s involved in the process? If so, you’ve come to the right place. In this blog post, we will provide a comprehensive overview of Massachusetts Form FP 056 and outline how to complete it correctly. We will discuss eligibility requirements, costs related to Medicaid coverage and other important details that every applicant should be aware of when submitting an application. So if you’re unsure where to turn for answers regarding this document or just want some additional guidance, then keep reading!

QuestionAnswer
Form NameMassachusetts Form Fp 056
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesma oil burning, massachusetts permit oil, massachusetts oil form, permit fuel oil

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The Commonwealth of Massachusetts

Department of Fire Services

FP-056

(Rev. 1.26.2015)

527 CMR 1.00

Section 1.12.8.2.1

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

_______________________________________

 

 

 

(City or Town)

(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: _____________________________________________

Mfg: ___________________________________________________________________________________

Type: __________________

Model # or Size: _________________

Nozzle size: _______________

Fuel Oil

Kerosene

Waste Oil

Removal

Storage Tank: New

Existing

Location: _________________________________________

Type: __________________

Capacity: ______ gallons

No. of Tanks: ______________________

Special requirements (or additional safety devices) _____________________________________________

_______________________________________________________________________________

OSV valve Oil Line Protected

Co. Name: _________________________________________________ Tel # ________________

Address: _________________________

City: _________________________ Zip: ___________

Completion Date:_________________________

 

Combustion Test:

Gross Stack Temp.:________________

Net Stack Temp.: __________________________

 

CO2 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. Chapter 148 and 527 CMR 1.00 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 or whom the installation (or alteration) was made.

Installer:____________________________________________________________________________________________________

Print NameCert of C#Signature (no Stamp)

Address: _________________________________________________________________City: ____________________________________________

Once signed by the fire department, this is a PERMIT for the storage of fuel oil and use of the oil burning equipment.

Approved by: ___________________________________________________________________ Date: __________________________________

Keep original as application. Issue duplicate as permit. This form may be photocopied.

ALL INSTALLATIONS

All applications must be on Form 1

Over 10,000 gallons on site requires License & Permit from local community

Certificate of Competency required, no other license acceptable, plumbing, electrical, etc.

Verify emergency shut-off is outside burner room

Verify separate circuit for oil burner

Verify presence of overhead thermal switch

Verify presence of service switch within 3' of burner

Verify presence of high limit controller

Primary control has safety shutoff within 15 secs.

Stack type primary may be easily removed

Steam boiler equipped with low-water cut-off

Clear access to clean out and services panels

No oil leaks present at burner

Installation instructions present on site

Combustion test results on Form 1

Three metal screws at each joint in chimney

Thimble present at chimney connection

IF POWER VENTER IS USED: Check air pressure switch, post purge control and secondary control. Installation instructions present.

Draft regulator is present unless exempted

Adequate air is present for combustion

Adequate clearances per manufacturers listing

Thermal valves at burner and tanks

Listed flexible hose may be used.

No Teflon tape on oil line or on oil line fittings

No compression fittings are permitted

Solder joints made with 500 degree F solder or greater

All oil supply and return lines must be protected from injury. All new lines must be continuously sleeved with non metallic tubing. Oil safety valves may be used on existing lines not exposed to freezing. Overhead lines require no sleeve and are permitted

Oil supply lines and return lines to tanks exposed to freezing temperatures must come off the top of tanks

Lines for kerosene, and range oil (#1) are exempt -

No oil leaks present at tank

Listed oil filter is present

Tank is UL80 or (DIB+) PV-VI 321 (under 660 gal) or UL 142 (over 600 gal)

Shutoff valve located at bottom of tank

Size of vent as per manufacturer

Oil tank gauge must be present to determine oil level

Inside tanks have audible fill device (vent alarm)

Outlet cross connection at bottom of tanks must be 3/8" pipe or tubing.

Non-combustible tank supports, tank secure.

Note To Installer: Inspections will be conducted using this checklist as a guideline. Current regulations will apply.

UNENCLOSED TANKS

Single tanks shall not be larger than 660 gallons

Maximum aggregate capacity of unenclosed multiple tanks is 1320 gallons

Unenclosed tanks shall be at least five feet from an internal or external flame

Unenclosed tanks shall not obstruct service meters, service panels and shutoff valves

Bottom outlet tanks pitched to the opening

Tanks exposed to vehicles will be protected by barriers

ENCLOSED TANKS

Over 660 gallon tanks enclosed by two hour fire resistive assembly

Tank enclosures provided with 6" high tight sills or ramps

Tank is 4" above floor supported by 12" thick masonry saddles spaced not more than eight feet on centers and 15" from top and walls of enclosure

All oil must be transferred by pump, and connections must be at the top of the tank

ALL TANKS

Two tanks may be cross-connected as shown in Fig. 8.9.1 NFPA 31 2011 edition

Return lines must enter the top of tanks

Vent pipes must be two feet from building openings

Vent pipes must terminate 3 ft. above grade min.

Vent pipes must have weatherproof caps

Fill pipes must be two feet from building openings

Fill pipes must have tamper proof identifying caps

IF POWER VENTER IS USED:

All outside connections sealed Vent terminal must be three feet above all air inlets within 10ft. Burner air intake is exempted Vent terminal must be four feet from doors and windows. Vent must be one foot above finished grade. Three foot clearance from inside corners. Not above or within three feet of an oil tank. Seven feet above a public walkway.

OUTSIDE TANKS

All UST's and tanks over 660 gallons must be installed as per NFPA 31 2011 edition

Tank protected from physical damage

Tanks exterior coated with organic alkyd resin or asphalt paint

Damaged protective coatings must be recovered

Tank does not block means of egress

Tank mounted on continuous 4" thick slab that extends 8" beyond tank perimeter

Tank is supported by rigid non-combustible supports