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!
Question | Answer |
---|---|
Form Name | Massachusetts Form Fp 056 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | ma oil burning, massachusetts permit oil, massachusetts oil form, permit fuel oil |
The Commonwealth of Massachusetts
Department of Fire Services
(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
_______________________________________
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(City or Town) |
(Date) |
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Permit #'s: FD _______ Elec. _______ |
FDID#: _______ |
Fee Paid: $ ______ |
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Owner/Occupant Name: _____________________________ Tel.#: |
___________________________ |
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Installation Address: |
___________________________________ |
Serviced Floor or Unit #: __________ |
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Heating Unit |
Domestic Water Heater |
Power Vent |
Other ______________________ |
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Burner: New |
Existing |
Location: _____________________________________________ |
Mfg: ___________________________________________________________________________________
Type: __________________ |
Model # or Size: _________________ |
Nozzle size: _______________ |
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Fuel Oil |
Kerosene |
Waste Oil |
Removal |
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Storage Tank: New |
Existing |
Location: _________________________________________ |
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Type: __________________ |
Capacity: ______ gallons |
No. of Tanks: ______________________ |
Special requirements (or additional safety devices) _____________________________________________
_______________________________________________________________________________
OSV valve Oil Line Protected
Co. Name: _________________________________________________ Tel # ________________
Address: _________________________ |
City: _________________________ Zip: ___________ |
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Completion Date:_________________________ |
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Combustion Test: |
Gross Stack Temp.:________________ |
Net Stack Temp.: __________________________ |
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CO2 Test: ______________________ |
Breech Draft: ________________________ |
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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
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
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+)
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.
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
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