No.
APPLICATION FOR HEATING PERMIT.
[Separate application required for each building.]
Waltham
191
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to install (?) enlarge (?) or remodel (?) heating plant as specified
Underscore which)
below-
RESPONSIBLE PARTIES:
Address?
Owner of building?
Address?
Owner of heating plant?
Heating Engineer?
Address?
Are you authorized by the owner to do this work?
not owner of building.)
(When owner of heater
LOCATION:
Street and number?
no number, which side of street?
Which lot?
NATURE OF BUILDING in which heater is installed
Material?
Use?
HEATING PLANT:
DESCRIPTION OF
Kind?
More than one heater?
Where is heater placed?
Distance of heater from woodwork at front?
At sides?
Distance of heater from ceiling?
Distance
of smoke pipe from woodwork?
Protection?
Are heating pipes built into partitions?
If steam or hot water systems, how far are heating pipes from woodwork?
Protection for wood?
If hot air system, how far are pipes from woodwork?
Any pipes in closets?
Distance below ceilings of horizontal runs of pipes?
Distance of vertical pipes from furnace?
Any depositories for ashes in the building?
WILL THE HEATING PLANT CONFORM TO THE REQUIREMENTS OF THE LAW?
Owner's Name
by
Agent.
