Instructions For Form Pw1c - 2016 (Page 2 of 2) in pdf

Instructions For Form Pw1c - 2016 Page 2

PW1C

INSTRUCTIONS

6 Burner Specifications

Provide the manufacturer’s name for each item.

Provide the approval number (s) assigned by the Department of Buildings’ Materials and Equipment Acceptance (MEA) Division or the Board of

Standards and Appeals (BSA)

Provide the manufacturer’s model number for the equipment.

Provide the Gross Firing Rate of Oil Burners in BTU’s per hour / gallons per hour.

7 Fuel Storage Specifications

Indicate the total number of fuel storage tanks*

Provide the capacity in gallons for each tank*

Check (X) the appropriate box for the Grade of Oil to be used*

8 Chimney Information

Indicate the material that the chimney walls are made of

Indicate the material that the lining is made of

Provide full name and address of applicant

Sign and date statement

9 PE/RA Seal and Affirmation

Provide Name, License Type, and New York State License Number

Provide email address, telephone number, and fax number

PE or RA Applicant shall apply seal and then sign and date affirmation*

10 Master Plumber/Oil Burner Installer Seal and Affirmation

Provide Name, License Type, and New York City License Number

Provide email address, telephone number, and fax number

Oil Burner Installer or Master Plumber shall apply seal and then sign and date affirmation

This section required after work has been completed and must be presented at the time of the inspection.

*Although Plan Review may accept the Schedule C without this information the inspection request will be rejected if information is not

included on the Schedule C when an appointment request is made.

Page 2 of 2

September 2016

Instructions For Form Pw1c - 2016 Page 2