APPLICATION FOR CERTIFICATE OF APPROVAL
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To the Superintendent of Buildings of the Village
of Lynbrook, Nassau County, New York.
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The undersigned hereby requests that a certificate
of approval be issued for the oil-heating burner described below:
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1.
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Name of burner
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2.
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Name of manufacturer
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3.
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Address of manufacturer
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4.
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Kind of fuel recommended for burner
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5.
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Length of time burner has been on market
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6.
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List approvals by states, cities or recognized
laboratories
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Name
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Date
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7.
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Attach blueprint of assembly drawing showing
construction of device, indicating moving parts, oil passages and
air passages (size 16 inches by 22 inches).
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Application filed by
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At ___________ this _____ day of 20_____
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Sworn to before me this _____ day of 20_____
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Notary Public
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Endorsement of approval upon the application
shall constitute the same as a certificate as required herein.
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