Form FP-101 "Application for Construction and Installation" - Massachusetts

What Is Form FP-101?

This is a legal form that was released by the Massachusetts Department of Fire Services - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Massachusetts Department of Fire Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FP-101 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Fire Services.

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Download Form FP-101 "Application for Construction and Installation" - Massachusetts

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The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
Post Office Box 1025, Stow, Massachusetts 01775
FP-101
(978) 567-3300 Fax: (978) 567-3199
Revenue Code: 617
(Rev. 4.2018)
Application for Construction and Installation
of a tank in excess of 10,000 gallon gross capacity, for aboveground storage of fluids other than water.
One tank per application, unless the additional tank(s) are identical and contain the identical fluid. When approved, this
application becomes the Permit to Construct or install the tank. When the tank has been built, tested and approved, a Use
Permit will be issued. See page 2 of 2 of this application for the submittal requirements. For tank maintenance, as defined in
502 CMR 5.00, use the Application for Maintenance.
Business name:
Street address:
Business (mailing) address:
Address (or location) of tank:
Business contact name:
Telephone number:
Business contact e-mail address: __________________________________________________________________________
Description of tank:
Manufacturer of the tank:
Manufacturer address:
New tank
Used tank (additional information will be required)
Number of Tanks: _________________________
Tank constructed/manufactured according to: • API 650
ASME
UL 142
UL 2085
UL 2080
Other:
Tank construction standard:
Tank gross maximum capacity:
gallons
Horizontal tank Diameter (feet):
Length (feet):
Vertical tank
Diameter (feet):
Height (feet):
Fluid to be stored in tank:
Flash point (°F):
• Yes, number of compartments and capacities:
Compartmented tank?
No
Secondary containment tank (doublewall tank)? • Yes
Is this tank located in a vault?
Yes
No
No
Retaining basin (dike) provided?
Yes, net capacity of dike:
No
Description of retaining basin (dike): • Metal
• Clay
• Reinforced concrete
• Other
Office use only
Fee Paid:
Date received:
Date entered:
Entered by:
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
Post Office Box 1025, Stow, Massachusetts 01775
FP-101
(978) 567-3300 Fax: (978) 567-3199
Revenue Code: 617
(Rev. 4.2018)
Application for Construction and Installation
of a tank in excess of 10,000 gallon gross capacity, for aboveground storage of fluids other than water.
One tank per application, unless the additional tank(s) are identical and contain the identical fluid. When approved, this
application becomes the Permit to Construct or install the tank. When the tank has been built, tested and approved, a Use
Permit will be issued. See page 2 of 2 of this application for the submittal requirements. For tank maintenance, as defined in
502 CMR 5.00, use the Application for Maintenance.
Business name:
Street address:
Business (mailing) address:
Address (or location) of tank:
Business contact name:
Telephone number:
Business contact e-mail address: __________________________________________________________________________
Description of tank:
Manufacturer of the tank:
Manufacturer address:
New tank
Used tank (additional information will be required)
Number of Tanks: _________________________
Tank constructed/manufactured according to: • API 650
ASME
UL 142
UL 2085
UL 2080
Other:
Tank construction standard:
Tank gross maximum capacity:
gallons
Horizontal tank Diameter (feet):
Length (feet):
Vertical tank
Diameter (feet):
Height (feet):
Fluid to be stored in tank:
Flash point (°F):
• Yes, number of compartments and capacities:
Compartmented tank?
No
Secondary containment tank (doublewall tank)? • Yes
Is this tank located in a vault?
Yes
No
No
Retaining basin (dike) provided?
Yes, net capacity of dike:
No
Description of retaining basin (dike): • Metal
• Clay
• Reinforced concrete
• Other
Office use only
Fee Paid:
Date received:
Date entered:
Entered by:
Tank maintenance and tested according to:
API 653
API 510
STI SP-001
NBIC
FTPI
Other:
Name of applicant (print):
Applicant E-Mail Address:_______________________________________________________________________________
Check one:
Owner
Owner’s rep.
Operator
Installer
Engineer
Other: _________________
Business name:
Address:
Telephone number:
Fax Number:
By signing below, I certify that to the best of my knowledge, the tank, its installation and ancillary equipment were designed to
meet all the provisions of 527 CMR 1.00, 502 CMR 5.00, any other applicable standard and in accordance with good
engineering practices.
Date:
Signature:
Has the local fire department been consulted about a flammable/combustible liquids permit (MGL c. 148 s 10A & 23)?:
Yes
No
Not required - Local Fire Chief (or designee) signature:
• No
Any Fire Chief comments?
Yes, please put comments on a separate page. Number of separate pages:
The following is the Permit to Construct [502 CMR 5.04(2)] contingent on the attached approval letter:
APPROVED
: _ _ _ __ __ _ __ _ __ __ _ __ _ __ _ _ __ __ _ __
Issu e D at e : __ __ _ __ _ __ __ __ _ _
State Fire Marshal or designee
The subject tank work shall commence within six months from the date the permit was issued and must be completed within
one year of commencement. If the work has not started or completed during the stated time period the permit shall be
deemed expired and a new permit shall be required unless a written extension is granted by the Marshal.
Submittal Requirements - Please remember to include all of the following and mail to Office of the State Fire Marshal
P.O. Box 1025, Stow, MA 01775, Attention: AST Program.
FEE - $100.00 per tank up to 100,000 gallon capacity. An additional fee of one dollar per 1,000 gallons shall be
paid for tanks greater than 100,000 gallons capacity.
The following must be submitted in triplicate (an original and two copies are acceptable):
Application for Construction and Installation. One tank per application, unless the additional tank(s) are identical,
contain the identical fluid and are in a close proximity as the one listed on the application.
Plans. See 502 CMR 5.04 (2)(a) through (f). 502 CMR can be obtained from the State House Bookstore, Room
116, State House, Boston, MA 02133, (617) 727-2834. All plans must be stamped and signed by a professional
engineer duly registered in the Commonwealth.
License (MGL c. 148 s 13) and current registration (if applicable)
Material safety data sheet (MSDS) for the product being stored in the tank.
Note: Plans submitted without the proper information and returned or otherwise disapproved, will require a
reapplication fee.
Application for Construction and Installation. 11/01/00. Page 2 of 2. Ekaj.
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