Form SH-310 "Application for Permission to Install a Second-Hand Boiler" - New York

What Is Form SH-310?

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

Form Details:

  • Released on May 1, 1993;
  • The latest edition provided by the New York State Department of Labor;
  • 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 SH-310 by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.

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Download Form SH-310 "Application for Permission to Install a Second-Hand Boiler" - New York

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STATE OF NEW YORK
DEPARTMENT OF LABOR
DIVISION OF SAFETY AND HEALTH
Boiler Safety Bureau
STATE OFFICE BUILDING CAMPUS
ALBANY, N.Y. 12240
APPLICATION FOR PERMISSION TO INSTALL A SECOND>HAND BOILER
DO NOT BUY OR INSTALL BOILER UNTIL PERMISSION HAS BEEN GRANTED BY THIS DEPARTMENT
1. NAME OF COMPANY OR INDIVIDUAL DESIRING TO INSTALL THE BOILER
2.
HOW LONG HAVE YOU OWNED THE BOILER?
CITY > TOWN > VILLAGE
3. BUSINESS ADDRESS
ZIP CODE
COUNTY
4. COMPLETE STREET ADDRESS WHERE BOILER WILL BE INSTALLED
5. COMPLETE STREET ADDRESS OF PRESENT LOCATION OF BOILER
6.
HOW LONG HAS BOILER BEEN AT PRESENT LOCATION?
7. NAME AND ADDRESS OF COMPANY OR INDIVIDUAL WHO OWNED BOILER BEFORE BEING PURCHASED BY YOU. (Do not Give Dealerπs Name)
8. WAS BOILER EVER INSPECTED UNDER THE BOILER CODE OF NEW YORK STATE?
9.
DATE OF SUCH INSPECTION
" YES (If a certificate of Inspection was issued, complete Items 9, 10, 11, 12.) " NO (proceed to Item 14)
10. NEW YORK STATE BOILER NO.
11. CERTIFICATE ISSUED BY
12. PRESSURE
"
NEW YORK STATE
"
INSURANCE COMPANY ____________________________________
(Name of Insurance Company)
13. FEIN AND/OR SOCIAL SECURITY NUMBER
14. TYPE OF BOILER
15. BUILT BY
16. AGE
20. FOR WATER > TUBE BOILER ONLY:
17. NUMBER OF SHELLS, DRUMS, OR SECTIONS
18. DIAMETER OR WIDTH
19. OVERALL LENGTH
HEATING SURFACE
FT.
IN.
FT.
IN.
SQ. FT.
21. LONGITUDINAL JOINTS
22. STEAM PRESSURE REQUIRED
"
"
"
"
LAP TYPE
BUTT TYPE
WELDED
RIVITED
ALL BOILERS MUST BE INSPECTED BY NEW YORK STATE OR
AN INSURANCE COMPANY PROVIDING BOILER INSURANCE
23. DO YOU PLAN TO CARRY BOILER INSURANCE?
"
YES, Name of Insurance Company which Will Make Inspection _________________________________________________________________________
"
NO, When Will Boiler be Ready for Inspection? _______________________________________________________________________________________
24. SIGNATURE OF OWNER OF BOILER OR OFFICE OF COMPANY
25. DATE
This application must be made by owner or user, or prospective owner or user of boiler, and the words ™owner or user∫ in this section shall not be construed to
mean the manufacturer or seller of a boiler. See Section 14>4.1 of the Boiler Code. Unless the above questions are clearly answered this application will not be
accepted. Forward last inspection report or certificate of inspection with application. Boilers, which do not meet or exceed the construction requirements
specified in the New York State Boiler Code will not be allowed to be installed in New York State. See Section 14>9.45 of the New York State Boiler Code.
YOU MUST LIST ALL STAMPING APPEARING ON BOILER ON REVERSE OF THIS FORM
SH>310 (5>93)
STATE OF NEW YORK
DEPARTMENT OF LABOR
DIVISION OF SAFETY AND HEALTH
Boiler Safety Bureau
STATE OFFICE BUILDING CAMPUS
ALBANY, N.Y. 12240
APPLICATION FOR PERMISSION TO INSTALL A SECOND>HAND BOILER
DO NOT BUY OR INSTALL BOILER UNTIL PERMISSION HAS BEEN GRANTED BY THIS DEPARTMENT
1. NAME OF COMPANY OR INDIVIDUAL DESIRING TO INSTALL THE BOILER
2.
HOW LONG HAVE YOU OWNED THE BOILER?
CITY > TOWN > VILLAGE
3. BUSINESS ADDRESS
ZIP CODE
COUNTY
4. COMPLETE STREET ADDRESS WHERE BOILER WILL BE INSTALLED
5. COMPLETE STREET ADDRESS OF PRESENT LOCATION OF BOILER
6.
HOW LONG HAS BOILER BEEN AT PRESENT LOCATION?
7. NAME AND ADDRESS OF COMPANY OR INDIVIDUAL WHO OWNED BOILER BEFORE BEING PURCHASED BY YOU. (Do not Give Dealerπs Name)
8. WAS BOILER EVER INSPECTED UNDER THE BOILER CODE OF NEW YORK STATE?
9.
DATE OF SUCH INSPECTION
" YES (If a certificate of Inspection was issued, complete Items 9, 10, 11, 12.) " NO (proceed to Item 14)
10. NEW YORK STATE BOILER NO.
11. CERTIFICATE ISSUED BY
12. PRESSURE
"
NEW YORK STATE
"
INSURANCE COMPANY ____________________________________
(Name of Insurance Company)
13. FEIN AND/OR SOCIAL SECURITY NUMBER
14. TYPE OF BOILER
15. BUILT BY
16. AGE
20. FOR WATER > TUBE BOILER ONLY:
17. NUMBER OF SHELLS, DRUMS, OR SECTIONS
18. DIAMETER OR WIDTH
19. OVERALL LENGTH
HEATING SURFACE
FT.
IN.
FT.
IN.
SQ. FT.
21. LONGITUDINAL JOINTS
22. STEAM PRESSURE REQUIRED
"
"
"
"
LAP TYPE
BUTT TYPE
WELDED
RIVITED
ALL BOILERS MUST BE INSPECTED BY NEW YORK STATE OR
AN INSURANCE COMPANY PROVIDING BOILER INSURANCE
23. DO YOU PLAN TO CARRY BOILER INSURANCE?
"
YES, Name of Insurance Company which Will Make Inspection _________________________________________________________________________
"
NO, When Will Boiler be Ready for Inspection? _______________________________________________________________________________________
24. SIGNATURE OF OWNER OF BOILER OR OFFICE OF COMPANY
25. DATE
This application must be made by owner or user, or prospective owner or user of boiler, and the words ™owner or user∫ in this section shall not be construed to
mean the manufacturer or seller of a boiler. See Section 14>4.1 of the Boiler Code. Unless the above questions are clearly answered this application will not be
accepted. Forward last inspection report or certificate of inspection with application. Boilers, which do not meet or exceed the construction requirements
specified in the New York State Boiler Code will not be allowed to be installed in New York State. See Section 14>9.45 of the New York State Boiler Code.
YOU MUST LIST ALL STAMPING APPEARING ON BOILER ON REVERSE OF THIS FORM
SH>310 (5>93)