Form BPV-034 "Boiler External Piping (Bep) Report of Mechanical Repair" - Massachusetts

What Is Form BPV-034?

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 January 8, 2020;
  • 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 fillable version of Form BPV-034 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 BPV-034 "Boiler External Piping (Bep) Report of Mechanical Repair" - Massachusetts

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BOILER EXTERNAL PIPING (BEP) REPORT OF MECHANICAL REPAIR
522 CMR 2.04(2):
Mechanical Repairs to Boiler External Piping Systems (BEP). Mechanical repairs to Boiler External Piping may be performed under the
supervision of the Engineer in Charge. The Engineer in Charge shall record all work performed on it upon forms to be obtained from the Department. These
records shall be kept on file at the location of the boiler, and shall be always accessible to the Division and Authorized Inspectors. Design requirements for
mechanical repairs are to meet the original code of construction. Legible signed copies of completed forms together with attachments shall be submitted to
the Department within seven days of completion of the repair.
FACILITY INFORMATION
1. NAME OF LOCATION:
_______________________________________________________________________________________
2. ADDRESS OF LOCATION:
____________________________________________________________________________________
3. NAME OF ENGINEER IN CHARGE: ____________________________________________________________________________________
4. EIC LICENSE NUMBER:
_____________________________
EXPIRATION DATE:
_______________________________
5. EIC E-MAIL/PHONE NUMBER:
____________________________________________________________________________________
BOILER INFORMATION
6. MANUFACTURER:
____________________________________
YR BUILT: _____________ MFG. SERIAL NO: __________________
7. JURISDICTION NUMBER:
_______________________________
NATIONAL BOARD NUMBER: _________________________________
8. CERTIFICATE OF INSPECTION EXPIRATION DATE:
_______________________________________________________________________
WORK PERFORMED
9. REPAIR TYPE:
Mechanical
Replacement
DATE OF REPAIR: ________________________
10. WORK PERFORMED BY:
______________________________________________________________________________________
(CONTRACTOR OR IN-HOUSE STAFF; SEE INSTRUCTIONS)
______________________________________________________________________________________
11.
ORIGINAL CODE OF CONSTRUCTION FOR BOILER:
________________________________________
_________________________
(NAME/SECTION/DIVISION)
(EDITION/ADDENDA)
12.
CONSTRUCTION CODE USED FOR REPAIR PERFORMED:
________________________________________
_________________________
(NAME/SECTION/DIVISION)
(EDITION/ADDENDA)
13. DESCRIPTION OF WORK:
14. REPLACEMENT PARTS:
SUPPLEMENTARY SHEETS ATTACHED
(SEE INSTRUCTIONS)
I certify to the best of my knowledge and belief that the statements made in this report are correct, and that all material, construction,
and workmanship on this Repair conforms to the requirements of 522 CMR.
Date:
___________________________________
Signed:
_________________________________________________________
(SIGNATURE of the ENGINEER IN CHARGE)
(DATE OF REPORT)
BPV-034, Rev 1/8/2020
BOILER EXTERNAL PIPING (BEP) REPORT OF MECHANICAL REPAIR
522 CMR 2.04(2):
Mechanical Repairs to Boiler External Piping Systems (BEP). Mechanical repairs to Boiler External Piping may be performed under the
supervision of the Engineer in Charge. The Engineer in Charge shall record all work performed on it upon forms to be obtained from the Department. These
records shall be kept on file at the location of the boiler, and shall be always accessible to the Division and Authorized Inspectors. Design requirements for
mechanical repairs are to meet the original code of construction. Legible signed copies of completed forms together with attachments shall be submitted to
the Department within seven days of completion of the repair.
FACILITY INFORMATION
1. NAME OF LOCATION:
_______________________________________________________________________________________
2. ADDRESS OF LOCATION:
____________________________________________________________________________________
3. NAME OF ENGINEER IN CHARGE: ____________________________________________________________________________________
4. EIC LICENSE NUMBER:
_____________________________
EXPIRATION DATE:
_______________________________
5. EIC E-MAIL/PHONE NUMBER:
____________________________________________________________________________________
BOILER INFORMATION
6. MANUFACTURER:
____________________________________
YR BUILT: _____________ MFG. SERIAL NO: __________________
7. JURISDICTION NUMBER:
_______________________________
NATIONAL BOARD NUMBER: _________________________________
8. CERTIFICATE OF INSPECTION EXPIRATION DATE:
_______________________________________________________________________
WORK PERFORMED
9. REPAIR TYPE:
Mechanical
Replacement
DATE OF REPAIR: ________________________
10. WORK PERFORMED BY:
______________________________________________________________________________________
(CONTRACTOR OR IN-HOUSE STAFF; SEE INSTRUCTIONS)
______________________________________________________________________________________
11.
ORIGINAL CODE OF CONSTRUCTION FOR BOILER:
________________________________________
_________________________
(NAME/SECTION/DIVISION)
(EDITION/ADDENDA)
12.
CONSTRUCTION CODE USED FOR REPAIR PERFORMED:
________________________________________
_________________________
(NAME/SECTION/DIVISION)
(EDITION/ADDENDA)
13. DESCRIPTION OF WORK:
14. REPLACEMENT PARTS:
SUPPLEMENTARY SHEETS ATTACHED
(SEE INSTRUCTIONS)
I certify to the best of my knowledge and belief that the statements made in this report are correct, and that all material, construction,
and workmanship on this Repair conforms to the requirements of 522 CMR.
Date:
___________________________________
Signed:
_________________________________________________________
(SIGNATURE of the ENGINEER IN CHARGE)
(DATE OF REPORT)
BPV-034, Rev 1/8/2020
GUIDELINES FOR COMPLETING THE BPV-022,
BOILER EXTERNAL PIPING (BEP) REPORT OF REPAIR
Please use this as a guide when completing a BEP Report of Repair.
A legible signed copy of the completed form, together with any
applicable attachments, shall be submitted to the Department within seven days of completion of the repair.
FACILITY INFORMATION
1. NAME OF LOCATION:
__As shown on Certificate of Inspection issued by the Commonwealth of Mass._______________________
__Street Address, City, Zip________________________________________________________________
2. ADDRESS OF LOCATION:
3. NAME OF ENGINEER IN CHARGE: __First/Last Name_______________________________________________________________________
4. EIC LICENSE NUMBER:
__Mass Engineer’s License ____________
EXPIRATION DATE:
__Expiration Date of License___
5. EIC E-MAIL/PHONE NUMBER:
__Contact information for Engineer in Charge________________________________________________
BOILER INFORMATION
6. MANUFACTURER:
_Manufacturer of the boiler being repaired_ YR BUILT: ___Year______ MFG. SERIAL NO: ___Serial Number___
7. JURISDICTION NUMBER:
___Mass. Tag Number_____________
NATIONAL BOARD NUMBER: __National Board Number___________
8. CERTIFICATE OF INSPECTION EXPIRATION DATE:
__As shown on the Certificate of Inspection issued by the Commonwealth of Mass.___
WORK PERFORMED
9. REPAIR TYPE:
Mechanical
Replacement
DATE OF REPAIR: __Date Repair was Completed____
10. WORK PERFORMED BY:
1.
_CONTRACTOR: If the work was completed by a contractor, please include the name/address/phone__
_number/license number of the contractor._________________________________________________
_IN-HOUSE STAFF: If the work was completed by an employee at the facility, please include the _____
2.
_name/position of the person(s) who performed the repair work._______________________________
11.
ORIGINAL CODE OF CONSTRUCTION FOR BOILER:
_Indicate the name, section, division, edition and addenda (if applicable) of the _
_original code of construction for this boiler_______________________________
_Indicate the name, section, division, edition and addenda (if applicable) of the _
12.
CONSTRUCTION CODE USED FOR REPAIR PERFORMED:
_construction code used for the current work being performed. If code cases are
_used, they shall be identified in the Description of Work, Item 13_____________
13.
DESCRIPTION OF WORK:
__Please provide a summary of the repair work performed______________________________________
14.
REPLACEMENT PARTS:
__Please provide a list of all parts used in this repair. Please attach sheets for all additional information
__related to this repair, such as the Material Test Reports (MTRs) for all materials used ______________
Please submit completed forms by:
Email:
edward.kawa@mass.gov
FAX:
978-567-3199
Mail: Department of Fire Services
Boiler & Pressure Vessel Insp. Program
PO Box 1025
Stow, MA 01775
BPV-034, Rev 1/8/2020
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