MS-0269_10_1_001.pdf

Text: CERTIFICATE OF BOILER INSPECTION
Boiler No . .

J.:

Certificate No ............

..

This is to Certify that the herein-described boiler ins ured and in spected by
TIIE JJA RTFOR D STEAM BOILER INSPECTION

AND

..1 APRIL1976

on

may be operated at a Pressure not to exceed ..

15 psi

pound s per square inch.

ame of user PROTESTANT
EPISCOPALCHURCH
... of . the

DELAWARE AVE.
Location of boiler ST. Phillips .. Epis.
Address 1114

.
.
(No. and Street)
T ype of boiler.... CA
ST IRON
.

Made by ...

U.S.RAD..

INSURANCE COMPANY

DIOCESE

BUFFALO,N Y
Ch. 18 SUXXEX
.

WN

..................
ST. BUFFALO, NY,

(City)

....... ...

of

(_County)

.

1

Y.. .... .
... .. ..... .. .. .
ERIE

.-,I""

(State)

Year built .. 1 955

. . ..... .. ...... ... Std. and Std. No. .. .. ...... .. .. ... .. . ...

.. .. ... .. ...... .. .. ...

Certificate expires one year from date of last inspection.
RE-INSP ECTIONS
Kind

Date

Inspector

.. ... ; ······

...... by .
by .

Signature

. W.J.

Tanski

POST THIS CERTIFICATE IN A CONSPICUOUS PLACE NEAR THE BOILER
2069