HomeMy WebLinkAboutinstall oil burner 2014 (not inspected)Crr*rr**//l / n"At /r,/r/b
$ J* b**i,^ - W 'l#* $t"1" J;ru Ttt ,il*l
P.0. 8". 1025, bl"j, P*"1, bt**, mA 01115
APPLICATION FOR PERMIT
City or Town: Yarmouth
Date rL/25/2014
permit Number: 101575
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 9 Rainbow Rd /YVest Yarmouth, MA 02673
For permission to: lnstall Oil Burning Equipment/tanks
Name of Competent Operator:Rustv's lnc. oh.: 508-775-1 303
Date lssued-Rejected f! / 25 / 2O74 By
Date of Expiration 02/25/2oL5 Fee: s50 ' 00 g Paid
Cert. No.
(Sagnature of applicant)
Due
THEUOl
RAINO3
C,,-.,**//l "/ f/7,r*t rrr/,
$ Jr* [,*ir* - W rl il* #r]" J^ Tfi-,,'l*l
P.A. Er, 1025, bt"j, P*"/,, bk*, ma 01115
PERMIT
City or Town: Yarmouth
Date:
Permit Number (if applicable) I 01 ! I :
For permission to: lnstall Oil Burning Equipmenutanks
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
At 9 Rainbow Rd /West Yarmouth, MA 02673
DIG SAFE NUMBER
Start Date:
$s0.00Fee Paid $This permit will expire on 021251?015
Title
This permit must be conspicuously posted upon the premises
07/o6/201s
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: Rusty's lnc. ph.: 508-775-1303
Signature of Official Granting Permit
SL\1fi2 Comrunateiltf,. of g"tnssa{uset*
Deporana* of 2,riti" Safrty
527 CMR 4.00
Form I
Application for Permit, Permit, and Certificate of completion for the Insrallarion or
Alteration of Fud Oil Burning E ipment and lhe Stomge of Fuet Oil 'es- t
(Gry or Town)(Dalc)
h
Permit #'s: FD
Owncr/Occupanr Name:
ln5rrll4i6l Addrcss:
{a.*rgurlrr.
Bumer: Edcw
Trade Name:
€z Y
lcl fn
Scrviced Floor
E Domestic Warcr Heats E Fowcr Venr E Orhcr
E Exlsting [.ocadon:B,o-n*
Mfg:B*
Tlpe:C-t, n Model # or Size: Ltr G'
EfFuet Ou E Kcrcsene EI Wasa oil
Sorage Tank EI New {*i"*rg Location:Bo*-raf
Locadon:Bn*en*
E OSv valve frrl t^" protecred E Shcct Rock E Sprintlcr 6*tr
,trs ttt'B Gmss Stack Tcrnp.:
/.7 "L
AFUE:
.<oo
no
Combusrion Tcsc Nozzte Sizc
New Stack Tcmp.: COlTcsr
Co. Name
Brcech Drafc -. 04
I, the undersigned cenifi that th€ installation of fuel buming equipment has hcen made in accordance with M.O.L. c. 148 and 52? CMR 4.oo
currendy in effecl Funhermore, rhis installation has been tested in accordance with such requiremen$, i5 now in proper opcrating condition and
cornplete instructions as to its use and maintenance have been fumished to rhe person for whom the installation (or alteration) was made.
Address City:V), VO cmo.^-th zip D21o )3
lnstaller al e-R.G \\f
Pnnr Name Signatre (ump)
Once signed by the fire department, this is a PERMIT for rhe storage and use of oil buming equipment
Inspectcd hy:Date:--'Lvta;ucD .4)o (rtQ h,.ron-p
WHIIE coPY: Property onne/! copy; CANAFY COPY: Y.F.D. Copy - notum nien lob b conpletcd; PI K COPY.This copy md be post€d 8t insdl.tion
or
tols+SB*.FDrD* C6\61 Fccpaid:lrcoo
'fy1e 1va-l Capaciry: 2-l { gais. No. ofTanks:
Special requiremcnlr (or additional safely ds/ices)
Smoke: O Ovcrfire Drafc ' . o
^ Efficicncy rating fo: t t" /"
u " Oi J7{/Jo <