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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
02/7a/2Ot3
permit Number: 101236
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 58 Adams Rd /West Yarmouth, MA 02673
For permission to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operato r: tank removal service p: 508-778-8265
Date lssued-Rejected 02 / LA / 20L3 By
Date of Expiration: 03/!4/2O!3
Cert. No.
Fee $ Paid
re app can
Due
115
STROOl
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APPLIGATIO]II FOR PERTUIIT
City or Town:
Date:
Yarmouth
oL /23/2Or3
permit Number: 101220
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 58 Adams Rd /South Yarmouth, MA 02664
For permission to. lnstall Oil Burning Equipmenutanks
ua Services Plumbin and Heati LLC
Date lssued-Rejected 0l / 23 / 2or3 By
Date of Expiration OL / 3L / 2OL3
Cert. No
(Signature of applicant)
Due
STROOI
Fee $ Paid
Name of Competent Operator:
d5..
rylaKe apPllcarlon Io IOCaI Flre uePanmenL
Fire Department retains original apPlication and issues duplicate as Permit'
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APPLICATION and PEHMIT
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 3AA,527 CMFI 9'00, application is hereby made by:
Afler removal(s) send Form FP-290R signed by Local trire Dept. to IJST Begulatory Compliance Unit, One Ashburton Place,
Ftoom 1310, Boston, MA 02108-1618.
Fee:
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zipail
Tank Owner Name (please Print)
Address
C lFCl Certified D LSP #
-
other
-
Cc, or lridividual
Signature (if applying for
Address
rmit)
Other
-
3 lFCl Certified
A4--..-.;^,+
\_aCompany Name :tr(-
s lo
SU
Signature (il app
Tank Dimensions (diameter x lengrth)
5c.D,
LI
N
CityTank Location
Substance Last Stored
(4*
Tank Capacity (gallons)
Remarks:
Slate Lic. #
E.P.A. #.Ll
S/Tank yard address
(u-.
1'1OI1Firrn transporting waste
L
6
A,A5 n- C'
Z-1,o.1
Type ot inert gas
Tank yard #Approved tank disposal yard L/n l l-.-
Hazardous waste manifest#
Dig Safe Toll Free Tel. Number - 800-322-4844
Permit#Cr Utll,\I
\
\\\\
Date of expiration
FDID#
Signature / Title of Offlcer granting permit
Dig safe approval numben
City or Town
Date oI issue
TankOwner
Contamination Assessm€nt
Disposal lnformation
Apprwals
FP-2s2 (@vis6d 9,€6)
Bemoval Gontractor
I
Address
Iank lnformation
lb
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527 CMR 4.00 Form 't
Application lor Pcrmit. Permir. and Cenifi!-atc ol-Compldliort lor thc
lnslallnli(,n or Allerarir, n ol l-uel Oil Buming [:quipmcnl and lhe Sloragc of l:uel Oil
Permil #'s FD _
Owner/Occupant Name .lir r 6I()BL
lnstallatlon Address .4€ AMnns ?,'
D Heating Unil fl Domestic Warer Heater
Burner ENew O Exrsting B Location
(Cty or Towl)
Fee Pato S _
,et* 5O8-'f)A-O27 I
Elec FDID*
O Power Vent
Servced FIoor or Unit #
Other
Mlg
Type Model # or SEe Nozzle size
D Kerosene - Waste Oil
Storage Tank {^*t fj E&strng Locatroo Baszmesr-
rype 3Ws- {eilrtC*C capacity 275 salons No. of Tanks I
Speoal requiremenls (or addibonal safety devices)
- osv vatve E/51 Line Protecteo n Sheet Rock O Sprintter AFUE. E yes E no EF flyes D no
(furnace and boilers) lvater hertsr)
AQUA SERVICES PLUMBING & HEATING LLCCo Name
Address
I et l 77 4470]1350
1268 ROUTE 28 Crty z'c 02664
Completion Dale:
Combustion lest Gross Stack Temp Net Stack Temp
CO, Test Breech Drafi
Overfire Dlaft Efficiency Rating %
r |ne unders€ned c€n fy tlut lhe nslalialon olltrel burrurE equrpnEnt ha3 b€€n macle In a..ordancd wnh M G L Chspla f4a arld 527 CMR a OOcurefllly rn stled tufiermoto. |nls nslallalpn has been |eqed in accoa6sme w{tl such requirefitenls ls now ln proper opeftttng cofldrlrcn afidcompEle lnsfudlons ag to {S u5€ and maanEnanco hale been fumGhed tO the person or wirofi tlE (or made
.I , DOUG LANGTRY 026149Pr,r &in)e
1268 ROUTE 28 Crly SOUTH ARMOUTH
liis rs e slorage ol luel o and us€ ol lhe od bornaE e+4rnent
oare I
Keep ongrnal as applEation plrcale as perm{ Thrs fofm may be photocop€d
SOUTH YARMOUTH
Onoe srgn€d b, tro firE
Approved by _
ALL INSTALLATIONS
tl4 0311)d All apphcatons musl be on Forn 1
tr4 03 ( 1)e Over 10.000 galons on stte equirss License &Pemxt kom local community
E)4 03 (1)g Cadficate of Compebnc] requrred. rro otherlicense acaeptable, plumbrnq, electncal. eta
04 04 (3)a Venly efteEency siut-ofl6 oulsde bumer room
tr4 04 (4)b Vent separate circ.,il for oil bunrer
El4.Od {4)e Veafy pre3€nce ot overhead thermal swltct}
04 04 (4 )c V€nt Eesence of se.vrce switch withm 3' of bumer
04 04 (3)b Vedly pres€nce ol hrgh lrm{ contIolter
E1 04 (3)c{1) Pnmary corirol has sabty tirnrng ot 45 secs lmar)
Oa 0a laE Sbrk type prmary may be easly removed
Ek 0a {3)d Sleam boalor equipped wth tol.r-vr6ter drl-off
tr4 04 (4)f Clesr access lo ctean oul aftd seMces pane{s
El 4 04 (5)b No oit teaks p.esent at burner
g4 04 15)d lrlstatlatbn rnstruclrons prcsent on sde
B4 04 ls)f Overhead @ryrbuslible clearanc.s wllhm 5 ,eei over
unn Gypsum boad or sponkler requrred unless untt
rs AFUE {Fumace or Borl€r) iated or EF (water
heater)
E4 04 (5)g Combuslon tesl .esulls on Form 1
E]4 0.1 (9)b{12) Thr6o m6lal raaelvs at each ,ornl rn chrnney
04 04 (9)b{7) Thrmbte pcsent al chmney conneclion
n4 01 {9)d lF POI rER VENTER ts uSEo ch€ck ar pressure
sw{cfi, pcl purge control and se@ndary contrct
lnstalbti9n inslrudlons p.esenl.
tr4 0{ {9[ Drafi Egulator is pGs€nt ufiless erempted
tr4 04 {5)m Adequale ar b p,esent br cornbustpn
fld 04 {5)o Adsquste clearances pe. manufaclure.6 l'stlng
Cla 04 {2)r Thermat valves al bum€r and tanks
E4 04 (1)b Lrsted fexrbb hose may be used
El4 0411)c No T€tlon rape on o lrne oron orlline ntings
E]4 04 (1)c No compress$n fitiin0s a.e permfied
C)4 04 {1 )q Solder Joints made with 5O0 degree F solder or
grsater
Oa 0{ t 1 )e All orl supply and retum lmes musl be ploteded
fom inlury All new lnes mult b€ @nUnuously
slgeved $4lh non nElallic lubrog Ol safety valves
may be $ed on exlstin! lines nol expoS€d to
freezing. Overhead lanes reqlirE no slgeve and a.e
p6rmitted
EI4 fi { t )g otl supply lnea and rerum lincs lo tanks exposed lo
lreezng Empe.alurcs must corne otl lhe lop of
tankS
Linei b. kerGene and range o 1#1)areexempt-
Ek 04 (1I No od haks presenl al tank
tr4 04 (1)h LEted orl ftller |s preEent
fk 03 {5}b Tank E uL80 or (DlB+) PV-vl 32'l (under 660 gal}
or UL 142 (oYer 600 gal)
B4 03 (5)a Shutoll ralve located at boltom ol lank
Ei 03 (5)t Slze of lent as per Table 4 03A
El4 03 (5)g Oallank gsuge musl be p.esenl to dete.mine orl
level
El4 03 (11|c lmide tanks have audible fill devrce {vent alarm)
Ek 03 {5j, Outat closs connecton al bottom of tanks n'ud be
1/Z pp€ or lubng
E4 03 {5}l Non-conbustible L.nk supporls, lank seclre
Note To lnstaller: lnspection3 will bo conductedchecklist .3 a guidelioe. Cur.ent legulations will
UNETTCLOSED TANKS
using l}ris
applv.
EL.03 (6)b
tr4 03 (6)b
tr4 03 {6)d
El4 03 t6)d
B{ 03 (6)e
El4 03 {6)f
Srogh tanks shall noi be largerthan 660 galbns
Maxfinum agg,Egaie aapaoty of unendoled
rnulilple tank$ 15 1320 galloni
Unendosed lanks shall be at l€ag five 661t om anrnternal or ext€mal tlame
Unendo6ed tanks shall nol obstRtd seMce mebrsservEe panels and ghutoft valves
Bottotn outlet tanks pddled to the openinq
Tanks exposed lo vehrdes vlrll be prole@d bybarnels
ENCLOSED TANXS
D { 03 (7)a Ove. 660 gatloo l,ank6 enctosed by t!rc how lllcres6tive assembly
84.03 {7}b Tank encloaures provd€d tr{h 6" hBh trght$rtls or
ramps
B4 03 (7)d Tank is 4" above noor supporEd by t2'thEk
mssoflry saddles spaced nol more than etghl ieel
on cenles and 15" from iop and walls ot€ncloaue
E4 03 (7)e All otl husl be transfened by purnp. end
conneclons musl t e at the t@ ol oie tank
EI4.03 (8)c
Da 03 (8)c
cl4 03 {8rc
Eh 0318)c
tr4.03 i8)d
ALL TANKS
oa 03 ig)d T,,t/a tanks may be cross€noected as shoon nFg 403 1
E4 03 {10)b Retlm hnes must enter lhe top of tanks
E4 03 {9)c Vent p'pes must be two feet trom bu drng openhgs
tr4 03 (9)c Vent p'pe3 must lermrnale 3 ft above grade mm
E14.03 {9)c Vent prpes musl have vleathe.prool cap3
B4 03 {10)a Frll ppe6 rYrusl be two feei from bu,ldrog openmgs
D4 03 (10)a Frll prpes musi hav. tamper p.oof rdentrfylrE caps
EI4 04 tg)d IF POIiVER VENTER IS USEO
All outslde @nnectrons s€aled Venl lemrnai musl b€ lhree
feet above all arr inlets wlhin 10fr BumE air intaka is
exempled Venl tefirnai mugt be four bet J?om doo6 snd
$ndows Venl must be one tool above finished grade. Th(ee
lool clearance trorn rnslde @me,9 Nol above or ndhm th.ee
feet o, afi orl t.nk. Seven leel above a gublirr walkltay.
lF UNDER PORCH OR OECK Healrng use only. no hor
water Four feet oelow deck AND not enclosed under deck
OUTSIDE TANKS
fl4 03 r8)a Arl USTS and tanks over 660 gallons mu6l be
rngtalled as per CMR I00
Tank prolec-led from phYslcal damaqe
Tanks e{tenor @aled wth organrc alkyd re!,n or
aEpha[ parnl
Damaged prcteclue coaings musl be recovered
Tank does nol blod( means of egress
Tanh hounted on @nlnuous 4" thrck slab thal
extends E beyond tank f,enmeter
Tank i6 sr.ippo(ed by ngd non-combustible
suppo.lstr4 0318)d