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APPLICATION FOR PERMIT
City or Town: Yarmouth
Date:o6/rL/20L5
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 251 Old Main St /South Yarmouth, MA 02664
For permission to: lnstall Oil Burning Equipmenutanks
Name of Competent Operator: Hall Oil Ph.:508-398-3831
Date lssued-Rejecled OG / Ll / 2OL5
Date of Expiration 09/L:-/20L5 Fee: s50 ' 0c $ Paid
Cert. No
rgna a
Due
THEUOl
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PERMIT
Date:
Permit Number (if applicable) .01r5F
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
ro: Hall Oil ph.: 508-398-3831
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.
251 Old Main St /South Yarmouth, MA 02664
06/7L/2ots
DIG SAFE NUMBER
Start Date:
At:
Fee Paid $s50.00 This permit will expire on 091'1112015
Signature of Official Granting Permit
This rmit must be cons icuous I posted upon the premises
permit Number: 101758
By
City or Town: Yarmouth
Ti!e
$fi}\A
FP-056
(Rev.'1.26.2015)
Permit #'s: FD {'f \S\Elec.FDID#:roESS
Tel.#:
527 CMR 1.00
Section 1.12.8.2.1
Form 1
Application for Permit. Permit, and Certifrcate of Completion for the
Installation or Alteration ofFuel Oil Burning Equipment and the Storage ofFuel Oil
S Yfttz$o,rrll
(City or Town)(Date)
Fee Paid: $
owner/occupant ruame: J Ollr..1 tFrt(s
lnstallation Address: 7St DLO MAtnt :T,
- Heating Unit - Domesti6 Water Heater' | )('. Power Vent
Bumer: - .NS,v :l Extting Location
3
Serviced Floor or Unit #:
Other
Mfg:
Type Model # or Size Nozzle size:
f Fuel Oil -i Kerosene
--,Storage Tank: f New - Existing
I Waste oil
Location: BF>gr"telrr
':- Removal
Type:(.pit-LFcru /N"e.e Capacity: Za ( gallons No. of Tanks: I
Special requirements (or additional safety devices)
: OSV valve loit Line Protected
Co. Name:
Address:
lJAte orL h rer# 9a3-375-38 3l
qls ef t3q City:5 Oeppr:Zip:ozb50
Completion Date G Ir rr
Combustion Test: Gross Stack Temp.
CO'? Test:
Net Stack Temp
Breech Draft:
l, the undersigned cedify
Overfire Draft:
that the installation of fuel buming equipmenl has been made in accordance with M.c.L. Chapte. 148 and S27 CMR .l.OO
currently in effect. Furthermore, this installation has been tested in accordance with such requirements, is now in proper operating condition and
complete instructjons as to its use and maintenance have been fumished to the person or whom the installation (or alteration)
lnstaller:\u1fta-o tLSzHL
Smoke:Efficiency Rating %:
7
Ced of C#
l\, \D,1J .;t City 5 .J
Once signed by the fire department, this is a PERMIT lor the storage of fuel oil and use of the oil buming equipment.
Date e/z y //)Approved by
ade
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I
Address:
Keep original as appllcation. lssue duplicate as psrmit. This form may be photocopied.