HomeMy WebLinkAboutunvented gas heat 2021C"r-*r**/11 / f7rr4./",1 /b
S,p,rjr- l "l Ju* &/*,r,' - W "l tl* [t l" Jv*, T[1"^l'"1
P.A. 8". 1025, bt"l" P*"t, bto*, mA U115
APPLICATION FOR PERMIT
City or Town: Yarmouth
Date:72 /11 /2O2L
permit Number: 102920
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section '10 A application is hereby made
by:
Address: 18 ANCHORAGE LANE /West Yarmouth, MA 02673
For permission to: Unvented Gas Heater lnstallation 527CMR 1.12.8.6
Name of Competent Operator PALATINO / CAPE GOD GAS HEAT & AC
Date lssued-Rejecled L2 / l'l /2o2f By
Cert. No
Date of Expiration Fee: Sso.00 $ paid
(SfgnaTurtof applicant)
Due
139
18AN01
(\V***orr*ot/ o/
?4*rr*rz/&r.r.
FP-056
(Rev. 1 .26.2015)
Permit #'s: FD _Elec
Owner/Occupant Name:
lnstallation Address:
527 CMR
Section 1.1
Form
Application for Permit, Permit, and C
Installation or Alteration of Fuel Oil Buming
1.00
2.8.2.1
1
ertificate of Completion for the
torage oIF loil
Hr'rl^,//,o
ztuione;y),*es
/Qrkl0 /2 -/ 7-J I
'CL-
c< rc?
FDiD#
(City or Town) (Date)
Fee Paid: $
Tel.#:
Heating Unit
Burner;
Domestic Water Heater Power
Serviced Floor or Unit #:
therre aNew Existino
,frnq,'r-
Location
Mfg:
Type W Model # or size: JO,ooo 0T<)Nozzle size:
Fuel Oil
Storage Tank:
Kerosene
Existing Location:
Waste Oil Removal
New
Type:
Special requirements (or additional safety devices)
OSV valve Oil Line Protected
Address
Completion Date:
Combustion Test:
l, the undersigned certify
currently in effect. F
complete instru
lnstaller;
Gross Stack Temp
CO, Test:
c ()Tel #
ct/City 0 zip o2f65
Overfire Draft:
FC
Efficiency Rating %
tallation of fuel burning equipment has been made in accordance with M.G.L. Chapter 148 and 527 CMR 1 .00
in been tesled in accordance with such requirem inp operat ng n and
have been furnished to the person or whom n(rati made
/{a.u \o Ce of C#
Address City:
Once signed by the fire department, this is a PERMIT for the storage of fuel oil and use of the oil burning equipment
Date
r
Approved by
amp)
(/
,/ " c>(f_€t, "
Capacity: _ gallons No. of Tanks:
Co. Name:
Smoke:
Net Stack Temp.:
Breech Draft:
Keep original as application. lssue duplicate as permit. This form may be photocopied.