HomeMy WebLinkAboutinstall oil burner 2011ll,lt L"onunanuutn o/ l/huoxfutuia
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APPL!CATION FOR PERMIT
City or Town:
Date:
Yarmouth
09/ o7/2orr
permit Number: 100884
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
For permission to: lnstall Oil Burning EquipmenUtanks
Name of Competent Operator Winslow p: 394-7778
Date lssued-Rejecled O9 / 0L / 2Ol!
Date of Expiration: lO/03/2Or 1 Fee: s25 ' 00 $ Paid
Cert. No
(Signature of applicant)
Due
THEUOl
AVEROl
Address: 28 Avery Ln /South Yarmouth, MA 02664
By
.4.Afiz Cormonu ealt ft of l+{ass adus etts
Dcpottnart of enhti" Safrty
527 CMR 4.00
Form I
Application for Permit, Permit, and Certificare of completion for the Insullarion or
Alteralion of Fuei Oil Burning E d of Fuet Oi
0
(Ciry or Town)(Dalc)
Permir #'s: FD tUOAg4
Owner/Occupanr Name:tsctufr Suor",l
Ag AYEfuJN
roro*, CB\!,\?{eFce Paid:
Tcl *h 6')i
Installaoon Ad&ess:
[r**
Bumcr:@N"',,
g Unir EI Domestic Warcr Heacr
cldfr{?
E] extting location:B+sen
Trade Name:Mfg:Rct'x
e:Model # or Size:
Fuei OiI E Kcroscnc E Wasrc oil
Locarion:
g Location:ilmetile*rr
gais. No. of Tants:
Gross Suck Tcrap.:
Brcech Drafr
Te[. #
f-?fr\tatttz.pTeut
fr
Storage Tank E New
re". sTc€L-Capaciry:
Special requiremcns (or additional safety &vices)
E osv vaive OiI linc protectcd
Combusdon Tesr Nozde Size
E Sheer Rock EI Sprintler mnVy* a
4co
no
N"* sJ.SO".p.,COlTcsr /L'./",o
Smoke:Ovcrire Drafr Efficiency rzdng 9o:
I, the undersigned cenify rhat the insrallation of fuel bLrming equipment has been made in accordance with M.G,L. c l48 and 527 CMR 4.00
currently in effect. Furthermore, rhis installatioo has been testcd io accordance with such requiremenrs, is now in Proper op€rating condition and
complele instructions as to its use and maintenance have been fumished ro rhe person for whom the instrllation (or alteration) was made.tr 3?/ 177FCo. Name
Addrcss
lnstaller:
c-t/{City
4 >tazg
Once signed by the fire
Print Narnz
department,
Signarur€ (no Srarnp)
this is a PERMIT for the storage and use of oil buming equipment.
lnspected by: Date:
WHIE COpy: property owne/s copy; CANAFY COPY: YF.D. Copy - neturn when iob is complsled; Pltlx COPY - 1ti3 copy musl be posted at installation.
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Scrviced Floor or Unit i:
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