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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
rL/r7 /2O!O
Permit Number: '100695
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 20 Barn Board Ln /West Yarmouth, MA 02673
Name of Competent Operator RIDELL HEATING P: 508428-6365
By
Cert. No
Date of Expiration Fee: S2s.00 $ paid
(Signature of applicant)
Due
THEUOl
BARNOS
rl,!rlit,ti
For permission to: lnstall Oil Burning Equipmenutanks
Date lssued-Rejecled LL/17 / 2OLO
N0'i:19-2010 FRI 02:45 PU RIEDEIL IAX: 5084200 i8!
Ifu Cotrmonarultfi of *{assanatsztt
Dcparanant of ?niti" S"f*y
527 CN,IR 4.00
Form I
P 002
Application fo Pcrmit, Permit,3nd Certiticac of completion for thc Insullarion or
A.ltrradon of Fud OiI Buraine EqurPmrnt
e4j,
(Gry or Town)
Perrnit *'s: FD
Owacr/Ocanpaat Neroc:D,.- 7i
F:DIDA (i).K ^ = io
Fee Par& / -'II
Installarion Addrcss:
TcL+s f-il/_ i t1_ S 8j1
L"J L -lSclviccd Floor or Unit *i 'L?- -,n ,\
El Hcadng Unit
Burncr: El New
EI Donrcstic Y/'arct Elcarcr E Pourcr Vcnt tr O*rcr
tr gxising Locatioa:Vr-
Tnde Nrme Zrty'o/Mfs:
Tygc: 2 "tr'. Model # or Sizc:
EI rua ou E Kcroscac E Wasrc oil
IFG Location:?2, I -; t''', t4
Stonge Trnh E Nox' E edstiag Locarion:Vt Ez:t.. '
E OSv val"e El OiI linc protccicd El shcct Rod( E spdallca AFUE: EI yes EI no
Combustion Tcsr Nozzle Sizc
-
Gross SE k T.nrp.:4%
Ncw Stac.k Tcrnp.: COsTcst 3.q Brccch Drsft #04
L drc urdEEign€d celtity dlnr th. inrrrllrrton of fucl butr .ag cqulph.nt h.s bcci oi& ir rcco(Lncc *ith M.6,L <, 148 |Dd 527 CMR 4.m
crsEntly in c(tct hntlrcimorc, thlr tn Blhdon hrr han tc*cd iu rccotd.ncc u,ith .udr ttquirEm.nE. i, ,ror, in plDpcr opcrrting condirion uld
com!lcrc iNtruclio.r ir to ir9 ulc .Ird nainlarun(c hlvc bccn trmirtrcd to drc pct,on for whom lha icrc.llatiqr (or J(tr.rio() r-i, meda.
V-/r/ {r.,Zrtc-Tel. +5OS'L/) S' (?(.'l
C,ty'/cri/L zip:a)G;;>.;77/l
Co. Name /!. r
Installer:
P'inr Na a S(rus.r. (n Srdnp)
Once signed by the fire depa.unent, fiis is a PERMIT for thc storage and r,se of oil buming equipment.
Irspccted by:Datc:-
WlmE COPY Prop!fly of,nC! copy; ClillFY CoPY: Y,F,o. Copy - Fct m ihrn iob io co|nplcted; PINX COPY.rlrls copy ftrsr br post d rt iNtr,l.{6!L
J/+
Lbe Srosagc of Fuat Oil
ryp", 1/or/ /r;u, /- Gpacirr 2 7 5- 3".ls- No. of ranrs:,/
Spccial requirurncns (or additiond safcty dct iccs)
Smoke:ov66re Draft ,- Eficicary tzt'ng %: W S
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