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P.A. Er, 1025, N"l, F*",1", $l^*, mA 01115
City or Town:
Date:
Yarmouth
o4/23/2OO8
Permit Number: 001904
ln accordance with the provisions of M.G.L. Chapte|I48, as provided in Section 10 A application is hereby made
by:
Address: 54 Barn Board Ln /west Yarmouth, MA 02673
For permission to: lnstall Oil Burning Equipment
Name of Competent Operator:Scudder & T lor
Date lssued-Reiecled O4 / 23 / 2OOg
Date of Expiration . 05 / 23 /2OOa Fee: S20 ' 00 g paid
Cert. No.
By
(Signature of applicant)
Due
FAO RUELL
BARNOT
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PERMIT
115
City or Town: Yarmouth
Date:04/23/2008
Permit Number (if applicable) 001904
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: Scudder & Taylor
For permission to: lnstall Oil Burning Equipment
Restrictions: Stract and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
54 Barn Board Ln /west Yarmouth, MA 02673
DIG SAFE NUMBER
Start Date:
s20.00 This permit will expire on 05/23/2008
Signature of Official Granting Permit Tifle
This rmit must be cons tcuous ted upon the remises
APPLICATION FOR PERMIT
.tr,'I
.iIr
iirylt
At:
Fee Paid $
afiz C onuflona)ea{tfl of *{zss o{us etx
Dryordnatt ,f 9"5fu Ssfety
527 CMR 4.00
Form t
Application for Permit, Permit, and Certificate of completion for the Installation or
Alteration of Fuel Oil Burning Equipment and the Storage of Fuel Oil
443-ox
(Gry or Town)@are)
Permit *'s: FD I EIcc.FDID#: _r..v^iat(ft(?l#
Owner/Oc Tcl *l:.,3
[n5tell3[91
fJ Hcgdng Unit
Bumcr:
Trade Name:Mfg:fn,l,',,
A,
T1rye:Model # or Size:Locarion:
d,roo E Kcroscne EI wasrc oil
Storage Tank Ei Ne*t
.-___-._/_/ =-El4xlsdng Location:
/
Type:Capaciry:,) )gals. No. of Tanks:
Spccial requircmcns (or additional safery dcvices)
E osv valrc Oil line prorecrcd E Shcct Rock E Sprinllcr AFUE:
Combusdon Tcsu Nozzlc Sizc ,Vl.t. bD Gross Suck ranrp.:?n
New Suck r-ryf4orr*Bnech Drafc .A3
Draft , h I
nr'tl 4
I
no
Smokc:Ovcrfire tr{1/Efficicncy radng 7o:7
I, the undenigned cenify rhat the insrallation of fuel buming equipment has been made in accordance wirh M.G.L. c. 148 and 527 CMR 4.00
currendy in effecr. Furhermore, dris installation has been rested in accordance with such requirements, is now in prop€r operating condition and
complere instructions as ro its use and maintenance have been fumished t<'r the person for whom the installation (or alteration) was made.
Co. Name t/Tel.:r
Address )City:
lnsta er:
Pnnt Nomz , T,;mi6*,o-
Once signed by the fire department, this T r the storage and rpment
Inspected by:
use of oil bumingpqu
q/zq l*.L--Date:/7
Warcr
WHm CoPY: Property owner's copy; CANAFY COPY: Y.F.D. Copy . Retuh when iob is completed; PINK CoPY.This copy must be posted at installation.
Scwiced Floor or Unit *
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