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APPLIGATION FOR PERMIT
City or Town: Yarmouth
Date:o4/o\/2o24
Address: 1301 Route 28 /Cumberland Farms/South Yarmouth, MA
For permission to: Storage of LPG 527 CMR'1.'12.8.50 NFPA 58
Blue Rhino Cumberland farms
Date lssued-Rejected O4/ 0l/2024
Cert. No
Fee: 5s0.00 g paid
(Signature of applicant)
DueDate of Expiration: 04 / OL / 2026
142
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PERMIT
City or Town: Yarmouth
DIG SAFE NUMBER
Date:o4/02/2O24
Permit Number (if applicable) 103309
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: Blue Rhino Cumberland farms
For permission to: Storage of LPG 527 CirR 1.12.8.50 NFPA 58
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
1301 Route 28 /Cumberland Farms/South Yarmouth, MAAt:
Fee Paid $s50.00 This permit will expire on 0410112026
Signature of Official Granting Permit /1.A4'a't'P Title L/.lAr/.
This rmit must be cons rcuous du on the remtses
permit Number: 103309
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Name of Competent Operator:
By
GOPY Start Date:
G.(gl7qr,{ro,n o.South Yarmouth
FP.006
(Rev. 1.20'lE)a
Permil Number:
City or Town: South Yarmouth
noto.
by Ferrellgas dba Blue Rhino
OIG SAFE NUXIBER
Start Date:
(FdlName ol Porson. Flm 6 CotPo€tlon)
1709 Page Blvd, Springfield, MA 01 104
(PhorE Number)
of
(Addr€se: Ste€t o. P.O. 3ox. Cily d Town, Zip Co<lo)
lorpe'missionto(stateclearlypurposeforwhichpermitisreqUested)ge
in a locked, vented, impact protected cage. Cylinders will be fllled off site at a location operated by Blue Rhino
and will comply wilh NFPA 58 / NFPA I / 527 CMR 1 / 527 Chapter 69.
Name of Competent Operator (if apdicable)Cert. No.
Date lssued{ejected By
(SrgnetuB of Apdlcent)
Dsle of expiration Fee 25.00 Amount Paid $25.00
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A.e
FP.O06
(Rev. 1..20'18)
City or Town South Yarmouth
Oale:
OIG SAFE NUTIBER
Start Date:
F s dba Blue Rhino / Cumberland Farms #2262
(Fu,or CdpoBlion)
Customer #to
for Storage of (21) 20 lb. Propane Cy'inders for retail or exchange
Restriclion s NFPA 58 / NFPA 1 I 527 CMR I 527 Chapter 69
at 1297 Route 28:South Yarmouth MA 02664
(5!6€l ld # or D€sclb€ L@ston for Ad€quato ldontificaton)
F€e Paid s 25.00 This permit will expire on
Signature of Official Granling Permit Title
t This permit must be conspicuously posted upon the premises F
aTkVr*"r--rr,".1il"/oil/"r*A-rm
Application for Standard Permit
a Rstum completod application to:
ln accordanc€ with the provisions of M.G.L. Chapter'14E, as proviOed in S€ction 10A application is hereby made
PERMIT
Pormit Number (if aoolic€ble):
ln accordance rvith the provisions of M.G.L. Chapler 148, as provid€d in 104 this permit is granted