HomeMy WebLinkAboutnew oil burner 2010L"onarunttatlhL ( trudarlum
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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
Permit Number: 100538
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 48 Brewster Rd /West Yarmouth, MA 02673
oL/25/20L0
For permission to: lnstall Oil Burning Equipmenutanks
Name ol Competent Operator Garv Jones Plumbino and Heatinq 509-2725 Cert. No
By
Date of Expiration: 0212512010 Fee: S2s.00 $ paid
(Signature of applicant)
Due
Date lssued-Bejected 0L / 25 / 20LO
FAOLENAHAN
BREWOl
A
EI Hcedng Unit
Burner: E New
Tradc Name:
'Ifu ComrunuesItfl of ly{oss othtset*
Deporfinart ,f 9"6fu S"f"tg
527 CMR 4.00
Form I
Application for Permit, Permit, and Certificate of completion for rhe Installarion or
Alteration of Fud Oil Burning Equipment and the Storage of Fuer Oil
(Gry or Town)(Darc)
Fcc Paid:FDID#:
Owncr/Occupant Namc:
[55tell isn Ad&ess:Scrviced Floor or Unit f
-
E Existing locadon:
/7t ,
Type:Modcl # or Sizc:
E Fuel OiI E Kerosane E Wastc oil
Storage Tarlk: E Nc* E Existing Location:
gals. No. of Tanks:
E osv vaive
Combustion Tcsr
New Sack Tcmp.:
Nozde Sizc g
CO lTcst Brcech Drafc
El Oit tlne protected E Sheet Rock E] Sprintlcr AFUE: E ycs tr
boa.?L 5
(i)??,
I, the undersigned certify tiat the insrallation of fuel buming eqtripment has been made in accordance with M.G.L. c. 148 and 527 CMR 4.00
currendy in effect. Furthermore, this installation has been tested in accordance with such requirements, is now in proper opctating condition and
complete instructions as to its use and maintenance have been fumished to the person for whom the insralladol (or alteration) was made.
Address: City zip
Installer ,/ ea"tft*" "u/ ,z/sioit*rY*s^no)
Once signed by the fire deparqnent, this is a PERMIT for the storage and use of oil buming equipmenr
Goq Iuhn r et) ioc - z12f
WHITE C0PY: Property owner's copy; CANABYC0PY:YF.D.Copy-Eeturnwhenjobiscompleted; PINK CoPY 'This copy must be posted at installation.(. I(
Permit #'s: FD _ Bcc. _
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Rr??.tr<
E Domestic Warr Heaur E Powcr Vcnt E Orhcr
I
Mfg:
, f, - & Location: '(c ,4'r(ri
2#
6r/tt ,
Ty?e: _ C:paciry:
Special requiremcns (or additional safety &vices)
Gross Stack Tcrnp.:
no
T.l. .
-
smoxe: ? ovcrfire Drafu ,/) ' Efticicnry rating 7o:
Z
/1 -
Co. Name
h /
6q-/,t dz,,re
Inspected by,
///
.a',Date: