HomeMy WebLinkAboutremoval and install of oil tank 2011L"onuruy.tutonlllt, o/ / / hltor/urile
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APPLICATION FOR PERMIT
Yarmouth
02/77 /2OrL
permit Number: 100756
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 1O A application is hereby made
by:
Address: 4 Briar Cr /South Yarmouth, MA 02664
For permission to: lnstall Oil Burning Equipmenutanks
Name of Competent Operator:Oil Express p: 800-222-6400
By
(Srgnature ol applicant)
Due
THEUOl
BRIAOS
Fee: S2s.00 $ paid
City or Town:
Date:
Date lssued-Rejeded 02/L7 / ?OLL
Date of Expiration 03 / L7 / 2OLL
Cert. No.--
s-\afiz Comnatutea{tfi of grtus aitus etx
Deytaranmt of 9n6tir. Sofetg
527 CMR 4.00
Form I
Application for Permit, Permit, and Certificate of completion for the Insultation or
Alteration of Fud Oil Burning p ment and the Storage of Fuet Oil
own)
FDID* 0.
@arc)
Fee Paid:
Tcit-
Permit #'s: ED t-t R isl
Owner/Occupant Narne:
lnstelldistr Ad&ess:4A Sewiced Floor or Unit *
-LI Headng Unir
Bumen E Ncw
Trade Name:
Type
tBlruet ou E Kcroscne
EI Domcstic Warcr Heatcr E Power Vcnr [!rorher
g/*r^,[.ocarion:
Mfg:
Modcl # or Sizc: Locadon:
EI vr'asa oil
,/
Storage Tanlc El' Net E Exisring Location:
Type:Capaciry:2zK gais. No. of Tanls:
Spcciai requiremens (or additional safery &vices)
I
,'..E Osv valve 6 Oit tin" protccred
Combusrion Tesr Nozzle Sizc
E Shca Rock E Sprinllcr enfe, EI'i", tr
Gross Stack Tcmp.:
Brcech Drafc
Iro
New Sack Temp.:
Smoke:Ovcrfire Draft:
COrTest
l, the undersigned certify rhar the installation of fuel huming equipment has heen made in accordance with M.G.L. c. 148 and 527 CMR 4.00
currently in effecr. Furthermore, thh installation has been tested in accordance with such requirem€nts, is now in pnrper operating condirion and
complete instruoions as to its use and mainrenance have been furnished to the person for whom the installation (or alteration) was made.
Co. Name O/t Evaaz<5 Te[. +*€a
Address 1, DLV Rnzn<vatl,Z City:zrp:Des3 c
lnsta[er,
Pnn, Name
Once signed by the firi department, this is a PERMIT for the storage and use of oil buming eguipment.
Inspected by:N-Date:,lt
WHITE COPY: Prop€rty owner's copy; CANARY CoPY: YF.D, Copy. netum yrhen job k completed; PINK COPY . This copy musl be posled at installation,
(Ciry or
Efficiency rating 9o:
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F.0. E"* 1025, $t l, P*ol, Lt*u, mA 01115
APPLIGATION FOR PERMIT
City or Town:
Date:
Yarmouth
Permit Number: 100757
ln accordance wilh the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 4 Briar Cr /South Yarmouth, MA 02664
For permission to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operalor:
Date lssued-Rejecled 02/11 / 20Lf By
Date of Expiration: 03/ L7 / 2OL1-
Cert. No.
(signature ot applicant)
Due
THEUOl
BRIAOS
Fee
il,irlit,ti
02/11 /2O].L
oil express o: 8OO-222-6400
$ Paid
for sleal underground
wilh the provisions ol
.^.
Make application to local flre department.Fire department rstalns original applicslion and l;sues duplicate as permll.
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APPLICATION and pERMtT
.sjo]aSe tank removal and transportation to approved tank disposalM.G.L. Chapter 148, Section OAA, 527 CMR 9.00, application'is he
<FRr )'{OV tE 201.' ,l3t24rsf - 13-.23rlto.
Fee:
yard in accordance
reby made by:
XTank Owner Name (pl6ase print)
Address
ylng lor Fle.mit)
lFCl'CEnifi Olher
Company Name
Signalure (ii
Address /
Other
-.
Co. or lndivldua
Slgnalure (if applying for permit)
Addrsss
Are-/
Tank Dimenslons (diametor x l€ngth)
R€marks:
Type ol lnen Gas-Tank yard Addross 28 tlalcotE St. , Readville
MA 492
MAC300012903
Firm Transporting 1ry651s G1oba1 Remedlation Svcs
, r.rA 02137
Hazardous Wasl€ Manilest#
Slate Lic. #
E.P,A. #
Dio Sale approval number: _
orc s.r rar rorliI ilGEE-
Permil#
atwl \l
FDIDf
Signaluro / Title ol Oflicor granling pormi
City or Town
Dals ol lssue Dale ol Expiration
Trenching Permit #
Tank Owner
Tank lntormatlon
Conlamlnalion AssessmenlRemoval Contraclor
Allor removal(s) ("coosumptive us€" fuel oil tanks exempted) sond Fom FP29o or Fom FP-290R signed by lhe localfirs departmenl lo[4assDEP, Bureau ol Waste prev€ntion UST program, pO Box l2O-0165, Boston, MA 02t.l2.O165.
'lntomalional Fire Code lnstitute
FP 292 (revi6ed 3/10)
Vr*-rrr*r"*m
@nVo.*"n^t o/ &,;o pYr*,r;* -
D| lFCl'C€Itilled Dn LSP J
Tank Capacily (gallon ") il 7{ Substance Last Srorsd
/)*x
Tank Location
Disposal ,nlormatlon
Approved Tank Oispo""l y"r6 Jamee C Grant Co Inc. Tank yard * 008
Approvals
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