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APPLIGATION FOR PERMIT
Gity or Town:
Date:
Yarmouth
ot/12/2OrL
permit Number: '100729
ln accordance with the provisions of M.G.L. Chapter '148, as provided in Section 10 A application is hereby made
by:
Address: 20 Camelot Rd /South Yarmouth, MA 02664
For permission to: lnstall Oil Burning EquipmenUtanks
p: 385-9702 Brewster Burner Svc
Date lssued-Rejecled OL /L2 /2OLL By
Date of Expiration: 02/L4 lZOlL Fee: 925.00 $ paid
Cert. No
(Sagnature of applicant)
Due
TH E UO1
cAt\.4E04
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8,p^fr*,1 $ Jr* $r*t^ - W "l il* bt"l" Jr* Yll",rol*l
P.A. E"* 1025, bt"l" nool, [to*, mA 01115
PERMIT
City or Town: Yarmouth
Oate:o1/ 72/20Lt
Permit Number (if applicable) 144129
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: P: 38$9702 Brewster Burner Svc
For permission to: lnstall Oil Burning EquipmenUtanks
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
20 Camelot Rd /South Yarmouth, MA 02664
Start Date:
AI:
Fee Paid $s25.00 This permit will expire on O2J1N20'11
Signature of Official Granting Permit Title
This rmit must be consPicuous osted u on the remises
Name of Competent Operator:
rt,liiit,li
DIG SAFE NUMBER
A
Application for Permit, Permit, and Certificate of completion for the Insullation or
Alteration of Fuel Oil Burning Equipment and tbe Storage of Fuel Oil
Owner/Occupant Name:
[n5t-ll4is1 Addrcss:Serviced Floor or Unir *:
-EI Hcaring Unir
Bumer: EI Ncw
Trade Name:
E Domestic wucr Hcarcr E Power vcnt E other
EI existing l.ocarion:
Mfg:Z7
Type:Model # or Sizc:
E Fuel Oil E Kcroscnc EI Wasa oil
Storage Tank E Ncw @ Exlsting Locadon:
Capaciry:
Location:
Type:
Combusrion Tesc Nozzle Sizc
--
Gross Stack Tcrnp':
Smokc:
Te[. *
gals. No. of Tanls:
Co. Namc
Address, , CitY'
lnstaller:
Print Name
TF
zip:
Signaaf. (no Starnp)
Once signed by the fire departleit, this is a PERMIT for the storage and *",tf,"il l3*i"c,:q'ip*""'
lnspected by:Datc
wHmcoPY:Ptopertyovrne/3copy;G^NAFYcoPY;Y.to.copy.Retumwien|obi!complet?d;P|NKcoPY.ThiscoPymustbepostedatiBt8llstion'
n
'Ifrz Comnorruteafitfi. of lr{ass aiuset*
Dcporanant of 9n6ti. Sofrtg
527 CMR 4.00
Form I
(Cf,ry or Town) (Darc)
Perndr #'s: FD
-
Etcc.
-
FDID#:
-
Re Paid:
+
/,-rL , - ,
,/+FG ,.,.-l
I
aL )tlz0/
Special requiremcnrs (or additional safery dcvices)
E OSV Val"c EI Oit tine prorecred E Shcet Rock E] Sprinklcr AFLIE: E ycs E no
New Sack Tcmp.: CO lTcsr Brcech Drafc
Ovcrrire Drafc Efficicncy radng 9o:
l.theundersrmedcertifythatthcinstallationoffuelhumingequipmenthasheenmadeinaccordancewirhM'G.L.c.148and52?CMR4.00:;;il;il ;;".."* it * i*.rrL"" i", t ."i*,.a'i. *-.aance wirh surch requi.ements, is nou, in proper op€ratins condition end
complete instrucrions as ro its use ana mautlninJau. i."n furnirh.a to tt e person for whom the installauon (or alteration) was made'
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