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APPLIGATION FOR PERMIT Kft<'I 6I)
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City or Town: Yarmouth
Date: O5/L1/2O12
Permit Number: 101063
ln accordance with the provisions of M.G.L. Chapter '148, as provided
by:
go1q,'/ 619 5.^. k --,21
in Section
?,.".n a^, u.,*, , Un- .&) nor,.ry.T ,e .t-\-rf<?
.. :u15. tu,h.t r Rtn10 A application is hereby made 6ri) , t, *r
Address: 96 Camp St /West Yarmouth, MA 02673
Name of Competent Operato r: hall oil p: 398-3831
Date lssued-Rejecled 05/17 / 20]-2 By
Date of Expiration. O6/L8/2Or2
Cort. No
(Signature of applicant)
Due
THEUO,l
96CA01
Fee: $50.00 $ paid
For permission to: lnstall Oil Burning Equipmenutanks
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FP-056
(Rev.O4l10)
Permit #'s: FD o
(i\
Cnu
Elec. _
Za*ra.rr/€'"*Qg-,r*.
527 CMR 4.00 Form '1
Application for Permit, Permit, and Certificate of Completion for the
lnstallation or Alteration ofFuel Oil Buming Equipment and the Srorage of Fuel Oil
(City or Town) (Date)
cAE l Fee Paid $
-
ru*: SZ I €+#+t-e4L,4s,,$Owner/Occupant Name s
lnstallation Address ?L W.
ileating Unit E Domestic Water Heater n Power Vent
Burner:ew E Existinq E Location
FDID#
Serviced Floor or Unit #:
Other .
Mfs:
Type Modet # or Size: 4Fd-Nozzle size 2d- )oa
E Fuel oil E Kerosene E waste oit
Storage Tank: n New Existing Location
Type:Srr+4
Special requirements (or addjtional satety devices)
E oSV valve _.,/,,EOil Line Protected L-l Sheet Rock
Co. Name:
E Sprinkler AFUE: E yes E no
(furnace and boilers)
,*-h,-:-
Vs'o
Breech Draft: -- O ts
EF: L-..1 yes LJ no
(waier heater)
Tel #5283f"3a3/
zip o\4 laAddress
Completion Date
Combustion Test
3,
b - *-/2-
Gross Stack Temp {a.z
CO'? Test:/'L-'
Overfire Draft: -- O 7--Efficiency Rating %8//,smoke.'A-
L the undersigned certify
cunently in ellect. FLlrthe
complete inslruciiT
lnstaller: W
lhat the installalion ofluel burning equipment has been made in accordance with M.G.L Chapter 148 and 527 CMR 4.00
rmore this inslallation has been lesled in accordance wilh such requiremenls, is n rop ng and
s as to ils use and maintenance have been ,urnished to the person or whom the insta de
arfuc 5 la Ao>>
Ced ol C*l-v L-n^.* Tt"cit),
Once siqned by the ilre nt, this is a PERlvllT for the slorage of fuel oil aod use of the oil burning equipmenl
Date
S alute (no amp)
5
Approved by
ep original as application ue duplicate as permit This form may be photocopied
Capacity: 2 7 i-gatlons No. ofTanks:
tgelu,.^f-
Net Stack Temp.:
City:
Address:
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mA 01715
APPLIGATION FOR PERMIT
City or Town:
Date:
Yarmouth
o6/05/2012
permit Number: 101074
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section '10 A application is hereby made
by:
For permission to: lnstall Oil Burning Equipmenutanks
Name of Competent Operator: hall oil P: 398-3831
Date lssued-Rejecled O5/ 05 / 20L2 By
Date of Expiration: O7/05/20\2 Fee: ss0'00 $ Paid
THEUOl
Cert. No.
(Sagnature of applicant)
Due
iJ
Address: 96 Camp St /west Yarmouth, MA 02673
,.^.Vr*.*-rr,.-kl r/ e,/k *"h*r"h
A4-.2"r"-Z/eZrzue$*rr?*,
527 CMR 4.00 Form 1
Application for Permit, Permit, and Certificate of Completion for the
Installation or Alteration ofFuel Oil Burning Equipment and the Storage ofFuel Oil
(Cily or Town)(Date)
Permit#'s: FD \O\OF,j Etec.
-
FP-0s6
(Rev.M/10)
Owner/Occupant ru"r", @i XJ. YvtAS r4
Fee Paid: SFD|D#: oa tl.l
Tet.#: SOg 5v8 -46tL
lnstallation Address
E Heating Unit
Bumer: E New
7(-)5T
E Domestic Water Heater
E Existing El Location
ar
D Power Vent
Serviced Floor or Unit #
Other
Mfg:
Type Model # or Size:
fifuetoit fl Kerosene E waste oit
Storage Tank: -Bfrew E Existing Location:
5 ot-L Capacity: / ) fgattons No. of Tanks:
Special requirements (or additional safety devices)
Nozzle size
I
E OSV valve -*(6it lin" Protected E sheet Rock
Co. Name:
Address City:
Completion Date
Combustion Test: Gross Stack Temp.
CO'?Test:
E Sprinkler AFUE: E yes E no
(lumace and boilers)
EF: EyesE no
(water heater)
Tel #3?q-383/f oLb bo
Net Stack Temp.:
Breech Draft
Smoke:
Address
Overfire Draft:
->b c .14
Once signed by the fire
City
, this is a PER[4|T for the storage offuel oil and use ofthe oil buming equipment.
Date
Efficiency Rating %
l, the undersigned certify that the installation of fu€l buming equipment has been made in accordance with M.G.L. Chapter 148 and 527 CMR 4-00
clJnently in effect Furthernore, this installation has been tested in accordance with such requirements, is now in p co
to its use and maintenance have been fumrshed to the porson or whom the instra hadeo ao\L-
Ceft of Stamp)
Approved bv:
Keep original as a on. lssue duplicate as permit. This form may be photocopied
hs+*"^/-
Type:
complete
lnstaller:
&-,,- i Zip: