HomeMy WebLinkAboutnew oil burner 2023A,C"r,r*r*,*lfl / fl"rrrf,rrr/,
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City or Town: Yarmouth
Date:o4 / L1/ 2023
permit Number: '103152
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section '10 A application is hereby made
bv: LnM KELLY
Name of Competent Operator THE FUEL COMPANY/KELLY
Date lssued-Rejected 04 /LL / 2023 By
Cert. No
Date of Expiration Fee: Ss0.00 $paid
(Signature of applicant)
Due
APPLICATION FOR PERMIT
Address: 15 CAPTAIN NOYES ROAD /South Yarmouth, MA 02654
For permission to: lnstall Oil Burning Equipmenutanks
142
15CP01
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527 CMR 4.00 Form 1
Application for Permit, Permit, and Certificate of Completion for the
Installation or Alteration of Fuel Oil Buming Equipment and the Storage of Fuel Oil
FP-056
527 CMR 4 Form I
(Rev.0U09)
Permit #'s: FD
-
Elec.
-
(City or T n)(Date)
Fee Paid: $ Q{. > u
Owner/Occupant Name:
lnslallation Address
tr Heating Unit - Domestic water Heater
Burner: ENew I Existing I Location:
'lel.#: ("r-2a-7- 32r4
Serviced Floor or Unit #:
Trade Name Re. l*?*
Type:6u -u
SFuel Oil tr Kerosene
Storage Tank: i New fiExisting
Type
Special requirements (or additional safety devices)
. Power Vent Other
,4rnx )
Mfg:2 u. -f,3r:.2-*4t, /..n,-n /?., /o-
Model # or Size: ,rfe Ngzzle size . /€ ?-,,
Waste Oil
Location:.{?o,./
Capacity: _ gallons No. of Tanks
: oSV valve Joit tine Protected r Sheet Rock I Sprinkler AFUE;F yes I no EF: [I yes l- no
(furnace and boilers) (water heat60
tel* t{o f.-€?t- ?<, 62,
City:F E/.*t-L Zip:a <dOC
Co. Name
Address:
Completion Date:
Combustion Test:Gross Stack Temp.:
CO'Test: / /'
e-t Nst Stack Temp.:
Breech Draft:
?7,
{
Smoke: O Overlire Draft: r-Efficiency Raling o/o:?e-t ,n
l, the unds6igned certity that the installalion ot tuel burning equipment has been made in accordance with M,G.L, Chapter 148 and 527 CMR 4.00
curently in etfect. Furthermore, this installation has be6n testsd in accordance with such requirements, is now in proper op€rating condition and
complete instructions as lo its use and meintenance have been lurnished to the person or whom the installation (or alteration) was made,
lnstaller: V,r-7 47
Ceft ol C#Signature (no Stamp
Address ,,/,n l.ci
Once signed by the lire department. this is a lT for the storage of tuel oil and use of lhe oil burning equipment
//. k/o-q Date {-{-zlApproved by:
Keep original as application. lssue duplicate as permit. This lorm may be photocopied
allaL
FDID#:
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