HomeMy WebLinkAboutnew oil burner 2009001-:..-w (iotramoquubL { ftUuaAum
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APPL!GATION FOR PERMIT
City or Town:
Date:
Yarmouth
12/28/2OO9
permit Number: 100518
ln accordance with the provisions of M.G.L. Chapter'148, as provided in Section 10 A application is hereby made
by:
Address
J 9,^c,(,
South Yarmou , MA 02664
For permission to: lnstall Oil Burning Equipmenutanks
SCUDDER & TAYLOR P: 77 5-0474 Cert. No.
By
Fee:
)
DueS2s.00 $ paid
THEUOl
cAPT400039
(Signature ot aPPlrca nt
3.
tl'
Name of Competent Operator:
Date lssued-Rejecled L2 / 28 / 2OO9
Date of Expiration: Of / 28 / 2OlO
A'
Permir #'s: FD
Owncr/Occupant Namc:
[nstrll416s Addrcss:
fJ Heering Unir Warcr Hcacr E Fower Vcnr E Othcr
Tcl *
Serviced Floor or Unit *
-
Location:
gals. No. of Tants:
afiz Cotrmonu)eo[tfi of lilass ac$tts et*
Dcporarwrt of gn6fu Sofety
527 CMR 4.00
Form I
Application for Permit Permit, and Certificate of completion foi the lnsullation or
Alteradon of Fuel Oil Burning Equip t and the S of Fuet Oil
(Gry or (Darc)
(]FDID#:rg SI Fcc Paid: ?
Bumer:Ncw tr exbting locadon:
Tradc Name:Mfs:
Type:Modcl # or Size:
Fuel Oil tr Kerosenc Ei Wasrc oil
Storage Tank EI New A'C*, Locarion:J,/Capaciry:
Spccial requiremens (or additional safcry dcvices)
E osv valvc
Combusrion Tcsc Nozzle Sizl Gmss Stack Tenrp.:
Brcech Drafr
line prorecred E Sheet Rock E Sprinllcr AFUE:yes tr nor{y'rn
Ncw Stack r*,pJ )?co
rrcs,o
Smokc:n Ovcrire Draft:,bl
I, the undersigned cenify that the installation of fuel buming equipment has
currently in effecr. Furrhermore, this installation has been tested in accordanc
Efficicacy ndng 9o:
been made in accordance with M.C.L. c. 148 and 527 CMR 4.00
e with such requirements, is now in proper operating condition and
person for whom the installation (or alteration) was made.
Tel. +-?>t421completc inst
Co. Name
nrrnnr as r() irs use firaintenance have been fumished to the
?r*
Address, rr-/l,Jrck Rl /./_,-zip:Ciry:t/tlr I
0
lnstaller:
Once signed
Inspected by
Srgflatrre no Samp)
bvthe fire department, this is a PERMIT for the storage and use of oil buming equipment
^)IDate:
WHTTE COPY: Property owner's copy; CANAnY COPY: YF,D, Copy . Felurn when iob is completed; PINK COPY. This copy must be posted at instsllstion.
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