HomeMy WebLinkAboutnew oil burner 2011L"onnatrunlt| o/ )lkuailurllb
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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
t2 /13 / 21rr
permit Number: 100938
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 3 Carrie Ln /South Yarmouth, MA 02664
For permission to: lnstall Oil Burning EquipmenUtanks
Moldstad Hto. Svc o: 508-89&6183
Date lssued-Rejecled L2 /t3/20Lr By
Date of Expiration: 0l /L3 / 20L2
Cert. No
(Signature of applicant)
Due
THEUOl
CAREOl
Fee: S50.00 $ paid
ii,i il,i!
Name of Competent Operator:
e7l"V"rrr*"r-r*"*lrr/e,/kr.*t*"t
Gl/a42_/./,/?,.J
527 CMR 4.00 Form 1
Application for Permit, Pennit, and Certificate of Completion for the
Installation or Alteration of Fuel Oil Buming Equipment and the Storage ofFuel Oil
FP-056
(Rev.04/ l0)
Permit #'s: FD tU )d'.)yt, Elec. _
Owner/Occupant Name
lnstallationAddress: .7 LF. LIJJM Heating Unit Ll Domestic Water Heater_,/Burner: TNew I Existing E Location
Special requirements (or additional satety devices)
(City or Totlm) (Dare)
i)i 16l Fee Paid: $ 6'n. "<;
"*7'7
t- Azto
Serviced Floor or Unit #
Other ,
FDID#:
Tel.#: {f)
E Power Vent
B*se Y1c,ur
Mfs
Type:GvD Model# or Size: IFC
{Fuel Oil E Kerosene
Storage Tank: tr New /Exisring Location
Type:fro.tL orJau Capacitl: Z1(gallons No, of Tanks: I
Nozzle size: Ef ?DA
D waste oit
Fblt; r,:>f
E oSV valve 6u rrn Protected E/sheet Rock E Sprinkler AFUE: /yes E no EF: E yes E no
(fumace and boilers) (water heater)
Co. Name
Address:
Votth-i&r)VLut-r,5en rel# 5O - gctl"tzi
City 13o o a.Q-zip Oz- t,7l
Completion Date:
Combustion Test:
z- t4-ttI
O12 Net Stack Temp
Breech Draft: -.O,1
Overfire Draft: -' , O Z-'-1
l, ihe undersigned certify that the insta ation of Juet burni ng squipment has b€en made in accordance with M_G.L Chapler 14g and 527 CMR 4.00curronlly in etfect Furthermore, this installation has been lesled in acaordance with such requirernents, is now in prcper operating conditton andcomplste instruclions as lo its use and maintenance have been fumished to the person or whom the j al made
lnstaller:Z
Cen of Cl (no Slamp)
Address To Bo*,s t City
Gross Stack Temp
CO, Test:t"-o/a
Smoke: _
Once signed
Approved by:
by the ,lre depa s is a PERMIT for the storage offuot oiland use of the oil burning equipment
)1Date
Keep origtnal asapplication. lssue duplicate as permit- This form may be photoc!pied
t)
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Do uow l{(
Efficiency Rating 70:
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