EP-74007 TOWN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT 74007
PHONE: 508-910.1820 FAX: 508-910-1838
Name: a r s ta-/ l ,67 is D Property Owner:! `F! ' a t r �Date:6AVi
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Job Location: 9 .L.J/L.Cr'_,C'- iLf/ /an __ Map: , t/ Lot:
Description General Ledger#'s j h941o� Amount
Building & Building Misc. 01000-44105 / ✓Gt, it). ?o
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/ectrical��_ 01000-44106 i # -75
lambing & Gas 01000-44107 /
Trench Safety 01000-44129 �/
Other Department Revenue 01000-42420
'/.� . tZ White-Collector's Office Yellow CopyJ..r >-f'
-Customer's Receipt Pink Copy-Building Department Received B)' �' L#� v7"-
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS
pp,, f/q�//j/�) r/ PintForm' )
Commonwealth o/ la6lac/,nSeiti Official Use Only
1r_*- t'/ cy cc77 Permit No. 7 /06
�i ..Ueparimeni o�Jire SerU[Ced i—
Ifr S Occupancy and Fee Checked
re BOARD OF FIRE PREVENTION REGULATIONS [Rev. (leave blank)
APPLICATION FOR PERMIT TO PERFOR 1 ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electri'al Code(MEC),527 CMR 12.00
�I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Da e:6/24/14
City or Town of: Dartmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perf., the electrical work described belo• .
til(b
Location(Street&Number) 9 Blueberry Lane
\% Owner or Tenant Gary Pelletier
Telephone No. 08-958-4753
Owner's Address Same
Is this permit in conjunction with a building permit? Yes I I No ❑ (Check A t: opriate Box)
Purpose of Building Residential Utility A. .horization i r. /A
Existing Service Amps / Volts Overhead ❑ Undgrd . No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring an addition to include a kitchen and living room
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires S No.of CeilTotal
:Susp.(Paddle)Fans T of
Tr No KVAansformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires 3 Swimming Pool Above In- ❑ No.of Emergency Lighting
grad. grad. Battery Units
No.of Receptacle Outlets f8 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches (o No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges i No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers I Space/Area Heating KW Local 0 Municipal riOther
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
ti. No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 5,000.00 (When required by municipal policy.)
Work to Start:6/24/14 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete
FIRM NAME:Baraby Corp a� MC.NO.:1 7 4 8 7 A
Licensee: William G Baraby Signature W,, h' .. /! LIC.NO.:2 6 2 0 6 E
(If applicable,enter "exempt"in the license number line) Bus.TeL No.:508-678-3925
Address: 660 Jefferson Street, Fall River, MA 02721 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent I PERMIT FEE: $
Signature Telephone No.
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