EP-37604 rCOL:salS rK` TOWN OF DAR .MOUTH ,Y
BUILDING RECEIPTS `
trews COLLECTOR'S OFFICE • \ -
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Name •
r•J.r J --° L.�c..-f"(`f 13,4-G-'__0.. Property I . ,r - Date �/ t Ac
r ., owner: .A.. -j e , >,G.
Job Location: 4 4.7 `' J 4' �o J
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,r, y Collector's Office
Plot ^' Lot �,+t f Bow Co y-Customers Receipt
,-75 .r,p Or s opy 1 File Copy
9..r 1. 'Green opyy Building Department
Phone: 4 a X I. S L i �` \ - ,'�'..s' ‘
Description General Ledger#'s It f.# - ,3L Amount
License&Permits-Building 01000-44105 ti
License&Permits-Building Misc. 01000-44105 '
1
License&Permits-Electrical 01000-44106 K2 J_ Is'77 ,i J2
License&Permits-Plumbing&Gas 01000-44107 \ ' -
Other Department Revenue 01000-42420 - - ..,
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This is not a Permit or License for Building,Plumbing or Gas Received By: /// "`
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,per Commonwealth
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�-\ Commonwealth o/rcr7/amacLuae1to Official Use Only
7il -R 1Jeparlmenl of .-tire.ervices Permit No.
E; Ti _' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
'''-',�� Mown of Dartmouth [Rev. 11/99) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
11
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /--y- 0 6
By this application the undersigned gives notice of his or her intention;�to perform� the electrical work described below.
Location(Street&Number) 2 5 G o.n F/Nc if r pe e._
Owner or Tenant 13rRUC1 DETCSUc Telephone No. 5'0S--994---Hyaq
Owner's Address r2 5- 6-o L.jt P JAMery 57
Is this permit in conjunction with a building permit? Yes u No pi (Check Appropriate Box)
Purpose of Building GAR A GE Utility Autu orization No.
ExistingService/SD Amps a yen I?oVolts Overhead Undgrd No.of Meters /
New Service Amps / Volts Overhead Undgrd I I No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ke l ti ;1, Y in R ra-Y r K2,1, I /" A 6 His s (A/c i t any 2
Completion of thefollowing table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA ,
y_ Above In- No.of Eme enc Lighting
No.of Lighting Fixtures Swimming Pool rg Y Bh g
gmd. gmd, Battery Units
, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local I I Municipal I I
Connection Other
No.of Dryers Heating Appliances KW Security Systems: •
No.of Devices or Equivalent .
No.of Water No.of No.of Data Wiring:
Heaters KW 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.
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 BOND OTHER (Specify:)
i . (Expiration Date)
Estimated Value of tlect ical Work. ;, (." r 0 (When required by municipal policy.)
Work to Start: // ((0 S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under thnains and penalties o e�r/u y, that the information on this application is true and complete.
FIRM NAME: /'�J& /vc/6.(!Gk ,l_�t;K `... L LIC.NO. 1C E ,C� /L/
Licensee: ,To U Atip del A A/ Signature 4704,4,t,(/ t.,'^^+,+' LIC.NO.
(If applicable,enter"eAempl"in the license number line.) Bus.Tel.No.: co ((-Ffy-rr/Y
Address: / &4/t4Ul,V -CT Alt.Tel.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 low,I h y aive this requirement. I am the(check one) I I owner I I owner's agent
Owner/A en Signature. Telephone Nos '99G /` 20 V
PERMIT FEE:$
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