EP-3848 TOWN OF DARTMOUTH
BUILDING RECEIPTS
NO ■ AX ISSUES COLLEC OR'S OFFICE
Name: '1 �, ( Property , Date:
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Job.Location: /{ ✓ i L � ay,.%)ram . .:jam
- - - - White Copy-Collector's Office
Plot: - / i� _ 'Lot:.. /, v t Yellow Copy-Customer's Receipt
,-, c� G*C _c-, / Pink Copy-File Copy
Green Copy-Building Department
Phone:8
Description - General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105 TOWN 4 F OJH I Pi!W I ri
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106 OCT i7
License Sr Permits-Plumbing&Gas - 01000-44107 n R. r '
Mn
Other Department Revenue 01000-42420
This is not a Permit or License for Building.Plumbing or Gas Received By: 5--c: /..'...4._ ..1._..-
TOWN OF DARTMOUTH
0348
BUILDING RECEIPTS
COLLECTOR'S OFFICE
• .
Job Location: ' •
->:4-14-6: •d=-5Z. - C--
- - Wlute,Copy-Collector's Office
Plot: (1 tot A. Yellow Copy-Customer's Receipt
Pink Copy-File Copy
Green Copy-Building Department
Phone: /-r—
S
tzt
DescriOtilin General Ledger#'s Ref.# Amount
License&PerQts-13,ding 01000-44105
License&Permits-Bulding Misc. 01000-44105 I OWN OF DAR I MUU 111
CO1 FrTnnic nFriri
License&Pe;riitits-5cettical 01000-44106 <—
OCT 1 0 1997
License&Perlicits bing&Gas 01000-44107
Other DeparOent-Senue 01000-42420 C S 6 07
This is not a Permit or License for Building.Plumbing or Gas Received By:
o-w-_= The Commonwealth of Mrzctcachusetis 3 Fe
;G Dcparrmrnt of Public Safety 740 —/0 _jam/
ri 1L - 4c.pancT & e Qeclae
1L BOARD OF FIRE PREVENTION REGULATIONS SIT CMR 12CO 3/90 (lean blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Alt.crk to be performed In accordance with the Massachusetts Stcnical Code. 527 ChM 12.00
(PLEASE PRINT IR IKE OR TIPS ALL IHFORY3TT011) Date 10/8/97
City or Ton of Dartmouth
Town So the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. / G
Location (Street A Ntsber)
13 Goldfinch Lane v
Bob Fournier
Owner or Ienant
Owner's Address Same
Is this permit in conjunction with a build-mug permit: Yes 0 No ❑ (Check Appropriate Sox) •
Purpose of Building Utility Authorization NO. --
Existing Service Amos / Volts Overhead ❑ Undgrd E No. of Meters
Hew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Rapacity
Location and Nature of Proposed Electrical Work Wire & bond in ground pool w/light
otallo. of Lighting Outlets I No. of Hot Tubs INo. of Transformers IKVAl
No. of Lighting Fixtures ISvi.Yin Pool Above ��''''77
g g gr.M. In-
grnd.
❑ [Generators KVA
No. of Receptacle Outlets INo. of Oil Burners IBattefY No. of Emergency Lighting
No. of Switch Outlets INo. of Gas Burners [FIRE ALARMS No. of Zones
Total No. of Ranges INo. of Air Cond. tons No. of Detection and
Total
Initiating Devices
No. of Disposals No. of PI s Totalest n WHo. of Sounding Devices
No. of Dishwashers S ace/Area HeatingKW No. of Self Contained
PDetection/Sounding Devices
No. of Dryers Heating Devices KW Local lSssficipal Other
❑ Connection❑
No. of Water Heaters KW No, °f No_ of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of '.&tors Total F? I '
INSURANCE COVERAGE: Pursuant to the reouirenents of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 14 NO u I have submitted valid proof of same to this office. YES Q NO 0
*L If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑X BOND 0 OTHER ❑ (Please Specify) . 2/26/98
(Expiration Dace)
Estimated Value of Electrical Work S
Work to Start .. Inspection Dace Requested: Rough Final Will call
Signed under the penalties of perjury:
FIRM NAME John Sulyma Electric, Inc. ,1 tic. NO. A13700
Licensee John Sulyma Signature /W" LIC. NO.
Address
1203 Chaffee St NEw Bedford MA ( _. No• 5089983882
Alt. Tel. No.
OWNER'S INSURANCE.WAIVER: I as aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
- Telephone No. PERMIT FEE S
(Signature of Owner or Agent)
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