EP-499 WMR WR INFO WORK REQUEST INFORMATION PAGE 1 OF 1
MAR 20 , 1996
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Work Request No : 107551 Entry Date : 1 MAR., 96 Req . Date : ' 29--MAR--96
Entered By : RAMOS , DEBORAH A. Rate/Rev_ Code :
WR Type : NEW SERVICE Annual Base Rev :
WR Status : DES Annual KWH:
Demand Load KW:
WR Description : UC /RES WIRE NEW DWELLING UNIT
c
WR N • t RODERI UE T N E.vama /Cum omr : _ G S , C Y
Service Address : 4 GOLD--FINCH CIR 49ec;t# : -
City : DARTMOUTH N
_
Pci e /Pad /MH No : 90126 /110 Lot : =ol4-t :
Designer : PACHECO, JO--ANN L
CONTACTS Name Type - Prone No
13 EDWARD ST ELECT C_' ) -
NEW SEOFORD, MA 02740 ELECT ( ) --
SOUZA. DAVID ELECT (508 ) 996-1033 x
ELECTRICAL
REQUIREMENTS Voltage : 2 2 3W i H ^ t 1
CU t Service Jo age : 1 0 / 40 P Number ofMeters :
.Amperage : 200 Type of Heat :
Phase : 1 Meter Number :
Service ,Location : TERMINATE SERVICE AT HANDHOLE LOCATED ON LOT
LINE BET. • LOTS 14 AND 15 LEAVE ENOUGH LEADS
FOR COM' ELEC. TO MAKE FINAL CONNECTIONS . TLM
92631
LOAD -
ELECTRICAL PERMIT
.2.
FIELD INSPECTION
Dartmouth Building Departmlc t Plat: 66
400 Slocum Road-P.O. Box 7j11' {{ f7
North Dartmouth, MA 02747 +r,";911T �� Lot(s) : 2-71
Telephone 508-999-0720 LL L '� �L +� Fee: 80.00
Issued Date: 3/14/96 Permit No. : 499-96
Project Location: 4 Goldfinch Drive
Number Street
Subdivision Name:
Nearest Cross Street:
Electrician: David Souza
Address: 13 Edward Street, New Bedford, MA 02740
Contact Person Phone #: (508 ) 996-1033
License # A11168
Proposed Use: Residential
Residential, Commercial, Industrial, etc
Permit Issued To: New Dwelling
Type of Improvement,New Construction/alteration/addition/relocate
NEW SERVICE 200 amps/ 120/240 volts, overhead, 1 meter/ complete wire new
dwelling Est. Cost $2, 900. 00 ROUGH -READY
indicate location of work(bedrm.,bath,living rm.,garage,etc.) indicate#of outlets/fixtures
Owner(s) of Record: Jose T. Rodrigues
Address: P.O. Box 5125, New Bedford, MA 02745
DATES TIME TYPE OF INSPECTION REMARKS INITIAL
INSPEC.
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Signed By: -s ^-k���_
(l%, tet2/7/ olfl e Ir
^am' - < _ The Commonwealth of Massachusetts Permit No. _
G Occupancy&Fee ecked -eV
70i Department of Public Safety •.ar '`nk
4 _ :
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
i i N Town of Dartmouth
All work to be performed in accordance with the Massachusetts Electrical Code. y55�27 CMR� ��12:00
•
7%L
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION ) Date ! ev.C�1�. /cS) /776
The undersigned applies for a permit to e form the lectric I ork described below.
Location (Street & Number) J_ !1= �C/k-(..A. )/--i - ` 2
Owner or Tenant_
rl
-._
L
Owner's Adddrress3 __ [.,/4.__ l_ ?/ c '
Is this permit in connjjunction with a building permit: n//� ,jL- Yes VV No Di - (Check Appropriate Box)
Purpose of Building" (G2 -_ Utility/ Authorizationut No.
Existing Serv��re ,in . Amps / ae Volts Overhead. Undgrd _ No. of Meters
in r i
New Services; 200, Amps / U._/ c1'U_Volts Overhead Undgrd _._. No. of Meters
Number of Feedersand Ampacity _
cn
Location and Nature-be Proposed Electrical Work
Lighting Outlets - - 'No. of-Hot Tubs-- - - Total
No. of Li
gh g __--- - No. of Transformers- KVA --
No. of Lighting Fixtures Swimming Pool grbnodve grnd. _ Generators KVA
No, of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets • No. of Gas Burners FIRE ALARMS NO. of Zones
.Total No. of Detection and
No. of Ranges No. of Air Cond. Tons Initiating Devices
No. of Disposals No. of Heat Total Total No. of Sounding Devices
P Pumps Tons KW
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Local 11 Connection Municipal P1 Other
No. of Water Heaters KW No. of - No. of Low Voltage
Signs Ballasts _Wit:jag
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws •
I have a current Liability Insurance Polic including Completed Operations Coverage or its substantial equivalent. YES ❑NO ❑ I have submitted
valid proof of same to this office. YES L..1 NO Li If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) (Expiration uate)
Estimated Value of Electrical Work s. /G/U
Work to Start (27�LS-/--! _ Inspection Dale Ro a estcd. Rough "!u^'u�-- Final_gg'ece-c--"
Signed under the penalties of perjury:
FIRM NAME O/-F V /0 S o U 2-. _. `. 2 � t (/
t� _ ..� -'- - LIC. NO..���l�i'Q
Licensee Uf1-vil P SSo J' Z Signa�e C - _/ _ LIC. O
Bus.' el. No. -4 /o 9 —,_
Address /.3 & �C —.. ----- -----_--- V Alt. Tel. No. 99 `4'/O 3 -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
Massachusetts General Laws. and that my signature on this Ir=mit application waives this requirement. Owner Agent (Please check one)
(Signature of Owner or Agent) I irl hOpC No. _- PERMIT FEE S
RECEIPT FOR PERMIT c,
TOWN OF DARTMOUTH 7/
PERMIT NO.
(a.
+x
No
// 1 ,n! Date e// 9
Y L. 3
Received From ✓✓ ��"
Owner � �iF� �rC/A't ^-----' 1
Location47 - ��`"
Type
i ? 1
2511.// v /L �r�O
Amount Paid j
°° �Y�Received By
1
5
eas....... .............segaileNfisigratingSSFIADEnamezEisTr OF INDUSTRIAL ACCIDENTS
- 600 WASHINGTON STREET
ames Gamaoe!, BOSTON, MASSACHUSLIIS 02111
d -o ^ ssrone' WORKERS' COMPENSAZTON INSuRANCP APTIDAVIT
I, David P. Souza
(licensee/permit-tee)
with a principal place of business/residence at:
13 Edward Street New Bedford, 2.1; 02740
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ ] I am an employer providing the following workers' compensation coverage for my employees working on this
job.
Eastern Casualty Insurance Co. .;JCP 0005784
Insurance Company Policy Number
[ ] I am a sole prop, erot and have no one working for me.
[ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed belo
-who-have the-following workers' compensation insur —policies=
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
I am a homeowner performing all the work myself.
NOTE Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of Industrial Accident' Office of Insurance for coverage
verification and that failure to secure coverage as requ' d under Section 25A of MGL 152 can lead to the imposition of criminal penald
consisting of a fine of up t 0 and/or im onment of up to one year and civil penalties in the form of a Stop Work Order and
fine ofSIO a a ' st me. /
Signed day of "%��t/�-cal( l 1/45— , 19 2
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.icenseeiPermittet Licensor/Perrittor