EP-18601 eowm,osuevaia it,
�t DEPARTMENT OF PUBLIC SAFETY
Ft +11� _,a License: SEC SYS CERT.CLEARANCE
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Number SS CC 001066
• Birthdate: 02/25/1956
Expires: 02/25/2002 Tr.no: 247
Restricted To: 00
CLARK D MINSON �p
138 DURFEE ST )oauph &. fl.
FALL RIVER, MA 02720 Acting Commissioner
COMMONWEALTH OF MASSACHUSETT
DIVISION OF REGISTRATION`"
OF ELECTRICIANS
REGISTERERsuVSITAMENTg&MNICIAN
CLARK D MINSON _
m
748 ROBESON ST
FALL RIVER MA 02720-5443 rI
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L1f:ENSENO s�' EXPIRATION DATE .SERIPLN6 '
•
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TOWN OP" t`'�ARTMOUTH 1860,E
BUILDING RECEIPTS
COLLECTORS,OFFICE
Name: ,.LF,I;'rr 04 't ' „6, Property J It j, 7.t' I 4. !��..e. Date. /r 7. 1
'�.-' ' �.. cif,
_ G Owner: ip! l
Job Location: / '� ! / ' r. : i
1-J� r lc
r . 1. r�l �,;.
."/ l y�' �� � White Copy-Collector's Office
Plot: ` r; f Lot: cj�'J' {0,13
- Yellow Copy-Customer's Receipt
i '" TOWN OF D�RTnaOUTH P KQUpy-File Copy
COLLECTOR'S OFFICE Green..opy-Building Department
Phone:
JSN 9 2001 off# ) i
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105 C S 0 07
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106
License&Permits-Plumbing&Gas 01000-44107
Other Department Revenue 01000-42420
This is not a Permit or License for Building.Plumbing or Gas Received By:
Ste.. Commonwealth.o/ti'lasdachudeui Official Use Only
I
f ,o ccyy p Permit No.
1 2eparimenl o! 3ire Serviced
j BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Town of Dartmouth [Rev. 11/99]
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
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: / 9 U
By this application the undersigned gives notice of his or her in ntion to perform the electrical work described below.
Location(Street&Number) /5 lV fly 61 E u' ��le �jat /}1 lW �/�
Owner or Tenant e at / n-- . -"' S t l Telephone No.,567-.3y1 V-yt 6/
Owner's Address ,44.5 Atzm xJ SrALI , -,t,
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Is this permit in conjunction with a building permit? Yes )( No n (Check Appropriate Box)
Purpose of Building Utility Authorization No.
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: 4 L L -7706£S
Completion of thefollowing table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans T a Transformers KV
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above In- No.of Emergency Lighting
gmd. grad 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. TonslT No.of Alerting Devices
No.of Wast¢;Dtsposers Heat Pump Number Tons KW No.of Self-Contained
4 ( Totals: Detection/Alerting Devices
` C
No.of Dishwashers` ;\ASpace/Area Heating KW Local Municipal
Connection Other
No.ofD Dyers d
° ''"f Security Systems:
ry -> Heating Appliances KW No.of Devices or Equivalent d l40/tonL1
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:
r No.of Devices or Equivalent
OTHER: ,
Attach additional detail ifdesired,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:)
rrU (Expiration Date)
Estimated Value of Electrjcal Work:• /,9p6, (When required by municipal policy.)
Work to Start: ,95,4 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under thepains and,penalties of erjury, that the information on this application is true and complete.
FIRM NAME: Am blb 5 IrkJ'C C LIC.NO.
Licensee: L.q e< /1.J,N z)A/ Signature t,i°,2.2,,,/ .7�Fti LIC.NO.
(If applicable, enter"exempt";in the license number lins Bus.Tel.No.: ,7 -
Address: /3 9 / / 2Q S7 71 p GLjyle 4 Alt.Tel.No.: 9-
OWNER'S INSURANCE WAIVER: aware that the Licensee does not have the liability insurance covera a normally required by law. By
my signature below,I hereby waive this requirement. I am the(check one) owner owner's agent
Owner/Agent �
Signatur Telephone No. PERMIT FEE:$A 1u
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APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICA ,�hCE
Inspector of Wires-Town of Massachusetts
Customer on(Street#)
Lot# in the village of utility pole#or underground#
Customer's billing address
Temporary New Installation Change of Service Starting Date
Job Description
Service entrance voltage Amperage Phase
Wire size(cu.or al.) Conductor per phase_
Number of meters Water heater Off peak: Yes No
Electrical Contractor License# Telephone#
Address
Additional Remarks
CERTIFICATE OF INSPECTION
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and
approval granted for connection to your service.
Inspector of Wires Date
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit is Good for One Year From Date of Issue