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EP-85747 0, TOWN OF DARTMOUTH - 1UOILDING DEPARTMENT RECEIPT 3 5 i" 4 l PHONE: 508-910-1820 FAX: 508-910-1838 • Name: l/w/JJ a& 1 fO r: V O 2: A Job Location:J 9 /(ui J 9:ert i !v/ Map:hit_ 14: Description General Ledger#'s Ref. # Amount Building& Building Misc. 01 F A Ov Electrical 00-4l06 1\ /o- Plumbing & Gas 01000,44107,;; Trench Safety 1000-44129 I t' c r' X� ' tt gr tz r ' e,/ � ' ' - ; Other Department Revenue 0 ?ff�°=� � i�`y�-�y 7 White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received' £ IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS , Commonwealth a///taiiacluaettd Offi :. Use Only Y i  �y/� t `� Permit No. ' — ] d18PartmeM O��Lre JB/U{Ce1 = '��''� e BOARD OF FIRE PREVENTION REGU •TIONS Occup.: y and Fee Checked [Rev. 171 leave blank) APPLICATION FOR PERMIT TO " ERFO ' ELECTRICAL WORK All work to be performed in accordance with the Mas achuse 'ectrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IArINK OR TYPE ALL INFORMATION) Date: `] _ VI City or Town ofy��m6� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) \ \Nj a � r C� � N`�, Owner or Tenant ���-\� . "'� " ` "� �S - Telephone No.SA.2,4_Sal Owner's Address Is this permit in conjunction with a building permit? Yes f5q No n (Check Appropriate Box) Purpose of Building «b iN%.q .--, Utility Authorization No. Existing Service \©ip Amps )).m/ (k` Volts Overhead ❑ Undgrd la No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters Number of Feeders and Ampacity \ 22p. -7 ?c,,cQcMP "-p Location and Nature of Proposed Electrical Work: ^ �J 2$z 11., N.1t� p,, ,,hN._ a Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total y Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA. No.of Luminaires Swimming Pool Above ❑ In- Lighting*No.of Emergency grad. grad. ixcl Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No ones No.of Switches No.of Gas Burners No.of Detection an Initiating Devi No.of Ranges No.of Air Cond. Total No.of AlertinglL ces Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Con ned Totals: _ Detection/Ale 1 1 g Devices No.of Dishwashers Space/Area Heating KW Local M `-s ipal 0 C sS ection 0 Other No.of Dryers Heating Appliances KW '.curity ,z ems:* No.of Water No.of o.o li evices or Equivalent Heaters ' No.of ' Da W�v �g: Signs Ballasts '! i Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail 0edesirea or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: '1 ,\`_VT Ins ections 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 n. BOND ❑ OTHER ❑ (Specify:) I cent)",and the pains nd penalties of perjury,that the information on this application is true and complete. FIRM NAME: ,--Sl. Lam\ `C LIC.NO.: R1 � oCo Licensee: ,\!� �.ys`Jq.-3 Signature LIC.N0.: _2?, tZ3 (If applicable, enter "exempt"in the license number line Address: \per p`� \ --sutio •-e C � Bus.Tel.No.. *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No. S 7 UA-tiot'D'7 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 ❑owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ Map QLot g - /// ti w • b P o I o . 4 mlit o 0 1 0 ❑ i„�o�1Yll� Ar 3 Ci ,-, 5 a• 5. ° M 10 P o = o \r,� S a- 5• ICC n co i it a a w'CZ aoi b o n 2 • a � CD g St eb d p P N $L V kr p' . � A b g-- Z o 0 ❑ o J h 0 z 4 I , i 1. wU b d c b Lve d b co v a o teak r COco 0 Lim 77 b b 111/4 N. ti O ti ko O N O W