EP-3468 TOWN OF DARTMOUTH
! 034BP
HO TAX tSSU ES C BUILDING RECEIPTS
OLLECTOR'S OFFICE
Name: / "'
Date
Property t, _ /-
/
i-La-'2 ""' Owner: n '' "i A. I_, Li
Job Location: TOWN-OE DAlaTMOUTH
l 0_- t i.--mac_ LL-Le 1-L :is .- _,CS LLEf.?1ORS OFFFICE
- - White Copy-Collectors Office '
Plot: z ; Lot: - Yellow Copy-Customers Receipt
-•;r- - i —%/ ;t' SEP 1 2 1997 Pink Copy-File Copy
(�A (� { Green Copy-Building Department
M
.G.C.g01 .
1
Desq tion General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc., 01000-44105
License&Permits=Electrical , 01000-44106 _/: )
License&Permits-Plumbing&Gas Th1000-44107
Other Department Revenue 01000-42420
This is not a Permit or License for Building,Plumbing or Gas Received By:
f .
TOWN OF DARTMOUTH
NO TAIL t ,
SSUES BUILDING RECEIPTS
COLLECTOR'S OFFICE
Name / Property -. Date: :�-
'.-•`_ - Owner: S-- _---„"';
Job Location: �QWROF bARTMOUTH
l G « ` u `� COLLCCT6J13 orricE White Copy-Collector's Office
e -
Plot: Lot: ''a pg7 Yellow Copy Customer's Receipt
8 FP 1 2 477 Pink Copy-File Copy
Green Copy-Building Department
Phone: r --, ---7
M.C,C. 01
Descrption General Ledger#'s Ref.# Amount
License&Permits--Building - 01000-44105
License&Permits-Building Misc. 01000-44105
License&Permits Electrical , 01000-44106 i- '. ,
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:
Mee Use ly
�—- _ The Commonwealth of Massachusetts Permit No. 31/j'a
. ;
�c ,At—el Occupancy&Fee Checked
fi' 4 Department of Public Safety (leave blank) 9� /f
• BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
I ( Town of Dartmouth
�W a All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ?//199
The undersigned applies for a permit to perform the electrical work described below.
1Metion.(Street&Number) 6oTt62. Sansep) /0 C44/e/s $ WAy
Owner or Tenant .Lon RWAi7y /.tiC-
Owner's Address 6S8' Rocr-p,LL- twat / A/EL" BEOFocP1 nt9. oa7$0
Is this permit in conjunction with a building permit: Yes2No ❑ (Check Appropriate Box)
Purpose of Building /I/M.p. {{OvSE Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd ❑ No. of Meters
New Service Snips /2-0 / 2.Y° Volts Overhead ❑ Undgr4 No. of Meters y
Number of Feeders and Ampacity
laration and Nature of Proposed Electrical Work I.W/R.E A/Eto {fov5E
No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Totai
No. of Lighting Fixtures /r Swimming Pool R dVe Ej R d. El Generators KVA
—
No. of Receptacle Outlets yy No. of Oil Burners Batte fry UmrerLgency Lighting
No. of Switch Outlets it, No. of Gas Burners FIRE ALARMS NO. of Zones /
Total No. of Detection and L
No. of Ranges ( No. of Air Cond. Tons Initiating Devices 3 /Yet
Heat Total Total
No. of Disposals No. of Pumps Tons KW No. of Sounding Devices 3 7ti'
No. of Dishwashers Space/Area Heating KW NoDetection/Sounding
tif Self Counding Devices
fciC
Detection/Sounding De
No. of Dryers I Heating Devices KW Municipal0 Local El Connection Other
No. of Water Heaters KW No. of No. of Low Voltage
Signs Ballasts - - Wiring - DnoR Ikea -
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
4 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
' I have a current Liability Insurance Poli ludin Completed Operations Coverage or its substantial equivalent. YES NO.D I have submine
valid proof of same to this office. YES NO LJ If you have checked YES,please indicate the type of coverage b checking the appropriate bm
w INSURANCE BOND 0 OTHER 0 (Please Specify) /9E7?//Y Ph&
Estimated Value of Electrical Work$ .2 SZS (Expration Date)
Work to Start SW Inspection Date Requested: Rough link- &45 c.. pig /ii/ - 4-rti
Signed under the penalties of perjury:
FIRM NAME!!!! H'9Y'WGEI�S' £LC;Grnc Cempgry LIC. NO.
Licensee /AWES 0/.0-n/t Go . - Signature_' ,Z 4`_`= i LIC NO. /I-92-93
Bus. Tel. No. 9-79-S"2.rS'
Address 32-9 Be-Dcax-p Sr. Nau gEoxazn, MR - 02270 Alt.Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required b
Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
(Signature of owner or Agent) Telephone No. PERMIT FEES iYD 0 0
•
5 E COMMONWEALTH OF MASSACHUSETTS
E LaJ .II' .NI OF INDUSTRIAL ACCIDENTS
` �-�s�'l' 600 WASHINGTON STREET
James: Gamocetr BOSTON, MASSACHUStd lb 02111
rom"tsstone•
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I, Phu%% EjEcrt/c conpfNY
(licensee/perminee)
with a principal place of business/residence at
329 aa'opoizd sr NEw l32DibRD J Pm-. 0,1290
(City/StatdZip)
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
)ob. •
/t/EWA efts Sty 006 c ooz hilYrL ?tic
• Insurance Company Policy Number
[) I am a sole prop:trot and have no one working for me.
[ ) I am a sole proprietor, general contractor or homeowner.(circle one) and have hired the contractors listed belt
who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Poliry Number
Name of Contractor Insurance Company/Policy Number
0 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.sea. 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 required under Section 25A of MGL 152 can lead to the imposition of criminal permit,
consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and :
fine of5100.00 a day against me.
Signed this /l tit
day of Seers�t y,e , 19 9'7
7,7
Licensee/Permi et
�-
, Licensor/Permittor
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WMR_WR_INFO WORK REQUEST INFORMATION PAGE' . OF 1
- i SEP 18 , 1997
Work Request NoF -446614 Entry Date : 15-SEP-97 Req . Date: 25-SEP-97
Entered By: MEI,,LA,3AOQU;Efa8E A Rate/Rev Code:
WR Type : CNEW- SE-RVICE Annual Base Rev:
WR Status : DES Annual KWH: - -
Demand Load KW:
WR Description: UD/RES--WIRE NEW HOME
WR Name/Customr: LONG REALTY INC
Service Address : 10 WARBLERS WAY Acct#: 1629-317-0011
City: DARTMOUTH
Pole/Pad/MH Not 10126/410-A - Lot : 62 Plot :
Designer : YOUNGBLOOD, BARRY L
CONTACTS NameType Phone No
329 BEDFORD ST - ELECT ( ) - x
HAWES ELECTRIC CO ELECT ( 508 ) 999-5285 x
NEW BEDFORD,MA 02740 ELECT ( ) - -x
ELECTRICAL - -
REQUIREMENTS Service Voltage : 120/240 3W 1PH Number of Meters : 1
Amperage : 150 Type of Heat :
Phase : 1 Meter Number :
Service Location: 'LOCATION OK ON SOUTHWEST CORNER OR RIGHT -SID
FACING HOUSE, LEAVING ENOUGH CABLE FOR COM/EL
TO MAKE CONNECTIONS .TLM#93659
wommT.nAP
`� APPLICATION FOR PERMIT TO INSTALL AND REQUEST
•I FOR ELECTRICAL SERVICE
, e
1
Inspector of-Wires . - Wiring Permit# COM/Electric#
Town of Dartmtitt_h Massachusetts Building-Permit# Date - 9111 9:
Lot r62 Songbird
Customer: hang -Realty, Tetra on(Street#) 10 Warblers Wav
Lot# - ' ' in the village of - utility pole number or underground number - +
Customers billing address 69R 1-2ndkdale Ave- New Redford, Rya- 02740
Temporary New installation lC Change of service Starting Date coon
Job description Wi re flaw hoe ce,
Service entrance voltage 1 20/240 Amperage I Ci0 Phase 19
Wire size(cu.oral.) ' Conductor per phase
Number of meters 4-='1 Water heater Off peak:Yes— No X
Estimated load: Eteotric heat kw, lights kw, Range dryer - - Motors, H.P.&Phase
Ready for first inspection t,ri 1 1 Cal 1 Ready for final inspection: W i 11 Cal 1
Electrical Contractef, 189awaS PI ert-ri r Co . Lic.# - A.-777' Telephone# -'99-9 285
Address " RAd cord G'[ NArr* }3ad£nrd 7 ;10 0 27d0
Additional Remarks
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS DATE FEE CHARGE
Temporary Service
-
Roughing in
Service and Meter -
-
OffPeakMeter----^-
-Final Approval '`Of W---.. .1-r---- COOP` -
Disapproved*
*For the following reasons
CERTIFICATE OF INSPECTION D T "_S - et'?
To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has bee o eted a ha t is day been spected and
approval granted for connection to your service
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue _. CA 46-1
White—COM/Etedtnc Green—Inspector` ;Canary—Town Receipt Pink—Inspector's Copy Goldenrod—Electrical Contractor
to COM/Electric
LAST TRANSACTION REPORT FOR HP FAX-700 SERIES VERSION: 01. 03
FAX NAME: DART. BUILDING DEPT. DATE: 05-NOV-97
FAX NUMBER: 508 999 0738 TIME: 14:58
PATF TIMF REMOTF FAX NAME AND NUMBER DURATION m RESULT DIAGNOSTIC
05-NOV 14:52 S COM ELECTRIC 9-9999368----5108 0:01 :35 3 OK 663840100088
S=FAX SENT
I=POLL IN(FAX RECEIVED)
O=POLLED OUT(FAX SENT)
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