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EP-60890 /1") TOWN OF DARTMOUTH es ::BUILDING RECEIPTS \ �'`� TEA ( ONE: 508.910.1820 FAX: 508-910-1838 00890 f. Vame / Property f�l 'A /^ Date: /( J `1 1 i C- 'G r7 .t l/l Attl` ;1 "(14 'f) ,COVdne`':-' 1\ (.✓L ;•--r Ge Z.-7 , r:f r ) ! •, - Job Location. F � 4 J' White Copy-Collector's Office 11 /( -1 r Y J' / 7,--y Yellow Copy-Customers Receipt 'e �'r-' ' ` Pink Co File Co py Map: /, Lot, /1 //`` I' is Green Copy-Building Department t �� :�A TOWN.OF DAFFINOUTH TOWN GOLLEL i URI ✓ —' Phone: t 1 �3�`, Description General Ledgdt1*Js 2 0 Wi0 Ref. # Amount License & Permits - Building 01000-44105 License & Permits - Building Misc. 01000-44105 KM 44 License & Permits - Electrical 01000-44106 - i ,�( ,: 7 // / / ::1 , License & Permits - Plumbing & Gas 01000-44107 1 License & Permits - Trench Safety - 01000-44129 Other Department Revenue 01000-42420 THIS IS NOT A PERMIT OR LICENSE FOR BUILDING, PLUMBING-OR GAS Received By: r /,/�p._` (n,9'I� ConunonweaCth oil rr/a.nachudettd Official se/0/f 'D I -. V V /J t -_ I._�t c.f., a�'7 Permit No. v t_'ArI— y Wepartment o .}ire Serviced �� „1 l` i BOARD OF FIRE PREVENTION REGULATIONS RevOcel 0�cyandFeeChecked UCJ �'+..•ni j (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: S-)-7-lc) Cityor Town of: r o / l 1(w�Y'1 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) `.AD C.(1 )an \c kG Owner or Tenant 1\ .Q)e!"(-e(mcoC -i- Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No L heck Appropriate Box Purpose of Building Utility Authoriza don No. r Existing Service Amps - / Volts Overhead ❑ Undgrd r No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Mete s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: \VAD Vc v, ,e_1111P' Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Tf K Transformers KVAVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Na.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. 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. Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices + . No.of Dishwashers - Space/Area Heating KW Local Municipal Other Connection • Heating Appliances Key Security Systems:* 1 `\,� No,of Dryers No.of Devices or Equivalent No.of Water KW No.of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: S—) e—I(_j Inspections 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 cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ! BOND 0 OTHER 0 (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. • FIRM NAME: BROADVIEW SECURITY, INC. LIC.NO.:\O01fl Licensee: Signature©G,L Hots LIC.NO.: "\Ctp (C— (If applicable, enter "exempt"in the license number line.) Bus.Tel. No.• Address: Alt.Tel. No.: *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie, No, IJ 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 D owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: pin-- Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies State Online Services Home,Division of Professional Licensure, SFARCH Check A Professional License [OffceofConsumerAffairs _jl (search By the Division of Professional Licensure SEARCH CRITERIA ONLINE SERVICES Profession:Security and Fire Alarm Installers Check a License License Number:7067 Locate a Licensed • NEW SEARCH I Professional Online Address Change LIC. BOARD LIC. TYPE LIC. NUMBER NAME CITY/STATE LIC. STATUS Contact the Agency Systems Contractor • Electricians I Type Class C I 7067 DAVID K.HOLTON,WILMINGTON,MA Current '. More... Your search has resulted in I licenses REFERENCES& RELATED INFO Disclaimer Regarding Website License Searches The page above has been generated by the Division of Professional Licensure web Enforcement Process server on Thursday,August 26, 2010 at 1:39:00 PM. Glossary • Help on License Search • More... ©2007 Commonwealth of Massachusetts Site Policies Contact Us Site Map http://license.reg.state.ma.us/public/pubLicRange.asp?profession=Security_and_Fire_Alar... 8/26/2010 Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies State Online Services Home>Division of Professional Licensure> SEARCH Check A Professional License Lofficeof Consumer Affairs :II [search) By the Division of Professional Licensure SEARCH CRITERIA ONLINE SERVICES Profession:Security and Fire Alarm Installers Check a License License Number: 10070 Locate a Licensed NEW SEARCH I Professional _... _.... _... ....... _... _.. Online Address Change LIC. BOARD LIC. TYPE LIC. NUMBER NAME CITY/STATE LIC. STATUS Contact the Agency Systems Technician Electricians I Type class D I 10070 DAVE K.HOLTON DUNBARTON, NH Current More. . Your search has resulted in 1 licenses REFERENCES Sr RELATED INFO Disclaimer Regarding Website License Searches The page above has been generated by the Division of Professional Licensure web Enforcement Process server on Thursday,August 26, 2010 at 1:39:53 PM. Glossary Help on License Search More... 02007 Commonwealth of Massachusetts Site Policies Contact Us Site Map http://license.regstate.ma.us/public/pubLicRange.asp?profession=Security_and_Fire_Alar... 8/26/2010