EP-40115 TOWN_ OF', DARTMOUTH 7'�'
BUILDING RECEIPTS
e COLLECTOR'S OFFICE
if
Name '� Yj&s%ti o, sw„'.:o Property /r / f Date: /4-- f 1 /ih I''
e4u/i /l F?!//19 Ka (6 Li Owner: ,)Off/(_( -f{.(s i O, '�711/ J
Job Location: l /� //
/:>r Ar i ! 41-' 1 .
/ "-tNhiteLop�_Collector s Office
Plot: - /� Lot: <`fr`) - / ' - w` PeHow Cop Fill Copy er's Receipt
c.� ✓ . t reen C y-$wilding Department
N
Description General Ledger#'s Ref.er# -- Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc. 01000-44105 /
License&Permits-Electrical ) 01000-44106 /yoy. I .' ' 7
License&Pe its-Plum .&Gas 01000-44107 _—_:-_______-----
Other
Department Revenue 01000-42420
This is not a Permit or License for Building.Plumbing or Gas Received By: iC C �C�7- - — %.d am
n/� gg ��,�r-
1,omnwmaeallh o///lwsachwellr Official Use h
u=' ei ry c7 Permit No.
. 1 _ 1J_-_ epariment of Jire.ewicee e
T - BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked 2
,,Jp Town of Dartmouth (leave[Rev. 11/99]
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:—IA Li k 1 2-01,S---
By this application the undersigned gives notice of h' o her intention to perform tha.electrical work described below.
Location(Street&Number) `
Owner or Tenant ;e c tic .. Telephone Non cl Y'1 --t "7
Owner's Address 0_,tin fact, e__LQ,
Is this permit in conjunction with a building permit? Yes I` " No n (Check Appropriate Box)
Purpose of Building �Sic LA-'t-2c_ _ Utility Authorization No.
Existing Service Amps / Volts Overhead I I Undgrd No. of Meters
New Service _ Amps / Volts Overhead Undgrd I I No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: , 90k Spy¶bA.Q.k '^ 4\aa...l a,&ra I b t� ..A.,;-
CO u.' -I- &"v'. CS` v r'�v-s O . idrwt. V)\3CS tr e , t?�-e. I
Corn etion ofthefollowing table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above In- No.of Emergency Lighting
gmd. I I gmdl I 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. Tol
Tons No.of Alerting Devices
" No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
ce
No.of Dishwashers Space/Area Heating KW Local Municipal
Connection iI Other
No.of Dryers - Heating Appliances Key Security Systems:
N Devices or Equivalent .
No.of Water No.of No.of DI;Wiring:
Heaters KW 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.
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 fore d has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND I I OTHER (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: O. OC3
(When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, and r the airs and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: DAkn.. Act `E..�Q Q. f pLIC.NO.C.5\G S(
Licensee) -c i tr.nre W.q(Ly� Signature �-- LIC.NO.
(If applicable,enter"exempt"in r !teens numbe( line.) t - Bus.Tel.No.:'72-c D-3$�
Address: t`RO C it si tvep it-‘A C.)--1. ke 1 Alt.Tel.No.•SCjt7S' 2--(8r
OWNER'S INSURANCE WAIVER:I am aware that the Licensee do s not have the liability insurance covers a normally required by law. By
my signature below,I hereby waive this requirement. I am the(check one) owner ICI owner's agent
Owner/Agent ��i
Signature Telephone No. PERMIT FEE:$ c33
Map 46 Lot Va -
n 111Th
:. Ijr
x ° i L . w n may E.
tti
ttl o lalIyy`a.or.,�?
w ��MI'iyll o
n a �.
q,p.p;
n \� N 3
, HJtl
Y� '"
s ❑ b
t 0 , .,,,, ta+„., c,„ A
b
riia b
C7 iti trl h7 rn c )it, El El it o cc cc * z
��J it co O fi
Q CI d * b a �_
CA y
~ cb
��
ttiy C7 d C7 r r til y tat:
P w w � y c,� vAo P
CD CD cl
a C7 o e A
tit
pe? to
I
("--" I