EP-47890 TOWN OF DARTMOUTH ;, ; 4.1111
BUILDING f3EC '
j ; ;_
COLLECTOR'S OFFICE „;
Name,t it r,;-
Owner: - ° - �� ,:r ..._ `
Job Location: / l if - Dates
ti
}
Plot: .- ,/ {_ Lot: ;7. - Cr` __ -.. _ - -
lenget - fors Office
Phone: - , i , ', • Copy `�omer's Receipt
4
I 13 .. ent
Description
License&Permits-Building 01000-44105 CtattZZIIIIEVIIIIIIIIIIIL T
C-
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical,) 01000-44107
License&Permits-Plumbing&Gas • allaillir
Other Department Revenue
01000-42420
P r _ -
y' a Pe it or Licen
, 7um•t >. 'e
• - ` , � s s _� Received By: —Y1
'� n "/y4
Commonwealth of trladdachueeiid Official Use Only
tE nr, 'Jr_7.7t Teparimeni o/Sire Serviced Permit Na _
'-; _-14 - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _
6 [Rev. 11/99]
Town of 1DartmoutFi / (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: al 3s\ i
By this application the undersigned givemytice of:Iris ocher intention to perform theelectrical work described below.
Location(Street&Number) 32 ( tr. ._ M%ll t 1, . d i'tC MnJrvL P' �,of
Owner or Tenant [hM Pr1s_1S 'x ' ` Telephone No. t -1441 -a44['
Owner's Address
)+" Is this permit in conjunction with a building permit? Yes I V No pi (Check Appro ri to� °x) `I/t
Purpose of Building DL.XQ\t't%4Q, Uti ' Ault tonzation No. 15 t-rl,V — -
Existing ServiceloU Amps 2CJj / a $Volts Overhead Undgrd No.of Meters / :
1
New Service Amps / Volts Overhead Undgrd `, No.of Meters i _
Number of Feeders and Ampacity 31 260 - ,
Location and Nature of Proposed Electrical Work: RQ,uiw.(t ) \AG- (t jq Ne, bt.,,)^) - Dick_ 04e446G.0
Completion of thefollowing table may be waived by the Inspector of Wires.
No.of Recessed Fixtures i
t t2 - No.of Ceil:Susp.(Paddle)Fans No,ofotmers VA
No.of Lighting Outlets .C No.of Hot Tubs �
Generators i A
K No.of Lighting Fixtures Swimming Pool Above In- No.of Emergency Lighting `I° r `
- gmd. gmdI I Battery Units -,,.
No.of Receptacle Outlets i"I(,/ No.of Oil Burners I FIRE ALARtva, -No,of Zones
No.of Switches ` 3 No.of Gas Bumers No.of Detecti s-and t
✓ Mihaii vices.
No.of Ranges I No.of Air Cond. Tons Na of Alerting-Devito evuc 3
� w
No.of taste Disposers Heat Pump , Number Tons KW No.of Self-Conmm
6 Totals: Detection/Alerting Devices
No.of Dishwashers t Space/Area Heating KW Local TV/Municipal I I
Connection LJ Other
No.of Dryers I Heating Appliances KW Security Systems: •
I. -No.of Devices or Equivalent .
Na of Water No.of No.of Data Wiring:
I�
4' Heaters Heaters KW Signs Ballasts No.of Devices or Equivalent a
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 ins ce including"completed operation"coverage or its substantial equivalent. The undersigned
certifies that such coverage is in for and has exhibited proof of same to the permit issuing office. -7 7 4 2b2 r 7 2-6Zj
CHECK INSURANCE BOND OTHER I I (Specify:)
p a�-O rx V (Expiration Date)
Estimated Value of Electrical Work: i (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, andeur t�he p�Sains ndpena 'es of perjury, the the in orrtration on this application is true and complete. -7/ �^
FIRMN t ' Vbffi• I It W i• . NI — S-��P-Cf .a ' -LIC.NO.W-3�1-I�_'1 e
Licensee: 0,ttr \ . •� Signature \�► \�.. a _ - LIC.NO. E.3L1
(ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: Alt.Tel.No.:�,59 t6-
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance covers a normally required by law. By
my signature below,Yhereby waive this requirement. I'am the(check one) I I owner I� owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE:-$
1-- a ::t*-4,,,--. _
_. .4
Map 6 6 Lot 7'2-
En En
n o x a, ° C s 00 o o
°n <7 n ,"n E.
h ttd n'
FO
13
❑ * ` - m til
y a
0 0 0 ( H a
til
•
x x ti 2. O a.
k 7 0 0 ❑ V N o��o b -"win
cc oh;
C-`vril C o►q
p o
tt r r d r y � °° b
CD A' W N y Vjfj
\ e .y
kii En
CD
tj O b
w
li
d d
,
f D
' o+,. r .1 D 0
- D O .
! cr, 3 73 7J M
RI c cn n m O
t m a
r £ c_-t g
y mCDa
N m Crzrm- ',,
o --I ° ( zm' 2i
' I w - A D z mn
3 `., m 7_ cm- {.-{ O
> N g m r:: 3A mF
o > -I _4 • g
> I • m. >zzn D '.
-0 _ a m rd En
r%) mn CO
w orz >
a o+ MU) 0
Fr o r) 2
te o I -1 C
A W 77: N
1n D
Signature
So
//�////�, 7V
. I
CA
?
CT\
OS
.-1
, r u
. .
. -->i 7-----\
. v
, ..
. V
0
. \
. ..„.„
. \
1 .
. C
. ,
, r
\ C
" \ '------- ,
CA\ C-- ‘
1 \ 1
..----- - '
\ c-^,
1 C\J
\ (----
‘ \
___