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EP-32296
.t ". ,per //�J QQ yqA�/ /��, 3�-\ l,ommonweahl of lrlaaeac ells Offici5)s O�thy�Y" A—' - ifI ryry.. g� Permit No. �� _In_:- - .1Jeparlmenl o ire—Cervices el_ . 1-I ` - BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked o s Town of Dartmouth [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the.Massachusetts Electrical Code(MEC,,5f27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: fl/f3k`7 • By this application the undersigned gives gggqtice of his or er intention to perform the electrical work described below. Location(Street&Number) // Ka Owner or Tenant -1-O C OS Y 7 Telephone No. y ) —, Owner's Address Is this permit in conjunction with a building permit? Yes n No[ (Check Appropriate Box) Purpose of Building _Utility Au orization No. - Existing Service Amps I Volts Overhead Undgrd n No.of Meters New Service Amps / Volts Overhead Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ())(? r Set Uglify St/0 c Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.Tranotf formers Total No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Abo�dvel I rgmd� No. Units Lighting No.of Receptacle Outlets No.of Oil Burners L--1 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. Tuns No.of Alerting Devices No.of Waste Dispuners Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Connection Other • No.of Dryers Heating Appliances KWSecurity Systems: No.of Devices or Equivalent . No.of Water - - -:-- - No.of -- No.of Data 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 f and has exhibited proof of same to the permit issuing office. Qb/o/ /U , CHECK ONE: INSURANCE ['BOND ❑ OTHER H (Specify:) ( `7 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under thepains and penalties ofp ury,that the information on this application is true and complete. FIRM NAME: {ftL SC U� fly (U. T(/-C-- j/ LIC.NO Licensee: i it (. u)rt lJ L(/ _Signature ` LIC.NO (If applicable,enter"exempt' in the license number line.) Bus.Tel. 6661.Z�,(�t; Address: `-7'7/ �.{?y/t Vi, S 1> TV ,6 . Alt.Tel.N. OWNER'S INS ANCE WAIVER:I am aware that the Licensee does not have the liability insurance covera a normal my signature below,I hereby waive this requirement. I am the(check one) n owner I owne Owner/Agent Signature Telephone No. PERMITF. Plat Lot 2/6)- r a z (D O .� N ? N A ' O c � O Np K p p � M G • p iw XI:^ i�drr u C-i\ • np 'O, v a la IJ 'w m tzt.......�' O o co e v A w ❑ ❑ O b A. Na/* R- 0 -,,,,S'ID g CD m fDD fit. a a c a ©y z ea Pz '- d ill Cb z- fize. z t A. z o W I C b o FIT v d � v a 0 z A __ ___ _____ _ __ _ _ _ _ _ _ N , g -CD _ _ 1..- Nr: 11/4vl g ` 5 o e ri p PO b 1' -. c `� L °' b b N H t TOWN OF DARTMOUTH ri1 cilC BUILDING RECEIPTS COLLECTOR'S OFFICE 7 / Nark i i,a Zit^ G r Property Ajtif f t f� Da : / C-i� 7 `� b..:,,,-a 's Owner: ,16 JJJ` Job Location: s lest 4 OR t // to / UU� 'teCopy-Collector's Office Plot 1 � f Lot / % `, Y= ow opy-tustomeisReceipt L l' 1/ Lc, Cop -File Copy �1; Gre Copy -Building Department Phone: ' Description General Ledger#'s Ref.# Amount License&Permits-Building 01000-44105 -' License&Permits-Building Misc. 01000-44105 fi License&Permits-Electrical 01000-44106 / t -( d1O c , License&Permits-Plumbing&Gas 01000-44107 t \ 'Other Department Revenue 01000-42420 _' _ ' X c) This is not a Permit or License for Building,Plumbing or Gas Received By: r/ Office Use Only The Commonwealth of Massachusetts Permit No. ? - = Occupancy&Fee Checked It 2ri _e/ (leave blank) tv Department of Public Safety 4.=_�r BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Town of Dartmouth 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 •/// /° / The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) //o C 2�.±D ?D Owner or Tenant J OSE 1 COST79-- Owner's Address Is this permit in conjunction with a building permit: Yes U No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ____Amps______/ Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Name; of Proposed Electrical Work • w 1 cc- �5 SE-e.ugtrySlys%-ni ' No. of Lighting Outlets No. of Hot Tubs Total g No. of Transformers KVA No. of Lighting Fixtures Swimming Pool ple Li d Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS NO. of Zones Ranges No. of Air Cond. Total No. of Detection and No. of Ran g Tons Initiating Devices Heat Total Total No. of Disposals No. of Pumps Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KWNo. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local ❑ Con is pion 0 Other No. No. of No. of Low Voltage of Water Heaters KW _ Signs Ballasts Wiring _ No. Hydro Massage Tubs No. of Motors Total HP + OTHER: -- INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy_including.,includin Completed Operations Coverage or its substantial equivalent. YES ❑NO E I have submitt. valid proof of same to this office. YES LI NO LI If you have checked YES,please indicate the type of coverage by checking the aap�p�ro ate be INSURANCE p BOND 0 OTHER 0 (Please Specify) CO d/ i Expiation Date Estimated Value of Electrical Work$ - Work to Start Inspection Date Requested: Rough Final Signed under the penalties/ of`��erjury: ((� LL FIRM NAME !7 75 EC.U g(Ty OD O . Ne__ LIC. NO. Ciffae- r /l�I Licensee /7 kV L r,SoL ,, {',/Signaturr�e LIC. NO.(at5D '7 rii /"</e '}l AM'i c� t . ,V 8 , G,,n 4, yyo Bus. Tel. No. �fi3-Y�7! Address 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 I Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature or-Owner or n¢enq Telephone No. PERMIT FEE $ �� \ 4,:,, . . 0. . 7-7(:, .. 4._ Z y , LTI yPli O O v P n z .• b C y m Z 1-3 c c 3 z II "r1 MI _ _ _ . . n • r C a • IT C y cn Z cn C^ z