EP-186 The Commie wealth of Massachusett Permit NoOftiee Use Only
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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 n C ( t ( t 19°t 3 ,
The undersigned applies for a permit to perform the electricalri work described below. /n (�
Location (Street & Number) ‘2-
-22-I nee) I tk7 " r 2
Owner or Tenant M 14-5• 1 Ar+/Lse;A , CEO aa c
Owner's Address VI2A (Lela /th) *3 'DAI�iucLtrM „uAA 02`717
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Is this permit in conjunction with a building permit: Yes •E No ❑ (Check Appropriate Box)
Purpose of Building 'I2E1 f'DE•v E Utility Authorization No.
Existing Service Amps / Volts Overhead E Undgrd ❑ No. of Meters
New Service Amps / _Volts Overhead ❑ Undgrd ri No. of Meters
Number of Feeders and Ampacity //�� ' /l
Jncation and Nature of Proposed Electrical Work v`rLkkea `feA.rHFw•.. lt-€-M..ae-,..s ; de,...) (slumps
t ) kTn W&J , J E.,t lU Q 1+�0,1 q- rc•P I•H4••,r FA,..) ,.t IS A;µ,wo.
No. of Lighting Outlets V No. of Hot Tubs _ KVA
No. of Transformers Total
No. of Lighting Fixtures Swimming Pool gmd, In grnd. ❑ 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
No. of Ranges Total No. of Detection and
g No. of Air Cond. Tons Initiating Devices
No. of Disposals Heat Total Total
po No. of Pumps Tons KW No. of Sounding Devices
Ivo. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Mipal
Local Connecuniction ❑ Other
No. of Water Heaters KW No. of No. of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
r
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
` I have a current Liability Insurance Polic mcludin Completed Operations Coverage or its substantial equivalent. YES, O ❑ I'have submitted
valid proof of same to this office. YES f'NO LJ If you have checked YES,please indicate the type of coverage by checking the'Appropriate lam.
INSURANCE pBOND ❑ OTHER ❑ (Please Specify) ,c+�,tstrf `}rY
` Estimated Value of Electrical Work $ Z `t 0J. 0 0 / (Expiration Date)
Work to Start V/4i`f�' Inspection Date Requested: Rough T O et A. tit Final -TO /6 A9044E.9
Signed under the penalties of perjury: ��f/,//
FIRM NAME O/S r T-}t t:....k E t F e-1,.0 r✓
LIC. NO.
Licensee �/� r iF7't'-t- / QWJ+$a.T f�. Signature ///��/''' I� NO.A /38fl
Bus. Tel. No. ( 0bo- fj 7ro.Y
Address /08e To Y �C/..f rn A). Q. 0271J A1L Tel. No. (Sv B) $�`/S- /S3`>✓
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
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 FEE $
RECEIPT FOR PERMIT
O TH TOWN OF DARTMOUTH
o`- t PERMIT NO.
olkn. - to
`' �
�f� No
Date
e A
Received From
Owri€r
Location -
4
Type
Amount Paid -
Received By
Report Fee 9/14/93
Owner Patricia E. Lobo Date 9/14/93
Address 1221 REED RD. . N. D. 66/73 Permit No. 18
Contractor Robert A. Robitaille A13859 99 8 7105 S4/1-S Red
Ble
Address 1088 Tobey St. , N. B. MA 02745 Green white
Remarks EXISTING DWELLING: Kitchen and bathroom rewiring.
Est. value: $2400.00
Will call . •
Inspected By: Date