EP-2951 TOWN OF DARTMOUTH in;g r.;i
BUILDING RECEIPTS
N 0 TAX I S$ E COLLE OR'S OFFICE
Property Date �! - y
Name:;: _ _ r- ', 7
.- r . ,�`��- ,���. a.. Owner: ... . . _ -
JobLocafion: ' / :<,trtg a
/ i L-is L`-�- ✓ .A - White Copy-Collectors Office
Yellow Copy-Customer's Receipt
Plot y7 Lot: / C /q _` e- 4 / Pink Copy-File Copy
Green Copy-Building Department
Phone t / ...« �'� ✓ A.-„i. " -_ /Z.♦_ ( n <_. -rL - f�.
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General Ledger#'s Ref.# TMnuTH Amount
Descript€un TOWN OF D11R
. License&Permits-Building 01000-44105 TpXCOLVFCTORSO-FiC�
License&Permits-Building Misc. 01000-44105 ;�b t; �yy( l
License&Permits-Electrical 01000-44106 ':cam '
License&Permits-Plumbing&Gas 01000-44107 RS , e
Other Department Revenue 01000-42420
This is not a-Permit or License for Building,Plumbing or Gas Received By:
L j` UIlausevmr
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�� The Commonwealth of Massachusetts Permit No.
Occupancy&Fee Checked .-O a o
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-. Department of Public Safety (1C8Yt wank) F 7
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 /! , %- 7
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) /22/Z.Z.ore Pn Cc.;(i9/1 Us 2O Th. '
Owner or Tenant R. 4, .< /ex2 q- y4.-L`c /
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Owner's Address ?0 C :sr- 6 i4-4-J sr /1z/ 4,/- - . /'�i ,
Is this permit in conjunction with a building permit: Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd 0 No. of Meters
New Service Amps / Volts Overhead 0 Undgrd 0 No. of Meter'
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work (`N/2G/C/r;v-r6 (/7 i f) c-//7
Total
No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA
No. of Lighting Fixtures Swimming Pool gitAd ` ❑ gznd. 0 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
gTons Initiating Devices
No. of Disposals No. of Pumps Total Total No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW dal ❑ Mnnnecu n 0 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:
/
ir4SU ANCE COVERAGE: .asuant to the requirements of Massachusetts General Laws
I has'a current Liability In nce Polic mcludin Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 I have submit
valid proof of same to office. YES Li NO LI If you have checked YES,please indicate the type of coverage by checking the appropriate b
INSURANCE ISd DOND 0 OTHER 0 (Please Specify) (Expuauon Dar,
Estimated Value of rk S 7 Z,, c91)
Work to Start g-� Inspection Date Requested: Rough Final
Signed under the penalties of petty:
FIRM NAME c C?c,Z e G- -cc_.r/Z e.,_G„ ��� '/Cr. LIC. NO'O
Licensee A- Signature LIC. N .
Bus. Tel. No '
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 requirec
Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S
a2u
cJtenature of Owner or Agent)
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