EP-69566 if' I sr.tbARTMOUTH - BUILDING DEPARTMENT RECEIPT 7 01<;t 9
_'.' PHONE: 508-910.1820 FAX: 508.9101838
ids
fi Name/ +'.; � � v / e- Property Owner: A, Date / /,a/ ;
Job Location: 82 IV iLc6S 1)); Map: 23 Lot /3- 3)
Description General Ledger#'s Ref. # Amount
Building & Building Misc. 01000-44105
" Electrical 01000-44106 Pi F LIAR ,3 -'
\ �� pr00
u ' Gas 01000-44107 Q' MC 7 '
Trench Safety 01000-44129 JUN 1 3 2013
Other Department Revenue 01000-42420 5 ``rrAn, f
White-Collector'sOAce Yellow CopyC01- -- �n i4
-Customer's Receipt Pink Copy-Building Department • -
THIS IS NOT A PERMITILICENSE FOR BUILDING,-ELECTRICAL, PLUMBING OR GAS
1
T l' ARTMOUTH -BUILDING DEPARTMENT RECEIPT 69566
No �' PHONE: 508.910-1820 FAX: 508-910.1838 'g,LI,�
a- S) j j
Name: 1L1 l i A I ( f, /
l OW u Property Owner: �' Date f iG f r'?
.
Job Location: �� {"/ ,` iP< 3 %' Map: U Lot:� 7 7
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Description General Ledger#'s Ref. # Amount
,Building'&.Building Misc. 01000-44105
Electrical 01000-44106 P' u f II 7 )
Plurnbing�'i Gas 01000-44107 -
Trench Safety 01000-44129 APR 2 21013
Other Department Revenue 01000-42420 "
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White-Collectors Office Yellow Copy-Customer's Receipt Pink Copy Building Department Reeeived By /"-- (/ ��'�
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS
Commonwealth.
qq� / Official U e Only
Commonwealth o�///aeeachwet/a
n" `t
Permit No..r
r—' it Thepartment oJire Seruicea i
tit_[ @ Occupancy and Fee Checked 7�
'"'a� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PEI4FORM ELEC 'RIC . L W t. RK
All work to be performed in accordance with the Massachuse Electrical Code(ME r ,527 C 1. 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) \ Date:
City or Town of: 7),-;,..7c,,,.,)1-4 To the I :.ector of Wi 7
By this application the undersigned gives notice of his or her intention to pe -.rm - electrical work dikcribed below.
Location(Street&Number) 8) /"i f/'Sr. «,he 1
Owner or Tenant /h/5 .71)y r t' Telephone No. 7 7/7 -/757
Owner's Address ,5'4 int P
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ NOW Meters
New Service Amps / Volts Overhead I Undgid❑ No.o Meters
Number of Feeders and Ampacity \
Location and Nature of Proposed Electrical Work: t
/fP /n.../ cr.,G� CIP.D� �/ .S h 4)i,Nn�)
iti
Completion of the following table may be waived by t e Inspector of Wires.
x No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs - Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad. 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
ANo.of Ranges No.of Mr Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers • Heat Pump Number Tons KW No.of Self-Contained
i. Totals: ' Detection/Alerting Devices
Y Municipal
No.of Dishwashers Space/Area Heating KW Local Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters 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.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: —J2-/3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability ' surance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cover e is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND D OTHER ❑ (Specify:).
I certibt,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: ._Stj hn -I) the,nno Signature ' , ' LIC.NO.: ?&i&yt
(If applicable,enter "eampjj"in the license nymber lie.) f Bus.Tel.No.:
Address: IS /�/ {irn L tj[f >evn ei e/ Ca 7ot6 Alt.Tel.No.:
*Per M.G.L.c. 147,s.5/-61,security work requires Departifrent of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: S
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November 30, 2012
Dartmouth Wiring Inspector
This letter is to inform you that I have discontinued using the services of Jeff Mateus Electrical on my
inground pool project. We will be utilizing the services of John Dimanno for the remainder of the
electrical work to be performed.
a
Tharlk you.
94,thh
Stine Potter � ,
82 Millers Drive •
Dartmouth, MA 02747