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EP-12222 TOWN OF DAR MOUTW 2 ?2 BUILDING RECEIPTS COLLECTOR'S OFFICE Name:,, ' _ j -r' . 7" Property f % Date: ? i f r jJf _ � ft-i �Wf �/ �.�t.,�L`r.'f��a"�9x�ner� -tl c�/t�:/� f/ �/_,i� � j / ! ( J.. Job Location: f f - - WO WhiteYello Cop Copy-Collectors Office Plot: - ` �� Lot: /3 -� /O'N QC`09 F\Ci Pink op -FileopDepartment Copy-Building -p Phone \C-59 \ Description General Ledger#'s I .0S Amount License&Permits-Building 01000-44105 �✓ -' License&Permits-Building Misc. 01000-44105 / License&Permits Electrical 01000-44106 �� �/ / /1,1C.-// License&Permits-Plumbing&Gas 01000 44107 - Other Department Revenue 01000-42420 This is not a Permit or License for Building.Plumbing or Gas Received By: Al AC L-4'% l t AL - v" .4' / r The Commonwealth of Massachusetts Office Use Only -� T - ' DW ,h.test of Public Safety Peni[ W. 1010, UVs. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1203 3/90 Occupancy E. Fee Checked (leave blank-----) ..' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR I2:00 (Pr.FnsE PRINT IN INK OR TYPE ALL INFORMATION)) Date �—/r--�.,9 City or Town of /?prim- The-undersigned applies for d Tk es ripdctor of Wires: a permit to perform the electrical work described below. Location (Street & Number) 7 '"f` DVJ µ� Owner or Tenant Li1/2 N t /QGYG , P- 1 �� Owner's Address 2/ G Is this permit in conjunction with a building permit: Yes No Ell (Check Appropriate Box) Purpose of Building fC•j e- ' `��� y�,, Utility Authorization NO. Existing Service Amps _Volts Overhead 0 Und d fir0 No. of Meters \ New Service �e Amps �2� / Volts Overhead 0 Undgrd[El-- No. of Meters /` Number of Feeders and Ampacity ej Location and Nature of Proposed Electrical Work _� // ` / LrJ /7L9/� O 1 No. of Lighting Outlets No. of Hot Tubs No, of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- KVA No. of Receptacle Outlets grnd' grad' CI Generators KVA No. of Oil Burners No. of Emergency Lighting No. of Switch Outlets Batte Units No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Ranges No. of Air Cond. tons No. of Detection and No. of Disposals - Initiating Devices • No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained L ti No. Detection/Sounding Devices t of Dryers - Heating Devices KW Local O Municipal Other No. of Water Heaters KW Connection Low Voltage No. Hydro Massage Tubs Wirin- No. of Motors Total HP . OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its subst�arttial equivalent. YES NO[l�" I have submitted valid proof of same to this office. YES NO 7�J If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND ❑ OTHER 0 (Please Specify) Work $ 9r2D L2k u 2 (Expiration Date) Estimated Value of Electrical Work to Start _7/ Inspection Date Requested: Rou /'�o( Final ��"�� �' 41 perjury: Signed under the penalties of er u gh�`/ `' ' FIRM NAME S/ Sid— Licensee f/ LIC. NO. Signature LIC. NO.,�,j�61,� Address r� f /. --��—c�' - �l� �) z j Bus. Tel. No. 7r--7 3 f/ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent required by Massachusetts General Laws,�t mysignature applic.tion waives t s r quirement. Owner 0 A gent gnature on this permit ' /// fry 8 (Please check one) /,'�� " " X`7 Telephone No,Sag 679-3 5q7 Signature of Owner or Agent PERMIT FEE S • F 7111111111111111111— Platt/0 Lot/3 -` r t /� . 5 5 * pyy * * t� O Z .F / _ . 1 AA a o 5 3 �° " oo bo FT � ca a 3- - Fa" n •• M ..t rh a P O CD a _ •n a n M;itr ./ -c:::1 w E. .. a e CZ O co \ t x it 0 0 0 M I g 1 1-3 Vg o n � z ato. ic Fir b et n ti. C7 0 w C , �� Pm �� r ci-vi . o APPLICATION FOR PERMIT TO INSTALL AND REQUEST[ EL CAL SERV ICE.w, '„ , i U Inspector ofWires-Town of Massachusetts • I � :1 i Customer gN 1 O/Q I p A' YEA)i o R A on(Street#) •7 1 7 i i (ers D c' Lit " '- Lot# ?j q in the village of M i i lees i%rnf M utility pole#or underground# C.: Customer's billing address 0?i 1..Pint o x 5% rfrit k t O&Q_ 04,4 © 02 /-7 Temporary Neq/IIn-stallation �� Change of Service Starting Date 7- /S-9 9 Job Description vU 1/ZE IJPY ''j4v OS C -}- S cry 1 G a Service entrance voltage L2O/2 y O Amperage 0 0 Phase / al. 3' Wire size(Cu. o 0 m Conductor per phase / (07er7kwx/ 4T-7 kw) (en,'" 8' Kc ✓1 Number of meters / Water heater / Off peak:Yes . No ✓ / �So 8) //`° Electrical Contractor .5 I Ve-AJ COS 1 f) License# 3 S V 6 9 e. Telephone# 6 76 " (2 3 °l 7 Address 916 PI1i 1 SI, runt, RVgut2 .4/4. oa ) 23 Additional Remarks CERTIFICATE OF INSPECTION lll To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed �ns ang has this day been inspected and approval granted for connection to your service. /,/ `CYOC R� % " die / ��7 Inspector of Wires Date WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit is Good for One Year From Date of Issue