EP-27444 TOWN OF DARTMOUTH
_ 27444
BUILDING RECB ITS
- " 5 jaPPIrtIlr 'il COLLECTOR'S OFFICE
Name: �. i � , 7 Property ' a �'} ` 0 Date: A. r -7-
,v=-2�41 f' i -7 f i i�/icowner: - �4./. ,,,.-7, . _ .- i-, `. --c-,il-) / f 1:-�J
�ikr ) ° COLT r.. r vr,.,,y, !,/ / /
Job Location: ['"//' (." li _.r /4.7 ,�J , 'i S �, es,t f i
�I � lef r d C�F✓1 �f ( r •I J f
Whi.�e Copy-Collector'sOffice
Plot: /1! Lot: / r JAN I Jf 0 Yellow Copy-Customer's Receipt
-�1 } Pin*Copy Pile Copy
/ -� i r:. y F Gre[' Copy-Building Department
Phone: i s J -?CS.e_.. t.( ' 7 -/4..-. r �,r., Id _J
Description General Ledger#'s Ref.# Amount:
License&Permits-Building 01000-44105
License&Permits-Bui Wisc. 01000-44105
License&Permits-Electrical i 01000-44106 :/` ,� ���j��-��---�
1�n d� , C 1 - <_ .>
License&Permits%-71un bmg&Gas 01000-44107
1
Other Department Revenue 01000-42420
t /
This is not a Permit or License for Building,Plumbing or Gas Received By:
— — commonwealth o//gadiaciLdelli Official Use Only
_ -SIIMccyy�� c�77 �a Permit No.
lelia 1Jeparlment of ire Jervicea
awil BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[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).527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORM IliON) Date:
- City or Town of: fl -- ,t it l l l To the Inspector of 6Lu es: '-
By this application the undersigned gives notice of his or her Intention to perform the electrical work described below:
Location (Street S Number) .-c/o 0 )(1 FR) 1 A 1 > e
Owner or Tenant )nhN arar4liii n aa,,.., ce/. (� Telephone No. Soli Rq6-ggtg
d c w
Owner's Address i9 0( ee D r RI, r*vnoiJ1L
1 Is this permit in conjunction with a building permit? Yes n No V (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ 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: t
w
—, alf— f.tilrn�, orlciltr FoR }��� `;}�)
w n C.
z ' Completion of the followinz table may be waived by the Inspector of(Fires.
oz No.ofRecessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers • KVA
H No.of Lighting Outlets No.of Hot Tubs Generators KVA
N No.of Lighting Fixtures Swinvuina Pool Above ❑ In- ❑ No.of Emergency Ltghtutg
o e grnd. grnd. flattery Units
Z No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
EA
d No.of Switches No.of Gas Burners No.of Detection and •
Initiating Devices
El No.of Ranges No.of Mr Cond. Tons No.of Alerting Devices
H No.of Waste Disposers Heat Pump ,Number Tons KW__ _ No. of Self-Contained
_.._
H Totals: Detection/Alerting Devices
❑
No. of Dishivashers Space/Area Heating KW Local Municipal
Connection ❑ Other
•
H No.of Dryers Heating Appliances KW Security Systems:
En
No.of Devices or Equivalent
z No.of Water No.of No. of
ricatdrs IOW Data�Yiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydrontassage Bathtubs No.of Motors Total IiP 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 force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE D BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: dt g r,&•ym Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certij•, under the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: }I.koN � f
T . 'pp.-fap" Signaturtat* iIn••,c LIC.NO.: 3,;;11,Ri E
(If applicable,enter "exempt"in the license number line) . Bus.Tel.No.•
Address: P.Cl. Rcc l e Ha ;R�p,Jt?ri \P Alt.Tel.No.:_cCA- art-yrisc
OWNER'S INSURANCE WAIVER: l 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) 9'owncr ❑ owner's agent.
Owner/Agee �Jo ,�
Signature Telephone No. 5251 c[� aJ gict PERMIT FEE: S
9RS-w5,6�
lib fu ..
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tc :
EXISTING FIXTURES IN DETAIL i{
7
X_
Leafs,of leen lYt+
(Mani S. Mgt Pm lecuw a Rwn bolt GYu S. Pins rm
•
No.of Sur.Out. - Heat —Type /
No.of Outlets Lt.
No.of Rec. Oi1
-.Gas .
No.of Motors H.P. Electrical— KW Connected load
No.of Signs • Trani.
Hot water—Motors and Ski
Air Cond. Steam— .Motors and bite
Range Name Plate Rate Hot Air— Motors and Size
Water }cuter Hama Plate Rate
Mitt.
Clothes Dryer Name Plata Rate
Total Load
Size of Main En Su,. • -
a
Site of S.E. Conductor
0 �,