EP-13845 TOWN OFDARTMOUTH 13845
BUILDING RECEIPTS
COLLECTOR'S OFFICE
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Name: : r , ;t P . Date `!f t r;r /
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White Copy-Collectors Office
Plot: .rii Lot:- - - Yellow Copy-Customer's Receipt
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Green Copy-Building Department
Phone:
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Description General Ledger#'s of if Amount
License&Permits-Building 01000-44105 COLLECTOR'S OFFICE
License&Permits-Building Misc. 01000-44105
.
License&Permits-Electrical 01000-44106 DEC 27 1?9D tT 5 Czy
License&Permits-Plumbing&Gas 01000-44107 Cr, C
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•Other Department Revenue 01000-42420
This is not a Permit or License for Building SPlumbing or Gas Received By: ,.%
The Commonwealth ofMassachusetts Permit NoOceueaner&Fa
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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 Elefcat.Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Date /-)-2/ CV ar 9
The undersigned applies for a permit to perform the electrical work described below.
Location (Street&Number) ��r� 9 CC-l7 f /fi /R �ci/ •4.c--
Owner or Tenant 21 Q fri-7U Rj W 1' L)
Owner's Address Si1-71Z
Is this permit in conjunction with a building permit: Yes 0 No Irj- (Check Appropriate Box)
Purpose of Building _ Irda� A�---/ n NO__
')t Existing Service s t'/ ' r taiVolts [Q overhead ndgrd ❑ No. of Mete
New Service s / Volts overhead 0 undo ❑ No. of
Number of Feeders and Ampacity I_L�//IIn�IL_
Location and Nature of Proposed Electrical Work .T�-v)a" OT f7L- I�/a y
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-
No. of Lighting Outlets No. of Hot Tubs I��"'ion
it No. ofTransfotmers KVA
• No. of Lighting Fixtures Swimming Pool sjgre ❑ hind. 0 Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Batter,Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS NO. of zones
No. of Ranges No. of Air Conti. Total No. of Detection and
Tons Initiating Devices
eat No. of Disposals No. of Ptmmns Toms KW No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW N o of nrSoualf ontog Devtiu
No. of Dryers Heating Devices KW Munpal
Local ❑ Cosmeicirnon El Other
No. of Water Healers KW No.
imsf No. ofWhin Voltage
Na. Hyd.o Massage Tubs - No. cfMo+ors Tos'1 HP -
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy includi,ngg Completed Operations Coverage or its substantial equivalent. YES ❑NO ❑ I have submit
valid proof of same to this office. YES ❑ NO l_I If you have checked YES,please indicate the type of coverage by checking the appropriate c
INSURANCE ❑ BOND 0 OTHER ❑ (Please Specify)
Estimated Value of Electri works tespnanon Dar
Work to Start /� )f3 '5 /, 0
J Inspection Date Requested: Rough Final—�y�i�
Signed under thepatr es of
FIRM NAME hL:CnV Cr Ce-- 77e2 C- re'rio iteitgGp~pt L G. NO.,4 Yf
Licensee \\ __ // -- Signature LIC._ NO G�rTn'
Address oU/ /'z40Zl, Leff
��" p Bus. Tel. No. l4''i'
�� /t f/ r 3Cs�P7n MO al 7`241 Alt.Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee don not have the insurance coverage or its substantial equivalent as recuirec
Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Anent (Please check one:
Telephone No. vcaj1IT cc_ _ r"
Signature of Owner's Agent
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APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE
Inspector of Wires-Town of Massachusetts
Customer on(Street#)
Lot# in the village of utility pole#or underground#
Customer's billing address
Temporary New Installation Change of Service Starting Date
Job Description
Service entrance voltage Amperage Phase
Wire size(cu. or al.) Conductor per phase
Number of meters Water heater Off peak: Yes . No
Electrical Contractor License# Telephone#
Address 4
Additional Remarks
CERTIFICATE OF INSPECTION
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and
approval granted for connection to your service.
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