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Report 3:3
0 c Fee pd $ 25.00
Owner Michael LaCroix Date 10/17/90
Address 548 OLD FALL RIVER, RD., N. D.' Fe ero. 222
Contractor Michael LaCroix /10e, p Red
Address same as above Green ,/ -
Remarks Wire bedroom addition and porch
Will call.
Inspected By: Date
1�77 2�11 �✓
The Com onwealth of Massachuse S Office Use Only
Permit No.
/ Occupancy&Fee Checked—/6 -Y 7 -r!6
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i IA�1- Department of Public Safety (leave blank) pit
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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 Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
The undersigned applies for a permit to perform the electrical work described below. _
Location (Street&Number) .7 Ve OZ r) 1-/9GL A.z,, ER Re' .
Owner or Tenant li -1CiJ 45L L4c D r21Y
Owner's Address SA ill S
Is this permit in conjunction with a building permit: Yes 0 No ❑ (Check Appropriate Box)
Purpose of Building L'l_ r) ecorn Utility Auu h(9rization No.
Existing Service /dd Amps //*) Volts Overhead IJ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead h Undgrd n No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work w �� AE b Roots A bb gle- h7+e/nic„eS forosi
No. of Lighting Outlets Y No. of Hot Tubs No. of Transformers Total
_$VA
No. of Lighting Fixtures ._. - - Swimming Pool grnd.—Above ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets ✓✓ No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets / No. of Gas Burners FIRE ALARMS NO. of Zones
Total No. of Detection and
No. of Ranges No. of Air Cond. Tons Initiating Devices
Heat Total Total
No. of Disposals No. of Pumps Tons KW No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Mal
Local Counicipnnection ❑ Other
No. of Water Heaters KW No. of No. of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I ha'e a current Liability Insurance Polic mcludin Completed Operations Coverage or its substantial equivalent. YES ❑NO ❑ I have submitted
valid proof of same to this office. YES U NO LI If you have checked YES,please indicate the type of coverage by checking the appeopriatebox.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify)
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Estimated Value of Electrical Work$ /b O a7 xpuanon ate
Work to Start /O/d 0/9'o Inspection Date Requested: Rough /62/0707j9/0 Final
Signed under the penalties of perjury:
FIRM NAME q ��f!J LIC. NO.
Licensee Signaturev,,,-,iiGl LIC. NO.
us. Tel. No.
Address Alt. Tel. No.
OWNER'S INSURANCE AIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
M?4jot
al La and tha y signature on this permit application waives this requirement. Owner Agent (Please check one)
GC p� p ^ 6--
caner or gent) Telephone No. //✓` -�// 6 PERMIT FEE $ J``�
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TOWN OF DARTMOUTH
t? � � WIRE DEPARTMENT
a
Date f
�n Names In Payment of Amount
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