EP-772 _~ Report C r Fee pd $ 50.00
Owner Matthew Vangel < �i �, �?� Date 6/27/94
Address 15 SUNDANCE RD. , N. D. 76/22-11 PermitNo. 772
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ContractorFred Borges A10125 99 1 5805 weuo�[. Red
Address PO Box 61416, N. B. MA 02745 Green f.4
Remarks Finish wiring house.
Will call .
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Inspected By: Date
M7714111111%
_L`i ict Use Only
=- The Commoni�ea th of Massachusetts � �"'�
p E t "? remit No.• C�f b Department ofPublic SaI`ety )1.0
• >• -gip 1" 5 Safety
Occupancy a Fee Checked
F£ _�a BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12130 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusetts Electrical Code.527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE..AtJLL L`:c�ORtIA1.'I0N) Date to — at '( v
City or TOUT/ of O/4rc1T To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical workdescribbeedb{ell w.
� /mot
Location (Street St Number) L S i sn/ 40,7/e.SS �s d :�,,nF 7"� 72a—//
Owner or Tenant t7f'fl-� • J//9-Al e 25—C_
Owner's Address
Is this permit in conjunction with a building permit: Yes;g3 No ❑ (Check Appropriate Box)
Purpose of Building a iU1ir Pal-flu s tit #0,." CT:" Utility Authorization NO.
Existing Service Amps / / Volts Overhead ❑ Undgrd❑ No. of Meters
Nev Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Number of Feeders and Aapacity U
Location and Nature of Proposed Electrical Work =/�,rjS i9 Lt-dI tCd tiiiej k1S•'r
No. of Lighting Outlets No. of Hot Tubs No. of Transformers TKoVtAal
No. of Lighting Fixtures Swimming Pool Above❑ In- ❑Arnd. grnd. Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of BatteryEUnitsncy Lighting
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
No. of Disposals No. of Hpeerms Total TotalsTOKWl No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. ofDryers HeatingDevices KW Local❑ Municipal ❑Other
Connection
No. of Water Heaters KW No, of No. of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Iubs No. of Motors Total LIP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
•
equivalent. YES® NO 0 I have submitted valid proof of same to this office. YESJ( NO 0
If you have checked YES, please indicate the type of coverage,.by checking the appropriate box.
INSURANCE Et BOND ❑ OMER❑ (Please Specify) R
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Inspection Date Requested: Rough Final
Signed va.:der the penalties of perjury:
FIRM NAltE/21.40 ;Bvt—rf, !?ttc LIC. No. 1-I 6/ 2.S
Licensee Signature LIC. NO.
Address P:O , &'LX 6 i d /L Ala.:._ r ten' /LQ ` fin Bus. Tel. No. /,% $c�'t.Z.0
/ Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S Se'U�
(Signature of Owner or Agent)
8C- 84 7
RECEIPT FOR PERMIT
TOWN OF DARTMOUTH
rx PE/R-MITSN;O.x ,, a
No
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Dat
Received From /.Ae / 4 .,-;q-,
�itrr 7'7 1� 1 -
Owner -��p
Location /5— J& daa��'C"�-- f ` v``^�
Type (,,,r ._42 ,
Amount Paid f-r D Q ( /C 71- 3 /9
Received By