EP-431 Report fd� fin ' Fee pd $ 25.00
Owner Herbert S. Wilkinson III k•-i tuL'-ii "' L L/oate 3/12/93
Address 2 SHINGLE ISLAND LANE, N. D. 76/24-2 Permit No. 431
Contractor same as above lieta Red
Address creep t -a7e-575r
Remarks Wire 2nd floor bedrooms and bath. Est. value: $500.00
Will call .
Inspected By: Date
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RECEIPT FOR PERMIT
;611Tii. TOWN OF DARTMOUTH
0:e..,‘ 4 PERMIT NO.in
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,- The Comm wealth of Massachusett Permit No. Office Us6��
t =�e_ / Occupancy&Fee Checked c2 6-r 'l
`W�I Department of Public Safety (leave blank) /a- t r
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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 R 12:00.
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date P
The undersigned applies for a permit to perform the el trical work described below.
Location (Street & Number) / ,./�O/7//C ' -TS/-
C %iG� L.ai'') e � VD�- , _
Owner or Tenant �7�"n,t>�/-/ S 14✓4/05-0r i/�
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Owner's Address a i%,1 b ,Z. c�ai) �7 i)Cs
Is this permit in conjunction with a building permit: Yes ""Y No El (CheckAppropriate Box)
Purpose of Building Div,c building
Utility Authorization No.
c2,0 .1 Am s /d D/ a °0 Volts Overhead N Undgrd ❑ No. of Meters 1
Existing Service pg
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity -
Location and Nature of Proposed Electrical Work Ulf/+'�'/J r� elf S/a/d'Y"S' ,✓,O . )-3o m S d, p.,i/
No. of Lighting Outlets No. of Hot Tubs /i p rj No. of Transformers KVA Total
No. of Lighting Fixtures Swimming Pool-. . Abovern . �d _ Generators - KVA
No. of Receptacle Outlets No. of Oil Burners `_ B tte f me Emergency Lighting
ry
No. of Switch Outlets No. of Gas Burners,- FIRE ALARMS NO. of Zones
Total No. of Detection and
No. of Ranges I-1 •; t y' No. of Air Cond. 1 Tons Initiating Devices
l., No. of Sounding Total Total No. of Disposals 4 0/7 - No. of Pumps Tons KW Devices
c
No. of Self Contained
No. of Dishwashers /2 Dn Space/Area Heating KW Detection/Sounding Devices
No. of Dryers h 3'n Heating Devices KW Local ❑ Municipal ❑ Other
Connection
No. of Water Heaters KW �. No. of No. of Low Voltage
/. J Signs Ballasts Wiring
No. Hydro Massage Tubs !'l0/1rcl 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 substantial equivalent. YES A NO ❑ I have submitted
valid proof of same to this office. YES LJ NO Li If you have checked YES,please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) •
S.O. °,� (Lxpiration Date)
Estimated Value of Electrical Work$ /
Work to Start Inspection Date Requested: Rough' Gv.// - �// Final G,./ /�'�/�
Signed under the penalties of perjury:
a
FIRM NAME LIC. NO. 1
Licensees Signature LIC. NO. u
Bus. Tel. No.
Address Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
Massac useipts.z7era Laws, and at my signature on this permit application waives this requirement. Owner Agent (Please check o_n-e)'l
Telephone No. / PERMIT FEE $
(Signature of Owner or Agent) V-?/