EP-160 Report '(�1,� DII�I C
J 4J 0.,'i! L _ !!f Fee pd $ 70.00
Owner Pat Tavares Date 9/29/92
Address2 SHINGLE ISLAND LANE, N. D. 76/24-2 Permit No. 160
ContractorEric Sylvia 13901 99 9 2901 Yellow Red
Address87 Laurel St. , Fairhaven, MA 02719 4.1!- cegg
Remarks WIRE MODULAR HOME 200 amps. , 220 volts 1 meter
6 fix, 2 rec, 1 dryer, 1 oil burner
Est. value: 1200:
Ready 10/2/92 . t t 2--
/O - 6 - 22
Inspected By: Date
Office Use O91y
TheInmonwealth of Massaoh etts PermitNo. / �; '/Occupancy&Fee Checked4.Department of Public Safety (leave blank)BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Town of DartmouthAll work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DateThe undersigned applies for a permit to perform the electricallwoork described bbelow. /Location (Street& Number) Ant--1/. _Jh ;1 ,/, ' I�.r viOwner or Tenant ` ; /you ai'' COwners--Address___... .—_. �P�9,P -Is this permit in conjunction with a building permit: Yes I1 No I 1 (Check Appropriate Box)
Purpose of Building Utility Authorization No.Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service ?Amps i/D / 7 Volts Overhead/2 Undgrd No. of MetersNumber of Feeders and Ampacity / // //Location and Nature of Proposed Electrical Work /t4, oity / e1, -- . =4..JV-, w
-.1 1..vol^.4"
No. of Li tin Outlets No. of Hot Tubs KVA
! g No. of Transformers KVA
No. of Lighting Fixtures I Swimming Pool grndVe d ❑ Generators KVA
No. of Receptacle Outlets zA No. of Oil Burners ./ No.Batte ry of UN[Emergency.Lighting
No. of Switch Outlets No. of Gas Burners FIRE ALARMS NO. of Zones
Total No. of Detection aid
No. of Ranges No. of Air Cond. ' Tons Initiating Devices
Total Total
No. of Disposals No. of Pumps Tons KW No. of Sounding Devices
HeatingKW Space/Area No. of Dishwashers P No. of Self Contained
Devices
No. of Dryers / Heating Devices KW Local II Municipalo n ❑ Other
No. of No. of Low Voltage
No. of Water Heaters KW Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Polic,yYincludinn Completed Operations Coverage or its substantial equivalent. YES-RNO E I have submitted
valid proof of same to this office. YES,�YN6 LJ If you have�checkedt YES,please indicate the type of coverage by checkin the/3ppropriate box.
INSURANCE,BOND ❑ OTHER ❑ (Please Specify) 27ur/C 7.l%f7t- rv," %_s
j/ `y ��y/ (Expiration Date)
Estimated Value of E egVi Work$ /ail0- CS e'lle_airi �7� 5 '�' ��/Work to Start 97-2 Inspection Date Requested: Rough Final L;"1i/°
Signed under the penaltiesr of perjury: .�- �/ p
FIRM NAME C—' - .- I��t / - C Y- . 1/t.#.sr/ f�/ LIC. NO. /-3lO/�
Licensee -i e .t/.€c Signature /-n.� y / LIC. NO. 3V/-5 -
//�� // / ! Bus. Tel. No. 9 9f-.2.00/
Address 77 L.LU/'2/ J—/-C,2h ttUPn/ /t4J.t.- c 27/9 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
(Signature ot Owner or Agent) Telephone No. PERMIT FEE $ //^- z.0j
/J 6
RECEIPT FOR PERMIT
TOWN OF DARTMOUTH 17;511-
PERMIT No.
O
tf
Date
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)Received From � r /
Owner j"
Location G/1
Type r jj L� l7
0
Amount Paid
Received By