EP-134 Report Fee pd $ 80 . 00
Owner Gene Beaudoin (i7 � Date 8/26/94
Address 19 SHINGLE ISLAND I : `76/24L5-=7 'a.` J PermitNo. 134
Contractor Glenn Wood 27638 636 6605 yeif/'7K Red
ue
Address 88 Drift Rd., Westport, MA 02790 Green wnte -
Remarks NEW DWELLING; 200 amps., 230 volts
Will call.
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Inspected By: Date
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W'MR_WR_INFO WORK REQUEST, INFORMATION PAGE 1 OF
` AUG 11 , 1994
fij:CFPFD
Work Request No : 71133 Entry Date: 2S6-JUL-94 Req . Date : 05-AUG-94
Entered By : MElLO, JACQUELINE'SkLAUG 17 P19 3 R//R to /Rev Code :
WR Type : NEW SERVICE }t nual Base Rev :
WR Status : DES Q.,p ual KWH:
Jh ; .uJni bUiDkG uc
WR Description : UG/RES--200 AMP U/GR ERV . FOR NEW RESIDENCE
WR Name/Customr : BEAUDOIN , GENE
Service Address : 19 SHINGLE-ISLAND LN Acct#: -
City : DARTMOUTH
Pole/Pad /MH No : 10086 /090A Lot : Plot :
Designer : PRZYBYSZEWSKI , CYNTHIA
CONTACTS Name Type Phone No
88 DRIFT RD ELECT ( ) - x
WESTPORT , MA 02790 ELECT ( ) - x
WOOD, GLENN ELECT ( 508 ) 636-6605 x
ELECTRICAL
REQUIREMENTS Service Voltage : 120 /240 3W 1PH Number of Meters : 1
Amperage : 200 Type of Heat :
Phase : 1 Meter Number :
_SerV'ice Lo`c'a`t"ion-: TERMINATE SERVICE ON SE COR OF HSE-BE SURE T
TRENCHON"GUSTPROPERTY TO HH--TLM 93305
Office the Only le,
The Commonwea of Massachusetts Penult Na -lid-/3y
c.4i-: Occupancy � Fee Checked p (i c .U'J
:sl, 5 Department of Public Safety 3/90 (leave blank/
HE e
'',,.. s 1? 20 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR i0 8hask IL/
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 ALL INFORMATION) Date (/2-Li I C1L1
City or Town of 2)-1;7Tt 11 0'-'1 1( To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. yLocation (Street & Number) 1fV c: I- c11,3 il- a, L,?.c.D i2. , 0--6
Owner or Tenant (- Eh.)it Iv.)tz>i 1/4..-in0nal
,Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No n (Check Appropriate Box)
Purpose of Building !J a:('.\`t,J rI Utility AuthorizationNO.
Existing Service Amps l
/ Volts Overhead ` Undgrd❑ No. of Meters
New Service -1-C"C Amps 1 I S / 2.-1)Lm Volts Overhead ❑ UndgrdIji No. of Meters /
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Ccn-sD14 T t ii,' „2.,,•.;- i/ ,CPl..' FICi III_ L-(
'2.cC ii,\,\r 1.)r`2 ID t-; - ,Lcnci,J0 S('.2.`'r (C
No. of Lighting Outlets No. of Hot Iubs No. of Transformers Total
KVA
No. of Lighting Fixtures SwimmingPool Above In-
Above ❑ grnd, ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners INoatteo. ry Unit£ Emergency Lighting
Bs
No. of Switch Outlets _ -- _ No. of Gas Burners -- FIRE Al. -No-of-2onr�
Total No. of Detection and
No. of Ranges No. of Air Cond. tons
Initiating Devices
No. of Disposals No. of Heatps Total .
Tons KW Total No. of Sounding Devices
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices _
No. of Dryers Heating Devices KW Local ElMunicipal ❑Other
Connection
No. of Water Heaters KW Lowof 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' have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 0. NO 0 I have submitted valid proof of same to this office. YES®_ NO ❑ t
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ® BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME [I f,U r'J U'J k)O rO - L LC-T'(•NCI C - LIC N .1-7(.3 t-S
1
Licensee 6lCl�,r.' \I4tCOY1 Signature 5(2-a-`-v.. (,)(ill - LTC NO.1?17(. 8
Address ii} IC r:\rr rn ,,cc 51 sor4 rn C1-7CI,; Bus. Tel. No.
Alt. Tel. No. (i: _3 i' ' G-(-0S
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) �j'
Telephone No. PERMIT FEE S Q e ('f,'2
(Signature of Owner or Agent) I
BC-44A #/ 3 V
./
RECEIPT FOR PERMIT
our , TOWN OF DARTMOUTH 7/3.e
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PERMIT NO.
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Received From �E-621,,- in t tt. [/j,/RL—
Owner / --a/f20 (,;?ertt fl1^1—
Location ✓ !/^ l-t/ not F(L
Type CLZ.121.1
Amount Paid ( u .6(2) ( / 7 gee
Received By .�'c✓'CNCCk `
RECEIPT FOR PERMIT
TOWN OF DARTMOUTH .. ...
PERMIT NO.
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Date . ,r-1.,' 2 . y •••••;: , ,' c';'.,, /
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Owner ''A'''./I/'.''' f; ' ' '(/' '' " r',/l''1.--7/1 -
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Amount Paid / ., ,: (- /- . _-!. i -2 ('i
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Received By .-x•it , .1 .J7 ), . •
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