EP-74430 1
TOWN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT i
PHONE: 508-910-1820 FAX: 508-910-1838
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Description General Ledger#'s Ref. # Amount
Building &Building Misc. 01000-44105
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Electrical 01000-44106 ,,T. ,,-)6/1//9-‘' /,i, . 6 _.,,,
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Plumbing & Gas 01000-44107
Trench Safety 01000-44129
Other Department Revenue 01000-42420 i
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White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-BuilchniDepaitmelit Received By ./., 11"--2 ,'"--7
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS
Commonwealth o/maMachu.letb ` J I Official�J Use Only
* i / / 1 li Permit No. "/5 06
_�!_ Tepartment o� ire Services
'.VW"W - Occupancy and Fee Checke
-: BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8/4/14
City or Town of: Dartmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 14 Medeiros Lane
Owner or Tenant Tino Pereira Telephone No. 774 328 8591
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No ®I (Check Appropriate Box)
Purpose of Building Single Family Utility Authorization No.
Existing Service 200 Amps 120 / 240 Volts Overhead ❑ Undgrd❑✓ No.of Meters 1
New Service Amps / Volts Overhead❑ Un rd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install a 8.57 kw roof mount solar PV system
Completion of the following table be wad'zed-b the Inspector of Wires.
No.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVAVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
'No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.ofAlerting Devices
Tons
No.of Waste Disposers Heat Pump I Number I r 1 Tons I KW No.of Self-Contained'
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $ 7,000.00 (When required by municipal policy.)
Work to Start:7/27/14 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND El OTHER El (Specify:)
I certify,under the pains and penalties of perjwy,that the information on this application is true and complete.
FIRM NAME: Phlip McCarron LIC.NO.:A14068
Licensee: Philip McCarron Signature LIC.NO.:E34460
(If applicable enter "exempt"in the license number line.) Bus.Tel.No.:SUti.-9.30-140h
Address: 2 Shaylee Lane Lakeville, MA 02347
Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)El owner El owner's agent.
Owner/Agent PERMIT FEE: $ �,.
Signature , Telephone No.
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