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EP-19-631 TOWN OF DARTMOUNISIODINt DEPARTMENT RECEIPT ' '-- PHONE: 508-1',. ....0 FAX: 508-910-1838 .- , - / f nrt, / `' 7,,...;,/, , ;-, - ',, •,' Name: Property Owner: ' '' 1 1 I L't ''''' ' Date,: '•• ' Job Location: i '' ''; : ' Map: Lot Description /e/:::-----•<e eral Ledger#'s - ' Ref. # Amount Building& Buil *Misc... •--' (.0 4 t 000-44105 Electrical , c; -,‘, ,-, a 000-44106 I (--, Plumbing & Gas 01000-44107 NO Trench Safety 01 .04 ..... otarrl-E RmENTS • Other Department Revenue 01000-42420 White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By THIS IS NOT A PERMIT/LICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS +, 1% t..ommos.a,aig o///lallachumks Official 1 se Only y• t r� n �`i� Permit No. ____ r T t�% .1Jeparbetenl'olI ire+7ernicats r'1.'<F BOARD OF FIRE PREVENTION REGULATIONS Rcc Occupancy.1 ,., l nkckcd IcatiY blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts I.Icetrical Code(MR),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE AL!. INFORMATIO\r) Date: City or Town of: North 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) 18 Medeiros Ln Owner or Tenant Eunice Franco Telephone No.(774) 930-3021 Owner's Address 18 Medeiros Ln Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Foisting Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters _ New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters -- Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work: Installation of a low-voltage,wireless burglar alarm system, s Comp/anion of the folloriny,table may be waived hvthe las,vtorofWires, No.of Recessed Luminaires No.of Coil:Susp.(Paddle)Fans To ota fransforrncn KVA • No.of Luminaire Outlets No.of Ilot Tubs Generators KVA No.of Luminaires Swimmin Pool Above in- No.o)1Gmergency Lighting g Ernd. irnd. � Batten,Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones lv'o.of Defection and --f No.of Switches No.of Gas Burners _ Initiating Devices No.of Ranges No.of Air Cond. Tots)Tons No.of Alerting Devices No.of Waste Disposers ?feat Pump Number,,Tons KW No.of Self-Contained Totals: �" ""' """"'_Dctedion/Alerting Dcviccs No.of Dishwashers Space/Area Heating KW Local© Municipal ' © Other Connection No.of Dryers Heating Appliances KW Security Systems:I No.of Devices or Equivalent No.of Water KH, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Flydromassage Bathtubs No.of Motors Total HP Telecommunications Wiriu : \o.of Devices or Equivalent OTHER: ,I ran h additional derail if desired,or as required by Ore Inspector of Wires Estimated Value of Electrical Work: S199 (When rcquircd by municipal policy.) Work to Stan: 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°Bice. CHECK ONE: INSURANCE Q BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on is application is true and complete FIRM NAME: Vivint, Inc LIC,NO.: 1471 C Licensee: Stephen B.Coppola Signature LIC.NO.: 1471,•C;' (if applicable.enter"esempl-in the license number line.) Bus.Tel.No..(877)4?§•11i67 Address: 4931 North 300 West Provo. UT 84604 Alt.Tel.No.:(877 479-1 667 *Per M.G.L.c. 147,s.57.61,security work requires Department of Public Safety"S"l.iccns. L.ic.No. SSCO-001351 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not;rave the liability insurance coverage normally required by law. By my signature below.I hereby waive this requirement. i am the(check one) ❑owner ❑owners agent. Ow ner/Agent Signature 'Telephone No. PERMIT FEE: $ 75 11 Z t V N Y C 1