EP-45165 TOWN OF DARTMOUTH
BUILDING RECEIPTS
COLLEOR'S OFFICE
Name:. _ ? 1,„T Property _ "'" Date (--t J f
Owner-- . "e
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Job Location: t'
' mow.. A'` GottECTOft'S C7�.1C' White Copy-Collectors Office
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Plot: - Lot: =� ellow Copy-Customer's Receipt
r °,. Pink Copy-File Copy
j 1 11. 1 ( 2006 GreenjCopy-Building Department
Phone:
NO TAX ISSUES \ :Csr ul 14 1
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106 gi, ` `y
License&Permits-Plumbing&Gas 01000-44107
Other Department Revenue 01000-42420
This is not a Permit or License for Building,Plumbing or Gas Received By:
Medeirod LsneCommonwealth of Massa- Official Use Only
.t t!l chusetts Permit No. r 6 7(fi 4
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C, -_I I'— Department of Fire Services 7)� _ %r)
h Occupancy and Fee Checked ,,`) L.,
Y - BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (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: July 11,2006
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&Num12511 9 Medeiros Lane
Owner or Tenant ; is 4 A-tv `'L-ep Telephone No.
Owner's Address same
Is this permit in conjunction with a building permit? Yes r] No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 200 Amps 120/240 Volts Overhead X Undgrd❑ No.of Meters 1
New Service Amps / Volts Overhead Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
a
Location and Nature of Proposed Electrical Work: Wire Air conditioner condensor
Completion of the following table may be waived by the Inspector of Wires.
1
Nootal
No.of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans Transformers of TVA
KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting
g g 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. nDeten and
Initiating
Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/AlertiiT Devices
No.of Dishwashers Space/Area HeatingKW Local ❑ Municipal ❑ Other
p Connection
No.of Dryers Heating Appliances KW Security of Devicesor Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
ions Wirin :
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicat No.of Devices or Equivalent
OTHER:
i
Attach additional detail if desired,or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
Ow 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 X BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 7//Uw Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I cent ,under the pains and penalties of perjury,that the information on th' application is true and complete.
FIRM NAME: Ken's Electrical Contractor ' r' LIC.NO.: 5455A
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Licensee: Kenneth M.Ferreira Signat / _�C LIC.NO.: 15985E
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508-999-1915 I
Address: 201 Maple Street New Bedford,MA 02740 Alt.Tel.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)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE:$25.00
Signature Telephone No.
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