EP-192 [71
Report Caul
.LE Fee $20.00
Owner Robert Peckham Ddte mn/05/91
Address 112 Pine Island Road 79-30 Permit No. 192
Contractor Days Electric A11854 Yellow Red
Address P.O.Box 49 Fairhaven 997-9469 Green White
Remarks
Storm related service repairs.
Work Complete
s�` jJ ..•
Inspected By: Date
Report Fee
Owner Date
Address /12S,1,,e 4 �'1 ) Permit No.
Contractor Yellow Red
Address �� ` 0 Blue White
Green
Remarks /
d
Inspected By: 1 Date
face Use Only
,- The Com nwealth of Massachuset Permit No. jr q,�--,
Occupancy&Fee Checked,---; `
—`� (leave blank) -,,
Department ofPublic Safeh arFy
j f
f%r6-
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Town of Dartmouth
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 y - 3 " y /
The undersigned applies for a permit to perform the electrical work described below.
s .
Location (Street&Number) // .Z P,' e-- , . K L '7 - 3
Owner or Tenant hob - { Po. c- l n- w
Owner's Address �`' `t-�
Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box)
Purpose of Building S- l s)/c - ' -�, Utility Authorization No.
Existing Service /v Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters /
New Service /':-- , Amps / Volts Overhead C Undgrd ❑ No. of Meters /
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ,.S Lci r ry" p i , .a ('c c' s i7 1 _'-,
1
No. of Lighting Outlets No. of Hot Tubs No. of Transformers K KVA
Above In-
No. of Lighting Fixtures Swimming Pool, grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS NO. of Zones
Total No. of Detection and
No. of Ranges No. of Air Cond. Tons Initiating Devices
Heat Total Total
No. of Disposals No. of Pumps Tons KW 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 [Ti Municipal n Other
Connection
No. of Water Heaters KW No. of 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 Polic includin Completed Operations Coverage or its substantial equivalent. YES E NO El have submitted
valid proof of same to this office. YES E NO If you have checked YES,please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work$ (Expiration Date)
Work to Start( vi, r t Inspection Date Requested: Rough Final
a
Signed under the penalties of perjury:
FIRM NAME 1 4 t: i e c (-, c LIC. NO. 2-) /i `/
Licensee ,d i/e ) �1:):y u'' V. ,
Signature C- =_ ti l. LIC. NO.
Bus./Tel. No.
Address a-/c'; I r.a • h a ti -1 Alt.Tel. No. .5 i %- i `t 4. 7
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 of Owner or Agent) Telephone No. PERMIT FEE $