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EP-95223 TOWN OF DARTMOUTH,.- BUJIt DING DEPARTMENT RECEIPT 1:'' s' . PHONE: 508-910-1820 FAX: 508-910-1838 :'` A Name: I - Property Owner ,,gs, ate Job Location: if I/— `� "", Map ,Lot: Description General Ledger#'s ef. # .t Amount e Buil` — • n 1000-44105 y�naWladG ao Electrical 01000-44106 , Plumbing & Gas 01000-44107 Trench Safety 01000-44129 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 Commonwealth.o/1aosacLettt Official Use Only ar=* fi Permit No. w==16(— c-�; .1 Department o/.]ire erviceo `=t4=- i Occupancy and Fee Checked } ., �- �' 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 TYP .ALL�ORMATION) Date: (s, a-(7 City or Town of: Ac,.c kr e_7. To the Inspector of Wires: . By this application the undersigned gives notice of his or her intention to erfor(m�the electrical work described below. Location(Street&Number) G 1 5 p; A a ,Lc lct < - Owner or Tenant 1.1)LA. A rz r;a c-ox,nn,-v\ Telephone Now 8Q 9(o o2 Owner's Address .5c4 Mt> Is this permit in conjunction with a building permit? Yes n No tL1 (Check Appropriate Box) i Purpose of Building S4 r,tp t✓>1c 0,I✓ Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead n Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (o : [,j /S-A vvli> 3 t..?-�c ILl V C/. M, /\_, S14(` A- ©.n -isib �.(-1O \(o ) Completion of the following table may be waived by the Inspector of Wires. No. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransfKVAormers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1-1 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.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal ❑ Other Connection No.of Dryers Heating Appliances KW -Security Systems:* No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector;of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -6 - a() Inspections to be requested in accordance with MEC Rule 10,and upolcompletion. 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [VBOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penaqicis ofperjury,that the information on this application is true and complete. FIRM NAME: \J (fOV e.-i L\---cv ' • LIC.NO.: '73 L Licensee: Mc 5 Signature V�� -?„,-,,1 LIC.NO.: G. (If applicabl ,,ranter " empt"in the license numberttline.) Bus.Tel.No..S q-c-( . 1 Address: "(_4-4-S AS't- Girt Sh/16 - 1tat 5(. 0-27 L f� Alt.Tel.No.:,ra'c7N aO *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)❑owner g owner's agent. Owner/Agent Signature Telephone No. S( �°/�� PERMIT FEE: $ �� Map rvi Lot Z/ - • CJ ma{ - HW ^^ �*c f* O lI „ , ••. • . 0 * p a 1k IV.1411 �CA I I 3 i1 o 5 bo r - dc U No 0 r b --I CI '1 ' r �. 7 s' x 1 Q S � o • 0 )-3 a Y S ��. a a* a cr H b H y d d a . . y; . �? ,_.. C rtalliii C rtl O `1167:i-. . ill .1=1 o6\i', 1 IN 0 0 o 0 ti ,1\ 7c) 00 °° a .1 N • C N 0 • w