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EP-65926 f TOWN OF DARTMOUTH -BUILDING DEPARTMENT RECEIPT 6 T '' 6 PI1ONE: 508-910-1820 F 508.910l838 / Na *.> n*: / . - - ;�t/ „ ''- 4--- 'r'ope 'Owne,114 /. / Dad ` ' 6-, lr � c-' Job Location:2') , J / . t M (_- t Map: // Lot: /' ( r�P Description General Ledger#'s Ref. # Amount Building &Building Misc. 01000-44105 Electrical 01000-44106 y ; _'`f'` '-) ) 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 n ; k = t ( PNo. ' O y airs Fee Checked• J " BOARD OF FIRE PREVENTION REGULATIONS _J / - APPLICATION FOR PERMIT TO PERFORM ELECTRICAL Wfi PK All wuti-132 be irrm:ted;r wee tti_iii the lvf us FTer}riral Cottle(y.11E),527 CAA iioo 1<k`,4. TENT.AT Ea-ORITT d7:T, 1hOCRDIY) Dat• S ') I X _ _City or Town of: a 1 V Y1'�_ _ .To the I3z� tor of Wires_ By-this e I2c_ction the red gn ed gives nc a of r a or... -••u- '-on . i.o,to eledticaI wnrlc desmbed bel. ^_ • L :aE.0n( tfSetE�ber - �_ . .L, ' '��a1 'ice ; Owner or TF;-rarri ..� ....� _r�� .:A' Tel:..one N. ©�, tIII l A Y • Owner's Addrers ' . Is this permit in conj u aetIon with a building permit? Yes 1 ( No El (C'heckk - .propria e Bo,) . • Purpose[otf Bt�.dIn.g t (� T' /�_ Utility Au hoiIL.tt±ioa No_�T x n. s 1Ii g Ser?ice Amps I Y olt--s O Y cities'd❑ Undid iT o.o.y7lFi F . • New Service Amps I Volts Overhead 1 I Undgrd El No_of M�tFrs Neer of F hers and ArlpauLy ' Locat ion and Nature i of Proposed.J,Jj Ic al Work:�f LY Q ,"-. c Ct;,,_. ,:` .1 ' .9 c;. 't,,- . Crmplet:nn o,j;hefo& zg table rsay be-w ped 77 the sE spe.ctor Tr-Trues. No_of Rer-f l Lorrrinair-es INo-of Ce 1-Sus n p.(Paddle)Far] INC-of 'Total Transformers RVA No_of Dcani,2_re Credets No.of Hot Tubs I Generators KVA Above In- Q '"o-of "e =cy g i No_of Lrrrnin2fre•.s S ami-agP'ool �lud grad BatteyUnitr • No. of Receptacle Orrdes No.of 011Bulliers FIRE ALARMS No_of Zones •`a o o_N fD rf-Rion and No_of SW-Aches No.of Gas Burners f Initiating Devices Total No_of Ranges No_of Air Cond_ Tons No.of Alerting Devices IHr fPulup Number ITons IKW No_of Self-Contained ' Na_of Waste Disposers Totals_ I I DetechonJAler4ugDevirFs �/ No_ofDishwasliers 1Space1Area.Healiig KW Local Mrrnial"- Li Oth Connect ion • No_of Dryers jBeatsg Appliances !KW I f3 comes orE[ uiFe ni 15.E Na_of Water KW. of No_of Data ;s: Heaters $ids Balias's • 'No_ofDeyire-c or L 1 yaleut Na_Hydro-massage Baihfr 1 is No.of Mors Total HP IT�Nu_ofDe-vices or Equivalent . OTHER: Attach nrT�it,r rl r7;r 7'-d -ert or as renired by the Inaperfar ofrre_ Bsth + Value oft ledrelWuli_ 1.49 . (WhenictiL .1tI.bymmiciaalpolicy.) Wulxto SL.uL P f1f) Inspec ons r'r,beiexiucsLcdm accarrl with MECRole ID,and upon completirin INSIJRA_NCE COVXRaGE: Unless waived by l e u rr ,l tea,no pez=it for-the .0111111111 ce of eIectical work n air issue lmj s Mr-licensee vides proof of liability i Lu,wce including"c.u,upleted u .,iiori overage or its sabstaith-al e niivale tt_ The TMrif -igned LA-littler nr I Seth Cave£Is In force,and I,a'r--111bi F3proofor tame Lo. 'the pe nit iss-twig office_ ( PW ONE:INED AN al BOM) El 01'htiil [I (Spec-ry).Se1z Insured fverify,nrdhrthepr c,ar p,rrrI:1fcofperjuty,t ntzRE o1•rizrforon this`c Tr-rr'inn?S endcovuIee 4 FiR2'MNAMI : ��T Security SF v cas mac_ LICNO= C-?5 Ilne see: /v1. --k A. Brophy S �_ _ LIC.NO.: C-45 (7g` ?e, ae-npr"NA the hL r. .$mob_e) Bus.Tel_No_:781-355-5619 Address: 410 U,ii varsity k i-iue Westwood, MP 02090 AIL Tel No_781-355-5500 Ped I G.L_c_147,s_57-6I,w itty w ±l ctiuu L s 1Dc t ue olfFubre qa-FoLy 'Lic4m se_ Lie_No_ 0 0 953 OWNER'S IN URANtAWAIV.K I awaicL the Lir�e tee does n. have the habTy-..urn-mce en afy - ieiu.uol by law_ By my sign,thue below,I hereby w:ivr:this regoirement I rn (sheik nr r)0 o n-es Li ownn's a e ;� �� Te?ep7aone Na. .? . :. 15 . r - C— c,, ,-S ---,--,i , \\