EP-120 R � Fee pd $ 80.00
Bob Viana p 8 1�, ��� / 8/94
Owner . � Date
Address 14 SUNDANCE RD., N. D. 79/48-26 Permit No.120
Contractor Wayne Simoes 2697A 99 94',27'11 \l i Yeuow)S--'S`-f`t Red
374 Cross Rd., N. D. MA 02745 Blue 'White?3.5i
AddressGreen /N
Remarks NEW DWELLING; 100 AMPS., 220 VOLTS, 1 ME'IER
WILL CALL.
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Inpected By: Date
WMR, WR INFO. W0RK. R.EOL, EST INFORMATION PAGE 1 OF
-
A U G 18 , 1994
Work Request No : 72556 Entry Date : 18-AUG-94 Rea . D11 t SO-AUG--94
Entered By : LEGER, GEORGET T E L . � i r.1!0� 23nn Rk c�R v :
nu
WR Type : NEW SERJ s' --,
WR Status : DES
WR Description : UG/ RES NEW HOUSE
WR Name /Custornr : VIANA, BO5
Service Address : 14 SUNDANCE RD Acct#: -
FOX RUN TERRACE
City : DARTMOUTH _
Pole/Pad /MN No : H . H. 10072 /120A Lot : Plot :
Desianer : FRAZIER, SARSARA A
CONTACTS Name Type Phone No
374 CROSS RD ELECT (
N DARTMOUTH ,MA 02747 ELECT ( ) -- x
SIMOES , WAYNE ELECT (508 ) 999-1746 x
ELECTRICAL
REQUIREMENTS Service Voltage : 1.2C /240 3W 1PH Number of Meters : 1
Amoeraae : 1.00 Type of Heat :
Phase : 1 Meter Number :
Service Location : TE%MINATEaSERVICE OUTSIDE HANDHOLE ON
NOFTHEAST CORNER OF PROPERTY-LOCATION OK-
LEAVE ENOUGH WIRE FOR COMM ELECTRIC TO MAKE
CO','NECTIONS . TLM IS 29342 .
oOiie Use Only
,, . { The Commonwealth of Massachusetts �/ V.,
VL _'�/ rr rott So.
�= nl _ Department of Public Safety g--
Occupancy i�)41==_ b Fee Qtecked"' M��a ,—2tttI;L4=
= BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave plank) ,qlgfl
3�''sc lJ vc
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusetts Electrical Code.527 CMR I2:00
(PLEASE PRINT IN INK OR TYPE ALL I:'FORMA iION) Date —��
City or Town ofrk T�tucAt-GC To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street E. Number) {`-f ^� ;�,F ""
Owner or Tenant U A / / ?—
Owner's Address ;Si --
Is this permit in conjunction with a building permit: Yes ci<EI (Check Appropriate Box)
Purpose of Building + Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
New Service j)(y Ames I r'c' / ) 7 ,Volts Overhead ❑ Undgrd No. of Meters it _
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work tk.),--; 1-1 �� ,-.=
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures SwimmingPool Above In-
grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of
Emergency Lighting
nts
No. of Switch Outlets- No. of Gas Burners - FIRE ALARMS No. of Zones . -
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals No. of Heat Total Total
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❑ Municipal ❑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 Policy including Completed Operations Coverage or its substantial
equivalent. YES❑ NO 0 I have submitted valid proof of same to this office. YES❑ NO 0
If you_have the YES, please indicate the type of coverage by checking the appropriate box. i
INSURANCE BOND OTHER❑ ❑ (Please Specify) �'"��,'"" V .
(Expiration ate) ,
Estimated Value of Electrical Work S
Work to Start A - Inspection Date Requested: Rough Final
r Gigned u.:der(th> penalties of perjur;.
FIRM HARE � �`'(/�,_� -3,j 7\ LIC. NO. ,'? M
Licensee 6)A tom- Si ature IC. NO.
Address ,�,11 t✓ s. k* -------- L.i Bus. Tel. No. '
/k U 4 Alt. Tel. No. , -_� 'VC
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance cove a' e o it s
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $ ( l.) 0/�]�)
(Signature of Owner or Agent)
8C- 84 i4
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RECEIPT FOR PERMIT
TOWN OF DARTMOUTH 61-6
OUTN.
PERMIT NO.
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Received From Wa ///a ( C-/ ,
O kner VL&A.
.Location /V 24(41dam.,a-
Type M.22J�
Amount Paid "n
Received By LJVI
1 RECEIPT FOR PERMIT
TOWN OF DARTMOUTH ; ---,
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PERMIT NO.
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