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EP-56159 TOWN OF DARTMOUTH f• , X g BUILDING RECEIPTS 3 6' I 5 PHONE: 508-910-1820 FAX: 508-910-1838 „ Name: . . Property - Date: _ / Owner: ,' 4 ---- .----' ,•. / / - i Job Location: , , White Copy-Collector's Office Yellow Copy-Customer's Receipt , Pink Copy-File Copy Map: 11 , -..03vgn,iy-Building Department , 4. • TOWN OF DA_R 1 . . Phone: MAR 17 2009\. COLLECTOR'S OFFICE Description General Ledger#'s Ret # VIM 1 3 Amount License &Permit0—\uilding\-, ) 01000-44105 License & Permits -iililding Misc. 01000-44105 .---, - • License &Permits -Electrical 01000-44106 -, -- ..;,,,,.• License & Permits - Plumbing & Gas 01000-44107 _ . • License & Permits - Trench Safety 01000-44129 NO TA)( ISSUES • Other Department Revenue 01000-42420 THIS IS NOT A PERMIT OR LICENSE FOR BUILDING, PLUMBING OR GAS ---pl—''L-4:-------7-7----- <'- Received By:„.....‹.,-,----,--4 -7:-/-), -To? . `6-,31 - a ) _ �J/1 / ie----' 5-------/ ', Commonwealth // o/r l/aiia f tt5 .? eaClh c zaSe fficial Use ni rULLZB BOARD OF FIRE PREVENTION REGULATIONS O` I/07] and Fee Checker S , [Rev. 1 07] (leave blank) APPLICAll work to be ATION performed PErRMIT TO PERFORM ELECTRICAL WORK dance with the Massachusetts Electrical Code(MEC),52700 (PLE4SEPR111ThTT IN INK OR TYPE AL INF RMATI '�r CMR City or Town of: ve/ �1 Date: / �� By this�lication the undersigned gives notice f U✓� To the Inspector ofW his o her intention to perform the electr ]t Tres: Location:(Street&Number) dirk described below. Owner("Tenant Al LC OWner'sAddress T¢'a LEE Telephone No. Is this permit in conjunction with a building permit? e 7 Yes No ❑ (Check Appropriate Box) Purposesf Building • Existing;lervice Utility Authorization No. Amps / Volts Overhead New S�tace Amps ❑ Undgrd❑ No.of Meters _/ Volts Undgrd Overhead❑ Und g ❑ No.of Meters NumberiFeeders and Ampacity Location�d Nature of Proposed Electric al Work: rk: 4L� C �`n completion o the ollowin:table maybe waived by the Inspector of Wires No.of Rcessed Luminaires --No.of Ceil.-Susp.(Paddle)Fans No.of No.of hminaire Outlets Transformers Total No.of Hot Tubs KVA No.of Isrrinaires Generators K A Swimming Pool Above .❑ In- grnd. rnd. ❑ °'° mergency rg nagNo.of lleptacle Outlets Batt( Units No.of Oil Burners No.of Snitches No.of Gas Burners FIRE ALARMS No.of Zones No.of •etection and No.of Images Initiatin: Devices No.of Air Cond. Total No.of Waste Disposers Heat 'um Tons No.of Alerting Devices Totalp i'umber Tons No.of Self-Contained s: ...-.._..-.................. No.of Dishwashers • Detection/Alertin_ Devices Space/Area Hefting KW t Local❑ Municipal No.of h ens Heating Appliances Connection ❑ Other No.of er KW Security Systems:* B -- ------ Seaters KW No.of No.of No.of Devices or E uivalent Si: s Ballasts Data Wiring: No.Hydrtmassage Bathtubs No.of Devices or E No.of Motors Total HP Telecommunications Wia ringenr OTHER No,of Devices or E a uivalent ork: wu'0. .� Attach additional detail ifdesirecd or as required by the Inspector of Wires. Estimatedalue of Eleetrica to Sint: (When required by municipal policy.) I Work S Inspections to be requested in accordance with MEC Rule 10,and upon coin RASCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may the licenser:provides proof of liabilitycompletion. undersigns€certifies that such coverage is in force,and has exhibited proof of same to thepermit is insurance including"completed operation"coverage or its substantial equivalent. The CHECK ONE: INSURANCE i BOND ❑ OTHER suing office. I certify,raider the sins and penalties o perjury, ❑ (Specify:) FIRM NAME: c fP J ry,that the information on this Dee_ `(i* S erU application is true and complete. Licensee: 0( Y\ ; n L uzz LIC.NO.: +� C (If applicable enter "exemnr"in the ice Signature Address: umber line T LIC.NO.:�5 C`- lx-I`l �E(L f�,f d \t ', we,,►( o,�® �,, o®This.Tel.No.: 1%1- 3r)=-509 *Per M.G.I.c. 147,S.S7-61,security workrequires Department OWNER'SINSURANCE WAIVER: I am blaze that icensee does not have the ',I abil' Alt Tel No.: �� 3J��-���-�� Safety e License: Lin. coverage 1X��o ca3 required bylaw. By my signature below, I hereby waive this requirement. I am the(check one)insurance normally Owner/Agent []owner Signature0 owner's.a ent. ��/ Telephone No. PERMIT FRP% e r, \