EP-473-96 ELECTRICAL PERMIT,o,
FIELD INSPECTION
Dartmouth Building Department Plat: 080
400 Slocum Road-P.O. Box 79399 Lot(s) : 004
North Dartmouth, MA 02747
Telephone 508-999-0720 ?�'�j + Fee: $40.00
Issued Date: 03/04/96 Permit No. : 473-96
Project Location: 18 Pine Island Road
Number Street
Subdivision Name:
Nearest Cross Street:
Electrician: David Gonsalves
Address: P.O. Box 79365, North Dartmouth, MA 02747
Contact Person Phone #: (508) 997-2185
License # A13593 & E23773
Proposed Use: Residential
Residential,Commercial, Industrial,etc.
Permit Issued To:- New-ver vi cA-?Add t ionaL-- Wiring--
Type of Improvement,New Construction/alteration/addition/relocate
EXISTING SERVICE 60 amps/ 220/110 volts, overhead, 1 meter, NEW SERVICE
150 amps 220/110 volts, 1 2-pole 30 amps/ replace sevice & run sub-panel
for green house Est. Cost $950. 00 WILL CALL
indicate location of work(bedrm.,bath,living rm.,garage,etc.) indicate#of outlets/fixtures
Owner(s) of Record: Evangelho
Address: 18 Pine Island Road, North Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
INSPEC.
r �/
Signed By:
11 i eOj,
r< _ The Commonwealth of Massachusetts Permit No.
16-• Occupancy&Fee Checked ,_ -
��- Department of Public Safety (leave blank)
e._I1.= Ih�r
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90
' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
o 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 \ & `t. ) k' c i
The undersigned applies for a permit to perform the electrical work described below.
Location (Street& Number) \ \4.- \ r 3 �'�T)
Owner or Tenant V(.Iv k:,-..\�-C
Owner's Address S ry.-
Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box)w
Purpose of Building �"LR_.S',. 's-S\3(-- Utility Authorization No.
Existing Service (-s-) Amps 'L i .3 / I l 0 Volts Overhead 0, Undgrd ❑ No. of Meters
New Service 1 7 Amps 2 cj / ; i(..TD Volts Overhead 51,Undgrd ❑ No. of Meters
Number of Feeders and Ampacity \ -PO (5c_ �, .ter- •
Location and Nature of Proposed Electrical Work V\C�� Cam_ -- -\) :c;C 'k c"\-\ns..S J —\ INS ,
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA
- --- -Above ` -_ In-
No. of Lighting Fixtures Swimming Pool grnd. LJ grnd ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets Ni.,. of.Gas Burners FIRE ALARMS NO. of Zones
Total No. of Detection and
No. of Ranges No. of Air Cond. Tons Initiating Devices
i, Heat Total Total-
No. of Disposals No. of Pumps Tons KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices
No. of Dryers Heating Devices KW Local ❑ MConnectunicipalion El Other
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 Policx4ii nncludin Completed Operations Coverage or its substantial equivalent. YES .NO ❑ I have submitted
valid proof of a to this office. YES f .NO LJ +If you have checked YES,please indicate the type of coverage by checkm a appropriate box.
INSURANCE ND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$°tS0% —
Work to Start 4' 3-z1 - (e Inspection Date Requested: Rough Final IA I 4-
Signed under the
epenalties of perjury:
FIRM NAME >1r-CV �:-s k(,c`,�) S S,\ --- - :,... ,..lc-1-• LIC. NO.N\ J .3
Licensee ,.�\. _<,) C,cam,-7 tr r\:\! .--- Signature V\.\-).> ,, a'�\1 LIC. NO. '�Z -3 7-7
Bus. Tel. No.
Address V s - C N -)13 L j cx) 1'_ rY. E C' Alt. Tel. No. t al?-Z 1 C;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)
Telephone No. PERMIT FEE $
(signature of Owner or Agent)
RECEIPT FOR PERMIT �J
ourH. TOWN OF DARTMOUTH L/73r
�
s�
o� PERMIT NO.
i /
30 - = No -,1
JDate C"
Received Fro 117/6-11/4-44_,' ei-A 4411,154-Th..--
I j Owner
.11 Location //- AA....X.-/ / 14‘
Type f13314-"--- \.. '.<`L - _: , .
j �`y�
Amount Paid ,,,,�y i &� a(....-(14:6`4-
Received By clic7 7 J7
Amount Paid 6/- ,//j/ji__ _:�
Received By ;E#� ( ,? 7
The Commonwealth of Massachusetts
- 2:= -_74 DeRarrnsest o�'IndundiQ1 Accidents
11 O/i7CEol/a6 ,,#,DS
:z== ` 600 Washington Street
_:�'i Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
•ali nett" email. _._— _
mi. n---- .-. ._.., __ _.._ -.;f mac:kg el;--�---- --•---- - -
lac_.._..
cir•
C i am a homeowner performing all work myself. Nhone
r tamp
sole Droprle.Or andworking
_ have no one in any capacity
Z.....Larn an employer ,rovidins workers compensation for my employees working on this job.
c m^'n�' names cL)
addr=F a
c
ntroneitr l7-Zl8 1
-Troffer ,:.: :: -7 4 L \
it i .7 .
C. i am a soie prnprTL_or. genera! cr .n ractJr. or bomeoWoer(csr ie one)
and have h the contractors ,:fisted below wi
allowing workers' compensation polices:
corntart name:
address: ..
city-.
•
-n n t i NP-ffs'
cc ;ry ,ame:
ad�ress-
.
alit..
!Atone*it - . -
in.Turance co,
Attac_ada i�oaii sael:r.' BvAie�*i: - .
aeeessan- - am..- ,-- -- ---_ - --_—- -
Failure :a secure coverage as required under Seenon 25A of JIGL 152 can lead to the ltnnosttion of crtmiau
one 'ears :mortsonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofSI00.00 a day against me- I understand t'
cop. of this srarement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I co -erec:•; \ry under the . s and penalties of perjury that the fniornsarion provided above is nae and come=
,_- _
_.r ..
_: mac' o
Date �1 `' /c
�...� Phone 6 c l �- S
otT:ctai useonic
do not waste in this area to be completed by city or town official
city-cr town:
permit 1Ieease# r Building Department
. - = neck ii immediate response is required [Liutaing Boardttt
[Seiectmen's Office
[Health Department
cerion: phone=•
r-•Otber
•
Information and Instructions
Massachuserts General Laws chapter 152 section 25 requires all emniovers to provide workers' compensation fc
ernpioyees. As quoted from the "law", an employee is defined as every person in the service of another under an
contract of hire, express or implied, oral or written.
An employer is defined as an individual, partnership. association. corporation or other legal entity. or any two Cr
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer. or:he
receiver or trustee of an individual , partnership, association or other legal entiry, employing employees. Howev
owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the
dwelling house of another who employs persons to do maintenance . construction or repair work on such dweilir.:
or on the _rounds or building appurtenant thereto shall not because of such empiovment be deemed to be an ern
MCL chapter 5= section :5 also states that every state or local Iicensing agency shaII withhold the issuance a
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
�dditicnaiIy neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with :he Insurance requirements of this chap
been presented to the contracting authority.
ppiicants - - - •- =
Please ::ii in the workers' compensation affidavit completely, by checking :he box that applies to your situation a
supplying company names, address and phone numbers as ail affidavits may be submitted to the Depar::..en: of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
aff..avi: should be returned to the city or town that the application for :he ce.mit or license is being requested.
not :ne. Department of Industrial Accidents. Should you have any questions reczrding the "law" or if you are rep •
c.-.. a workers' ,ompensation policy, please call the Department at the number listed below.
_ ;ice.- _ _: _ - _Cry or Towns
Pease be sure that the affidavit is complete and printed legibly. The �..D�pa-„
-::-:err: ::as roved at the
:h_ LIf :davit for you to fill out in the event the Office of investigations hascontacta i the
to you re.-rangabblicant.
re sure to till in the per-nit'iicense number which will be used as a reference number. The affidavits may be rer. -
:he Depar:Trient by mail or FAX unless other arrangements have been made.
'ire Off:- of Investigations would like to thank you in advance for you cooperation and should you have any aces
iea se not hesitate to give us a call.
- - -- ._ •_• •_-. Y!� '+-�r iw.�^_.i'4�P'.in1 •ti _-- -- - _.- _ - - -
.e Departments address, telephone and fax number:
The Commonwealth Of Massachusetts �.
Department of Industrial Accidents
Office of Investigations
600 Washinvon Street
Boston. Ma. 02111
fax =: (617) -7749
phone =. (617 4900 ext. 406. 'no or 3"5
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
FOR ELECTRICAL SERVICE
Inspector_of Wires _ ` Wiring Permit# COM/Electric#
Town ofE' -``` � _\ Massachusetts Building Permit# Date
Customer: v� h � . �,� - on (Street#) 0 1 �� \ LCA. ` � •
Lot# in the village of utility pole number or underground number
Customer's billing address f
Temporary New installation Change of service .�- Starting Date
Job description
Nszi-
Service entrance voltage Z.- + ( ► L.. Amperage 1 '� Phase
Wire size(cu.or al.) 240 At-' Conductor per phase
Number of meters t Water heater Off peak:Yes— No—
Estimated load:Electric heat kw, lights kw, Range dryer Motors, H.P.& Phase
Ready for first insp ce t, ion Ready for final inspection '
Electrical Contractor V. .5' ,^> [- J J '`) Oar- Lic.# Telephone# t� }
Address Q• "ic,3 tn5 Iv® . ' vrt"A -- 4
Additional Remarks:
Do Not Write Below This Line
—ELECTRICAL-MIRING-INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS DATE FEE CHARGE
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved*
*For the following reasons
CERTIFICATE OF INSPECTION DATE
To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been completed and has this day been inspected and
approval granted for connection to your service.
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CA 46-1
White—COM/Electric Green—Inspector Canary—Town Receipt Pink—Inspector's Copy Goldenrod—Electrical Contractor
to COM/Electric
VMR`WR_INFO WORK REQUEST INFORMATION PAGE 1` {�F �
' MAR 12 , 1996
,
�
°
Work Raoumst No : 106710 Entry Date : 07-M/\R-96 Rea . Date : 19-MAR-95
Entered By : RAMOS ^ DEBORAH A. �`�'�� Rato/Rev Code :
WR Type : UPGRADE SERVICE - Annual Base Rey :
WR Status : DES g � q ��� < « ZuAnnual KWH:
Demand Load KW:
WR Doschiption : INSTALL NEW 150AMP 0/H SERV
WR Namn /Customr : EVANGELLIO, STEVE
Service Address : 18 PINE ISLAND RD Aoct#: - -
City : DARTMOUTH
Pole/Pad/MH No : 331 /2 Lot : Plot :
Designer : Y0UNGBLDOD, 8ARRY L
CONTACTS Name Type Phone No
DARTMOUTH,MA 02747 ELECT ( ) - x
DAVID GONSALYES ELEC ELECT (SO8 ) 997-2185 x
PO BOX 79365 ELECT ( ) - x
ELECTRICAL
REQUIREMENTS Service Voltage : 120/240 3# 1PH Number of Meters : 1
Amoarage : 15O Type of Heat :
Phase : I Meter Number :
Service Vocation : RAISE WGATHERHEAD U9 TO PEAK AND ATTACH 1-FO'
BELOW.TLM#35132
LOAD
IN FORMAT I0N