MISCMIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No ------------------ _--- -- ----- – Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ___.
Registered Architect and /or Engineer .
Employing Electrician's Name -------------
N
-__ No.
Location and Legal Description Lot ------------ – -------------- – -------------------------- Block ----------- ------------------------------ Subdivision ---- – ------ – ------- ___ ---------- – ----
Street and Number where work is to be performed— No________________! --------------------------- _------ ____ --- - ------ St Meet______________ _— _____– ____— ___— _____________-
State work to be performed and purpose of building (By Floors) _______ -_ _._
New Buil ding-- -- ---- -------------- ---- - -- - -- Remodeling ---- ---- -------------- - -- - -- Addition----- ------------ --- - - - - -- Repairs ------------- ------ - - - - -- No. of Stories. ------ --------
Service Overhead Size Feeders ----------------- Conduit -------- _------ Main Sw ------------- ------ Amps. _— __________----- Main Fuses ----- – --- – ---- – ------ Amps.
Underground
Type of Installation--Conduit ---------------- Tubing---------- - - - - -- B.X.L ----------------- Metal Moulding ____ ------------------------- ___ --------- — ______— ___ --------- --
Amount of Permit $-- ---- ----------- ---- -- - - - - -- – – -- - ��_ -- (Signed) - - - -- - -- - – — --" ---- ---- --
- — — – Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) ---------------- ------------ --- -- ------ --=- -=- -- ------ -- - ---
-------------------
Master Electrican.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared--------------- -- ---- – --------------------------- -- --------- – ------------------------------- ----------------------------
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ------------------ __– --- — ----------------- – --- - -----------
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
LIGHT
PLUG
FIXTURES
REFRIG.
IRON
RANGE
RANGE
WATER
W. HEAT.
SPACE
STRIP
TOTAL
OUTLETS
OUTLETS
RE99'P'T's
No.LAMPS
OUTLET
OUTLET
OUTLET
CONN.
HEATER
CONN.
HEATER
HEATER
CONTR.
�-
LIST
.�•:
:� .,
,
'.,
J
/.
CHECK
ENT.
DIST.
SERVICE
SERVICE
MOTORS
MOTORS
NEON
RADIO
TOTAL
SW.
CAB,
TEMP.
PERM.
0.1 HP
1 -5 HP
TRANS.
CONTR.
LIST
CHECK
Service Overhead Size Feeders ----------------- Conduit -------- _------ Main Sw ------------- ------ Amps. _— __________----- Main Fuses ----- – --- – ---- – ------ Amps.
Underground
Type of Installation--Conduit ---------------- Tubing---------- - - - - -- B.X.L ----------------- Metal Moulding ____ ------------------------- ___ --------- — ______— ___ --------- --
Amount of Permit $-- ---- ----------- ---- -- - - - - -- – – -- - ��_ -- (Signed) - - - -- - -- - – — --" ---- ---- --
- — — – Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) ---------------- ------------ --- -- ------ --=- -=- -- ------ -- - ---
-------------------
Master Electrican.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared--------------- -- ---- – --------------------------- -- --------- – ------------------------------- ----------------------------
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ------------------ __– --- — ----------------- – --- - -----------
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE PERMIT
Office of Electrical Inspector No.
CERTIFICATE OF INSPECTION
THIS CERTIFIES THAT the wiring and apparatus installed
by Address
for owner, and occupied as
has been inspected and current is authorized to be turned on, until otherwise notified, for:
Size of Service Number of Lighting Circuits __
Range_ — watts. Water Heater_ __ watts
Power: Connected load H. P. Space Heaters __— _watts
Other Apparatus _
ELECTRICAL INSPECTOR.'@
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DATE
ELECTRICAL PERMIT loT° 3063 Contractor's
License No._
PLUMBING
Work to be performed under this Permit --
Owner of
Building
Contractor
or Builder.
Legal Lot
M.
Subdi-
vision
194—
I Amt. of
Value of
Address of Project Permit
Building
This permit is granted to the contractor or builder named above to construct the building or to install the eGttipment or device described in t
application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in complian
with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit m
be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further conditi
upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge
the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications a
that he assumes responsibility for work done by his agents, servants or employees.
Signed: By.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance ordinances and regu
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the : - rities of Miami Sho
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or emp }oy__
R
AUTHO
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑ - DATE_ — , 19_
PLUMBING ❑ PERMIT l� 9 7158 Contractor's
ROOFING
License No.
❑
❑ Work to be performed under this Permit-----,___-
Owner of
Building t -
Architect
Contractor e or Builder
Legal Lot subdi.
Description I Bl. vision
Address of { Value of - Amount of
Building Project Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the app
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be rev,
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes res
sibility for work done by his agents, servants or employees.
Signed: + . -. z ., INSPECT
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulal
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. Ir.
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
.M
CONTRACTOR OR BUILDER BY AUTHORITY -90T 'kj-;