30 day electrical affidavit EL-10-21-2575�S Miami Shores Vilia
Building Depart
mr
Miami Shores,
N.E.2nd Avon
'�_ Shores, Florida 331
`YbAiu u�Tel: (305) 795.22
Fax: (305) 756.M
AFFIDAVIT FOR 30 DAY TEMPORARY -ELECTRIC SERVICE
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY
TERMINATION UNLESS APPLICATION IS RENEWED.
it is understood that the temporary -electrical approval by the Miami Shores Village, Building Department given
in connection with the building being constructed under:
Building Permit N: .�o
At Adore��rr--��•//
Electrical Permit N:
Por Owners: _ Miami Shores, FL
construction purpose or for tesfing the following equipment in said and is being given only for
The owner does herby agree to assume the responsibility of maintaining the installation in such manner that
there is no hazard to life or property. Such approval
event
structure for the Purpose of use and occupancy. and no O cupancytshallll be graconsidnted or permitted of
further
inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of
Occupancy Or Completion is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and
nbuilding and electric power can be cut off l i the discretion Of the building Official and will be disconcerted of
re building concerned is occu led before final ins ections are approved
Occupancy or Completion, Note: Failure to comply with the provisions of thisteda will result a, your
�'I" e e to Oct taptn future Temporary for Test permits, ion and/or obtained affidavit Certificate i
�AIr q
adnve escntred F�perty and that I agree that the sbeing first tructure to euly ocova covered depose th s atiogreemand say eI am the owner of the
nt shall not be occupied
until the building contractor has obtained approval
Occu m I etio : Failure to comply with the provtsi and
u o tut T obtained a Certificate of
... porary for Test permits, hl
�alwe of Owner EZ
M1' COMMIS510N p HH 186195
slit a 2025
the above- d scribed Property being duly sworn, de �"`thmiI§�I
t to P P rty and that the electrical installations as nowte
service is connect
y am the Electrical Contractor for
Ps�2 0 - g will not create a sates h
gnature o� c, f, t ac[oc� �` Y hazard
YANAY collZi
I.— n4i ^JpV ��'Q Bgn lneas5
of v,F a uescntred ro`} being first duitU o
P Porty and that I will not y sworn, depose an ay thUndd W ^tre4
been called n for by the contractors and subcontractors 11 Occupad and final this a
Obtained and that i have the authority insofar permit occupancy of this buildin t 0 t"'
until such final inspections are authority
i and/or a Certificate of g until final inspections have
as the owner of said pro PPr°val by the inspection division
POrry is concerned to prohibit occupancy
O�UQ_Nf Occupancy or Comoletta to Ieuucd,
gnature of Buitding Contractor
t i 519ne tit ra fo Notary'"— -- —
Signature of for
Slgna ru et of N toteary'_ �---- —�-