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ELECTRICMIAMI SHORES VILLAGE ELECTRICAL INSPECTIO)NI DEPARTMENT APPLICATION FOR ELECTRICAL PER IT Permit No.........�..` .................... Date .........�f ^: f...... ....�...."'..�. Application is hereby made for the approval of the detailed statement of the plans and specifications her ' submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Or net 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. I — Owner's Name and Address..... Registered Architect and/or E. Employing Electrician's Name... Location and Legal Description Lot....................................................................Block..........................................Subdivision............................... .. Street and Number where work is to be per(ormed—No.......... I.KT.../..........f................p..................Street.../.p.�!:`�,TM....... PL........:C...,l�................. State work to be performed End purpose of building (By Floors) ..... �jjic../..K.. 4........ /s...zG7_m... :�'...... —LA Y.0.9-✓..r�. ,c....���5..&/!� New Building... ............................. Remodeling ................................ Addition .... Ace................. Repairs ...................................... No. of Stories.................... SWITCH LIGHT PLUG FIXTURES REPRIG. IRON RANGE RANG& WATER W. HGT. aSE Cc STRIP TOTAL OUTLETS OUTLETS RECE•P'Ts No. LAMPS OUTLET OUTLET OUTLET CONN. HEATER COHH. Hd11T[R HBATER CLISTONT LIST ♦ // CHECK ENT. DIST. SERVICB I SERVICE MOTORS MOTORS Nee" RADIO TOTAL SW, CAS. TLMP. PERM. O•f XP t•S HP TRANS. LIST lee`/ Al CHECK Service Underground Size FeedersOverhead ��'4......fEonduit.i..R ..wMain Sa u�I`/d..Amps ...........................Main Fuses. .......... _... _.........Amps Type of Installation —Conduit.................... .... Tubing ........................ B.X.L........ ................. Metal Moulding ........................................................................ Amount of Permit $............ ..1....�.................................................... (Signed) ....... cl•rl/1.�dr-cX__1�/......................................... •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 complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 undersigned agrees to employ only such sub•contractora, work u performed under this permit, as are licensed by Miami Shores Village. (Signed)9:i_e ... ...... ...._....................... I............. STATE OF FLORIDA, l Master Electrician. COUNTY OF DADE. J as' "" Before in% the undersigned authority, a notary public, duly authorized to administer oaths End take acknowledgments, personally 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, and 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. 11 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 5r Job Address 1619 l V I W, / 6 J S 7� Tax Folio Legal • . I. � /s.RA��aLI/Ti�lY��i1 Arclutect/Engmeer Bonding Company Mortgagor Historically Designated: 0tMaster Permit #, / q-3 8 Phone /�`7� — 703(a _Address I q36 A) , E, 'l/Sl SS# Phone q %I/ 6373 / _Competency# Ins. Co.f• Iax; h to Address Permit Type (circle one): BUILDINGLECTRIC LUMEING MECHANICAL ROOFING PAVING FENCE SIGN n lk - _ I WORK DESCRIPTION Square Ft. Estimated Cost (value) Z ©D,-� ♦ 0 0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -Wed c rtractor to do the work stated. Signature of otter and/or Condo Presid t '/Date/ Signature of////Contractor/orr Owner -Builder / Dde(> Notary as to Owner and/o Notary as to Contractor or Owner-Build�te MyCornmissionExpire : �p9y P&6 OFFICIAL NOTARY SEAT. My Commission Expires- RY Pp OFFICIAL NOTARY SEAT. O ei BARBARA ANN FUGAZZi qp, q 2 l rT n ei BARBARA ANN FUGAZ: t COMMISSION NUMBER 2 �� ,� O COMMISSION NUMBER CC360191 N �� ¢ CC360191 9l if MY COMMISSION EXP. � � MY COMMISSION E%V. FOF PLO' MAR. 29.1959 �F OF F�O� MAR. 25 199t3 FEES: PERMIT 33-,�+o RADON C.C.F. NOTARY J TOTAL DUE L10, APPROVED: y Zoning Building Electricai,4 .26 Mechanical Plumbing Engineering cy O r 3 -- l vd)k, (u, J'n )) C- VORTH MIAMI, FLORIDA 33181 0 PHONE: (305) 949-6373