1050 NE 91 Terr (10)Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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 rz 1 No Street
Registered Architect and /or Engineer
Employing Electrician's Name '' No � ` Street
-
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No /c? 7 r.
......��...._.._ Street ...........
State work to be performed end purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit (/ Main Sw Amps Main Fuses
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ ' (Signed)
F leet cal Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig;tio as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pert Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors 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 idch public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, ')
COUNTY OF DADE. j
SS.
(Signed)
Master Electrician.
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, 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.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HTER
STR IP
HEATER
TOTAL
CONTR.
LIST
%)
%
'
_.
,
/ ,
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL.
CONTR.
LIST
CHECK
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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 rz 1 No Street
Registered Architect and /or Engineer
Employing Electrician's Name '' No � ` Street
-
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No /c? 7 r.
......��...._.._ Street ...........
State work to be performed end purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit (/ Main Sw Amps Main Fuses
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ ' (Signed)
F leet cal Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig;tio as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pert Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors 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 idch public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, ')
COUNTY OF DADE. j
SS.
(Signed)
Master Electrician.
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, 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.
:UILDING ❑
:LECTRICAL ❑ DATE ' 195'
'LUMBING ❑ PERMIT N° 7561
'OOFING ❑
❑ Work to be performed under this Permit__ _
Awner of
uilding
,rchitect
: ontractor
r Builder
egal Lot
)escription
.ddress of
uilding
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
81.
Subdi-
vision
Sq. Ft
Value of
Project $
/
Contractor's -.)
t .
License
Amt. of
Permit 3
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 application
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in co npliance with any plans,
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition Lpon which this permit is
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumi:s responsibility for work
one 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 with all or linances and regulations
ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities o1 Miami Shores Village.
accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTH DRITY