1225 NE 91 Terr (10)Date
Type Insp'n
Permit No.
-- Name
Address
Company
Phone #
MIAMI SHORES VILLA
BUILDING DEPARTMEN
305- 795 -2204
Building Inspeci4tn Reques
�(pow oo 3
For Inspector: h � /
Approve (i O
Correction ❑
Re- Insp'n Fee ❑
fPlyilozA
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n-
Permit No.
Time
Name
Address
Company
Phone #
For Inspector: Z3Name & D
Approved 71
Correction ❑ �y ��j
Re- Insp'n Fee ❑
PAY TO THE
ORDER OF
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: EL2003 -26
Printed: 1/31 /2003
Applicant: ELLIOT
Owner: PILSHAW
JOB ADDRESS: 1225 NE 91
Contractor SANDERS ELECTRIC INC
Local Phone: 305 - 624 -1003
Parcel # 1132050010240
BLUM BUILDING CONTRACTORS, INC.
275 N.E. 92ND STREET
MIAMI SHORES, FL 33138
,dde;c 04,4-
MEMO /2 if /tie 9/4/111.
0'00588711' i':066009 L55I: • 00 L"f6 65 211'06
Electrical Permit
PILSHAW
ELLIOT
TERR
Contractor's Address: 3915 NW 164 ST
Legal Description: WATERSEDGE
G o, o
_S,, 0
Permit Status: APPROVED Permit Expiration: 7/30/2003 Construction Value: $1,800.00
4Z Work: ROUGH OUTLET FOR SWITCHES RECEPTACLES & LIGHTS
TOTALBANK
CORAL WAY BRANCH
MIAMI, FLORIDA 33145 -3271
63- 915 -660
5887
$
Page 1 of 1
PB 9 -141 LOT 28 & LOT 29 LESS E15FT BLK 1
O C)
Total Fees: $000
Total Receipts: $0.00
NP
N
nspection
n herefor in strict compliance with all
ons that may have been submitted to
f the plans are changed without
ibility for a thorough knowledge of the
he assumes responsibility for work done
DOLLARS
2
.ertaining thereto and in strict conformity
onisibility for all work done by either
ELECTRICAL
'1'YPF.
Minimum Fee
QTY.
TYPE
Dryer . • •
Q'1 Y.
TYPE.
• Outlet, Appliance
Q"I'V.
TYI'i;
Service Repair
QTY.
A/C Central 1 -3 Ton
1
• • •
Fan
►
I
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Ventilation, Cost
Outlet, Switch
.5
Signs
Ductwork, Cost of
A/C Central 8 -15 Ton
Piping, Flammable Liquid
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
I
Parking Lot Lights
Fireplaces, Number of
Spas/Hot Tubs
Pressure Vessel
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
i
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE.
Minimum Fee
QTY.
'TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY. 'TYPE.
Refrigeration, Tons
QTY.
A/C Central, Tons
Bath Tub
Cooling Tower
Drinking Fountain
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of .
Paint Booth
Ventilation, Cost
Pool Piping
Air Handler, Tons
Sprinkler Repair
Ductwork, Cost of
Cap - Fixture
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Gas - Appliance
Bath Fan - Vented, #
Pump, Domestic
Fireplaces, Number of
Supply, AC Well
Pressure Vessel
Cap - Sewer
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
Tv'PI?
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOIiR yAr.If:ATECr1 PIRMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limitetl to: Monday thfdlie Mday f251h'7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREEtROA'f alltTW D DEBRIS. • • •
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQULOMEN'f aR'yAt-IIZLIS,i4CiD MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk. • •• • • • • • • • •
.• •••• • • • • •
••
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other constriction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
• •• •• • -- •- ����
• • • • • • • • • •
• • • ••• • • •
• • • • • • • •
•••• ••••••• •
STATE. '"FLORIDA, COUNTY OF MIAMI -DADE
Signa� of Contractor / Qualifier
Print Name Print Name .�
Sworn to and subscribed before me this day of • w to . d subscribed before me this 3 day
PERMIT APPLICATION
; My Commission D0150048
„y" Expires November 15, 2000
Personally known V OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
Page 3
• • • • •
• • •• ••• • • •
• • • • • • •
• • ••• . t • • •••
• • •
PERMIT APPLICATION
• •
•• • • • • • • •
• INSTRUCTIONS: Please indicate Oie type of vd4rk beirtg performed and quantity(ies) in the space provided below.
•
RECEIVED AND REVIEWED BY: DATE:
CONTRACTOR
Name ..74 S EzrzfroL, ...a/c_,
License No. /735f
Address 3 `, is tt ve f 64 gr .
(!(I`gr , i , FL. 336 s4
Telephon G7 / */A0 Fax 4 624
C
Qualifier Name /,2w D` SA 40)0,2...5
PROPERTY OWNER
New Construction
Name 7/j ta) iv
Enclosure
Address /ZZ5 ,/E
/?i I f S't
s Fe___
Home Telephone
Business Telephone
Fax
Alteration Interior
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
L
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
- Add'I Detachment
Other
Page 4
OFFICE USE ONLY
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
.•
••. •
.•• •
❑ IMPACT FEE
(New Construction)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
• •• • • • •
• • • • • • •
• • • •••
❑ OTHER
(Specify & Attach)
(¢.01 /sq.ft.)
•s. •.•
•
(¢.005 /sq.ft.)
•
•• ••
• • •
• •
• • •
• •
CHECKLIST
❑ PROOF OF OWNERSHIP •• "L7 cc M O ASSOCIATION APPROVAL
(Attach)
( x .60) x/1000
(Attach)
• • • ••
PERMIT APPLICATION
•• ••• ••
❑ HRS / DERM APP.R • • • • 4 $P"A aPROVAL (Restaurants)
(Septic / Sewer) •
.. ••• • • • • • ••
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ �J
ISSUING OFFICIAL
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2.
APPLICATION
Job Address:
IZZ& &iE, CI T
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
•• •• • • • •• •• •
• • • • • • • • • •
• • • • • ••• • • • • •
• • • • • • • • • • • •
• • ••••••• ••.•
•
•• .•••
• •
• •
• •
Complete the attached permit agplicatiowwhich
print or type to allow for a more accirate pjocessjn g
ted along with this permit applicatjor • • • • •
•• • • • •
Submit the completed application with all necessary
processing of your application, you may be asked to
nturt besigned Jay the property owner and qualifier. Both signatures must be notarized. Please
ofVpur Wplication. If roofing work will be done, a roofing application must be submit-
• •
•
An t!
Folio Number 1 1 QOG. z4
Lot Block
Subdivision PB PG
Current Use of Property T S «/%QC.
Proposed Use of Property
Tenant Information
••
•
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Master Permit No. BP ZQ0i'. Zoo 7
.•. 'S>;tbsidiary Permit No. 0- °s
• •
•
• • • •
• ••• ••
documents to the Building, Planning
submit additional information.
i Am i %(-1 0E.E. F _
City State
and Zoning Department for processing. During the
Zip
escription of Work -i Foe€ s hair* 4Es,
Tcepract..3 and:, G��NTS
Zoning Linear Feet
\ Square Feet
)Value of Work 860, Bldg Value
/ Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Units Floors
ENGINEER
Name
License No.
Address
Telephone
Fax
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
3 FOR ELECTRICAL PERMIT
Permit No 1 0 1 I... Date 7 /7 7
Application is hereby made for the approval of the detailed statement of the plans and specifications here sub Itted 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 '•1
Registered Architect and /or Engineer
Employing Electrician's Name. (pI. . . A, �.,C" C ('t Q.C. No. . &. 4 7' XStreet
Location and Legal Description Lot B. yl . �� Block
Street and Number where work is to be performed —No .. r 5 kV �
Subdivision k if
Street.. .f..5.r
State work to be performed and purpose of building (By Floors).,//ii c. /2.4e- /..Q. .d �� �� . Gr iey9 /" 6 .
New Building Remodeling Addition Repairs G�
Overhead e t, � d
Service Underground Site Feeders..p-ya.Conduit /I ....Main Sw Amps Main Fuses Amps
Type of Installation— Conduit.....V Tubing B.X.L Metal Moulding
Amount of Permit $
1.2
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of F)orida 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 subcontractors, on work to be performed under this permit, as are
11 ___ _d by Miami Shores Village.
/1/ � (Signed )....
Master Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. I s° '
A VA, 4 No of as 444' Street... x1.57 7 /k t.,
(Signed)
No. of Stories
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.
�3 s_7
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
L
%
T'
CHECK
y
__
LG a
ENT.
SW.
DIST.
CAB,
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
�/ -
RADIO
TOTAL,
CONTR.
LIST
/
E1
cl
3l/Pd
5
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
3 FOR ELECTRICAL PERMIT
Permit No 1 0 1 I... Date 7 /7 7
Application is hereby made for the approval of the detailed statement of the plans and specifications here sub Itted 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 '•1
Registered Architect and /or Engineer
Employing Electrician's Name. (pI. . . A, �.,C" C ('t Q.C. No. . &. 4 7' XStreet
Location and Legal Description Lot B. yl . �� Block
Street and Number where work is to be performed —No .. r 5 kV �
Subdivision k if
Street.. .f..5.r
State work to be performed and purpose of building (By Floors).,//ii c. /2.4e- /..Q. .d �� �� . Gr iey9 /" 6 .
New Building Remodeling Addition Repairs G�
Overhead e t, � d
Service Underground Site Feeders..p-ya.Conduit /I ....Main Sw Amps Main Fuses Amps
Type of Installation— Conduit.....V Tubing B.X.L Metal Moulding
Amount of Permit $
1.2
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of F)orida 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 subcontractors, on work to be performed under this permit, as are
11 ___ _d by Miami Shores Village.
/1/ � (Signed )....
Master Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. I s° '
A VA, 4 No of as 444' Street... x1.57 7 /k t.,
(Signed)
No. of Stories
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.
�3 s_7
Permit No... /3 FO
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE ! j
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
• t (Signed) e '"
471/A , /-4.Z,4
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.
Date /- -7 /
No Street / i �,% ( 7 �'�
Registered Architect and /or Engineer
Employing Electrician's Name 2 �E -� � 1—,z) No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No / L ✓ �.. C4..Street 7 / - 2 �` /
State work to be performed and purpose of building (By Floors) e/J/.4e/A
New Building Remodeling Addition Repairs
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit dots 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 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 sit of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on wo to be performetj/under this permit, as are
licensed by Miami Shores Village.
No. of Stories
(Signed) v
O /477114 1 2Ater EIe riot.._.
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
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -3 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
�/
/�
CHECK
Permit No... /3 FO
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE ! j
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
• t (Signed) e '"
471/A , /-4.Z,4
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.
Date /- -7 /
No Street / i �,% ( 7 �'�
Registered Architect and /or Engineer
Employing Electrician's Name 2 �E -� � 1—,z) No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No / L ✓ �.. C4..Street 7 / - 2 �` /
State work to be performed and purpose of building (By Floors) e/J/.4e/A
New Building Remodeling Addition Repairs
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit dots 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 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 sit of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on wo to be performetj/under this permit, as are
licensed by Miami Shores Village.
No. of Stories
(Signed) v
O /477114 1 2Ater EIe riot.._.
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.