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1250 NE 91 Terr (4)Date v , Job Address /2✓ 0 A/6.- ?/ ierlax Folio Legal Description Historically Designated: Yes No T Owner /Lessee/Tenet 1 7 Q (ill Master Permit # C061_, " ! L 7 (o Owner's Addre ril Phone a0004 • O ` g • Contracting Co. O I 1GL )`c T (, Address 1 q ? A) E ) `'fegs 1 . Qualifier tau 1 R. in 4d5 e l SS# q-4 373 State # Municipal # Permit Type (circle one): BUILDING WORK DESCRIPTION: C-'c, Square Ft. Si atu a of owner and/or Condo President Date Notary as to Owner and/or Condo President My Commission Expires FEES: PERMIT °:49/! RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 n f`evvlo V1 ©v\ Lt_ C LECTRICAL Date C.C.F Zoning Building Electrical Competency # Ins. Co. G -L( vi IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. PLUMBING MECHANICAL ROOFING -ekI bc:;( d J Y15 it +It-- Pdrz- Yl 1 �7 Estimated Cost (value) C ) C9 ©0 1. v 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 ANY 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 all disciplines. OWNERS 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 named contra ateftt do the work stated. 1 , > IL Signature of Contractor or • • • • , • j2e4 • My ' s mmission NOTARY APPROVED: TOTAL DU E�_- e ty)) \) a 1) BOND Mechanical Plumbing Structural Engineer ITEM BATH 118 UNIT - FEE ITEM SWITCH OUTLETS UNIT 4 FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS '3 CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AWS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 if HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEIWBLIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CL03fr MOTDRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL .. - MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET - ' - -.. MOTORS OVER 100 HP VIOLATION INDIRECT WASTES - A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER - FIRE SPRINKLER ' ,, , GENERATORS TRANSFORMERS • i HEATER -NEW INST. •- . GENERATORS TRANSFORMERS HEATER - REPLACE - GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMAING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS • •. SIGN TRANSFORMERS UT I L I TY- SEWER' . • • • • S.I GN - T I I,IE CLOCK UTILITY- WATER' FIXTLRES SEPTIC TANK ANTENNA ' RELAY TELEVISION OUTLETS DRAINFIELO, 4" TILE/RES VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN - DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER =IRE STANDPIPE POOL PIPING _AWN SPRINKLER SYSTEM 3AS RANGE AETER SET (GAS) 3AS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING. PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 -795 -2204 Permit Number: EL2002 -268 Printed: 8/19/2002 Applicant: MR PILSHAW Owner: JOB ADDRESS: 1250 NE 91 TERR Contractor P & M ELECTRIC INC Contractor's Address: 1936 NE 148 ST Local Phone: 305 - 949 -6373 Parcel # 1132050010550 Signed: 6.06 Permit Status: Approved j Permit Expiration: 2/15 /2003 Work: WIRING REMODELED BATHROOM AND INSTALLING CEILING FAN ON BACK PORCH If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may 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 condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done his agents, servants or employees. Signe• 000111/,y SPECTOR) BY: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my age ants or employes. ))14AeS-At- Electrical Permit Construction Value: $2,000.00 Page 1 of 1 Legal Description: WATERSEDGE PB 9 -141 ELY5FT LOT 30 & AL LOTS 31 & 32 LESS ELY2OFT Total F: es: $0.00 Total Receipts: $0.00 (Contractor or Builder) BY: PAY TO THE ORDEf OF 4 I . J _ /It f P & M ELECTRIC, INC. 1936 N.E. 148TH STREET NORTH MIAMI, FL 33181 -1137 MEMO 0 Bank of America ACH R!T 063100277 v00 7 3 L40 1:0 6 30000 4 71: 00 L 5 9 5 2 9 20 L LII' 63 -4/630 FL s . 1348 7314• DOLLARS Owner's Address Qualifier State PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date t� 93 Job Address /25 r`L 1/ T4 2 ' E' Legal Description ly- a_ Owner / Lessee / Tenant -"k G)UE 1 -1^ 1 -= CAL Zsa 1 J & I/ y 2,e Phone , Z6?.3940 Address` �v.I S Z,-(p . 1)Av ( — Phone 9M-- ��Fi�D/ X�1t >Municipal �k Competency # Ins .Ci D -6 11 /° 3 Contracting Co. 5�vuatT DA B C 4>iG /7!" = ss# Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION it2(� -M '? 1E■ � C.kCPZQl- Square Ft. Estimated Cost(value) 4 1 D 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 -named contractor to do the work stated. ,. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: ** * * * * * * * * * FEES: PERMIT 52147e RADON C.C.F. 5 O APPROVED: Fire Zoning Building Mechanical Plumbing Tax Folio / 326 °S;v �- T a - OLc..r -s' Date:// Signatur of �i2 N.1 f AMA tary as to C Master Permit #-, ntractor or Owner- Builder * * * * NOTARY 5 r 7O Other 1,1;4,7,7. PHINE CHURCH r te r e 1 ` Public, State of Fiend' No. cC197545 �ectricaj\ Engineering_ * * ** TOTAL DUE eel ' LJ 2 FORM 25-8 [7/90] CERTIFICATE OF INSURANCE ISSUE DATE: 13 PRODUCER This certificate is issued as a matter of inform- T' CHARLES WILSON INSURANCE :ation only and confers no rights upon the certi- 2260 S. XANADU WAY, STE. 280 |ficate holder' This certificate does not amend; :extend or alter the coverage afforded below. AURORA, CO �------------------------------------- 80014 | COMPANIES AFFORDING COVERAGE 303-368-5757 :LETTER A Scottsdale Insurance Company CODE SUBCODE | -------------------------------- :LETTER B National Fire Insurance Co. INSURED :LETTER C IMIF IV Service Corp. �------------------------------------------------- dba Security Data Group :LETTER D 4960 S.W. 52nd Street |------------------------------------------------- Davie, FL 33314 :LETTER E COVERAGES: This is to certify that policies of insurance listed below have been issued to the named insured for the policy period indicated; notwithstanding any requirement; term or condition of any contract or other document with respect to which this certificate may be issued or may pertain; the insurance afforded by the policies described herein is subject to all the terms; exclusions; and conditions of such policies. Limits shown may have been reduced by paid claims. CL1TYPE OF INSURANCE : POLICY NUMBER |EFF DATE|EXP DATE: LIMITS GENERAL LIABILITY . . 1GEN'L AGG |$2000,000 A[x]Commercial GL |CLS133259 |12-1-93 ;12-1-94 :PD-CMP/OP AG:$1000,000 [ ]Claim [x]Occur: ! � :PR & ADV INJ|$1000,000 [ ]Ownrs/Cntr Prot | | EACH OCC. :$1000,000 [x]ERR & OMISSN � � | :FIRE DAMAGE |$ 50,000 [ ] � � \ !MED EXPENSES|$ AUTOMOBILE LIABILITY | ----------------- [ ]Any Auto � | |COM. SIN. LT|$ [ ]All Owned Autos : | | (---------------------- [ ]Scheduled Autos 1 | | |BOD INJ/PPER|$ [ ]Hired Autos | |---------------------- [ ]Non Autos : | � |BOD INJ/PACC|$ [ ]Garage Liability! | : �---------------------- [ ] | | | |PROP DAMAGE :$ EXCESS LIABILITY < [ ] � EACH OCCURR.|$ [ ] Other than Umb \ :AGGREGATE |$ WORKERS' COMPENSATION( -----: Statutory------------ B AND EMPLOYERS' (WC3 01171575 |8-2-93 :8-2-94 EACH ACCID. ($500,000 LIABILITY � : | (DISEASE LIMT1$500,000 ( � :DISEASE EMPL:$500,000 OTHER�----------------------------------- | Description of operations/locations/vehicles/special items CERTIFICATE HOLDER :CANCELLATION: Should any of the above described City of Miami Shores :policies be cancelled before the expiration date :thereof; the issuing company will endeavor to 10050 N. E. 2nd Avenue :mail 10 days written notice to the certificate Miami Shores, FL :holder named to the left; but failure to mail 33138 !such notice shall impose no ig ion or liab- lility upon the company; its � nt~ �'�� ------Authorized Representative: - M FORM NO 401.280/AC 25 -061 ❑ RENEWAL ❑ TRANSFER SEC' It O NEW DATE BUSINESS OPENED STATE OR COUNTY CERT /REG tt E F U 0009 1 5 Business Location Address: 4960 SW 52 ST 401 IIAVIE 33314 BUSINESS PHONE: (305)321 -8696 BROWARD COUNTY OCCUPATIONAL LICENSE TAX FOR PERIOD OCTOBER 1, 1993 THRU SEPTEMBER 30, 1994 18 1.. 181, 11/12/93 TAX BACK TAX PENALTY T, C. FEE TRANSFER TOTAL L I • U IJ 27.00 Ir1IF. 4C SERVICE .CORP PAIiL KENT PREUS . 4960,,SW 52 ST #401 DAVIE ri RENEW ON OR BEFORE SEPTEMBER 30, 1994 PENALTIES IF PAID OCT. - 10% I NOV. -15% • DEC. - 20% • After DEC. 31 - 25% • Plus Tax Collection Fee of up to $25.00 Based on Cost of License If Feld On or After November 30, 1993. ACCOUNT NUMBER 181.0000367 THIS LICENSE MUST BE CONSPICUOUSLY DISPLAYED TO PUBLIC VIEW AT THE LOCATION ADDRESS ABOVE. BROWARD COUNTY REVENUE COLLECTOR 115 S. Andrews Avenue, Governmental Center Annex FT. LAUDERDALE, FLORIDA 33301 SEE BACK FOR TRANSFER INFORMATION PAYMENT RECEIVED AS VALIDATED ABOVE 0000000000 01100002700 0000001 81 00003 67 i001 4 L TYPE OF LICENSE TAX PAID BROWARD COUNTY ELECTRI C()NrRAC1OR 1171•O1CIMINW1 8 UNITS 1993 -1994 33314 ac« 2534920 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECT CONTRACTORS LICENSING BD THE ALARM CONTRACTOR I , ''''. 1: 7' '°' NAMED BELOW I S CERT I F,I ED • UNDER THE _PRQVISIQN.S 40 F, CHAPTER _ _.`•- 4.89; , ` F EXPIRING AU 19 PREUS, PAUL KENT ' , .� IMIF IVC SERVICE CORP ": ' 6726 ARLINGTON, EXPRESSWAY, �u '3 JACKSONVILLE,;; ;; x " 32211 - ;,r BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE, FLORIDA ❑ � DATE 3 _ PERMIT 7265 Contractor's ❑ License No. ❑ Work to be performed under this Permit Owner of Building C4 Architect Contractor or Builder Legal Description Address of Building t Lot 11 1 C LC L7 r ... e_. 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 applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may 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 condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. ' T� In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in com pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the prop ceptinq this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. r l /. fl T -' CONTRACTOR OR BUILDER BY 19( 40 (a. 1J Subdi- vision T 7 • t.• . t. N+ c C. Value of 11 Amount of Project $ II Permit $ INSPECTOR ce with all ordinances and regulations thorities of Miami Shores Village. In ac. AUTHORITY • ••UT ►• Permit No APPLICATION FOR ELECTRICAL PERMIT 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 com ed 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 G No ._.... Street../ Amount of Permit $ 55. Registered Architect and /or En in r Employing Electrician's Name.. ..r%Z- - MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block Subdivision El Street .. . .. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories q 37 Service Overhead Size Feeders. / ' �' Conduit /'2...Main Sw 1 Amps Main Fuses.... Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding 6 No �' Street... (Signed) (Signed) Date r d. ectrical 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 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 undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. / - Master Electrician. STATE OF FLORIDA, l COUNTY OF DADE. I 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. S H ATER TOTAL CONTR. LIST -7/ ii ¢- � _ / ) � . 1� J . 's , r 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 APPLICATION FOR ELECTRICAL PERMIT 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 com ed 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 G No ._.... Street../ Amount of Permit $ 55. Registered Architect and /or En in r Employing Electrician's Name.. ..r%Z- - MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block Subdivision El Street .. . .. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories q 37 Service Overhead Size Feeders. / ' �' Conduit /'2...Main Sw 1 Amps Main Fuses.... Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding 6 No �' Street... (Signed) (Signed) Date r d. ectrical 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 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 undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. / - Master Electrician. STATE OF FLORIDA, l COUNTY OF DADE. I 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. � Permit No ...2–(47/ . Owner's Name and Address Location and Legal Description Lot Street and Number where work is to be performed —No Overhead 3 , a Underground Site Feeders. .. ., Conduit pe if Installation— Conduit Tubing STATE OF FLORIDA, j COUNTY OF DADE. IT MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 complianc. 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 complieylzwith, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Enginegr Employing Electrician's Name -.. :.. ..._ No State work to be performed and purpose of building (By Floors) �/ 2 New Building Remodeling �� ..' g g...� .... :. - Addition Repairs No. of Stories Block Subdivision �� Street Amount of Permit S o (Signed) s s. 3 Main Sw Amps Main Fuses B.X.L .........Metal Moulding. eetricel Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli' . ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P. , anent 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 - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) .... Date ; Street. Street..s: Master Electrician. Amps 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, a,d 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. SPACE HEA. ER STRIP HEATEI TOTAL CONTR . LIST 7 _it— 1 CHECK ENT. SW. DIST. CAB. SERVICE T. P. SERVICF PERM. MOVOP.; 0.1 HP .`..OTORS I.5 HP NErN TRANC. RADIO TOTAL CON ". R. LIST CHECK O--- � Permit No ...2–(47/ . Owner's Name and Address Location and Legal Description Lot Street and Number where work is to be performed —No Overhead 3 , a Underground Site Feeders. .. ., Conduit pe if Installation— Conduit Tubing STATE OF FLORIDA, j COUNTY OF DADE. IT MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 complianc. 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 complieylzwith, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Enginegr Employing Electrician's Name -.. :.. ..._ No State work to be performed and purpose of building (By Floors) �/ 2 New Building Remodeling �� ..' g g...� .... :. - Addition Repairs No. of Stories Block Subdivision �� Street Amount of Permit S o (Signed) s s. 3 Main Sw Amps Main Fuses B.X.L .........Metal Moulding. eetricel Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli' . ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P. , anent 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 - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) .... Date ; Street. Street..s: Master Electrician. Amps 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, a,d 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.