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ELECTRICAL PERMIT'Inspection Number: INSP -19653 Inspection Date: 06/12/2006 Inspector: Devaney, Michael Owner: DOMLESKY, ROBERT Job Address: 285 91 Street NE Project: <NONE> Friday, June 9, 2006 Miami Shores Village, FL 33138- Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 JUN 1 z EII�Si 1 CL Contractor: ASCUNCE ELECTRICAL CONSTRUCTION INC Block: ¶SPzco5-Lq) Permit Number: EL2005 -80 Permit Type: Imported Permit Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132060133460 Lot: Phone: 305/756 -2892 Page 1 of 2 Passed Inspector Comments 2 yam'" e Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 'Inspection Number: INSP -19653 Inspection Date: 06/12/2006 Inspector: Devaney, Michael Owner: DOMLESKY, ROBERT Job Address: 285 91 Street NE Project: <NONE> Friday, June 9, 2006 Miami Shores Village, FL 33138- Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 JUN 1 z EII�Si 1 CL Contractor: ASCUNCE ELECTRICAL CONSTRUCTION INC Block: ¶SPzco5-Lq) Permit Number: EL2005 -80 Permit Type: Imported Permit Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132060133460 Lot: Phone: 305/756 -2892 Page 1 of 2 Parcel # 1132060133460 Signed: (INSPECTOR) Electrical Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: EL2005 -80 Printed: 3/17/2005 Applicant: JANINE DOMLESKY Owner: DOMLESKY JANINE JOB ADDRESS: 285 NE 91 ST Contractor ASCUNCE ELECTRICAL CONSTRUCTION INContractor's Address: 1041 NE 78 RD, #1 Local Phone: 305/756 - 2892 Permit Status: APPROVED Permit Expiration: 8/29/2005 Construction Value: $400.00 Work: KITCHEN ELECTRICAL REMODEL Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 20 & 21 BLK 25 LOT SIZE Fees: Description Amount FEE2005 -3483 CCF $0.60 FEE2005 -3484 Building Fee $150.00 FEE2005 -3485 Notary Fee $5.00 FEE2005 -3486 Technology Fee $3.75 FEE2005 -3487 Training and Education Fee $0.20 FEE2005 -3488 Submittal Fee ($50.00) Total Fees: $109.55 Total Fees: $109.55 Total Receipts: $0.00 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 agent, servants or employes. Signed: (Contractor or Builder) BY: BUILDING PERMIT APPLICA'T'ION roc 2001 ('ilk / /.0-r :L.. S 5Y (44 . _ Slate 'l;' L 'I cnani /I .cssee Name Is !Wilding Historically Designated YES Onalilicr '� 1 SI;rlc ('ertilicale or Itegis(ration No. L. ► C C� 1 (_• C 1 c'I Architect/Engineer's Nanie (if applicable) Value of Work For this Permit 1/2 y 0 C, Type of Work: Describe Work: ['Addition l l I A J V 1 V I.J V .1 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 l'er Type (circle): Building Electrical luntbing Mechanical Roofing Owner's Name (Fee Supple Titleholder) .:Act 4 J 1\me Dop4`►Di e #6 J( -77g Address a !'v ti .10h Address (where the work is being done) pC. Dj / v 11 St. Zip 33V3 Phone # City _ _ Miami Shores Village County Miami -Dade Zip ('onlraclor's Company Name _` _� - 1c'(.1)ione 1/ :-) ��- ) ( n nliacIor's Address q � l ■ 1� � — - -- Stale 1` ' Zip [jAltera(ion O C n(., C Permit No. IV1 si:er Periuit: No. 1 05 Phone # Square Footage Of Work: • Certificate of Competency No. , ` 1 L 05 ['New ❑ Repair /Replace ❑ Demolition = �J *,* * * * * * *,* * * ** * * ** *,** ** * *,** Fees* * * * * ** * * * * * * **** * ** * * *t * *� * ** ** 1 Submittal Fee $ ,` 2 (. / Permit Fee $ /,5 ©r e"© CC.F $ .L49 r� o /C -- Nolan.. 'Training /Education Fee $ 0 • ?3 s Technology Fee $ F scanning $ Radon $ Zoning Bond $ ('ode Enforcement $ Structural Plan Review. $ 'iota! Fee Now Due $ (Continued on opposite side) )24/36) Bonding Company's Name (if applicable) Bonding Company's Address ___ City ___ _ State Zip Mortgage Lender's Name (if applicable) ,46 Mortgage Lender's Address City State _ Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOTJIR PROPERTY. IF YOU INTENT) TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise In good faith that 0 copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement roust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 10 the crb.s•er:ce of such posted notice, t/le inspection will not be approved and a rein.spection fee will he charged. Sigualur�_ - .1s ( L- , Oc or Agent Th ° foregoing instrument was acknowledged before clay of 0 l) , h -- G�'�'"°" who is personally known to n or who has produc As idea • iication and who did take an oath. NOTARY PI I'rinL My Conunission Expires: APPLICATION APPROVED BY:•71, !-%/1V Chc 05/13/03 Si in: 3 * ** ***44.44 4* ** ** * * *4** *4 k44 4444 4.******* 4 1** Signah►re Contractor this The foregoing instrument was acknowledged before me this 1 ay of In rid(' Ct5 by , who ipersonally know' me or who has produced as identification are f niia a r a ilhi ii1►. My Commission DD1911114 NOTARY PUBLIC: /►s' A ea Plans Examiner Engineer Zoning 30,2007 Sign: i/ es'N...—...../ tot: I ' CY'S __ si ,, n u. 4 -rj---___Ginn.y.ri-ii- � so C / ...7.: `�'"' C p . Ma y Commission Expires: 3 ;ices. (�-Ct' o ndeu ITEM BATH TUB UNIT FEE UNIT FEE ITEM SPACE HEATERS UNIT FEE ITEM SWITCH OUTLETS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES 1-40, 1p C),i1r)S. -- A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS 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 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MJTCRS OVER 100 HP VIOLATION INDIRECT WASTES-' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 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 FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING Y ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUS OBTAINED, THE OWNER'S NOTARIZED SI PLUMBING NO ELECTRIC THIS ADDENDUM. IF A MASTER PERMIT HAS B. ENT ON SUBSEQUENT APPLICATIONS.) MECHANICAL • I l vy\ r ‘ 'Do m(e.S�C being the legal property owner, for the property Located at: 1 Q� e Y l r 1 Legally described as Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),,,nd I have read and understand the following disclosure Statement, which entitles me to 3srork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal Iicensing ordinances. Any person working on your building who is not Icensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provide By Produced OWNER BUILDER DISCLOSURE .STATEMENT Owner VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT DISCLOSURE STATEMENT initial of reviewing clerk. Tlie foregoing instrument Was acknowledged before me this day of 0 0 is personally known to me or who has as identification and who did take an oath.. • � Ginn Gonell t'�Y Commission #DD323870 ):* Expires: May 26, 2008 •. „ •' a s s ��F, Bonded Thru Atlantic Bonding Co., Inc. PERMIT NO. .1 0 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: NOTICE _OF COMMENCEMENT A RECORDED COPY MU OSTED ! N THE JOB SITE AT TIME OF FIRST INSPECTION FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: cs.3-- T r o - 7n 1. 5-)• a., 1 13- kciz, �zs 2. Description of improvement: ‘‘,.\! �,.u.� may- �` QL i°t 3. Owner(s) name and address: - .'n Y),UJa --.- �2= lMl eskk sU += £ f ,S { 'r U'(l. G- miL_;. In ge L 33135/ Interest in property: Name and address of fee simple titleholder: P 4. Contractor's name and address: O ts- 1/\s -�� �.1N`n►Y(� � 0 <� `fei.(es f 33 s M1-� I 5 T� L 3313 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: Name and address: -LORi )/ ,C01111 f ;tr=RA e £' d FY tt;aa 91i true c. t' ri ffli YI P7: 9. Expiration date of this Notice of Commencement: the n n : xpi u n : 7 different date is specified) Notary Pu ' �'`` . i d_-.... ._ / Print Notar��'s Nam.' �..%r_� MY commission expire:: ear Fditii 6u ?u � ♦. !D.c. Illlh I111111lll 1111111II1111II IIIII I III II II CFI 200F5RO U2O4913 DR 3k 23127 F'y 3153i (1Py) RECORDED 03/02/2005 10.32 :17 HARVEY RUVIN v CLERK. OF COURT f'1IAI1I -DADE COUNTY? FLORIDA LAST PAGE of ii'eaorditig,:i l'iless'a` gnature of Owner /C��m� `es` t�; t Print Owner's Name Sworn to and subscribed before me this day of � r l(�C � Prepared by . 20 Address: 2,6 S tv C r ( `n C .Ot � -. [ Ginn 3 3') ?j mmission tiDD323870 �....o�0 2008 R(;nc un, an c nding en,, Ins. ((k 1 \ en otgS 91s1 f ft o L Star / GL.5 R.sttQ' Covkq MS me ci olio -vv� Ske e ! 3f_ L* CO �e� PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date J -1 Q - () i Job Address oC 8- N, (— - 90 S"}• Tax Folio 013 - () Legal Description Historically Designated: Yes No Owner/Lessee / Tenant 1'L3R F.y - 1 n � Ic E tA, Master Permit # Owner's Address .r, N . ! / Phone ( a( ) �1 S " 6 c i 6 a Contracting Co. fl U l= N - t Y' ()ONT.) (0 I) i lJ (5 Address 1 43 7 3 C t>`1 . C V - Qualifier n' L6 t✓ 11+0 f: .5 4- fl— SS# Phoneb c7 (-)17),1 State # ( @ (' O 1 .12. 6 as Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION YC Square Ft. Estimated Cost (value) 1r 2, ED() ` O (� WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR LMPROVEMENTS 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. 1/(4 ' Sraure of o ' o tract er and/or Condo / RADON C.C.F. l a NOTARY 6 ------ 3 l Plumbing or Owner- Builder Al /_ // —01 Notary : s to Contractor or rI NAM R ". to My Commission Expires: h CLAW, , , 1 NGre VZY PUBLIC'T i fir OF FC.osarSA "`JRAMLSSION NO CL7E4%' ii :IV aMiLVISSICN F..)0 t. AP+'• 2 Electrical Structural Engineer BOND TOTAL DUE .• Permit Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name Amount of Permit $ $s. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No (Signed) __ • • • APPLICATION FOR ELECTRICAL PERMIT (Signed) — 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. Street Street No Street_______ Location and Legal Description Lot Block Subdivision _____— _______________________ 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 Service Overhead ,/ Size Feeders.____________ Conduit.__ Main Sw — - Amps Main Fuses________-_______Amps. Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding ___________________________ y Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his bltgations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public. State of Florida No. of Stories Master Electrican. STATE OF FLORIDA, COUNTY OF DADE. 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST • CHECK .• Permit Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name Amount of Permit $ $s. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No (Signed) __ • • • APPLICATION FOR ELECTRICAL PERMIT (Signed) — 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. Street Street No Street_______ Location and Legal Description Lot Block Subdivision _____— _______________________ 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 Service Overhead ,/ Size Feeders.____________ Conduit.__ Main Sw — - Amps Main Fuses________-_______Amps. Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding ___________________________ y Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his bltgations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public. State of Florida No. of Stories Master Electrican. STATE OF FLORIDA, COUNTY OF DADE. 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Job Address . g6 NE 9l Tax Folio J /-3 ,2®/ /3.4a en 1/4 Legal Descriptioni,D7 204-21, jL2A'. ga'c .Alp PL. Master Permit # j/es� Owner / Lessee / Tenant iigllecgederioe Owner's Address A/,� 9/g7. phone 7,6--g 696 . Contracting Co. Address Qualifier SS# - - phone State # Architect /Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION/ p Af/ $c . 5 w/ i of/g r/l SE B Wi E77. 14/PTW f/ 210 A Square Ft. Estimated Cost 206 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENTT� 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. 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 0 n r and/or Signa / Condo President Signature of Contractor or Owner - Builder Date: � Date: Noy =r' to Owr!er and /or Condo LEgAide "W A% Sala d At My Commission Exp PERMIT FEE: APPROVED: Zoning Mechanical Competency# Ins. Co. Address Address Address * Notary as to Contractor or Owner - Builder My Commission Expires: * * * * * * * Fire Other Building Electrical ta1� Plumbing - / e ngineering Permit No i 2/ Application is hereby fnade 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 wqF k. � l/{ Owner's Name and Addrei'� '� �C No 1/I� Registered Architect and /or Engineer �" ,' _ C-7 d e , IY . Employing Electrician's Name...��� .: .. ��� � No ..F... Street. Location and Legal Description Lot Block Street and Number where work is to be performed —No 2 W 8 " 41 i& Street State work to be performed and purpose of building (By Floors).. .e A... / %: :‘a - @' New Building Remodeling Addition Repairs No. of Stories Service Overhead f✓ Site Feeders.i Underground Type of Installation — Conduit Tubing of 9/' 9 /, 07 • ,/� STATE OF FLORIDA, 1 COUNTY OF DADE. Ij ss. APPLICATION FOR ELECTRICAL PER IT Dat — MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Conduit ` ` 1 Main Sw % Amps Main Fuses Amps B.X.L Metal Moulding j Street....? �f Subdivision � G >> o (Signed) . Q 2r.Sl� � �� e. 6 IG Amount of Permit $ /.. o (Signed) 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 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. 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 Char! e-! / 1,...c i / � PLUG RECE'P'T'S FIXTURES NO. LAMPS L REFRIG. OUTLET IRON OUTLET RANGE OUTLET . RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER - TOTAL CONTR. LIST CHECK CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1-5 HP NEON TRANS. RADIO TOTAL CONTR. . LIST ;'5 •, '7 1.- ,( 3/ /7 p� cr 0 "ECK Permit No i 2/ Application is hereby fnade 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 wqF k. � l/{ Owner's Name and Addrei'� '� �C No 1/I� Registered Architect and /or Engineer �" ,' _ C-7 d e , IY . Employing Electrician's Name...��� .: .. ��� � No ..F... Street. Location and Legal Description Lot Block Street and Number where work is to be performed —No 2 W 8 " 41 i& Street State work to be performed and purpose of building (By Floors).. .e A... / %: :‘a - @' New Building Remodeling Addition Repairs No. of Stories Service Overhead f✓ Site Feeders.i Underground Type of Installation — Conduit Tubing of 9/' 9 /, 07 • ,/� STATE OF FLORIDA, 1 COUNTY OF DADE. Ij ss. APPLICATION FOR ELECTRICAL PER IT Dat — MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Conduit ` ` 1 Main Sw % Amps Main Fuses Amps B.X.L Metal Moulding j Street....? �f Subdivision � G >> o (Signed) . Q 2r.Sl� � �� e. 6 IG Amount of Permit $ /.. o (Signed) 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 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. 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. BUILDING CI MIAMI SHORES VILLAGE FLORIDA ELECTRICAL [ Date 19U PLUMBING ❑ PERMIT N9 9466 L ontrac or s i : r ROOFING ❑ Owner of Building Architect Contractor or Builder t ' i•-• Legal Lot Description H B1 1 CONTRACTOR or BUILDER Work to be performed under this Permit Address of � . � r i. 1 Building Subdi- vision Sq Ft Value of 11 Amount of t; Project $ 11 Permit / _.' 2 t <, 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 an% 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, sexva is or; employees. , , Signed • 1 /'' (INSPECTOR) BY In consideration of the issuance to me of this permit I agree perform the work covered hereunder in compliance with all ordinances and regulation, pertaining thereto and in strict conformity with the plans, drawings, atements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this�ermit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY IUILDING LECTRICAL 'LUMBING )wrier of ; uilding rcbitect lontractor r Builder es nption Lot MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 8619 Work to be performed under this Permit CONTRACTOR OR BUILDER Bl. Subdi- vision t . DATE , 194 Contractor's License No. r ddress of i / Value of Amt. of ... /;,2 L — c. wilding / Project I Permit ir . 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 appli- -tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked _ 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 ermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and guaations pertaining to the work covered hereby whether shown on the plans or drawings or in the stater ents or specifications and that he assumes respon- bility for work done by his agents, servants or employees. • ' Signed. < , r .t .C...By /1 INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinices and regulations staining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of JGfiami Shores Village. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY UILDING LECTRICAL LUMBING MIAMI SHORES VILLAGE, FLORIDA DATE } Contractor's License No. PERMIT N° 8459 Work to be performed under this Permit F� f wner of uilding z.. rcbitect ontractor " Builder J F egal Lot Bl. Subdi- cscription vision ddress of A Value of Amt. of i / iilding , / c Proje Permit ' 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 appli- tion herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any ans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 snit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- .ility for work done by his agents, servants or employees. // _ j Signed. ! -? . 1 ! - / - 1. B ./ - - T INSPECTOR 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 staining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY ' Permit No 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 No 1 3 ' ! Street rifi Registered Architect and /or Engineer Employing Electrician's Name `j T Location and Legal Description Lol`. Block Subdivision EYlli]L da i iuil(7� Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Amount of Permit $ c I•..�� 8 5. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No Street Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) (Signed) lectrical 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE. 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 H EATER W. HEAT. CONN. ACE NEATER STRIP H EATER TOTAL CONTR. L187 \D X CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST 2,t' O • CHECK Permit No 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 No 1 3 ' ! Street rifi Registered Architect and /or Engineer Employing Electrician's Name `j T Location and Legal Description Lol`. Block Subdivision EYlli]L da i iuil(7� Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Amount of Permit $ c I•..�� 8 5. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No Street Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) (Signed) lectrical 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE. 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. Date.__ /f _____�l _______ t 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 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__. �'_� G �.,� L___________No._ Registered Architect and /or Enginee Employing Electrician's Name__ Location and Legal Description Lot Street and Number where work is to be performed—No .. State work to be performed and purpose of building (By Floors) Amount of Permit $__ ______�_ STATE OF FLORIDA, 1 COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT New Building________________ Remodeling _______________________Addition e No. 7 ,kr,2 Street - - -- c-= Block Subdivision Street__ _______ Repairs No. of Stories Service Overhead Underground Size Feeders Conduit____ Main Sw._ _____.______ Amps. Type of Installation— Conduit Tubing _ .B.X.L._____ Metal Moulding Main \ "_ ---__ ___ (Signed)_ .L`_ _ L / _!__�:'_, i ____ r r Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his `o gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridafermanent 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 p osted 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)_ L_ 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. q + M 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 1-5 HP N EON TRANS. RADIO TOTAL CONTR. LIST / /% V CHECK Permit No. Date.__ /f _____�l _______ t 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 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__. �'_� G �.,� L___________No._ Registered Architect and /or Enginee Employing Electrician's Name__ Location and Legal Description Lot Street and Number where work is to be performed—No .. State work to be performed and purpose of building (By Floors) Amount of Permit $__ ______�_ STATE OF FLORIDA, 1 COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT New Building________________ Remodeling _______________________Addition e No. 7 ,kr,2 Street - - -- c-= Block Subdivision Street__ _______ Repairs No. of Stories Service Overhead Underground Size Feeders Conduit____ Main Sw._ _____.______ Amps. Type of Installation— Conduit Tubing _ .B.X.L._____ Metal Moulding Main \ "_ ---__ ___ (Signed)_ .L`_ _ L / _!__�:'_, i ____ r r Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his `o gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridafermanent 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 p osted 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)_ L_ 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. q + M I2 64 .(9 iii Permit No 9(66-.Cr 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 Service Overhead Size Feeders Underground Amount of Permit $ STATE OF FLORIDA, l COUNTY OF DADE. ! j MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date S s. Registered Architect and /or En ineer Employing Electrician's Name. The undersigned applicknt for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to licensed by Miami Shores Village. No evq ..I `� Street../ 9/ f T - No 2 al) Street a" Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Conduit Main Sw Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) (Signed). lectrical Inspector. ccepts his obi' ions as an employer of of Florida rmanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are 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 REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEAVER STRIP HEATER TOTAL C L LIST 0774 r '. 3 " �••y CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1•5 HP NEON TRANS. RADIO TOTAL CONTR. LIST o.6A .2 C °1 i' - - / .L_ CHECK Permit No 9(66-.Cr 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 Service Overhead Size Feeders Underground Amount of Permit $ STATE OF FLORIDA, l COUNTY OF DADE. ! j MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date S s. Registered Architect and /or En ineer Employing Electrician's Name. The undersigned applicknt for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to licensed by Miami Shores Village. No evq ..I `� Street../ 9/ f T - No 2 al) Street a" Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Conduit Main Sw Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed) (Signed). lectrical Inspector. ccepts his obi' ions as an employer of of Florida rmanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are 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.