ELECTRIC PERMITBUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
PLUMBING ELECTRICAL o PERMIT N °. 8992
ROOFING ❑
Owner of
Building
Architect
2.�
Contractor
or Builder •.A �����,�
Legal Lox
Description BI
Building of �r 3~55/ , .
Building �
CONTRACTOR or BUILDER
Work to be performed under this 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 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.
�7
Signed- .* d; '—e (INSPECTOR) 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, d wings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all wor done by either, myself, yy agent, servant or employee.
)„#„
Date 7
Contractor's
License No.
Subdi-
vision
Sq Ft
Value of 11 Amount of <�
Project $ I I Permit $ .d
AUTHORITY
7 7 V
197
ELECTRICAL INSPECTION DEPARTMENT
9�J APPLICATION FOR ELECTRICAL PERMIT
Permit No 0 ( J Z- Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewi 6mitted Q. the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordin nc of Mia Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules a 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...
Registered Architect and /or Engineer
Employing Electrician's Name.,�N 'gAel yfra �Q�e i/I:a ... No. .. /0. i' . t ..y Street. &[ 9 Stj V? `
Block Subdivision qI
Street and Number where work is to be performed —No 31 Street..Q./...�C.,.* ..��..� ��G
Location and Legal Description Lot
State work to be performed and purpose of building (By Floors)
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
New Building Remodeling Addition..._. Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B. X.L .......................Metal Moulding
(Signed)
(Signed)
No '3JrY-
Street. . 7/
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
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
A,6,
�)
TOTAL
CONTR.
LIST
2 4
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
ELECTRICAL INSPECTION DEPARTMENT
9�J APPLICATION FOR ELECTRICAL PERMIT
Permit No 0 ( J Z- Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewi 6mitted Q. the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordin nc of Mia Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules a 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...
Registered Architect and /or Engineer
Employing Electrician's Name.,�N 'gAel yfra �Q�e i/I:a ... No. .. /0. i' . t ..y Street. &[ 9 Stj V? `
Block Subdivision qI
Street and Number where work is to be performed —No 31 Street..Q./...�C.,.* ..��..� ��G
Location and Legal Description Lot
State work to be performed and purpose of building (By Floors)
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
New Building Remodeling Addition..._. Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B. X.L .......................Metal Moulding
(Signed)
(Signed)
No '3JrY-
Street. . 7/
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 Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
Miami Shores Village
REMOVED
mov 6 M
Electrical
/
4
Owner's Name (Fee Simple Titleholder) /
Owner's Address 3,5z4 N E 9 / / �7
ci /29/ .,Ri� State fITJ Zip 3 •3 3S
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 3 S4 iCif g q / S /
City Miami Shores Village County Miami -Dade
Contractor's Address
City T riff; / GYl /�. x State
Qualifier /z� 1 ?O1 /L.� 1
$ Value of Work For this Permit
tDL
Total Fee Now Due $
(Continued on opposite side)
voo
Ale- ,E Aliwie-11P
Permit No. 0 1 0 4 --/ 5Z'
Master Permit No.
Plumbing Mechanical /� Roofing
if/e0 Phone # 3 AS 3 72 D
Zip
Is Building Historically Designated YES NO
Contractor's Company Name M /T /I f , ci- c ) C Phone # ' 7' — 7/ 0
S3 ' �� % 2U �
* * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zip 3'331
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ❑Addition LK Iteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
CCF $ 0. CO /CC
Submittal Fee $ aj ,OU Permit Fee $ / m ie ' a d
Notary $ Training/Education Fee $ 0 , Technology Fee $ 4 P ,)
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address "
City State Zip
Mortgage Lender's Name (if applicable)
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. I 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: 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
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 a 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 must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve a r eynspection fee will be charged.
Signature
Owner o Ag " Contract
The foregoing instrument was acknowledged before me this l 7 The foregoing instrument was acknowl ged before me this /7
day of \ , 20, by , day of , 4 , 20 m b
J / Y
who is personally known to me or who has produced [ I £ / S who is personally know, to me or who has produced
entificati and w
Chc 12/15/03
As identification and who did take an oath.
APPLICATION APPROVED BY:
NOTARY PUB
Sign:
Print: •VNCSNI NIVA A08t f1aH1030NO9
�� la cock
i lmiSgiOn Y " 3 {EGGNOISSIWWODAW '. �!� '= My Commission E l N
Densmore Daniels
;,,; ! :k: MY COMM �JD008864 E 0:, 0, auoE �twyt '' ?9, iPs Y XP ` pq,,
."- ; . c1li,.• 4 BONDED THRU TROY FAIN INSURANCE INC. d�
°'" E"p'res dune 01 2007
(Certificate of Competency Holder)
NOTARY PUBLI
Sign:
Print:
State Certificate or Registration No. Certificate of Competency No. /ree Y 7=
40 ,
Plans Examiner
Engineer
Zoning
M'
;.
3 ,r(0
c A) i-
• a� A•-P
C•ridl w SQL pi , et
1 3, 1e
7f � '•C •
1.r4
JOB
SHEET NO
0 3 's.. ( 70
I
S ' �t
VIIJ (I E /k4 ;‘) as
OF
CALCULATED BY /�!/. / 7"--3 /3
CHECKED BY
SCALE
n ,rrd �. J , P
&O �4
ur,w Gp� � i
i,c, R•K(
67 c.-
GN'd` r
DATE
DATE
IL ; -10,
° N1" 1
3� AKp 671
memo 3o?
4 _ . ,Svarriir
3v
e amore
My Commission DD218256
. d , Expires June 01 2007
atop
7.P6 - 6uA
II
•
Z.
SCALE
SF K- LoA - DP 1 tom
- 5 1 1Y\ Prt PflPI vTS
LPcv n . ) 1 . C �T
1. 3v.)
......:........ .
. 4 , p 0
•2"..-( 61+s'Tto1 euntii
- 7 - 10 KV ) C (W
M.P'4 o.,Drz2G Li0 �Z7
to F C 1 0
o,
g, I a- !o
or 2- o
000
oo
S
.. .. ............ ...
1.0
1,()
L15tSL
200o L
3 00 (AD
y
_2 3 o O �J
5 0
i$t
2
r
JOB Q
SHEET NO /f' `- // "1-7-
CALCULATED BY '� / #1 /y DATE
CHECKED BY DATE
SCALE
OF
4ensma" e te
My Commission 0D218256
Expires June 01 2007
Date_
Type Insp'n
Permit No.
MIAMI SHORES VILLAGE
BUILDING DEPARTMEN
305- 795 -2204
Buildi ig Inspection Request
-6f,,io)
�i oil '
Name mOncLC
Address 351 / v I / 54-
Company 14 V . /e( [ C
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11/24/2004
Applicant: PAULINE
Owner: MINDES
JOB ADDRESS: 354
Contractor MR ELECTRIC
Local Phone: 954/792 -6710
Parcel # 1132060190220
NE 91
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Electrical Permit
Permit Number: EL2004 -328
MINDES
PAULINE
ST
Contractor's Address: 4053 PETERS ROAD
Legal Description: EL PORTAL
Permit Status: APPROVED Permit Expiration: 5/14/2005 Construction Value: $400.00
Work: a/c electrical hook up
BY:
Page 1 of 1
PB 9 -101 LOT 6 & W1/2 LOT 5 BLK 2 LOT SIZE 75.000 X 135
Fees:
FEE2004 -11721
FEE2004 -11722
FEE2004 -11723
FEE2004 -11724
FEE2004 -11725
Description
Building Fee
CCF
Technology Fee
Training and Education Fee
Submittal Fee
Total Fees:
Amount
$100.00
$0.60
$2.50
$0.20
($50.00)
$53.30
Total Fees: $53.30
Total Receipts: $0.00
tco
kicA
DEC 1 6 PAID
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.
Permit No
New Building
44/
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specifie d or not. A copy of approved plans and specifications must he kept at
building during progress of work.
Owner's Name and Address No
Registered Architect and /or Engineer
Employing Electrician's Name 1`Z - a 4C/4 Ec 7'/& 1 C
Location and Legal Description Lot GJ /L Y 6 .. Block
State work to be performed and purpose of building (By Floors) i6
Street and Number where work is to be performed —No
!�
Service Overhead Size Feeders Conduit Main S w Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L. Metal Moulding
}
ss.
MIAMI SHORES VILLAGE
Remodeling Addition. Repairs No. of Stories
( Signed)
Subdivision
Street
(Signed) ___�°y� x
The undersigned applicant for this building permit does hereby certify that he{ nderstands and accepts his obtions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5866, Compiled General Laws of Florida manent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Street P1
Street M
a� �A
ctrical Inspector.
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
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 No
New Building
44/
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specifie d or not. A copy of approved plans and specifications must he kept at
building during progress of work.
Owner's Name and Address No
Registered Architect and /or Engineer
Employing Electrician's Name 1`Z - a 4C/4 Ec 7'/& 1 C
Location and Legal Description Lot GJ /L Y 6 .. Block
State work to be performed and purpose of building (By Floors) i6
Street and Number where work is to be performed —No
!�
Service Overhead Size Feeders Conduit Main S w Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L. Metal Moulding
}
ss.
MIAMI SHORES VILLAGE
Remodeling Addition. Repairs No. of Stories
( Signed)
Subdivision
Street
(Signed) ___�°y� x
The undersigned applicant for this building permit does hereby certify that he{ nderstands and accepts his obtions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5866, Compiled General Laws of Florida manent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Street P1
Street M
a� �A
ctrical Inspector.
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.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No.__ _____________K! ___________ 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.
New Building
Owner's Name and Address___
Registered Architect and /or Engineer
Employing Electrician's Name____ 4
e °
Amount of Permit 1
STATE OF FLORIDA, l
COUNTY OF DADE.
OUNT ss.
Location and Legal Description Lot n�
My . Commission Expires
� F
(Signed)
(Signed)
Remodibg A
• ^ �,d tion � Re
e
No. �! Street
No 0 N Street
Block ‘? Subdivision
Street and Number where work is to be performed —No Street_ -I/ k 1
State work to be performed and purpose of building (By Floors)
No. of Stories
Service Overhead Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation— Conduit Tubing B.X.L Metal Moulding
le
The undersigned applicant for this building permit does hereby certify that he' un erstands and accepts his obligati 'As, as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5960, Compiled General Laws of Florida Pnent 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 sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
0
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.
Notary Public, State of Florida
Master Electrician.
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
OU -TLET,
IGHT
71.1"4
PLUG
REC _Z
`'9
FIXTURES
NO. LAMPS
1/
REFRIG.
OUTLET
/
IRON
OUTLET
/
RANGE
OUTLET
/
RANGE
CONN.
WATER
HEATER
:/
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
o / r L
I O
y,JES
/ 7
CHECK
f7
'.0.-
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
ERVICE
PERM.
�
MO
0.1 HP
MOTORS
1-5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
a
Cy
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No.__ _____________K! ___________ 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.
New Building
Owner's Name and Address___
Registered Architect and /or Engineer
Employing Electrician's Name____ 4
e °
Amount of Permit 1
STATE OF FLORIDA, l
COUNTY OF DADE.
OUNT ss.
Location and Legal Description Lot n�
My . Commission Expires
� F
(Signed)
(Signed)
Remodibg A
• ^ �,d tion � Re
e
No. �! Street
No 0 N Street
Block ‘? Subdivision
Street and Number where work is to be performed —No Street_ -I/ k 1
State work to be performed and purpose of building (By Floors)
No. of Stories
Service Overhead Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation— Conduit Tubing B.X.L Metal Moulding
le
The undersigned applicant for this building permit does hereby certify that he' un erstands and accepts his obligati 'As, as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5960, Compiled General Laws of Florida Pnent 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 sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
0
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.
Notary Public, State of Florida
Master Electrician.
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.