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1050 NE 93 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 0� Job Address /(OLD / 1 r q35 Tax Folio Legal Description Owner/Lessee / Tenant Ai Owner's Address ) At E, E 73 S t Contracting C � 1 F 'ec - L / I �.I 1 0 State# e /0 5 Signa M Commission Expires: 0‘ 4 p,RY P& OFFICIAL NOTARY SEAL ? 7 0 SANDRA M MONTIEL * COMMISSION NUMBER 4- '" p CC401261 7c�`" ,,sts MY COMMISSION .EXP. O .,_.._...AUG. 17 1 FEES: PERMIT Municipal # Competency # Address Address ON d/or Condo President Date ; —&7 Notary as to Owner and/or Condo President Date C.C.F. Historically Designated: Yes No 2 -`i/ Phone 6t A d d r e s s 1q.36 ✓ V . C 1 1 4 SS# 99 - 3 -;7 Master Permit # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDIN WORK DESCRIPTION lA Gi! C 1 LUMBING MECHANICAL ROOFING PAVING FENCE SIGN ..eYV; re (V) h-ew cD004 ( V\€ . � Square Ft. Estimated Cost (value) t06 ; 6 0-0 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 d that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the abov ame ontractor to do the work stated. Signature of Contractor or Owner- Builder Notary as to Contractor or Owner- Builder My Comrnissio Ins. Co. / y ) vi c [ iS GwQ j Date /_ Date RY PU OFFICIAL NOTARY SEAL �! O e <� SANDRA M MONTII3L * COMMISSION NUM®EF �l �r Q CC401261 c �'� NY COMMISSION OF F A O A IA,, = „1Qf4 : NOTARY . BOND p� TOTAL DUE el / APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering DRIP LOOP TD BE 10' AFG GAIN) 5.5' • cv CL,1HP a J (METE C0A , 4 l EUEHDIS taw PLASITC FM-II GRADE MAIN CB PANEL • • MCI MIMS TEM IMP CLAMP wx 81D' MIN DEPTH Raz *co i I (P' SUB CB PANES - - CONTRAS • NOTARY - - - - -- -- K1:A_1' ilk • •I4)0,* Conductor stz° - 'Conduit stzc Conduit. -type Thru i-oof Ground were s.ze SIGNATURE OF CONTRACTOR MAIN DIScONNECT Rating 40 Amps Man � Amps Sub Breakers Amps • SUB FEEDER Type . 2 7 t Size Bond INSIDE PANEL Ratmg _AM Bond Bus Yes Loca PER S.F.B.C. 4505.2(B) P' FD i \z' F BY t C TnTf A I TIT\ rTC-%Tfl APPROVED BY DATE ZONING STRUCTURAL @ICY:1CAL '.. ' , ,0901,,,, A.,-- ,.....,„..: - 40Itetel PLUMEAG MECIANICAL - .. ROir.:C...1 ' BU:if.3.. (...:!:TICIAL . ....-...-- rin.'..:.CT TO COMPLIAC:CE INI7I-I ALI. i:'?:.I)ERAL, STATE AND COUNTY RULES f RIC:al ; '3:i0RE3 VLI.AUE ASSL1MM NO RESPCIBILITIES FOR ACCURACY ..) OF OR Ei:SULTS F2DMIl;IESE FUNS. U" '..i'.' MTN THE SOUTH FLORIIA nii.r.);N CODE M ADOPTED BY S VILLAGE LS REQUIRED. IRE AP,CHIIECT, RUDER & SUB Cik:..: ' • :: ARE CHARGED WITH PE l'■;` OF All BUILDING REGU'i.ATIO4 WHE.THER OR NOT SPECIFICALLY INDICATED HEREIN. MIAM I SHORES VILLAGE ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT CUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES 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. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MIOTCRS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTCRS 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 HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS .. TRANSFORMERS . UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES 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 1 SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 7.24.00 Job Address '05 q 5 Tax Folio 1 , 3 2 05 01 6012.0 P ' V/3 Legal Description ,ee �P ,° r-e.. ��,— l Historically Designated: Yes No Owner/Lessee / Tenant /� Master Permit # 4 79 L 2 Owner's Address 105 p e "13 31 Phone .305- 751 1' — 4 /3 M mum n Expires: FEES: PERMIT APPROVED: Zoning Mechanical Ooa No :T • as toGr er and/or Condo President � 1 President Comm CC 882032 Expires Oct. 24, 2003 Bonded Thru m,i ., Atlantic Banding Co., Inc 3 RADON Qo '>'6 Q I D Date 8-8 -a) Date C.C.F. NOTARY Building Address ' - R' \ �\ SS #� ( Phone - 4,D 5-159 - 5 - 1/" . ) Contracting Co. \— aray r � C--\ e *r' c-- Qualifier o o� a-r J E In z QN,r State # ` C ' C 1) 0 O p O Q (3 1 Municipal # Competency # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING LECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Notary as My Co Electri es: Ins. Co. WORK DESCRIPTION h ' 7 dit n c "c, ( ,) 7 ®�° � �� � - fd 0 ty 5 s ,r,s1.C.) 4- Square Ft. Estimated Cost (value) / , k) . a' 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 perfonned 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 th • all work be done in compliance with • icable laws regulating cons n and zoning. urthennore, I authorize the above -named contractor to +the works . ed. r or Owner - Builder Date Date '724 -CD Jacqueline Acosta SCommission # CC 882032 Expires Oct. 24, 2003 Bonded ng Co., Thru Atlantic nding C Inc BOND TOTAL DUE 7. D Plumbing Structural Engineer ITEM BATH TUB UNIT FEE ITEM SWITC4 OUTLETS UNIT FEE ITEM SPA ! T RS UNIT FEE B I OET LIGHT OUTLETS CENT?J& HEATING DISHWASitER RECEPTACLES A/C (WIND) ORAL SERVICE TE;FCRARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT'CRK FLCCR DRAIN SERVICE REPAIR/iETER CiAta CAM RE:RIGERATICN GREASE TRAP APPLIANCE OUTLETS PRf -C S ANO PRESS PIPING INTERCEPTOR RANGE TOP UICE.RC JFO TANKS LAVATORY OVEN ABOVE 6RCL O TAMS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTCRS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT RATER BOILERS SINK. POT/3 CCMF. MOTORS OVER 3- 5 HP !NECANICAL VENTILATION f SINK, RESIDENCE OVER 5- 8 HP TRAMMING ASS?.8LIES SINK. SLOP . MOTORS OVER 8- 10 HP ELEVA1 S /E.�Mi..tiLA itRS ' T EMFCRARY WATER CLOSET MOTORS OVER 10- 25 HP F IRE SPR IMdEi SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION • INDIRECT WASTES A/C WINDOW 1 REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS r2 ' A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFCRI€RS • HEATER-NEW INST. GEENE.RATCRS TRANSFORMERS HEATER-REPLACE GENERATORS TRIMMERS LAWN S?R I NKLER -?ELL . SPECIAL FUME SUING POOL CUTLETS COWL - CAL _ WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORJZERS UTILITY -SEWER SIGN TIME CLOCX UTILITY - ;'EATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION CUTLETS ORAINFIELO, 4' TILE/RES. VIOLATION PUP 3 ABANDON SEPTIC TAM( REINSPECTlON SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA CRAIN RCCF INLET SOLAR RATER HEATER FIRE STA?' IPE PCCL PIPING LAWN SPRINKLER SYSTEM GAS RA,` E METER SET (GAS) GAS ?!PING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR 3UILDING PERMIT MIST ACCOMP NT THIS ADDENDUM. IF A MASTER PERMIT HAS L. OBTAINED, TI OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL I)(R [P LOOP ro BE 30' I "FC; (1 N) r ' Lora HETER 2' ABOVE ROOF 1 • • • • • 10 rani run aim e - rlArt — Bi.C11111G • FIIITSIIED GRIME r , •/ ,.. • 1 PVC Sl..12V1 1 1 WO' H IN 'DEP TI I 1 MA]N 0) • SUB C PANEL * PANEL 1 N.N 4NU Kl�LI L. • iiii s I •l- 1001.1. ConducIor 5Cce • Conduit stz Conduit type- 'Ilcru roo YES __ttu G round wlrc tctze_— ___.________ ) AC11. DISYONUECT Rafinp • Sub I3rnolcer-s • SUI3 -FEEDER Neer Ex _ Typo Size r. - Dond :s'Lzv • ; r ,...____._ INS [DE PANEL • N r►r,pS An pit • A mpg R atsng • Nips Tlond lug • 1 • (1S _Ho . (. ocf.'L PER S.F.I1.C. A ?.(Il) • .CONTrt rts - C�t RL trsy+„ .�_:._/ ' ___..._ `__.. • S _.s_... _.. - - - -� —_ • 1 t111AT1IItL Of CORTRACTOR • NOTARY ---- ...._, —_._ ...,,__.. — • r1 \z' 1- .1D BY • TO: ELECTRICAL CONTRACTORS FROM: MICHAEL DEVANEY, CHIEF ELECTRICAL INSPECTOR Two copies of the applicable requirements must accompany all permit applications. If not met, applications will not be accepted by the Building Department. Permit applications where a master permit is non - existent will need the following. Service change: Riser diagram showing meter size, disconnects, wire and conduit size, subfeed, grounding and panels. The Work -With inspection can be scheduled after the permit has been obtained. A final inspection is required. Air Conditioning Hook-up: Load calculations showing service size to determine if service is adequate for new load. Need the wire and conduit size for air handling unit and condensing unit. Kitchen Remodeling: BUILDING AND ZONING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES. FLORIDA 33138-2382 TELEPHONE (3051 795-2204 FAX (305) 756-8972 Cabinet maker's layout will suffice showing location of outlets. In other situations where a master permit is not issued, I will need to have a line diagram showing what's being done. ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s bmitted 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 d i� ' No Street Registered Architect and /or Engineer 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) New Building Remodeling Addition Repairs No. of Stories O verhead Service T. Size Feeders Type of Installation — Conduit Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. 88. MIAMI SHORES VILLAGE Conduit.... Main Sw Block No. // ..P / (Signed) Date Street Amps Main Fuses Amps Tubing B.X.L Metal Moulding Street...., Subdivision. ..... ✓� The undersigned applicant for this building permit does hereby certify that he understands n accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General ws 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. (Signed)...47 /� i !i °. /._. / /.. • t Electrical 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 merials 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. Lis, 4 �. / / / U ` / y ,� cti p l�� ' 2 CH ECK \' __'' � � ' ��},� (` ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1 -5 HP NEON TRANS. • 1 E L , a , Q f/ �_-rr R ADIO N . / / �i i ...3" :. TOTAL CONTR. LIST � i p �� ( r � (Lj f ��_ CHECK C ,,� qqq /� ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s bmitted 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 d i� ' No Street Registered Architect and /or Engineer 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) New Building Remodeling Addition Repairs No. of Stories O verhead Service T. Size Feeders Type of Installation — Conduit Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. 88. MIAMI SHORES VILLAGE Conduit.... Main Sw Block No. // ..P / (Signed) Date Street Amps Main Fuses Amps Tubing B.X.L Metal Moulding Street...., Subdivision. ..... ✓� The undersigned applicant for this building permit does hereby certify that he understands n accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General ws 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. (Signed)...47 /� i !i °. /._. / /.. • t Electrical 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 merials and /or workmanship. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT � � Permit No 1 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 J `;' � - � No Street STATE OF FLORIDA, } COUNTY OF DADE. 55. Registered Architect and /or Engineer Employing Electrician's Name V. Location and Legal Description Lot Street and Number where work is to be performed —No p , ;` " :! Block t:. Street No Street Subdivision er State work to be performed and purpose of building (By Floors) 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 - -r Amount of Permit $ U y — .' (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 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. (Signed) Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS 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 CHECK MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT � � Permit No 1 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 J `;' � - � No Street STATE OF FLORIDA, } COUNTY OF DADE. 55. Registered Architect and /or Engineer Employing Electrician's Name V. Location and Legal Description Lot Street and Number where work is to be performed —No p , ;` " :! Block t:. Street No Street Subdivision er State work to be performed and purpose of building (By Floors) 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 - -r Amount of Permit $ U y — .' (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 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. (Signed) Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.