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.