ELECTRICAL PERMITCONTRACTOR
Name Al 5 ea 7y
License No. cG __ v 0 Jo 1 q
Address
71 17 Iv ?"`"'s #ice
Telephone(-7 ,33/, 3 .. 47 Fax (&,,,s..) (07_57_ Z�Os/
N Name
Qualifier
ayrn v nd //en-
PROPERTY TY OWNER
Name )(E■04/e94t L' h rishyv S EW
Address
3-b6 ) 1- j/ Sfi-�t
Home Telephone '
/_51 r7 `../ �J ^, j
l / r7 O�'
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
Address Apt.
Folio Number //— - G 7`� 0050
Description of Work
Lot Block 1 •+�. w S ��
Subdivision
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PB PG
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
Address
Telephone
Fax
City
State
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. Li ' o20 0-4. • / (40 7
Zip
414/ 6 t y / fir S I `
)e ce$
Zoning Linear Ft
Square Feet Units Floors
Value of Work ypd,o-� Bldg Value
Tax Assessed/Appraised Value
Flood Zone —Base Floor Elev.
ENGINEER
Name
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTEC1bD FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement m i a POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village on Construction Lien Law and
Choosing a Contractor.
STATE OF FtORIDA OUNT OF MIAMI-DADE
Signature of Owner
Print Name
Sworn to and subscribed before me this day of
SEAL:
IQ tot G(\rtS-k .
Signature of Notary Pubic - State of Florida
!a Cltr
ALBA.GAONA
tRY PUBLIC STATE OF FLORIDA
COMMISSION NO. OC i
Personally known _ uT�lli ,°
ST.
Print Name �},/�
S�yom end subscribed before me this rT v day of
Signature
• r� • UNTY OF MIAMI -DADE
. on
of Notary Public - State of Florida
SEAL: C IA- NO Aff
ALBA.GAONA
"4r0slitY PUBLIC SLATECW PIAMA V
GOMMESION NO. COMM
Personally
PERMIT APPLICATION
asommilagvgioni
cation
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TN PE
Minimum Fee
QTY.
'I'YPI:
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE.
Service Repair
QTY.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Recovery .
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar(f /
frigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. '11 PE QT Y.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY
TYPE
Drains, Roof
QTY.
TYPI,
Miscellaneous Fixture
QTY
TYPE
Soakage Pit
QTR,
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory -
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French - k, , -
; ;.
'Miscellaneous;Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CIIECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$
r
$ ;1
Metropolitan Dade County (C.C.F.) $ , 6 a ( sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
75
TOTAL $
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
ISSUING OFFICIAL
DATE: W,. ' J`9Ce��
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL m (305) 795 -2207 o FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: EL2002 -169
Printed. 5/24/2002 Page 1 of 1
Applicant: THERESA IMBURGIA
Owner: IMBURGIA THERESA
JOB ADDRESS: 506 NE 91 ST
Contractor ADT SECURITY SERVICES INC
Local Phone:
Parcel # 1132060400050
Fees: Description Amount
FEE2002 -3006 Building Permit Application Fee $60.00
FEE2002 -3007 CCF • $0.60
Total Fees: $60.60
Permit Status:
Work: LOW VOLTAGE BURGLAR ALARM SYSTEM 1 MASTER 6 DEVICES
Signed
Electrical Permit
Contractor's Address: 7747 NW 48 ST 160
Legal Description: PARK MANOR HOMES PB 86 -52 LOT 5 BLK 1 LOT SIZE 7088
Approved Permit Expiration: 11/20/2002 Construction Value:
$400.00
Total Fees: $60.60
Total Receipts: $0.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents. servants or employees.
4 5 ECTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
TOWN #
DEPARTMENT
AMOUNT
MARK
X) ONE
OR
OTHER
REST INST
COMM INST
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031699 09 C t 8ranchpayt9 1 - (800) 444-6899 Another service of Gelco Information Network, Inc. Eden Prairie, MN
26696000 05
BRANCHPAY
Security
Services, Inc.
For Permits
and Licenses Only
PAYABLE THROUGH 64 -1278
NATIONS BANK OF GEORGIA, N.A.
ATLANTA, DEKALB COUNTY, GEORGIA 611
TOTAL 6j 0 0 �
PAY TO THE
ORDER OF
•.GiM.f 110 e U1 �lrt�l
(NAME) (PAYEE)
(ADDRESS)
( lU
AMOUNT OF 2 1, -1 fri0
NOT 0006 FOR MORE THAN $250.00
SIGNATURE OF DRAWER'S AUTHORIZED REPRESENTATIVE
By signing this instrument, each of the aforesigned confirms that this instrument Inc been drawn in accordance with the authority issued by Gelco Information Network, Inc. 11 any
statement herein be untrue, we, the aforesgned, agree to pay the drawer upon demand the amount of this instrument and aN expenses and damages arising from such misstatement.
11'0 40 208 6 3 2 20 1 :06LL12 ?881: 0 LL 58 24 511'
0402086322
(CITY)
DOLLARS $
NOT VALID AFTER 50 DA05 FROM DA f
(STATE)
NOT REDEEMABLE FOR CASH 80 DRAWERS AUTHORIZED REPRESENTATIVE
•
SOCIAL SECURITY NO.
BP AUTH. NO.
ISSUE DATE
5,
3 -`) / -> Z-S
o 9 2102-
031699 09 C t 8ranchpayt9 1 - (800) 444-6899 Another service of Gelco Information Network, Inc. Eden Prairie, MN
26696000 05
BRANCHPAY
Security
Services, Inc.
For Permits
and Licenses Only
PAYABLE THROUGH 64 -1278
NATIONS BANK OF GEORGIA, N.A.
ATLANTA, DEKALB COUNTY, GEORGIA 611
TOTAL 6j 0 0 �
PAY TO THE
ORDER OF
•.GiM.f 110 e U1 �lrt�l
(NAME) (PAYEE)
(ADDRESS)
( lU
AMOUNT OF 2 1, -1 fri0
NOT 0006 FOR MORE THAN $250.00
SIGNATURE OF DRAWER'S AUTHORIZED REPRESENTATIVE
By signing this instrument, each of the aforesigned confirms that this instrument Inc been drawn in accordance with the authority issued by Gelco Information Network, Inc. 11 any
statement herein be untrue, we, the aforesgned, agree to pay the drawer upon demand the amount of this instrument and aN expenses and damages arising from such misstatement.
11'0 40 208 6 3 2 20 1 :06LL12 ?881: 0 LL 58 24 511'
0402086322
(CITY)
DOLLARS $
NOT VALID AFTER 50 DA05 FROM DA f
(STATE)
NOT REDEEMABLE FOR CASH 80 DRAWERS AUTHORIZED REPRESENTATIVE
•
Chairman
Member
Member
Council Approved
'H MI SHORES VILLAGE - 7
BUILDING INSPECTION DEPARTMENT
APPILLICATG N FOR 4:LN G [DERMOT
0
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
April 20,
Ownsr's Name and Address.. Dan Schmidt No 506 street. N.E . 91 St .
Regiaered Architect and/or Engineer. .
Name and address of licensed contractor. B randon Air Conditioning
Location and legal description of lot to be built on:
Lot Block Subdivision.
Street and Number where work is to be done 506 N.E. 91 St
State work to be done and purpose of building (by floors).
and for no other purpose.
New Building Remodeling Addition Repairs.. No. of Stories
To be constructed of Kind of foundation... Roof Covering..
Estimated Total cost of improvements $ 1 o 00 Amount of Permit $ 8.00
Zone cubage required _Plan Cubage.
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor...
I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent to....G.._coniclin, _Brandon. Conditigning,. 2475 W. 8th Lane, Hialeah
The undersigned applicant for this building permit doe. 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, Pennanent 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, o k to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)...
STATE OF FLORIDA,
COUNTY OF DADE. Ss '
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take a( knowledgments, personally ap-
peared
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 construe ion, that he has carefully read the f regoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No. Date ,S
Read, Sworn to and Subscribed before me.
Disapproved _ .......
Notary Public, State of Florida
( Signed )
Building Inspector T My Commission Expires
PLAN 'INC BOARD.. .. DATE
Member
Member
Member
Disapproved Date
---------- ---------- - -•
Date
Date..
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged 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 2 /
Permit No 1:...� Qd Date ✓ r 7(
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiurida,
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. r//
Owner's Name and Address ...ij4&' // '' . r �.c jif� / 1 No Q
Registered Architect and /or Engineer (_.. //.1� -. 1 . -...../ /�/�.ig
Employing Electrician's Name.. 7Zr, /X44% /e.QF/ ' ./ No.
Location and Legal Description Lot
Block
l
Street and Number where work is to be performed —No
State work to be performed }pd purpose of building (By Floors)
New Building 1 Remodeling Addition
Street ,/4l. ./9/
Street /(/ 4v /17
Subdivision.
Street
Repairs No. of Stories.
Service
Type o
ndergroun
Amount of Permit $
Size Feeders. Conduit , / 4.Main Sw Amps •2 DQ Main Fuses Amps
n— Conduit Tubing B.X.L Metal Moulding
i1e76.4 .. .... ... (Signed) 4 . c , C
1 2ca1 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 sucl u tc notice or notices
as are required by the Act. The undersigned agrees to employ only such sub•contra¢ tors, Ion worlOto be performed l def' this_ permit, as are
licensed by Miami Shores Village. // / ,
(Signed)
Master Electrician.
STATE OF FLORIDA,
COUNTY OF DADE. I ea'
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
LIGHT
OUTLETS
PLUG
RECE'P'T'8
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
f • . G K
��L
/D D
M TOTAL
,
COIET
LIST
S---
/
/
I/ DD
!/ /
6
Z.CD
CHECK
�I
� e
/�/�
/ /DD
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
NEON
TRANS.
RADIO
TOTAL
IST
C LIsr
L
/
/a/
3/DV
/
2
_ , )
1
2 // /�
.. d
�%'//
il4
CHECK
•
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT 2 /
Permit No 1:...� Qd Date ✓ r 7(
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiurida,
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. r//
Owner's Name and Address ...ij4&' // '' . r �.c jif� / 1 No Q
Registered Architect and /or Engineer (_.. //.1� -. 1 . -...../ /�/�.ig
Employing Electrician's Name.. 7Zr, /X44% /e.QF/ ' ./ No.
Location and Legal Description Lot
Block
l
Street and Number where work is to be performed —No
State work to be performed }pd purpose of building (By Floors)
New Building 1 Remodeling Addition
Street ,/4l. ./9/
Street /(/ 4v /17
Subdivision.
Street
Repairs No. of Stories.
Service
Type o
ndergroun
Amount of Permit $
Size Feeders. Conduit , / 4.Main Sw Amps •2 DQ Main Fuses Amps
n— Conduit Tubing B.X.L Metal Moulding
i1e76.4 .. .... ... (Signed) 4 . c , C
1 2ca1 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 sucl u tc notice or notices
as are required by the Act. The undersigned agrees to employ only such sub•contra¢ tors, Ion worlOto be performed l def' this_ permit, as are
licensed by Miami Shores Village. // / ,
(Signed)
Master Electrician.
STATE OF FLORIDA,
COUNTY OF DADE. I ea'
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
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
1 al Time
Type Insp'n 1 a e4 4 -
2®O.2r //
Date
Permit No.
Name
Address Sob /41 7� 5
Compan /'7 DT ci-
Phone #
For Inspector: [ / 2
Approved
Correction
Re- Insp'n Fee
ea.,/ eiviita4kiiii
��- ir� / 7
/2
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 6- Time
Time
Type Insp'n
Permit No. // 02.0D) /l /
7
Name t �61AL4 6 l
Address 556 /V € 9/ 5/
Company '4 P r cu
Phone # 10' 33 / - 3 y2
For Inspector. 6' /fir- Name D ate' \
Approved Ti '
Correction ❑ /3 J oe-s 2_
Re- Insp'n Fee ❑