ELECTRICALOwner's Name and Address
Registered Architect and /or Eng
G
Employing Electrician's Name Z'
New Building
STATE OP FLORIDA, 1
COUNTY OF DADE. I
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
CC) APPLICATION FOR ELECTRICAL PERMIT
Permit No 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.
-v nre
No Street
/.... ° t No. 6 e) Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 12-60 1 n.ts r.. :.. 9,
State work to be performed and purpose of building (By Floors)
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
Amount of Permit $ (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) ;� - , 'r�v2
Street
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
OTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
ma rials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
Q2,=
i �
CHECK
�
y�
1 e ,t ^.
,e
f ,
✓ � °'l
i •
-
ENT.
SW.
DIST.
CAB.
- ERVICE
TEMP.
SERVICE
PERM.
7
MOTORS
0.1 HP
MOTORS
1•3 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Owner's Name and Address
Registered Architect and /or Eng
G
Employing Electrician's Name Z'
New Building
STATE OP FLORIDA, 1
COUNTY OF DADE. I
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
CC) APPLICATION FOR ELECTRICAL PERMIT
Permit No 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.
-v nre
No Street
/.... ° t No. 6 e) Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 12-60 1 n.ts r.. :.. 9,
State work to be performed and purpose of building (By Floors)
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
Amount of Permit $ (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) ;� - , 'r�v2
Street
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
OTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
ma rials and /or workmanship.
Date / if
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / Z (0.0 N e 9 3
Legal Description % CZ
Owner / Lessee / Tenant 2 S
Owner's Address /oUp 79 6
Contracting Co . 4 ( cd»,") d Address / 2(,/ \".L
Qualifier IA)/ (CZ(1 A - Phone L� — . 6
I J 7.4-f
State W; # Competency ilk FY?J Ins. . 4C-i 1 ' c J
S --i /j '
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN ELEC RIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION c3 /cp C `
hi 9 bn-t_A_Auv,__
Square Ft. Estimated Cost(value)
' -- 4P�
Notary as to Owner and /or Condo President
My Commission Expires:
** * * �/-* * *
�t r1
Tax Folio / / - 2 me
Master Permit # ✓ Pg %
Phone
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 and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Sign.' ure of C ntractor or Owner . ' der
Date: Date: 5// 2/0
Notary as to Contractor or Owner- Builder
My Commission Expire PB9L1t stem 4F F
Y
CCIVISS1011 EXP. FE9.17,1995
3ONOFD THRU GEVER L 115, URN
* * * * * * * I **
FEES: PERMIT -Y RADON C.C.F. NOTARY TOTAL DU
APPROVED: Fire Other
Zoning Buildin
Mechanical Plumbing Engineering