ELECTRICALDate f 61 d / Job ddre s / q X7 Tax Folio
Legal Description Historically Designated: Yes No
vner/Lessee / Tenant J n Vt ✓✓
1 6wner's Address j3 L ) 9 �' E 6 2 3 $ / Phone 7 3 () a `i /1 2-
Contractin: _ :� 'f �_ Address , V . E. 1 1 4- Sf
Qualifier akA R dsevi ss# 'hone/'7 73
Ins. Co.214. r j C.!
/ r
State # C2 f// 0 Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDINCCITICTRICAL,TPLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
? ep a C k l (�4 eA1/i 0/1 Yl evJ .0 Q( Yx p
J
WORK DESCRIPTION'
f
Estimated Cost (value)
/ 1Y\ a
Square Ft.
Si
My Commissio
APPROVED:
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construe ion and zoning. Furthermore, I authorize the above -named contractor to do rk stated.
and/or Condo President 6/0)
do President I'Sate
OF D•∎.
eee ANC.
� o
' OF f\-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
Master Permit # 44g9- q
or>
/ /116
4 'o/
Si Sr► ature of Contractor or Owner - Builder e
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
FEES: PERMIT 'l RADON C.C.F. NOTARY S•_ 0 3 BOND �D
TOTAL DUE 6
Zoning Building Electrical�'!� 7 � / 6/4/1,e__ C'/
Mechanical Plumbing Structural Engineer
ITEM
3ATH TIB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
3IDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
y/
DUCT WORK
=LOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
3REASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
.AVATORY
OVEN
ABOVE (MOUND TANKS
.AUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
:LOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
;MOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
;INK, POT /3 COMP.
MOTCRS OVER 3- 5 If
MECHANICAL VENTILATION
;INK, RESIDENCE
MOTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
:INK, SLOP
MOTCRS OVER 8- 10 HP
ELEVATORS/ESCALATORS
EI+IPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
RINAL
PATER
MOTORS OVER 25-100 HP
COOLING TOWERS
CLOSET
MOTORS OVER 100 HP
VIOLATION
MDIRECT WASTES
A/C WINDOW
REINSPECT ION
ATER 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 COWERCIAL
WATER SERVICE
_
SIGN TUBES
:WER CONNECTIONS
SIGN TRANSFORMERS
ILITY -SEWER •
SIGN TIME CLOCK
ILITY -WATER
FIXTURES
PTIC TANK
ANTENNA
LAY
TELEVISION OUTLETS
AINFIELD, 4' TILE/RES.
VIOLATION
P & ABANDON SEPTIC TANK
REINSPECTION
WAGE PIT CU. FT.
FCH BASIN
CHARGE WELL
.
{ESTIC WELL
=A DRAIN
)F INLET
.AR WATER HEATER
.E STANDPIPE
IL PIPING
N SPRINKLER SYSTEM
RANGE
ER SET (GAS)
PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
(NAP LOOP
I - 0 BE 10'
AFG (MIN)
•' 6' •ri'-
I:L.u1P
I. • -•
2' AIIOVE ROOF
•
•
c04A
E
a- PIAS 11C
FIAT TIED (RAVE
r' 1O(MI ;
auamao '—
•
1 ^NC sL.EC
11'0' MN 1IEJ'T11
•
•
14 Nis-ii
2
T M II »1•
la-■ 11'
SUB C e
i
PANEL
PER
• ,CONTRAg
7
K1:3Lk IV /'•
.1-Icialvt: _16
Conductor sl•Lr
Condul stze
Condi41 - type -
Thru roof
11MIN. DIS Y01NUECT
Rafinp
Sub ?3rlQlrer 1
•
1
PIO
Ground) wIrc arr.
Anps
,:•_ Amps
SUB FEEDER
New
TYpa
Size
Bond �tze•; • : _
ENS EDE PANEL
Rntino ..x0 A,,bs
Dond Bass _ •1'as - -_Nn
LocV-tbn_G 0 e-
S.F.II.C, 4505 ► 2(1)
v
. 1 4 aZ
S I ONATORE OF CONTRACTOR
NOTARY
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
I A FOR ELECTRICAL PERMIT Q
Permit No 1 d `r-''' Date f -' �l "
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building pr 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. q
Owner's Name and Address �.Q. .. Yds./ /�w- No ? Street eV- ( 3S
Registered Architect and /or Engineer /�—
Employing Electrician's Nam..... y . R.,4 . ' ,t.;, ieppr . .No 3 T Street..
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street ."4. 3 S
State work to be performed and purpose of building (By Floors)
New Building Remodeling '' Addition Repairs No. of Stories
Service Overhead Size Feeders
Underground
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. I
ss.
My Commission Expires
Conduit
Main Sw Amps Main Fuses
Type of Installation — Conduit Tubing B.X.L Metal Moulding
(Signed)
Electrical Inspector.
The undersigned applicant or 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 Electricia
Amps
NOTE: A re- inspection lee 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
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
I�1
J
I % `
SE / RVi�C 1 E
PERM.
MOTORS
0.1 HP
I7',l
MOTORS 7.,,
1.5 HP
/.��
- r.)
TRANS.
RADIO
TOTAL
ENT.
SW.
L/ DIST.
CAL.
SERVICE
TEMP.
CONTR.
LIST
/
/^�
L,
C
s Al w
.` ex)
A s /i >�i
CHECK
/40
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
I A FOR ELECTRICAL PERMIT Q
Permit No 1 d `r-''' Date f -' �l "
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building pr 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. q
Owner's Name and Address �.Q. .. Yds./ /�w- No ? Street eV- ( 3S
Registered Architect and /or Engineer /�—
Employing Electrician's Nam..... y . R.,4 . ' ,t.;, ieppr . .No 3 T Street..
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street ."4. 3 S
State work to be performed and purpose of building (By Floors)
New Building Remodeling '' Addition Repairs No. of Stories
Service Overhead Size Feeders
Underground
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. I
ss.
My Commission Expires
Conduit
Main Sw Amps Main Fuses
Type of Installation — Conduit Tubing B.X.L Metal Moulding
(Signed)
Electrical Inspector.
The undersigned applicant or 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 Electricia
Amps
NOTE: A re- inspection lee 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
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
❑ DATE 1 if • ,.. 195_
(i(` PERMIT 'N° 13426 Contractor's
❑ License No
❑ Work to be performed under this Permit
Lot
II BL
114i . ..) C c
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 authorisation. A further condition upon which this pbnk s
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ord;aanaa and
responsibility t Stitldoss
pertaining to the work covered hereby whether shown on the plans or drawings o� in the statements or specifications and that assumes ffor work
done by his agents, servants or employees.
Signed.
In consideration of the issuance to me of this permit I agree to perfo
pertaining thereto and in strict conformity with the plans, drawings, statements
In accepting this permit I assume responsibility for all work done by either,
NTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
BY
Amt. of
Permit
i
the work covered hereunder in compliance with all ordinances and regulations
or specifications submitted to the proper authorities of Miami Shores Village.
self, my agent, sery ant or employee. -
BY AUTPIOBIT!
3
Permit No 1 7 / 4-> / Z
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 ✓! �o ' - S *`
Registered Architect and /or Engineer
Employing Electrician's Name 441 te. F f4- ■ No rz 9 Street.... % 4 "
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 3 V,
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit
Underground
Type of Installation— Condui' Tubing
Amount of Permit $
SS.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Main Sw Amps Main Fuses Amps
B.X.L Metal Moulding
(Signed) ��V — �..L
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contracto
work to be performed under tais permit; and will post or cause to be posted for inspection on the site of the work
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performe
licensed by Miami Shores Village.
(Signed).
No Street it' G.:. 3 f p
Street......./..a/ •; . d' 3 j7,
ctrieal Inspector.
ons as an employer of
nent Supplement, and
mployed by him in the
public notice or notices
under this permit, as are
th
aster Electrician.
STATE OF FLORIDA, t
COUNTY OF DADE. I
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•inT ection 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
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
M OTORS
0.1 HP
MOTORS
1•5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
1
CHECK
3
Permit No 1 7 / 4-> / Z
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 ✓! �o ' - S *`
Registered Architect and /or Engineer
Employing Electrician's Name 441 te. F f4- ■ No rz 9 Street.... % 4 "
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 3 V,
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit
Underground
Type of Installation— Condui' Tubing
Amount of Permit $
SS.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Main Sw Amps Main Fuses Amps
B.X.L Metal Moulding
(Signed) ��V — �..L
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contracto
work to be performed under tais permit; and will post or cause to be posted for inspection on the site of the work
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performe
licensed by Miami Shores Village.
(Signed).
No Street it' G.:. 3 f p
Street......./..a/ •; . d' 3 j7,
ctrieal Inspector.
ons as an employer of
nent Supplement, and
mployed by him in the
public notice or notices
under this permit, as are
th
aster Electrician.
STATE OF FLORIDA, t
COUNTY OF DADE. I
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•inT ection 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.
-
Amount of Permit $
STATE OP FLORIDA,
COUNTY OF DADE. I �''
MIAMI SHORES VILLAGE
f
ELECTRICAL INSPECTION DEPARTMENT
" (APPLICATION FOR ELECTRICAL PERMIT
lr ,,
Permit No V f? it
structure herein described. his application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fludda,
di
Application is hereby ma fo'r the approval of the detailed statement of the plans and specifications herewith aubmitted for the building ot other
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.
Registered Architect and /or Engineer f
Employing Electrician's Name 6 '� n e / ` ie f N Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 3 t4-7,--e 3 Street
' ON/"" A(4— l eifc ice_—,
State work to be performed ar_d purpose of building (By Floors)... Le _ C< c
— 2 (Signed)
(Signed)
Date...
7 Z
New Building Remodeling ✓ Addition Repairs No. of Stories
Se rvice Overhead Size Feeders Conduit Main Sw Am s Main Fuses Am s
Underground P p
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his q gations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent 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 pee • - d under this permit, as are
licensed by Miami Shores Village.
1
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
REC P'T'S
— C-
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. H EAT.
CONN.
SPACE
H EATER
STRIP
HEATER
a*4
TOTAL
LIST CL r
\
{.
1
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
-
Amount of Permit $
STATE OP FLORIDA,
COUNTY OF DADE. I �''
MIAMI SHORES VILLAGE
f
ELECTRICAL INSPECTION DEPARTMENT
" (APPLICATION FOR ELECTRICAL PERMIT
lr ,,
Permit No V f? it
structure herein described. his application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fludda,
di
Application is hereby ma fo'r the approval of the detailed statement of the plans and specifications herewith aubmitted for the building ot other
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.
Registered Architect and /or Engineer f
Employing Electrician's Name 6 '� n e / ` ie f N Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 3 t4-7,--e 3 Street
' ON/"" A(4— l eifc ice_—,
State work to be performed ar_d purpose of building (By Floors)... Le _ C< c
— 2 (Signed)
(Signed)
Date...
7 Z
New Building Remodeling ✓ Addition Repairs No. of Stories
Se rvice Overhead Size Feeders Conduit Main Sw Am s Main Fuses Am s
Underground P p
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his q gations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent 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 pee • - d under this permit, as are
licensed by Miami Shores Village.
1
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.
ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your Certificate of Approval, application is hereby made for an inspection of the electrical installa-
tion in the premises stated below, for which the undersigned agrees to correct any infractions of the National
Electrical Code and the City Rules pointed out by Inspector.
LO CATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION.
ALL SPACES MUST BE OR APPLIC4TION WILL BE RETURNED. `
•
Lot Number Block Number L' " ,re
Street and Number Side
Owner / Occupant
Occupied as
Building —New or Old (underline which).
FLOOR
Basement
lst Floor
2d Floor
3d Floor
4th Floor
5th Floor
6th Floor
7th Floor
8th Floor
"'Attic
NUMBER OF
LIGHTS
Received by Inspector
CERTIFICATES
Progress
Will inspect again
Rough Wiring'
FINAL 1 No
Corrected
Temporary Days
Approved Letter
Date Issued
Time
Allowed:
FOR FIXTURE WORK ONLY
CEILING OUTLETS
REMARKS
Work will be started__
(Applicant sign here)L "/
CorreLt`Lecation
Correct Equipment
DEFECTIVE
APPLICATION No. 2
Date , 192
Days
Work — Additional or New (underline which).
SPECIFICATIONS
r., ti+
Electric Light Co,
BRACKET OUTLETS
will be finished
Address f' (�
Street
SPACE BELOW FOR INSPECTOR'S USN O,NLY
,t/ — . 9 Inspected (°
NUMBER OF CIRCUITS
y
ti i (:... — Lu /u n.kil _ '^ t•+tr
J
r 1
�, , r Z
Fee remitted , ,
Remarks ( � YL -
„Inspector