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560 NE 93 St (7)PROPERTY OWNER PI 11 0l1� `t Pc y givkecon Address 5 Co N E X13 S + , Aram S kores , 3 Home Telephone (30 SIl C O' 3 SCQ Business Telephone (?)0 S I ! � r , , _ 4 1 8 i 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'! 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 submitted 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. APPL ICATION Job Address: Address Apt. Folio Number I I 3k 04 0 L /06n Description of Work LU t!l dO (dos + S h M f rs f'Y`Pi\C \ G(oo NE g3s Lo 7v Block Subdivisions n .t- � PB PG7 Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX oofing Fence Other Zoning Linear Feet Sgpare Feet Units Floors Value of Work Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No �9 Subsidiary Permit o, d a PERMIT APPLICATION Or1ici A � Shp R 3313g City V 1 State Zip ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES I. 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 PROTECTED 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 must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. t X Print Name /� _ /� Print Name SEAL: to and subscribed before me this gna' a •J otary ' bli - tate . Flo da_ Signature of Notary Public - State of Florida y PU ae ANC ::!..A NI pcCii''W � �� "r 'n cros s= ora auc:�en SEAL: i.'-,- , , = ':, , CC703E 1I .• C3' :av co: .: , ".1:.T 3 n ,Cli 7 Personally known • ' OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced:t ) v �b'S Li n ` r PS ' 5 LcO STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Sworn to and subscribed before me this day of PERMIT APPLICATION Type of Identification Produced: I'1 IPl. Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance Q TYPE Service Repair Q I'a1! A/C Central 1 -3 Ton Fan Outlet, Wall - Heating Strips, each Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch - Paint Booth Signs A/C Central 8-15 Ton Fixture - Fluorescent Oven - Piping, Flammable Liquid Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Process/Pressure Piping Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Pressure Vessel 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 Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Utility - Sewer Demolition Low -volt, Intercom/Teleph. Repair Circuits Pump, Sump Dishwasher Low -volt, Television - Service, Number of Amps Indirect Wastes , MCCHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. "NIT Refrigeration, Tons Q "Illli,: A/C Central, Tons Q l 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 Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance ''I Y I'1: A/C Condensate Q I 1 I YI'E Drains, Roof QTY I YI'P Miscellaneous Fixture Q I 1 I YI'1. Soakage Pit Q l 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 Miscellaneous Equipment Sink Well, Supply ..$ ; 3 : '#r'i.i` R. 4 it _f. :I; i l 1 n I xvista,A 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 CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ U 0 REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE sk), o d 2,1,,ttt iFeso,00 (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONTRACTO N �- /_ ` ame7' ,0.30/4 f; I Q n-ic?1/ P %r _r-pc) C License No. 74 - 000 CD — Address 3S S° u) ¢ s� a F4 33/3 Telephone 44 g 3 _ F cj e Fax U (.f Qualifier Name 114 / kJ D G ...- 2._ Q (.A-< I xi , PROPERTY OWNER • - %'=Y 1P u Name 2 4 „V it Address Cr 9 "epair H7V0eIephone7 5 (3L Demolish sassinnTT2 / j_ C C 0 i at c� .z Relocation of Structure Fax Foundation Only OF MANAGEMENT (I ) New Construction Enclosure Alteration Exterior "epair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l ') etachment Other Eli t 1 Slli ffi1aa „ ~Ti , ai lkfc - "T follo��t js teps•n st'be' ak en o obta n peanut from the n.Thami Shores Villa r M P 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 submitted 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. Apt. 3 Folio Number Lot�A, Z 30 Block 5 Subdivisio PB Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (r1 ) Building Electrical Mechanical Plumbing LPGX oafing Fence Other �0 PERMIT CHANGE ( ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. (4 S 3 Subsidiary Permit No. (� State Zip Description of Work � �-°..trc0�lL �{/ T--�a (� e 4611 City Zoning Linear Feet Square Feet Units Floors Value of Work Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 I NIPORTANi' 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 PROTECTED 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 must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STAT gnature of N SEAL: Y OF MIAMI -DADE gnature of Owner T e( I Print Name A , ' / Sw y to and subscribed before me this -t96 day of ! o V , orida O.F:CWLLO t )4::YS'.AL Gam" Ps 'ee , ANGELA 14 BECKER 2 �l (,i 0 eoty„JtSiOu NUMBS a Q CC786697 ' NO MY CO:.3 +Aa`::OP..'K? r `� U CF 0 BC,t. S ,"' : ' 11 Idend Scation STATE F FLOR DA, UNTY OF MIAMI -DADE Signature of Contracttr Print Name Sworn to and subscribed before me this 3 day of /U6 ? —QO &4( .i-6 alifier PERMIT APPLICATION - R, Pro�aced Personally known f i i ,, � • Personally known OR, Produced Identification Type of Identification Produce ` t / 42 5 ' t1,2 '& 2 9 1-6 � Type of Identification Produced: F t Page 4 OFFICE USE ONLY iaTIM ® OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi- family) • CONCURRENCY (New Construction) U OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ® PROOF OF OWNERSHIP (Attach) • HRS / DERM APPROVAL (Septic / Sewer) U IMPACT FEE (New Construction) U OTHER (Specify & Attach) $ - (sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) $ (0.01 /sq.ft.) 1 O V REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ID CONDO ASSOCIATION APPROVAL (Attach) • BPR APPROVAL (Restaurants) U CONTRACTOR REGISTRATION (On File) 9ERMlT FEES TOTAL $ 3, ce ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL 'I'YI'li Minimum Fee QTY. 'l'Yl'E Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan 1 Outlet, Wall Bath Tub Service, Temporary - Paint Booth A/C Central 4 -7 Ton Miscellaneous Repairs Fire Pump Solar Water Heater Outlet, Switch A5 Signs Filter Replace A/C Central 8 -15 Ton Pool Piping Fixture - Fluorescent Process/Pressure Piping Oven A S , Cap - Fixture Space Heater (kw) Fountain A/C Central 16-20 Ton Pressure Vessel Fixture Light vi Parking Lot Lights Cap - Water Spas/Hot Tubs Gas - Appliance A/C Central 20+ Ton Pump, Domestic Flood Lights Supply, AC Well Plugmold/Strip Cap - Sewer Subfeeds, No. of Amps Gas - Natural A/C Window Pump, Fire Stand FPL - Load Central Temporary Toilet Posts Catch Basin Swim Pool, Commercial Gas - Propane Air Conditioners Pump, Re- circulate Garbage Disposal Temporary Water Closet Range/Range Top / Swim Pool, Residential Gas Piping Chiller Pump, Replace - Pool Generators, etc. Urinal Receptacles Dental Chair Switchboards Grease Trap Clear Violations Pump, Sprinkler Heat Recovery Utility - Sewer Refrigerator, Comm. (p/PH) Discharge Well Temp Serv., Construction Ice Maker Compactor Pump, Sump Relay Repair Low -volt, Burglar Utility - Water Vacuum Pump Refrigerator, Domestic I Temp for Test - 30 days Indirect Wastes 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 TYI'I. Minimum Fee QTY. TYPE Condensate Drain QTY. TY Generator QTY. 'l'vl'E Refrigeration, Tons QTY. A/C Central, Tons Drains, Roof Cooling Tower Heating Strips, each Vent Hood, Cost Soakage Pit A/C Wall/Win. Tons Bath Tub Dryer Vents, Number of - Paint Booth Ventilation, Cost Miscellaneous Repairs Air Handler, Tons Solar Water Heater Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Filter Replace Barbecue Pool Piping Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fountain Fireplaces, Number of Pressure Vessel Sprinkler System PLUMBING TYPE; QTV TYPE QTY. TYPE QTY. TYPE QTY. A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit 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 Relay Repair Utility - Water Vacuum Pump Dishwasher Indirect Wastes Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tilt es. 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 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: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7 ! 6 - 9 b Address Legal Description 2 Owner/Lessee / Tenant 1. I v /e i` 4 Owner's Address t4,--4.0 / X J=- 3 (7 7' • Phone g r , 1^ :'l / �! ,ter 5 %r'�' C' f . S . Contractin Co. � � Address r D , / Qualifier (/) S v !4 / G I J F� � •� SS# ` ?� Phone ?e, J �� State # .f Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING WORK DESCRIPTION Municipal # Tax Folio Historically Designated: Yes N Master Permit # 3 0 3 3023/ Competency # Ins. Co. Address Address PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Square Ft. Estimated Cost (value) 0('7 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 Date Notary as to Owner and/or Condo President Date My Commission Expires: RADON C.C.F. Signature of Contractor or Owner -B ilder 3 � . 2 - � ' . 4 otary to o act or Owner - Builder y Commission Expires: • OFFICIAL NOTARY SEAL GLADYSIVI LAR NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 12002 APPROVED: Zoning Building Mechanical Plumbing NOTARY Electrica Engineering r BOND TOTAL DUE 4 -/6s 6 Date �� ✓u /, ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS () 5 CENTRAL HEATING DISHWASHER RECEPTACLES 2i) 3.0 A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS rQ /,: . 35 CUCT WORK FLOOR DRAIN SERVICE REPAIR/1ETER 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 FP HOT WATER BOILERS SINK. POT /3 COMP. MOTORS OVER 3- 5 FP MECHANICAL VENTILATION SINK, RESIDENCE MQTCRS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MDTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTCRS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 If VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS -76'145 / 4:45-1 ' A/C UNIT STRIP HEATER • 9 FIRE SPRINKLER GENERATORS TRAtSFRS ' HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL CUTLETS COIRCIAL WATER SERVICE • , SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY - SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA . RELAY TELEVISION OUTLETS _ ORAINFIEI.D, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT W. FT. 1 �''q �� L) / v / /- CATCH BASIN i' DISCHARGE WELL r. 14- (-- / it . DOMESTIC WELL F ,� AREA DRAIN ,i, ' ( . ' ."' ROOF INLET / r / O /' A,•, - ) v / 6e-) SOLAR WATER HEATER ,1 6 r / c, , 'IRE STANDPIPE . 00L PIPING • AWN SPRINKLER SYSTEM AS RANGE "TER SET (GAS) S PIPING (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 ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL State # Date 7-16— ?fob Address X, L /(9 9 ,2 Legal Description , 2 Historically Designated: Yes Owner/Lessee / Tenant - /e ) / L/ 1/`) 14 Master Permit # Phone Owner's Address C ? 3 CS I Contracting Co. )r --i.P ...- P , P 1 $ r � C Qualifier (9 £ 1'f / ( ea rim b f)e, Municipal # Architect/Engineer Bonding Company Mortgagor Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Conunission Expires: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE RADON C.C.F. Tax Folio Address Address y3 v 3 V3023/ C.L, ( S ss# Phone ?O Competency # Ins. Co. Address Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ; 0/4t 6 i )4 - J 2 (r ' Square Ft. Estimated Cost (value) 9 2 d26.7 9 - 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 Contractor or Owner -B ilder Date a� act OFFICIAL NOTARY SEAL GLADYS J VTLLAR PUBUCSTATE OF FUORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. N-1'? 3 otary a to 0 or Owner - Builder y Commission Expires: -- 40 ® /6,r Date BOND TOTAL DUE APPROVED: Zoning Building Electrica Mechanical Plumbing Engineering ITEM BATH TUB UNIT FEE ITEM SW ITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS U 5,g' CENTRAL HEATING DISHWASHER RECEPTACLES 2/) WYJ A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) OR INKING FOINTAIN SERVICE SIZE IN AMPS I _i II - DUCT WORK FLOOR ORAIN SERVICE REPA'RACER CHANGE / REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUM) TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 If STEAM BOILERS SHOWER MOTORS OVER 1- 3 If HOT WATER BO ILERS SINK, POT/3 CORP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 If TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 If ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL MGTCRS OVER 25-100 If COOLING TOWERS WATER CLOSET 1OTCRS OVER 100 If VIOLATION INDIRECT WASTES A/C WINDOW RE INSPECT ION WATER SUPPLY TO: AIR CONDITIONERS -S /c N.$ . / lU A/C UNIT STRIP HEATER 9 FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL ' OUTLETS COt ERC I AL WATER SERVICE • SIGN TUBES SEWER CONNECT SIGN TRANSFORMERS UTILITY -SEWER S IGN TIMIF CLOCK UTILITY -WATER FI XTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS ERA INFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPT IC TANK RE INSPECT ION • SOAKAGE PIT W. FT. �' ,,, , :r., D ( - :,-- CATCH BAS 4 DISCHARGE WELL DOMESTIC WELL . _ P . ` j . AREA GRAIN EIOOF INLET n /At) � i / o b f SOLAR WATER HEATER Re (4 r ,,., , ' IRE STANDPIPE '00L PIPING AWN SPRINKLER SYSTEM AS RANGE 7TER SET (GAS) S PIPING PLUMBING 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.) ELECTRICAL MECHANICAL BUILDING ❑ ELECTRICAL c2 PERMIT N? PLUMBING ❑ ROOFING ❑ Work to be performed under this Permit Owner of Building Architect ontractor or Builder Legal Description Lot Address of Building % , CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. 11434 DATE 195 Contractor's License No Subdi- vision Value of Project $ Amt. of Permit $ ' 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. Signed: INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. BY BY AUTHORITY BUILDING ❑ ELECTRICAL ❑ DATE 195 PLUMBING ❑ PERMIT N? 9674 Contractor's License No ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA BL Subdi- vision Sq. Ft Value of Project $ Amt. of Permit $ 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. Signed • BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 17 BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE, FLORIDA Owner of Building Architect Contractor or Builder Legal Lot Description Bl CONTRACTOR OR BUILDER DATE _` -" 19 PERMIT 6653 Contractor's License No. ❑ Work to be performed under this Permit __„: Subdi- vision Address of Value of Amount of - Building Project $$_ I Permit $ 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed. ` INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complianck 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 ao cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employes. BY AUTHORITY Ali DOT Permit No 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 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT C.4) /7 / 4.4 No 6-6 Street !" Registered Architect and /or Engineer Employing Electrician's Name .. .b j ...(,J ..�,�,.�i Location and Legal Description Lot No.,,! 6 Block , � -�. Street and Number where work is to be performed —No.�o Street � '!l � 1 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 Underground Type of Installation — Conduit Tubing B.X.L Q :� Amount of Permit $ SS. (Signed) Date / /CS � Street.. e'? Subdivision The undersigned applicant for this building permit does hereby certify that he understands and accepts his labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contr work to be performed under this permit; and will post or cause to be posted for inspection on the site of the w as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be perfo licensed by Miami Shores Village. Amps Main Fuses Amps Metal Moulding Electrical Inspector. ligations as an employer of ermanent Supplement, and rs employed by him in the such public notice or notices ed under this permit, as are STATE OF FLORIDA, , l COUNTY OF DADE. I t 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•insrcction 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. seACE H lEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. M OTORS M OTORS 0.1 HP 1•5 HP N EON TRANS. RADIO TOTAL LIST ///7 � V CHECK Permit No 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 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT C.4) /7 / 4.4 No 6-6 Street !" Registered Architect and /or Engineer Employing Electrician's Name .. .b j ...(,J ..�,�,.�i Location and Legal Description Lot No.,,! 6 Block , � -�. Street and Number where work is to be performed —No.�o Street � '!l � 1 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 Underground Type of Installation — Conduit Tubing B.X.L Q :� Amount of Permit $ SS. (Signed) Date / /CS � Street.. e'? Subdivision The undersigned applicant for this building permit does hereby certify that he understands and accepts his labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contr work to be performed under this permit; and will post or cause to be posted for inspection on the site of the w as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be perfo licensed by Miami Shores Village. Amps Main Fuses Amps Metal Moulding Electrical Inspector. ligations as an employer of ermanent Supplement, and rs employed by him in the such public notice or notices ed under this permit, as are STATE OF FLORIDA, , l COUNTY OF DADE. I t 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•insrcction 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. f APPLICATION FOR ELECTRICAL PERMIT Permit No ( &/19- z� Date.../ r ` w2 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 compaied 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._ Employing Electrician's Name Street and Number where work is to be performed —No MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT P ,", ./. e No Street Registered Architect and /or Engineer c•'.L- No Street - - ti • Location and Legal Description Lot Block ' Subdivision Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Sipe Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L .Metal Moulding Amount of Permit $.. The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE I ss. (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be performed under this permit, as are (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. M OTORS 0.1 HP M OTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST v CHECK f APPLICATION FOR ELECTRICAL PERMIT Permit No ( &/19- z� Date.../ r ` w2 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 compaied 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._ Employing Electrician's Name Street and Number where work is to be performed —No MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT P ,", ./. e No Street Registered Architect and /or Engineer c•'.L- No Street - - ti • Location and Legal Description Lot Block ' Subdivision Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Sipe Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L .Metal Moulding Amount of Permit $.. The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE I ss. (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be performed under this permit, as are (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. Permit No Registered Architect and /or Engineer Amount of Permit $ 1 STATE OF FLORIDA, COUNTY OF DADE. 11 SS. MIAMI SHORES VIED :GE i / . Employing Electrician's Name I7 e-4.4 4 Location and Legal Description Lot r Street and Number where work is to be performed —No - N3 (Signed) (Signed) ELECTRICAL INSPECTION DEPARTMENT APPLMAT10N Fi! R ELE TRD AL. PE ' MIT Date .F' F Street No 7Z 2e /f /) Block D NS 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 e No 1f1.. Street Street W Ls CI i Subdivision 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 The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on w t licensed by Miami Shores Village. EIInspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be performed under this permit, as are 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 M OTORS HP N EON TRANS. /�.d RADIO TOTAL CONTR. Pk S /1.S / , CHECK Permit No Registered Architect and /or Engineer Amount of Permit $ 1 STATE OF FLORIDA, COUNTY OF DADE. 11 SS. MIAMI SHORES VIED :GE i / . Employing Electrician's Name I7 e-4.4 4 Location and Legal Description Lot r Street and Number where work is to be performed —No - N3 (Signed) (Signed) ELECTRICAL INSPECTION DEPARTMENT APPLMAT10N Fi! R ELE TRD AL. PE ' MIT Date .F' F Street No 7Z 2e /f /) Block D NS 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 e No 1f1.. Street Street W Ls CI i Subdivision 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 The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on w t licensed by Miami Shores Village. EIInspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be performed under this permit, as are 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.