ELECTRICALBUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE, FLORIDA
Lit DATE__V- 7 195
❑ PERMIT N? _ 4 Contractors J
❑ License No. 111
❑ Work to be performed under this Permit
Owner of 1
Building i.'") - l t y -
Architect
Contractor ,•
or Builder
Legal Lot
Description Bl
Address of
; uilding f 2 1 - 1 2
// .
This permit is granted to the contractor or builder named above to construc 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
,ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifitfians and that he assumes responsibility for work
lone by his agents, servants or employees.
Signed ( . � it lee
INSPECTOR
z r�.� . z d • • .3 J / Z
Subdi-
vision
Value of I I Amount of
Project $ I Permit $ 7 )
In consideration of the issuance to me of this permit I agree to perform the work cover 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 ac-
epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY 6 .
UILDING
:LECTRICAL
LUMBING
- OOFING
)wner of
uilding ' r.
rchitect
ontractor
Builder
egal Lot
.escription C 4.
ddress of
wilding
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 3953
0
r„
CONTRACTOR OR BUILDER '
Work to be performed under this Permit
Bl
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
zrefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ue 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
anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and eons
ataining to the work covered hereby whether shown on the plans or drawings or in the statements or - • - i 'cations and that he assumes responsibility f work
me by his agents, servants or employees.
Signed. tN
INSPECTOR
BY
Subdi-
vision
a.L
Value of
Project $
DATE 4- 195
Contractor's
License No.
3
Amount of
Permit $
BY
In consideration of the issuance to me of this permit I agree to perform the work co red hereunder in compliance with all ordinances and regulations
ortaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
-pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY 44€110°
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No 10043° Date !' - 8 S
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, Fiu:ida,
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 plane and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
// t3 � D ame. .IIS� 4....(,,L...P...C-
' Loeauon anH Legal Description Lot... 1 II
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Service Overhead
Underground Size Feeders Conduit
Type of Insall ' — Conduit f000PTubing
E...t�. t L.r
STATE OF FLORIDA,
COUNTY OF DADE. J j 88.
/66--17 7
MIAMI SHORES VILLAGE
R.. od..s No 1t .
/5.0 /i?L[AU
/AiG
Block 6 .S'
No 73.S
Street 1J GU
Subdivision...
Street - .. ./.11,x... 7.3
Repairs / No. of Stories
Main Sw Amps Main Fuses
B.X.L .Metal Moulding
E / L —
�r� CA
(Signed)
Amount of Permit $
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 wo to be performed u this permit, as are
licensed by Miami Shores Village.
Before me the undersigned authority, a notary public, duly authorized to administer oaths
appeared f .4 h ...L. � .Q./� ... .
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 carefullr'ttitd the foregoing application, and that he
therein by him stated are mflY pat lc ft*fl !
MY COMMISSION UP. Ai NAM
011111) (1..IHRU.LEIEAAL WO.
My Commission Expires
NOTE: A re-inspection fee of $1.00 will be made when such re•insp. -.on is made necessary by impro
materials and /or workmanship.
and take acknowledgments, personally
Amps
did sign the same, and that all facts
orida
for inspection, or faulty
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO LAMPS
REPRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H
W. HEAT.
CONN.
SPACE
H
STRIP
H
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Q ter--
1 ,/iv(
�-�'C
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No 10043° Date !' - 8 S
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, Fiu:ida,
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 plane and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
// t3 � D ame. .IIS� 4....(,,L...P...C-
' Loeauon anH Legal Description Lot... 1 II
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Service Overhead
Underground Size Feeders Conduit
Type of Insall ' — Conduit f000PTubing
E...t�. t L.r
STATE OF FLORIDA,
COUNTY OF DADE. J j 88.
/66--17 7
MIAMI SHORES VILLAGE
R.. od..s No 1t .
/5.0 /i?L[AU
/AiG
Block 6 .S'
No 73.S
Street 1J GU
Subdivision...
Street - .. ./.11,x... 7.3
Repairs / No. of Stories
Main Sw Amps Main Fuses
B.X.L .Metal Moulding
E / L —
�r� CA
(Signed)
Amount of Permit $
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 wo to be performed u this permit, as are
licensed by Miami Shores Village.
Before me the undersigned authority, a notary public, duly authorized to administer oaths
appeared f .4 h ...L. � .Q./� ... .
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 carefullr'ttitd the foregoing application, and that he
therein by him stated are mflY pat lc ft*fl !
MY COMMISSION UP. Ai NAM
011111) (1..IHRU.LEIEAAL WO.
My Commission Expires
NOTE: A re-inspection fee of $1.00 will be made when such re•insp. -.on is made necessary by impro
materials and /or workmanship.
and take acknowledgments, personally
Amps
did sign the same, and that all facts
orida
for inspection, or faulty
Village of Miami Shores
JOB
4 - 4 , 4
ADDRESS 4 :ell
INSPECTION b tr
REMARKS P
?
TIME READY
N? 4736
)1474 f
INSPECTOR 4 !' DATE
Permit No 11 '" 7
Amount of Permit $
ss.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith st'ibmitted 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 ® ®'® No ir / s'� • Street 9C •1
Registered Architect and /or Engineer G / ' - l
Employing Electrician's Nam c; T ®y / No �l.Q.. (Q Street of S _
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
(Signed)
(Signed)
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
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 bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo t 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.
/0
STATE OF FLORIDA, l
COUNTY OF DADE. I j
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.
‘ 0
Notary Public, State of Florida
Master Electrician.
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
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
BRACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
U
CHECK
Permit No 11 '" 7
Amount of Permit $
ss.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith st'ibmitted 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 ® ®'® No ir / s'� • Street 9C •1
Registered Architect and /or Engineer G / ' - l
Employing Electrician's Nam c; T ®y / No �l.Q.. (Q Street of S _
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
(Signed)
(Signed)
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
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 bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo t 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.
/0
STATE OF FLORIDA, l
COUNTY OF DADE. I j
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.
‘ 0
Notary Public, State of Florida
Master Electrician.
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
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No S Date , 1/4 /
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.
LJ oo I�
Owner's Name and Address � F � � �� No Street
Registered Architect and /or Engineer
Employing Electrician's Name No Street
Location and Legal Description Lot r C? � Block Subdivision , .. A ...
Street and Number where work is to be performed —No s A ' 4:` Street
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
Amount of Permit S
My Commission Expires
(Signed)
(Signed)
•
w
Electrical nspector.
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 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.
Notary Public, State of Florida
Master Electrician.
STATE OF FLORIDA, '!
COUNTY OF DADE. I ss.
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.
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
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
H ATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
015T.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.13 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
V
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No S Date , 1/4 /
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.
LJ oo I�
Owner's Name and Address � F � � �� No Street
Registered Architect and /or Engineer
Employing Electrician's Name No Street
Location and Legal Description Lot r C? � Block Subdivision , .. A ...
Street and Number where work is to be performed —No s A ' 4:` Street
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
Amount of Permit S
My Commission Expires
(Signed)
(Signed)
•
w
Electrical nspector.
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 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.
Notary Public, State of Florida
Master Electrician.
STATE OF FLORIDA, '!
COUNTY OF DADE. I ss.
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.
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.
/ '.
Owner's Name and Address
Registered Architect and /or Ejneer
Amount of Permit $ /7' 7 r
Bd.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
/ APPLICATION FOR ELECTRICAL PERMIT
Permit No ! Z/ Date `.0
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.
Employing Electrician's Name --\ r AI 1 f l>-' t / / ma c- r ic Ca ° Street ' � ' ¢
Location and Legal Description Lot Block Subdivision
ra
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building
Remodeling Addition
Service Und rground Size Feeders Conduit / 2— Main Sw / .0 A
° No Street
(Signed)
" ' ° Street
Repairs
Type of Installation— Conduit Tubing i° B.X.L Metal Moulding
Amps .Main Fuses Amps
(Signed). (
No. of Stories
Electrical Inspector.
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 subcontractors, on work to
licensed by Miami Shores Village.
ccepts his obligations as an employer of
of Florida Permanent Supplement; and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
;' Master Electrician.
STATE OF FLORIDA, l
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•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.
ACC
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/ /
/ %
/ �
/ L/
/
/
'/
I"
� €' 'A�
6� -
• y
✓'.
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
1
f
CHECK
/ '.
Owner's Name and Address
Registered Architect and /or Ejneer
Amount of Permit $ /7' 7 r
Bd.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
/ APPLICATION FOR ELECTRICAL PERMIT
Permit No ! Z/ Date `.0
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.
Employing Electrician's Name --\ r AI 1 f l>-' t / / ma c- r ic Ca ° Street ' � ' ¢
Location and Legal Description Lot Block Subdivision
ra
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building
Remodeling Addition
Service Und rground Size Feeders Conduit / 2— Main Sw / .0 A
° No Street
(Signed)
" ' ° Street
Repairs
Type of Installation— Conduit Tubing i° B.X.L Metal Moulding
Amps .Main Fuses Amps
(Signed). (
No. of Stories
Electrical Inspector.
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 subcontractors, on work to
licensed by Miami Shores Village.
ccepts his obligations as an employer of
of Florida Permanent Supplement; and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
;' Master Electrician.
STATE OF FLORIDA, l
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•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.