59 NE 92 St (8)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Reques
Date 11 L U Time
Type Insp'n )-71 Foal Po 0
Permit No. 0 o3-113-.
Name 'li� Iva
Address S ci NsE —1
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
Name & Date
MIAMI SHORES VILLAGE
BUILDING DEPARTME T
305- 795 -2204
Building Inspection Request
Da 1 • Time
Type Insp
Permit N
Name
Address 51 . es
Compan ccc�'
Phone # • 5S—
For Inspect°,
3 2_, 1 03 Name & Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 1 � , `^
Type Insp'n ! > 1,.,1' C) (� j
Permit No. t,\ M /v 1
Time
n &rclinci
Name
Address 5C1 C D— S 4-
Company \ C�
Phone It(, q - 5L-Da
For Inspector: Ni e & Date
Approved ❑ S
Correction I ` '.,‘(
Re- Insp'n Fee 71 '
/ '7'/ 5,/,6'/(-
/3Y4i. fie .tea
S e 4'/ /� `/ ..- l';
Date
Type Insp'n
Permit No.
Name
— Address
Company
Phone #
For Inspector:
Approved
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Re -Insp' n Fee ❑
❑ /7 er /.6-l5
MIAMI SHORES VILLAGE
BUILDING DEPARTME
305- 795 -2204
Building Inspection Requ
Date g laq Time
Type Insp'n itp, CCD1 /SIab Rough Bondi i nQ
�1 `J
Permit No.3 • 11
Name FA nQ
Address 5q N E AOS of
Company V i UI K
Phone # 305 . a3 3 . ga)?
For Inspector: QI
Approved
Correction
Re- Insp'n Fee
Name &Date
Printed: 5/7/2003
Applicant: LANI
Owner: KISILUK
JOB ADDRESS: 59
(4)
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Contractor P Local Phone:
Parcel # 1132060130250
Signe
In consideration of the issuance to me of 11
conformity with the plans, drawings, stateme
done by either myself, my agent, servants 01
Signed:
NE 92
Z OD
8
Electrical Permit
Permit Number: EL2003 -117
KISILUK
LANI
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 17 & 18 BLK 2 LOT SIZE 100.000
1
C. oG
Total Fees: $#):60
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 11/3/2003 Construction Value: $1,000.00
Work: ELECTRIC FOR POOL
PAY
TO THE
ORDER OF
s ec nri7
enhanced A'oc'um.cn7: "g'r b �
\d tai I S
O TECH 2000 ELECTRICAL CONTRACTOR,` INC
8230 NW 168TH ST. `
MIAMI, FL 33016
PH. 305 -505 -5800
� 2�
i Inreramericon Oor
'� 9190 Coral Way
. Miami, Rnride 33165
FOR % E_.
116 000: 501'' s : ?OB? ?691: fl L cnn
DATE 5
00
DOLLARS
63- 8776/2670
CONTRACTOR
Name
Teo _tQ .2000 c
License No. C , C # 07 COO /0‘f
Address
T 30 Pte.' / G' s
Telephone 90.c- ` 5_O lux S 3'0
Qualifier Name
PROPERTY OWNER
New Construction
Name eT o_"'ISZ-
{< ■ 5 I / Yc
Address
�r _
13?.. 20o3
- y‘,3
Home Telephone
Repair
Business Telephone
Alteration Interior
Fax
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: 5 C/ /v E cl -2 $ ieik ( 5 h i p/Z(15
Address
Folio Number Description of Work
Lot
Subdivision PB PG
Current Use of Property JJ�
Proposed Use of Property /Z n, 5 / c>r
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PI
CL AY - 5 2003
Block
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
State
Master Permit No. B P- .260 3 — L/6 3
Subsidiary Permit No. (7 A • 1 t 2
Bldg Value
PERMIT APPLICATION
Zip
/1)(' °
Zoning Linear Feet
Square Feet Units Floors
Value of Work f) (0C—)
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
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, P 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.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
STA
igna a of Contractor / Qualifier
Print Name
orn to d subscribed before ,. this day of /
gnature of Notary Public - State of Flori
SEAL:
Personally known
PERMIT APPLICATION
COdAtNtatialaosER
IAMI- ADE
Type of Identification Produced:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CIIECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ FIRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
Metropolitan Dade County (C.C.F.) ( sq.ft. = x/l000
x ¢.60)
Inspector State Educational Fund $ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
CONDITION OFAPPRO\AL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
7
Minimum Fee
Q
. 1 . 1 , 1'1:
Dryer
QTY
TYPE
Outlet, Appliance
QT1
TYPE
Service Repair
QT1'
AJC Central 1 -3 Ton fr -�j
g41-
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
/
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
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
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
1VIECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
T1TE
Generator
()Ty.
TYPE
Refrigeration, Tons
QTV.
AJC Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUNIBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
Tl'1'1»;
Miscellaneous Fixture
()Ty.
TYPE
Soakage Pit
()TN.
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
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 No,//
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subfrfitted 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 C/L. No Street
Amount of Permit $
STATE OF FLORIDA, l
COUNTY OF DADE. I
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
70 2 / 9,-/
Registered Architect and /or Engineer ,
Employing Electrician's Name.. .�J '� ? f . ... No —3 Z~ 1/ Street & ' / 7
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No ,--- 7 Street. .. 9
State work to be performed and purpose of building (By Floors)
New Building .1 Remodeling Addition
Service ° Overhead Size Feedersl Conduit......1..rMain Sw.....r...!'.V Amps
Type of Installation — Conduit Tubing v B.X.L Metal Moulding
ss.
MIAMI SHORES VILLAGE
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 emplo only ugh subcontractors, on work to
licensed by Miami Shores Village. / (
Before me, the undersigned aut�,,,pri.
appeared
to me well known, and who, being by me fir
of the above described construction, a
therein by him stated are true.
Lf
Date
Repairs No. of Stories
a Main Fuses Amps
(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
f � '1'Signed)
P 7,9
ul authorized to administer oaths and take acknowledgments, personally
savor u • • ' th deposes and says that he is the
foregoing application, and that he did sign the same, and that all facts
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
CGNTR.
LIST
/ /
(j i
/ .
"'7 /
0.2
/ Qs
it _ ,
/
) �i
) I 1
q
�/
/
p �/J
'`�
/ .c
7
/ f
/
/�
5
�
,( /a�,
i J V
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CLusr
LIST
/
f
it
CHECK
/ GP`'''''
� �
/
Permit No,//
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subfrfitted 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 C/L. No Street
Amount of Permit $
STATE OF FLORIDA, l
COUNTY OF DADE. I
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
70 2 / 9,-/
Registered Architect and /or Engineer ,
Employing Electrician's Name.. .�J '� ? f . ... No —3 Z~ 1/ Street & ' / 7
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No ,--- 7 Street. .. 9
State work to be performed and purpose of building (By Floors)
New Building .1 Remodeling Addition
Service ° Overhead Size Feedersl Conduit......1..rMain Sw.....r...!'.V Amps
Type of Installation — Conduit Tubing v B.X.L Metal Moulding
ss.
MIAMI SHORES VILLAGE
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 emplo only ugh subcontractors, on work to
licensed by Miami Shores Village. / (
Before me, the undersigned aut�,,,pri.
appeared
to me well known, and who, being by me fir
of the above described construction, a
therein by him stated are true.
Lf
Date
Repairs No. of Stories
a Main Fuses Amps
(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
f � '1'Signed)
P 7,9
ul authorized to administer oaths and take acknowledgments, personally
savor u • • ' th deposes and says that he is the
foregoing application, and that he did sign the same, and that all facts
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.... // .. 4
Owner's Name and Address
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
Registered Architect and /or Engineer
Employing Electrician's Name �%- No 3,.../) Street
Location and Legal Description Lot / 7 / t Block Subdivision...
Street and Number where work is to be performed —No , Street 05
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
No
Date
Street_S...
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or 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)
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
REFRIO.
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
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
T
CHECK
Permit No.... // .. 4
Owner's Name and Address
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
Registered Architect and /or Engineer
Employing Electrician's Name �%- No 3,.../) Street
Location and Legal Description Lot / 7 / t Block Subdivision...
Street and Number where work is to be performed —No , Street 05
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
No
Date
Street_S...
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or 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)
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.
BUILDING ❑
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
e
CONTRACTOR' OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ( ' PERMIT 'No 11421
PLUMBING 1
ROOFING ❑ Work to be performed under this Permit
Owner of'���
Building
Bl.
•
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 of in the statements or specifications and that he assumes responsibility for work
done by his ag servants or employees. /< <'
Signed F
INSPECTOR
In consideration of the issuance to me of this permit I to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all wort: dgrie by either, myself, my agent, servajt or employee.
Subdi-
vision
Value of
Project $
BY'
P } [ 4
DATE 195A.
Contractor's
License No
Amt. of
Permit
BY
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor '
or Builder ^`
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 11247
Work to be performed under this Permit
Subdi-
vision
Legal Lot II 31.
Description
Address of . ; Value of Amt. of
Building t v �i Project $ I Permit $
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` :ion
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 iany
time if th'e brlis' 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 derstanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulat'forf's
t
pertaining xo; 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. 1-.3 y ;,
Signed • . ! { � . <r r
A f f � , . . : W4 , v; - By 1`,
In consideration of the issuance to me of this permit I agree t9' 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 ermit I assume responsibility fori.all work done by either, myself, my agent, servant or employee.
CONAGfTdR OR BUILEk
BY
DATE
r 195
Contractor's
License No
AUTHORITY
•