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812 NE 92 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date v 6 15 — Job Address 1 eT up Tax Folio Legal Description Owner/Lessee / Tenant l/' { /04 1 it-- RoF Owners Address 'g Contractin Co. VP 6 - w Q� Qualifier WORK DESCRIP'T'ION 1` 6te. • / / � SSlOn P{X PFFI C IAL , NOTARY SEAL 4NRRA &l MONTIEL l ilt * COMMISSION NUMBER 4.1 > Q CC401261 j PAY COMMISSION .EXP. OF FL AUG. 17 1998 ** S Not My C FEES: PERMIT 3 o a 7 RADON of owner and/o on s P ent Date Date C.C.F. Historically Designated: Yes No 77 f 7\_) li 1 6 ; '> a 1 a SS #{ ���� Phone 0,55 Q (' 2 (t'J - M4' Address Master Permit # Phone State # �CA t its k c Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Competency # Address Address Square Ft. Estimated Cost (values t Signature of Contrac Electrical Ins. Co. 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 regulatin: construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Notary as to Contractor or Owner- Builder My Commission Expires: Date D NOTARY ,S . TOTAL DUE 64- Date Plumbing Engineering Permit No XACq Owner's Name and Address I-1 r e'c - New Building STATE OF FLORIDA, COUNTY OF DADE. J •• MIAMI SHORES VILLAGE S�✓a — ✓���� 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 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 plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer _ � �f /� r Employing Electriciat'e Name. " ". .. .1 ". .. I .EY. v)t' I...t�.' No' - / Street 1 5 � )o()o r Location and Legal Description Lot 1/ Block r Subdivision l t 1 0'�� & to .(. Street and Number where work is to be performed —No Il Street "..I.l C � �t State work to be performed and purpose of building (By Floors)...n.1k.Y.V).s- 1.1C1.CLC��� �5 Ct�5(1C� - _ Amount of Permit $ 1 1 eJ (Signed). No A r I� Date l ` � e,® 5-`1 Street /4C- 9 Remodeling Addition Repairs No. of Stories ii sem Oyerhea Size Feeders Conduit.)- Main Sw Amps /'.) & Main Fuses Amps erground Type of Installation— Conduit Tubing B.X.L .Metal Moulding bectrical Inspector. The undersigned applicant for this building permit does hereby certify that :ncPunderstands -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. (Signed) 17_:%7 vi g/2 7 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally . . to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the d @�9p�© as carefully read the foregoing application, and that he did sign the same, and that all facts of the abo�01f3f9tr61t I�IL�4��}Q therein by i Ikt1 forMpires Feb. 4, 19CD BONDED THRU FLORIDA NOTARY SERVICES My Commission Expires Notary Public, State of Merida NOTE: A re-inspection fee of =1.00 will be made when such re-inspection is made necessary by improper notice for inspection, cr 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 H W. HEAT. CONN. SPACE HEATER 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 Permit No XACq Owner's Name and Address I-1 r e'c - New Building STATE OF FLORIDA, COUNTY OF DADE. J •• MIAMI SHORES VILLAGE S�✓a — ✓���� 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 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 plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer _ � �f /� r Employing Electriciat'e Name. " ". .. .1 ". .. I .EY. v)t' I...t�.' No' - / Street 1 5 � )o()o r Location and Legal Description Lot 1/ Block r Subdivision l t 1 0'�� & to .(. Street and Number where work is to be performed —No Il Street "..I.l C � �t State work to be performed and purpose of building (By Floors)...n.1k.Y.V).s- 1.1C1.CLC��� �5 Ct�5(1C� - _ Amount of Permit $ 1 1 eJ (Signed). No A r I� Date l ` � e,® 5-`1 Street /4C- 9 Remodeling Addition Repairs No. of Stories ii sem Oyerhea Size Feeders Conduit.)- Main Sw Amps /'.) & Main Fuses Amps erground Type of Installation— Conduit Tubing B.X.L .Metal Moulding bectrical Inspector. The undersigned applicant for this building permit does hereby certify that :ncPunderstands -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. (Signed) 17_:%7 vi g/2 7 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally . . to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the d @�9p�© as carefully read the foregoing application, and that he did sign the same, and that all facts of the abo�01f3f9tr61t I�IL�4��}Q therein by i Ikt1 forMpires Feb. 4, 19CD BONDED THRU FLORIDA NOTARY SERVICES My Commission Expires Notary Public, State of Merida NOTE: A re-inspection fee of =1.00 will be made when such re-inspection is made necessary by improper notice for inspection, cr faulty materials and /or workmanship. Disapproved __,� _.7Dat (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 budding during progress of the work. /o.- //— 73 Date... _ ..�..... _. __ _ . _....__........ , lA.. Owners Name and Address `�" h 1 r %Z ` .e—e L _ No... 6_ ._....__. Street Ai - JZ It Registered Architect and /or Engineer Name and address of licensed contractor b e"' n Location and legal description of lot to be built on: Lot Block Subdivision © Street and Number where work is to be done 4 1 A- 1' .. .$ State work to be done and purpose of building (by floors)... Chairman Member Member ...... ___.___ Council Approved Date and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ /4, C., Amount of Permit $. Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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 pennit, as are licensed by Miami Shores Village. Remarks..._ (Signed) STATE OF FLORIDA, COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 3 Permit No.__...J 3 Date 3 2;7 7 Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building / nspector My Commission (Expires PLANNING BOARD DATE C NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has the Planning Board. A re- inspection fee of $1.00 will be charged when catch re- inspection is made rteseasnry by improper notice for materials and /or workmanship. to me well known, Member Member Member - • -• - - -- Disapproved Date been obtained from inspection or faulty MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No /x' 3 Date f® — // 73 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building ot other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:lda, 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 644, -r �' $ F- No ? J r ? Street Registered Architect and /or Engineer Employing Electrician's Name "''� ? ' 1 ( l a No Street Block Subdivision. Street and Number where work is to be performed— No.._. ..... 7 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Location and Legal Description Lot Service Overhead Site 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 accepj his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of "lorida 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. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. 50. / Street /4 ct 561' . K (Signed) 2 6/el m cr F fl Master Electrician. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made w en 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 REFDIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LI BT CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK . MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No /x' 3 Date f® — // 73 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building ot other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:lda, 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 644, -r �' $ F- No ? J r ? Street Registered Architect and /or Engineer Employing Electrician's Name "''� ? ' 1 ( l a No Street Block Subdivision. Street and Number where work is to be performed— No.._. ..... 7 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Location and Legal Description Lot Service Overhead Site 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 accepj his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of "lorida 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. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. 50. / Street /4 ct 561' . K (Signed) 2 6/el m cr F fl Master Electrician. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made w en such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Mr. Hilliam Bradford Miami Shores Village 10050 N.E. 2nr Ave. Miami Shores, Florida 33138 % Building and Zoining Dept. Dear Mr. Bradford: CFR /sr October 11, 1972 As per our phone conversation of October 11, 1972, I'm enclosing our check for $ 23.00 . $ 15.00 Electrical connection 8.00 4 Ton Air Conditioner $ 23.00 Thank you very much, Charles F. Rice Mr. Charles F. Rice 812 N. E. 92 Street Miami shoes, Florida Dear Mr. Ricer WRB /ar Please find enclosed: October 17, 1972 (a) Copy of Zoning Ordinance # 299 (b) Application for Building Permit (This form used for A/C also) (c) Application for Electrical Permit° Your letter of October 11 1972 did not have the drawing for your A/C system. I am particularly interested in the duct layput and compressor location. Air Compressors have only been issued permits for rear yard instal— lation without written approval from the next door neighbor. Please fill out the applications and furnish drawing so that a permit may be issued. Thank you in advance for your cooperation in this matter. Very truly yours, William R. Bradford Building & Zoning Inspector Permit No ..?.. 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 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 Miarth 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 Registered Architect and /or Engi e Employing Electrician's Name:...�4 Location and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE 88. Service ,Over Size Feeders usaientrowd Type of Installation — Conduit b Tubing Conduit • No Street , No Block Street and Number where work is to be performed —No C'. 1- _ Street State work to be performed and purpose of building (By Floors) i e "' f ' New Building 6/ Remodeling Addition Repairs 1 ' , > Street ' / No. of Stories Subdivisiorj m � a. . • l. � Main Sw B.X.L Amps.. 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 subcontractors, on work to licensed by Miami Shores Village. Main Fuses.,' Amps (Signed) Electrical Inspector. 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 (Signed) !' Mastei—�ectrician. Before me, the undersigned aority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and w being by me first duly sworn, upon oath deposes and says that he is the of the above described ,onstruction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts :herein by him stated : re 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 C ONTR. . - ,-- CHECK �-, CU � � �' ) s � J ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. - 77 - z' MOTORS 0.1 HP OTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST ry CHECK �� 1 A Permit No ..?.. 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 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 Miarth 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 Registered Architect and /or Engi e Employing Electrician's Name:...�4 Location and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE 88. Service ,Over Size Feeders usaientrowd Type of Installation — Conduit b Tubing Conduit • No Street , No Block Street and Number where work is to be performed —No C'. 1- _ Street State work to be performed and purpose of building (By Floors) i e "' f ' New Building 6/ Remodeling Addition Repairs 1 ' , > Street ' / No. of Stories Subdivisiorj m � a. . • l. � Main Sw B.X.L Amps.. 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 subcontractors, on work to licensed by Miami Shores Village. Main Fuses.,' Amps (Signed) Electrical Inspector. 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 (Signed) !' Mastei—�ectrician. Before me, the undersigned aority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and w being by me first duly sworn, upon oath deposes and says that he is the of the above described ,onstruction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts :herein by him stated : re 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. Application is hereby made fort he 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. 7' Owner's Name and Address Permit No Registered Architect and /or Engine Employing Electrician's Name Location and Legal Description Lot Street and Number where work is to be performed —No ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 1 Amount of Permit $ (Signed) SS. MIAMI SHORES VILLAGE No Block_, { No Street i Street Subdivision, Street , 4 • State work to be performed and purpose of building (By Floors) Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding 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 he 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) ° C )l,Eter Electrician. STATE OF FLORIDA, 1 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 e 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 MOTORS 1-5 HP NEON TRANS. RADIO TOTAL CONTR. / LIST CHECK Application is hereby made fort he 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. 7' Owner's Name and Address Permit No Registered Architect and /or Engine Employing Electrician's Name Location and Legal Description Lot Street and Number where work is to be performed —No ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 1 Amount of Permit $ (Signed) SS. MIAMI SHORES VILLAGE No Block_, { No Street i Street Subdivision, Street , 4 • State work to be performed and purpose of building (By Floors) Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding 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 he 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) ° C )l,Eter Electrician. STATE OF FLORIDA, 1 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 e 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.