443 NE 95 St (9)/41/1/0 51/61-4,-
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date ,A/9-2 Job Address 1 N. ,! 9 17 Tax Folio �� ���' 4 � y'
Legal Descriptiont' W 4 / 5.1
Owner Lessee Tenant /,) !i Ma er Permit Ifr
Owner's Address 1 /Y6 9s 57 Phone
Contracting Co. /e1 di
Qualifier a 41-- Ni !6 Phone el_r o
State 4r 7DDLVP9 Municipal # Competency 4fr Ins.Co.
Architect /Engineer Address
Bonding Company
Mortgagor Address
Permit Type(circle one): ILDING ,EL'CTR •!/ PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
ignature of owner. and /or
Date:
FEES: PERMIT
APPROVED:
Zoning
Address
-
Square Ft. Estimated Cost(value) ..„1 -6)0
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 (' ,f a ppli•cab1e), } n .,,certify that all work will be performed to meet the
standards of all laws regal'ating: ;Fo04rw°cti'dn in this jurisdiction. I understand that separate
permits are required for ELECr'RICAL, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is ac urate and that all work will
be done in compliance with all applicable laws regulating con ructi n and zoning. Furthermore, I
oriz the above -named contractor to do the work stated.
President
S. 1 � 1 RIpA.
NOTARY K�51At,E >.• ="
( my cpMMIs,' 01'1 WIRES; AU . 30�,�6934
•o unwn TN RU NOTARY ►URUt UNDERWRITtRS1
Notary s to Owner and /or Condo President
My Co fission Expires:
NOTARY PUBLI :, STATE of-
MY COMMISSION EXPIRES: AUG. 3U,
ROND{D TNRU NOTARY PURUC UNDERWRITERS:
** * * * * * * * * *
Building
Mechanical Plumbing
Address 7 '5 '4
of Contr
Signature
Date:
Notary 's to Contracber•br Owner-
My Commission Expires:
OWIleFfRDALCISEAL
JULIO ROBLES
My Commission Expires
June 4, 1996
er
10• RADON C.C.F. , NOTARY TOTAL DUE ,.j re)
Fire Other
cect_rical t ,LOLY*
Engineering
Permit No
/
Service Overhead Size Feeders
Underground
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/1 (d Fie'.t
c'v
Amount of Permit $ (Signed)
STATE OF FLORIDA, }
COUNTY OF DADE.
S8.
Date
.Application is hereby made for the ap•,roval 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 / L "Al
No `/ SI / Street../.. (/ ::: £5 S
Registered Architect and /or Engineer.. V.. r
Employing Electrician's Name. frill ' `' U ��. ' No L ? 1 t kU 7 Peet /- (.c.PC.Z.e 4=! 6,
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) . TOA) 4 rtz. Q- o-->Q.c.Z:Get,.•,,?.s.�F..4,,,
New Building Remodeling Addition Repairs No. of Stories
Conduit Main Sw ' Amps Main Fuses Amps
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 acce • his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o 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).. it i .tatides L u„
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 $1.01) 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'8
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
trace
HtATLR
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIRT.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.0 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
/
Service Overhead Size Feeders
Underground
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/1 (d Fie'.t
c'v
Amount of Permit $ (Signed)
STATE OF FLORIDA, }
COUNTY OF DADE.
S8.
Date
.Application is hereby made for the ap•,roval 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 / L "Al
No `/ SI / Street../.. (/ ::: £5 S
Registered Architect and /or Engineer.. V.. r
Employing Electrician's Name. frill ' `' U ��. ' No L ? 1 t kU 7 Peet /- (.c.PC.Z.e 4=! 6,
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) . TOA) 4 rtz. Q- o-->Q.c.Z:Get,.•,,?.s.�F..4,,,
New Building Remodeling Addition Repairs No. of Stories
Conduit Main Sw ' Amps Main Fuses Amps
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 acce • his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o 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).. it i .tatides L u„
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 $1.01) will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.