ELECTRICALArchitect
.
Contractor
Jar Buildec
Legal
Descripti
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IRON
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MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL.
CONTR.
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LIST
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CHECK
:•
Owner's Name and Address , T.
..•• No Street
2 O Reg A rc h itect and /or Engineer t ;�{ r t f
LD Employing Electrician's Name yr /1 i / No StFCet x� . ,
; and Legal Description Lot 'i
I �,�-- '��” Block — %= Subdivision.._. � `"'
A
Street and Number where work is to be performed —No 1 _._. Street
//
State work to be performed and purpose of building (By Floors) .• ,
5 r gew Building r Remodeling Addition Repairs No. of Stories...;: ,r
75
75 TATE OF FLORIDA,
OUNTY OF D ODE }
I
, APPLICATION FOR ELECTRICAL PERM / IT
v {
Permit No./ "' g� 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 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.
Service ( gsouaald Size Feeders "
Type of Installation — Conduit Tubing ter. B.X.L .Met
Amount of Permit $
4
ss.
.
eared
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
7
Conduit '
Main Sw
2-
Main Fuses Amps
Electrical
The undersigned applicant for this buildinn permit does hereby t at h nderstands and accepts his obligations as . n emplo r of
or under the Florida Workmen's Compensation Act, being Section 5966, Comp ed General Laws of Florida Permane Suppleme• , and
/ complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors em oyed by h' , in the
Q r: rk to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public noti or notices
C
^s 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)
Master Electrician.
B fore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
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.