534 NE 94 St (12)/ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date —7 f 6 '/ fif Job Address rl y A✓ e, 9r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant — W . `'' 1,,,,, T fo ,) Master Permit # Wa ci
Owner's Address Phone
Contracting Co. Ar i o n, Inc . Address 8723 S w 129th Ter r.
Qualifier Richard R. Wynne SS# Phone 251 —1 279
State # Municipal # Competency # 000013371 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
SgFt..r A
/ 6d
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 regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Ze 7/eZ
Signature of owner and/or Condo President Date
et alit& 'al
Eli. -,t NI
OFFICIAL N NI SEAL
JENNIFER L JAFTAL
NOTA.I?Y PUBLIC STATE Cr FLORIDA
CC. NO. CC? .6?_6
Lkly COMi∎AIS °;ON EXP. OCT. 11
ot as to Own
My Commission E
FEES: PERMIT / V. RADON C.C.F.
APPROVED: t
Zonin g Building 71/ )
Mechanical Plumbing
Estimated Cost (value)
(1 -
ary as to Con
My Commission es:
`&tICTAL I ARY SEAL Elite
?NI. EP. , r,lc.rTAL q
UUC rLC`_?IDF
CC_..i.._S Ir NC. CC.7::.i G
CGM? 'Xi'. GO`l. 11,19;6]
I 0 NOTARY TOTAL DUE 7U1
Electrical
Engineering
Permit No._
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMI4 @2
Da
Application is hereby made for the approval of the detailed statement o f the plans and specifications herewi h submitted for the ilding or othe
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Flori d`
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 Divisi
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 wor
Owner's Name and Address
Registered Architect and /or Engineer_
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
Amount of Permit $
The undersigned plicant for tluilding permit does hereby certify tha
labor under the Florida Workmen's Compensation Act, being Section 5966,
has complied with the provisions thereof, and will require similar complianc
ri No Street
No Street____
Block di n
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.
Underground
Type of Installation— Conduit_____ _________ ____Tubing — _______B.X.L.__ __ Metal Moulding_
(Signed) _
Amps Main Fuses_
.Amps
E ectrical e ector.
rstands and accepts his obligations as an employer of
eneral Laws of Florida Permanent Supplement, and
1 contractors or sub- contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted - spection 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 b Nerformed under this permit, as are
licensed by Miami Shores Village. j
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
(Signed)._
Mauer Electrician.
Before me, the undersigned authority, a notary public, duly a uthorized 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.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
I
//zit,
, tr
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No._
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMI4 @2
Da
Application is hereby made for the approval of the detailed statement o f the plans and specifications herewi h submitted for the ilding or othe
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Flori d`
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 Divisi
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 wor
Owner's Name and Address
Registered Architect and /or Engineer_
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
Amount of Permit $
The undersigned plicant for tluilding permit does hereby certify tha
labor under the Florida Workmen's Compensation Act, being Section 5966,
has complied with the provisions thereof, and will require similar complianc
ri No Street
No Street____
Block di n
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.
Underground
Type of Installation— Conduit_____ _________ ____Tubing — _______B.X.L.__ __ Metal Moulding_
(Signed) _
Amps Main Fuses_
.Amps
E ectrical e ector.
rstands and accepts his obligations as an employer of
eneral Laws of Florida Permanent Supplement, and
1 contractors or sub- contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted - spection 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 b Nerformed under this permit, as are
licensed by Miami Shores Village. j
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
(Signed)._
Mauer Electrician.
Before me, the undersigned authority, a notary public, duly a uthorized 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.
Permit No
STATE OF FLORIDA, Ij
1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
73 57
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.
Owner's Name and Address
Registered Architect and /o
Employing Electrician's Name 4`
ngineer
0\
Amount of Permit $ �1....�
ss.
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
No
(Signed)
Date a- .2
Street.,c '
No / 3 B 3,r Street
Location and Legal Description Lot Block Subdivision
Street..
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
6m
0
9
'r
(Signed) l ....L...... ...... � : � ..
Ele rival Inspector.
Master Electrician.
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.
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
REPRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
3
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
141 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
A
/,
—C—
CHECK
Permit No
STATE OF FLORIDA, Ij
1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
73 57
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.
Owner's Name and Address
Registered Architect and /o
Employing Electrician's Name 4`
ngineer
0\
Amount of Permit $ �1....�
ss.
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
No
(Signed)
Date a- .2
Street.,c '
No / 3 B 3,r Street
Location and Legal Description Lot Block Subdivision
Street..
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
6m
0
9
'r
(Signed) l ....L...... ...... � : � ..
Ele rival Inspector.
Master Electrician.
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.
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.
No.
STREET
PART OF LOT
LOT
BLOCK
SUBDIVISION
ROOF
COST OF BUILDING
PERMIT FEE
FRONT
DEPTH
HEIGHT
STORIES
TYPE OF CONSTRUCTION
BUILDING TO BE USED FOR
ROOF
COST OF BUILDING
PERMIT FEE
f
Frame, Tile Concrete, Stucco
Residence, Apts., Stores, Hotel
r f f
jr, w
BUILDING PERMIT
Miami Shores Village, Florida, / / / , 19 J I
Owner of Building
Architect
Contractor or Builder
PROPOSED LOCATION
DESCRIPTION OF BUILDING
MIAMI SHORES VILLAGE
OFFICE OF BUILDING INSPECTOR
N? 297
This permit is issued to To
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances or rules and regulations, or upon any change in the plans and specifications unauthorized by the building inspector.
BUILDING •INSPECTOR
In consideration of the issuance to me of this building permit I hereby agree to do the proposed construction in strict conformity with the application
and plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village.
Dated , 19-
•
(SEAL)
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building Miami Shores Village, Fla , 19
Contractor or Electrician
NO.
Outlets
Motors
Receptacles
STREET
Generators
Stoves
Dated , 19
aiami cShores9illage
F L O R ID A
OFFICE OF ELECTRICAL DEPARTMENT
PART OF LOT
LO CATI 0 N
DESCRIPTION OF WORK
Water Heaters
NUMBER OF
Signs
LOT
BL'K
Billboards
Other Apparatus
N° 495
SUBDIVISION
Permit Fee
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
he plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
,f Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
ipon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
its Department.
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
°e of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and reylations of the Electrical Department of Miami
res Village. y ` t`
(Seal)
-mss
ELECTRICAL PERMIT A N° 421
•4JG
ii
Owner of Building '
Architect and /or Engineer__
'41 3 J / INANE , /�
Contractor or Builder 1 /s� r U `
Proposed Location
$ _ -_
A
U NT
NAME
NAM
6
Mi
RECD. PAYMENT ACCT. DEPT.
/ /i
EL
ADDRESS
F =?
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT,
ADDRESS LICENSE NO.
/;) ADDRESS „ --
LOT BLOCK T A% , SU■DIVISION
This permit is issued to y ''' ' To
/ 19
_L
NO.
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, o distances or rules and regulations, or upon 4ny change in the plans and specification), una thorife 1- by the building inspector.
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict onformity with the application and
'ns and - specifications thereof heretofore by me submitted, and :fn compliance with all provisions of all butdin, aws'�lf the rat
Se of Florida, all the 7 de
building or ances and zoning law of Miami Shores Villa eland all rules and regulations of the build ll age.
LICENSE NO.
INSPECTOR
(SEAL)
NO A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
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.
i/ P. Y.
BIALDING
ELECTRICAL PERMIT A N° 421
PL-44MB#NG
Owner of Building
Architect and /or Engineer
NAME
Contractor or Builder
NAME
Proposed Location
LOT
NAME
BLOCK SUB - DIVISION
ADDRESS
ADDRESS
ADDRESS
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
. 19
LICENSE NO
LICENSE NO.
NO. STREET
This permit is issued to — — — — — — — — — -- -- — — — — — To
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances or rules and regulations, or upon any change in the plans and specifications unauthorized by the building inspector.
r•
$ .
AMOUNT
RECD. PAYMENT ACCT. DEPT. INSPECTOR
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity wiw t1' pplication and
plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all buildin -$aws the State of rlorida, all the
building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building depaftm� o iami Sb�)res Village.
( t)
. (SEAL)
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
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.
Dated —
t
NO.
/lit- STREFI
PART OF LOT
LOT
BL'K
SUBDIVISION
Signs
Outlets
Receptacles
� ators
Stoves
canters
Signs
- .,, .oa s
Af
Other Apparatus
Permit Fee
Motors
r
0
/ e
ye
p (16: )
/S°.
j�
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building r-W/' 0. fr;;-<i"(5 &/Q
•tractor or Electrician I 1/(42. •'%
Dated
0, , 1F
aiami cJhores'9illage
F L O R ID A
OFFICE OF ELECTRICAL DEPARTMENT
iami Shores Village, Fla ,
• U BER OF
LO CATI O N
DESCRIPTION OF WORK
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in plans and specifications unauthorized by
= epartment.
//7 .- zr'
,ir/
N° _ 495
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agre� o do the proposed construction in strict conformity with
.e Application and the plans and specifications thereof heretofore by me submitted, and i._ ompl., ce with all provisions of all Electrical Laws of the
ate of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, a
Cores Village.
ations of the Electrical Department of Miami
(Seal)
UILDING
LECTRICAL
- LUMBING
- OOFING
MIAMI SHORES VILLAGE. FLORIDA
❑
DATE 195
❑ PERMIT N° 3362 Contractor's
License No.
0
❑ Work to be performed under this Permit
)wner of
uilding
rchitect
ontractor
Builder
egal Lot
escription I Bl
ddress of
wilding
CONTRACTOR OR BUILDER
Subdi-
vision
Value of
Project $
Amount of
Permit $
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
_refor 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 regulations
=rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
me by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
:rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
:piing this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY 8
BUILDING ❑
ELECTRICAL M DATE
PLUMBING ❑ PERMIT N? 9454
ROOFING ❑
Owner of
Building_
Architect
Contracto
or Builder
Legal
Descriptic
Address
Building
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
Contractor's
License No
195
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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to 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 permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
7
r
n
Lot
Bl
Subdi-
vision
f
•
t
Sq. Ft
Amt. of
Permit
$
w:
Value of
Project
$
BUILDING ❑
ELECTRICAL M DATE
PLUMBING ❑ PERMIT N? 9454
ROOFING ❑
Owner of
Building_
Architect
Contracto
or Builder
Legal
Descriptic
Address
Building
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
Contractor's
License No
195
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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to 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 permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
7
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL DATE 195-L___ {
PLUMBING E PERMIT N9 8357 Contractor s
License No
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
❑ Work to be performed under this Permit ' +
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
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 or in the statements orAptcifi a ions and that he assumes responsibility for work
done by his agents, servants or employees. ,f
Signed. } s � r ={ d�. -,'�v - 4 BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to 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 permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY
Amt. of
Permit $
AUTHORITY
n
NO.
6-1
"''
='', ' 'l" ' 4 STREET
Stoves
PART OF LOT
LOT
BL'K
TOWN, ADDITION, OR SUBDIVISION
:Sq r
t
t
'l ,.. �
r
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters'
Signs
Billboards
Other Apparatus
Permit Fee
1 , f"..5
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises
during the construction.
yp
Owner of Building
Contractor or Electrician
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of the Town of Miami Shores and the rules and regulations of the Electrical Department of the Town of Miami Shores. This Permit may be revoked at
any time upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unau-
thorized by this Department. a.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to . do "the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of the Town of Miami Shores, and all rules and regulations of the Electrical Department of the
Town of Miami Shores.
Dated , 192
ANOE PRINTING CO., MIAMI, FLA.
Town of Miami Shores
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores, Florida, �'. 4s, ...., 1921..
PROPOS
DESCRIPTION OF WORK
NUMBER OF
N° 1l 4
, Electrical Inspector.
(Seal)
D -(
Permit No
Street and Number where work is to be performed— No.,,_
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
C
State work to be performed and purpose of building (By Floors) e ' ''1f
Amount of Permit $ (Signed)
Date Cc
V
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.
Owner's Name and Address C� No <`
Street
Registered Architect and /or Engineer
Employing Electrician's Name .. ` ( r � ' I � i '" 2, . i t No. r % I1
Location and Legal Description Lot /'.. t' < n Block 4.4-'' ,ice
Street
-' ` / ',n ' is .,-,
Street`
(Signed) ' f
Subdivision . : ti
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
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations u 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•coneractors 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, / �o work to be performed under this permit, as are
licensed by Miami Shores Village. -
'Master Electrician.
STATE OF FLORIDA, }
COUNTY OF DADE. 86 '
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
RE ►RIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LISTU
/ /,
`—
C: -,
G
(�:�
c '
CNECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.0 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
D -(
Permit No
Street and Number where work is to be performed— No.,,_
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
C
State work to be performed and purpose of building (By Floors) e ' ''1f
Amount of Permit $ (Signed)
Date Cc
V
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.
Owner's Name and Address C� No <`
Street
Registered Architect and /or Engineer
Employing Electrician's Name .. ` ( r � ' I � i '" 2, . i t No. r % I1
Location and Legal Description Lot /'.. t' < n Block 4.4-'' ,ice
Street
-' ` / ',n ' is .,-,
Street`
(Signed) ' f
Subdivision . : ti
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
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations u 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•coneractors 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, / �o work to be performed under this permit, as are
licensed by Miami Shores Village. -
'Master Electrician.
STATE OF FLORIDA, }
COUNTY OF DADE. 86 '
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
ELECTRICAL
PLUMBING
Owner of .) f"
Building .'
Architect
(4)
or Builder
PERMIT N? 7951
Work to be performed under this Permit
Legal Lot B1 Subdi-
Description vision
Building
Address of
' , . „e' y { Value of 1 1 Amt. of
✓ �n Permit
/ P rojec t
This permit is gran ed to the contractor or b der named above to construct the building or to install the equipment or device described in the appli-
cation 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 or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE i1 _.� 1 g
Caractor's
License No.
BY
Signed. P'--r ra' -- 41 -Q.-41✓ B �'` ' 2_
`INS . � j - �w �� jj' O S
In considera of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with i Brdirianc and eg irlations
pertaining thereto and in strict conformity with the plans, drawings, statements' or specifications submitted to the proper authorities of Miami Shores Village.
In accepting ermit I assuresponsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
APPLICATION FOR ELECTRICAL PERMIT ; 7
Date
•
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submi4ed 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
Permit No.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Owner's Name and Add s' L I �_ °? �� 1/,,,,-,-- / 9 /
No - -- - - - S treet - -- � , -- �' --- -\ -- - - - - - -
Registered Architect and /or Engineer /-
i, -- -- – – – No o Street - -L� – 4 - J – . --
Location and Legal Description Lot �j ® ° _Block____ Subdivision__
Street and Number where work is to be performed—No. L-2/ e / ___E 2
Employing Electrician's Name
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
Amount of Permit $ ij -_
My Commission Expires
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
(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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. (/ /.
(Signed) 1� // �� I>_
Notary Public. State of Florida
Master Electrican.
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, 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.
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
•
1/
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O -I HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
APPLICATION FOR ELECTRICAL PERMIT ; 7
Date
•
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submi4ed 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
Permit No.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Owner's Name and Add s' L I �_ °? �� 1/,,,,-,-- / 9 /
No - -- - - - S treet - -- � , -- �' --- -\ -- - - - - - -
Registered Architect and /or Engineer /-
i, -- -- – – – No o Street - -L� – 4 - J – . --
Location and Legal Description Lot �j ® ° _Block____ Subdivision__
Street and Number where work is to be performed—No. L-2/ e / ___E 2
Employing Electrician's Name
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
Amount of Permit $ ij -_
My Commission Expires
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
(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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. (/ /.
(Signed) 1� // �� I>_
Notary Public. State of Florida
Master Electrican.
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, 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.
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.
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 wok
Owner's Name and Address" !� �___(�
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot
Amount of Permit $__ __ -
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
ss.
If
Street and Number where work is to be performed— No.
State work to be performed and purpose of building (By Floors)
;T - .- --1
No. _L_ G Street �.
_ (Signed)
(Signed
f
Date
Street__:
rr 4
Subdivision_ _
sub - contractors, on work to be performed under this
Notary Public, State of Florida
et
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
Electrical Inspector.
The undersigned applicant for this building .ermit 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 com-
plied 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 under signed agrees to employ only such
licensed by Miami Shores Village.
permit,
as
Master Electrican.
are
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, 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.
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
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
SENT.
- ^ SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O -I HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No.
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 wok
Owner's Name and Address" !� �___(�
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot
Amount of Permit $__ __ -
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
ss.
If
Street and Number where work is to be performed— No.
State work to be performed and purpose of building (By Floors)
;T - .- --1
No. _L_ G Street �.
_ (Signed)
(Signed
f
Date
Street__:
rr 4
Subdivision_ _
sub - contractors, on work to be performed under this
Notary Public, State of Florida
et
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
Electrical Inspector.
The undersigned applicant for this building .ermit 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 com-
plied 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 under signed agrees to employ only such
licensed by Miami Shores Village.
permit,
as
Master Electrican.
are
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, 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.
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.
FLOORS
FIATUNe5 UNLY
NUMBER OF
TOTAL.
OUTLETS
SIZE OF
SIZE SERVICE
CONDUIT
No.
CIRCUITS
LIGHTS
CEILING
BRACKETS
MAIN
SUBS
BRANCHES
BASEMENT
� �
/7
f" 'E%
� ��\
LJ
_
FIRST
dd
SECOND
THIRD
FOURTH
A-63
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL
IL Lo BE RETURNED.
� 1 2 p �
LOT NUMBER o fBLOCK NUMB IBDIVISION
STREET NUMBER 5 -
a l/
CEILING I BRACKETS
� /
KIND OF INSTALLATION
MASTER ELECTRICIAN
ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your certificate of Approval, application is hereby made for an inspection of the
electric installation in the premises stated below, for which undersigned agrees to correct
any infractions of the National Electrical Code and the City Ordinance pointed out by In-
spector.
S DE
OWNER w OCCUPANT
OCCUPIED A8
BUILDING - -NEW OR OLD (UNDERLINE WHICH) WORK -- ADDITIONAL, NEW. ALTERATION OR REPAIR
SPECIFICATIONS
H. P. OF EACH MOTOR VOLTS TOTAL AMPS PHASF
RECEPTACLES
ROUGH WIRING
FINAL No.
CORRECTED
TEMPORARY DAYS.
DATE ISSUED
SWITCHES
/ d
REMARKS •
FEE REMITTED
APPLICATION
STOVES
4 -) e
WATER HEATERS
SPAC S
VQ
P ^ n o
OPEN OR CONCEALED KNOB. RX.. BX.
REMARKS
RECEIVED BY INSPECTOR INSPECTED
PROGRESS
WILL INSPECT AGAIN
INSPECTION WANTED
DATE
Sxa>
BY ADDRESS 01 % 6 ° r
SPACE BELOW FOR INSPECTOR'S USE ONLY
NO
MUST BE FILLED OR APPLICATION
1
yr
OTHER APPARATUS
LDG.. CONDUIT. METALLIC TUBING
`
N
° Sl
INSPECTOR