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95 NE 95 St (12)Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address q5�' ! ✓ d/ Tax Folio Legal Description Owner/Lessee / Tenant Rom / N i K TM dip Owner's Address 15 15 5T: Contracting Co. 7)/1/L) �'e.r COOT: /� O*)7 Qualifier State # EGQ'>O /570 Municipal # Architect/Engineer Bonding Company Address Historically Designated: Yes No Master Permit 11 Lie 74j , 3) 1 / t 7 it, Phone Address /40/ c / 57- fl -Z° 2 SS# Phone It Competency # Ins. Co. Address Mortgagor Address Permit Type (circle one): BUILDIN ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION MV,11/4' / Square Ft. Estimated Cost (value)? ZL ad 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. APPROVED: Zoning Mechanical Notary as to Owner and/or Condo President Date otary as t My Commission Expires: My Conunissi Signature of owner and/or Condo President Date Signatti a of Contractor or Own Builder .D L S 3 4.- a&/ yS FEES: PERMIT '622 ® RADON C.C.F. "' O — NOTARY S 0 Ch BOND Building Electrical TOTAL DUE C4 Date Contrac r or Owner- Builder • " 1 rFne OFFICIAL NOTARY SEAL P e, ANGELA NI BECKER A • � = ,r COAMISSION NU478ER U ' - a CC786697 4` 4 . MY COMMISSION EXPIRES OF F� O NOV. 15,2002 D to Plumbing Structural Engineer o ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) ORINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0— 1 If STEAM BOILERS SHOWER MOTORS OVER 1— 3 If HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3— 5 If MECHANICAL VENTILATION SINK, RESIOENCE MOTORS OVER 5— 8 If TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 If ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 If ` F IRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If _ COOLING TOWERS WATER CLOSET MOTORS OVER 100 If VIOLATION INDIRECT WASTES A/C WINDOW RE INSPECT ION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER —NEW INST. GENERATORS TRANSFORMERS HEATER — REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PLRPOSE SWIMMING POOL OUTLETS COMAERCIAL WATER SERVICE SIGN TUBES ;EWER CONNECTIONS SIGN TRANSFORMERS IT ILITY —SEWER SIGN TIME CLOCK IT ILITY —WATER FIXTLRES ;EPTIC TANK ANTENNA :EL AY TELEVISION OUTLETS IRA INFIELO, 4' TILE/RES. VIOLATION 'LIMP & ABANDON SEPTIC TANK RE INSPECT ION 'OAKAGE P IT CU. FT. , 5uhmM I NG Poo L. CY ' ATCH BASIN , ISCHARGE WELL OMESTIC WELL REA DRAIN OOF INLET OLAR WATER HEATER IRE STANDPIPE 001 PIPING • AWN SPRINKLER SYSTEM AS RANGE _TER SET (GAS) aS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT 'APPLICATIONS.) ELECTRICAL PLUMBING MECHANICAL Permit No ILL STATE OF FLORIDA, } COUNTY OF DADE. EL MIAMI SHEDfRES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Z7 — 7 Z 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, Fiurida, 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 Mik1.N.1"LL 0 Registered Architect and /or Engineer Employing Employing Electrician's Name L�/�?52 Location and Legal Description Lot..,< ' ( Block Street and Number where work is to be performed —No ' 6 ) F. 2 State work to be performed and purpose of building (By Floors) Service Overhead Size Feeders Underground Type of Installation— Conduit Tubing Amount of Permit $ r ' ( (Signed)...6-�" / ` Pik; k/ Street.l /� S (Signed). No. 42? / f Street New Building Remodeling Addition X Repairs No. of Stories Conduit Main Sw Amps Main Fuses Amps B.X.L .Metal Moulding JYi 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 sub - contractors, on work to licensed by Miami Shores Village. Subdivision `' Street Electrical Inspector. ccepts hi obligations as an employer of of Flori a Permanent Supplement, and sub- tractors employed by him in the of the work such public notice or notices be performed under this permit, as are z 7/ 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 $1.00 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'8 �- FIXTURES NO. LAMPS REPRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST 7 J ^)' , `� CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit No ILL STATE OF FLORIDA, } COUNTY OF DADE. EL MIAMI SHEDfRES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Z7 — 7 Z 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, Fiurida, 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 Mik1.N.1"LL 0 Registered Architect and /or Engineer Employing Employing Electrician's Name L�/�?52 Location and Legal Description Lot..,< ' ( Block Street and Number where work is to be performed —No ' 6 ) F. 2 State work to be performed and purpose of building (By Floors) Service Overhead Size Feeders Underground Type of Installation— Conduit Tubing Amount of Permit $ r ' ( (Signed)...6-�" / ` Pik; k/ Street.l /� S (Signed). No. 42? / f Street New Building Remodeling Addition X Repairs No. of Stories Conduit Main Sw Amps Main Fuses Amps B.X.L .Metal Moulding JYi 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 sub - contractors, on work to licensed by Miami Shores Village. Subdivision `' Street Electrical Inspector. ccepts hi obligations as an employer of of Flori a Permanent Supplement, and sub- tractors employed by him in the of the work such public notice or notices be performed under this permit, as are z 7/ 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 $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA PLUMBING ELECTRICAL °❑ PERMIT N? 10151 ROOFING ❑ Owner of Building 0 Architect Contractor _ or Builder Legal Lot Description Address of Building CONTRACTOR or BUILDER Work to be performed under this Permit B1 Date— , Contractor's License No. Subdi- vision Sq Ft. Value of 11 Amount of Project $ 11 Permit $ BY AUTHORITY 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 applica- tion 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. Signed— (INSPECTOR) BY 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. 1 APPLICATION FOR ELECTRICAL PERMIT Permit No f V Date (0,,r 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 4& No Street Registered Architect and /or Engineer o ,op Employing Electrician's Name No ! 0 G7 Street 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) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Underground y e of I llati STATE OF FLORIDA, , l COUNTY OF DADE. Il ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Conduit Main Sw Amps Main Fuses �dGf' Tubing B. L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or 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. (Signed). Master Electrician. 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. 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. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST C3-4 CHECK ' �� ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST LIST CHECK 0 1 APPLICATION FOR ELECTRICAL PERMIT Permit No f V Date (0,,r 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 4& No Street Registered Architect and /or Engineer o ,op Employing Electrician's Name No ! 0 G7 Street 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) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Underground y e of I llati STATE OF FLORIDA, , l COUNTY OF DADE. Il ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Conduit Main Sw Amps Main Fuses �dGf' Tubing B. L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or 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. (Signed). Master Electrician. 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. 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. BUILDING ❑ ELECTRICAL PLUMBING I ROOFING Owner of . Building Architect ontractor or Builder Legal Description Address of Building Lot ❑ PERMIT 'N? 12952 ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. Subdi- vision Value of Project $ ) �f DATE Contractor's License No Amt. of Permit $ 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.. AUTHORITY Permit No v 1 , 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 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 No ? Street Registered Architect and /or Engineer , Employing Electrician's Name // , /�' ' No % Street , Location and Legal Description Lot " `') Block Subdivision Street and Number where work is to be performed —No Street R State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Overhead / Service Underground Size Feeders ! Conduit l % ClMain Sw Amps Main Fuses Amps Type of Installation — Conduit Tubing f B.X.L .Metal Moulding 1 (Signed) b �-- -nr. ( 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 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. Amount of Permit $ STATE OF FLORIDA, j COUNTY OF DADE. I s s. (Signed) 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 $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty mater s 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 c;\ c;� r< o 7 c Y 7 > G / / i / U / �� � ^ �� i% 1 ( �_, �_ CHECK - j: - - - n { C� 6 p I ll N ' I i r ( G�j1 >� 6 r / ti ENT. SW. DIST. CAB. SERVICE TEMP. + ,I SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST i /) j' / t CHECK 1)e (c) J� d \ ('I ..T), Q (I l`J ..L-'J r(L1\ (() Permit No v 1 , 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 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 No ? Street Registered Architect and /or Engineer , Employing Electrician's Name // , /�' ' No % Street , Location and Legal Description Lot " `') Block Subdivision Street and Number where work is to be performed —No Street R State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Overhead / Service Underground Size Feeders ! Conduit l % ClMain Sw Amps Main Fuses Amps Type of Installation — Conduit Tubing f B.X.L .Metal Moulding 1 (Signed) b �-- -nr. ( 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 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. Amount of Permit $ STATE OF FLORIDA, j COUNTY OF DADE. I s s. (Signed) 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 $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty mater s and /or workmanship. Permit No / 3 5 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ¢¢�� Ownei s Name and Address... .o. .. Lo... No Registered Architect and /or Engineer Employing Electrician's Name. Location and Legal Description Lot Block Subdivision /� Street.,.4 t.. j Fs " Street and Number where work is to be performed —No oo Amount of Permit $� S S. U 1� � FGTx cNo 3g08If 7 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. (Signed).,f��1�w STATE OF FLORIDA, 1 COUNTY OF DADE: I j Before me, tl;e undersigned authority, a notary public, duly authorized to administer oaths Street..:,tiZ.a. a FS Street //''u .0 r .1/.. .. �.. 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. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices b performed under this permit, as are Master Electrician. 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. H EAT. 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 N EON TRANS. RADIO TOTAL CONTR. LIST OA �^ '� ( D r .`fti ,-� CHECK Permit No / 3 5 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ¢¢�� Ownei s Name and Address... .o. .. Lo... No Registered Architect and /or Engineer Employing Electrician's Name. Location and Legal Description Lot Block Subdivision /� Street.,.4 t.. j Fs " Street and Number where work is to be performed —No oo Amount of Permit $� S S. U 1� � FGTx cNo 3g08If 7 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. (Signed).,f��1�w STATE OF FLORIDA, 1 COUNTY OF DADE: I j Before me, tl;e undersigned authority, a notary public, duly authorized to administer oaths Street..:,tiZ.a. a FS Street //''u .0 r .1/.. .. �.. 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. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices b performed under this permit, as are Master Electrician. 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.