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12 NE 96 St (6)APPLICATION FOR ELECTRICAL PERMIT i h /fur Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foe' 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. d' `1 - r Owner's Name and Address __ / r _ —: f __ '` '4,_ No Street__ __________ c Registered Architect and /or Engineer - •� R Employing Electrician's Name >, - ( - - ° -- - -L P - - J 1 L . .. b _° e , – – — Street__ – -- • No.___4 _ Location and Legal Description Lot �. C Block — Subdivision_____ —'_4_; _ _t__%•lt'- f f= a I Street and Number where work is to be performed —No '.___.±r _ �1 r* — ' �" State work to be performed and purpose of building (By Floors) Service Overhead V Size Feeders Underground es. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT New Building t-� Remodeling Addition.. Repairs ____ No. of Stories Conduit__ � _ b __ Main Sw.1_ ° – s —_____ Amps. __Z Main Fuses - Amps. Type of Installation— Conduit Tubing B.X.L. ° e' ___ _ Metal Moulding Amount of Permit $ (Signed) L % ` • 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. I ; � �1 . (Signed) Master Electrican. My Commission Expires Notary Public, State of Florida STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared .— to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _ __ - -__ -- of the above described construction, 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 REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL. CONTR. LIST • d I 4 ♦ d ei ?i i-1 ,. , '� / A' 'If .' s ! t, CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST '` \ CHECK APPLICATION FOR ELECTRICAL PERMIT i h /fur Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foe' 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. d' `1 - r Owner's Name and Address __ / r _ —: f __ '` '4,_ No Street__ __________ c Registered Architect and /or Engineer - •� R Employing Electrician's Name >, - ( - - ° -- - -L P - - J 1 L . .. b _° e , – – — Street__ – -- • No.___4 _ Location and Legal Description Lot �. C Block — Subdivision_____ —'_4_; _ _t__%•lt'- f f= a I Street and Number where work is to be performed —No '.___.±r _ �1 r* — ' �" State work to be performed and purpose of building (By Floors) Service Overhead V Size Feeders Underground es. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT New Building t-� Remodeling Addition.. Repairs ____ No. of Stories Conduit__ � _ b __ Main Sw.1_ ° – s —_____ Amps. __Z Main Fuses - Amps. Type of Installation— Conduit Tubing B.X.L. ° e' ___ _ Metal Moulding Amount of Permit $ (Signed) L % ` • 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. I ; � �1 . (Signed) Master Electrican. My Commission Expires Notary Public, State of Florida STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared .— to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _ __ - -__ -- of the above described construction, 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. JOB: BUILDING ELECTRICAL PLUMBING ADD: The Following is ready for inspection:- Inspectoris Report: - WORK DONE BY: • REQUESTED : WILL BE READY j BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA DATE 194___ PERMIT N? 2765 Work to be performed under this Permit Owner of Building Architect Contractor or Builder Subdi- vision Legal Lot Bt. Description Address of Building 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 regula- tions 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. Value of Project Contractor's License No. Amt. of Permit CONTRACTOR OR BUILDER BY AUTHORITY • MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date (� / i Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fo4 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. Permit No._ Amount of Permit $ ss. No Owner's Name and Address _ � a Registered Architect and /or Enginee ��/// _ — � Employing Electrician's Name /2_Lf ,' ,. -?!%2 -No.___ - 2f r__ Street___ -L_ _ 1 _)__ _ ,___ Location and Legal Description Lot Le m IL_ -____ Block ____. Subdivision-_ — a_- v Street and Number where work is to be performed —No G sr 4 1 )7/s '�^-St State work to be performed and purpose of building (By Floors) New Building (1 Remodeling Addition.. Repairs —___ No. of Stories.. (Signed) _ Street C r Overhead 4 �— f 4 Service Underground Size Feeders Conduit__ Main Sw. _� Amps. Main Fuses________Amps. Type of Installation— Conduit Tubing____' B.X.L. Metal Moulding My Commission Expires Notary Public. State of Florida /-- Electr Insper or. The undersigned applicant for this building permit does hereby certify that 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) ___ _ ___ Master Electrican. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is 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 REC FIXTURES NO.LAM REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL C L ST 1 � n ' !/ a�� _ E'P'T'S EC !� /< Il A / V .r CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1-5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK • MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date (� / i Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fo4 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. Permit No._ Amount of Permit $ ss. No Owner's Name and Address _ � a Registered Architect and /or Enginee ��/// _ — � Employing Electrician's Name /2_Lf ,' ,. -?!%2 -No.___ - 2f r__ Street___ -L_ _ 1 _)__ _ ,___ Location and Legal Description Lot Le m IL_ -____ Block ____. Subdivision-_ — a_- v Street and Number where work is to be performed —No G sr 4 1 )7/s '�^-St State work to be performed and purpose of building (By Floors) New Building (1 Remodeling Addition.. Repairs —___ No. of Stories.. (Signed) _ Street C r Overhead 4 �— f 4 Service Underground Size Feeders Conduit__ Main Sw. _� Amps. Main Fuses________Amps. Type of Installation— Conduit Tubing____' B.X.L. Metal Moulding My Commission Expires Notary Public. State of Florida /-- Electr Insper or. The undersigned applicant for this building permit does hereby certify that 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) ___ _ ___ Master Electrican. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is 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. 4 + 11.4 JOB BUILDING ELECTRICAL PLUMBING The following is ready for inspection:- Inspectorls Report:- (;/) 4 A Dn c 6 WORK DONE BY: RJDJJESTED WILL BE READY ° • • /-/ Date i' -)-9: 9S Legal Description Owner / Lessee Owner's Address Contracting Co. Qualifier State # 0E,e !fr Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): UILDIN ELEC C PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION /.14,W,„7:•-/ RA-el ``4'31‘ OWNER'S AF be done i authorize Signatur Date: ** * FEES: PERMIT APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address /0 N / 5 / Tenant Master Permit # 3 8 y�5 /e 1E 9 Phone / L /s� Address ,S 7 ��' / . �� SS4� / � - 5:6 - S76 7 P .S �� � � Square Ft. Estimated Cost(value) 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. Notary as t•4)wher a My Commission Expir =s: AVIT: I certify that all the foregoing information is accurate and that all work will omplianc , .th all applicable laws regulating construction and zoning. Furthermore, I e abov .red contractor to do the work stated. (President a>g 4"/ 0G9S3 ondo Pres * * * * Fire Other Tax Folio My Commission Expi Signatur ' o • , ms 's'' $- Builder • o f c�PQD Air Notary as to Contrac •r •r Owner- Builder * * * * * * ** RADON C.C.F. /. NOTARY TOTAL DUE "5:" Zoning Building Electrical Mechanical Plumbing Engineering_ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Dates _ 1" Job Address �J �>� . Tax Folio Legal Description C - Aame / Lessee / Tenant A pklx � ct<, 1 3 Master Permit # 3 7Y'&( Owner's Address n f71 n1, *P Phone Contracting co. l` L `e C � 't` \ C Address 5�1 A)� C�� v e.� \1q Qualifier ■ h U1 %� SS# _ - Phone 1.o5 State # Municipal # Competency 11'1"11 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN W RK DESCRIPTION 0 Ok, Square Pt. Estimated Cost(value) M0 V 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, ROOPING 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. 1 Signature of owner Condo President Signature of Contr g g Date: Dater ** * My Commission Expires: * * FEES: PERMIT rJQ 4712 Notary as to bwne and /or Condo President Notar My Co APPROVED: Fire Other Zoning Building Electric A a> R 04/ •� T � �7 od xp=9414: Am NONTIEL. * COMMISSION NUMBER �� \ O CC401261 VY COMISBION P. orf\a AUG. 17199 - Builder RADON C.C.F. NOTARY TOTAL DUE c*'0 ** Mechanical Plumbing Engineering t X86A`v e i kk O 1C•S Nve 6"V‘ 1 \O'S , 1 to 1Y\ ` � C ITEM BATH 118 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) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR CRAIN SERVICE REPAIR/IETER 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 FP STEAM BOILERS SHOWER MOTCRS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 CORP. MOTORS OVER 3- 5 FP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEM3LIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS ';"-� } . A/C UNIT STRIP HEATER \(>K FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL J WATER SERVICE SIGN TUBES _ SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS ORAINFIEl0, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE P00L PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT. APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERHIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL Permit No 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 oI other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ,y _ Owner's Name and Address �f\ U 'Y 2- � L No /� Street ,�,L� ' / S' / �-. ...... Registered Architect and /or Engi neer _ ' Employing Electriciafi's Name 4.1/24- !- - ` 7 C No S$ /SO Street A /L / /T / Location and Legal Description Lot Block Subdivision Vi a Street and Number where work is to be performed—No. /c2. . 4✓4 �� Street A ° / � l State work to be performed and purpose of building (By Floors) M e 1� /`"�' '� ---^ New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Underground Type of Installation — Conduit Tubing B.X.L MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Amount of Permit $ (Signed) / ,Electric..) (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 Flon43 'Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con ractors 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. (Signe Date /._ 31-7r Amps Metal Moulding STATE OP FLORIDA, COUNTY OP DADE. I °°• Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REYRIO. OUTLET IRON OUTLET RANGE OUTLET RANG[ CONN. WATER H W. HEAT. CONN. SPACE 11 STRIP HEATER TOTAL CONTR. UST ti J 1 i i / �� I � � ' � �Y� CN[CK .1 r �� Floor i elp e tom✓ DI CAB. SERVICE TEMP. • [RVICE PERM. MOTORS ' HP R1 � ^-� J y MOTORS 1.5 HP NEON TRANS. -:� RADIO TOTAL CONTR. UST - I // •- ✓�� %i i CHECK � Permit No APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oI other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ,y _ Owner's Name and Address �f\ U 'Y 2- � L No /� Street ,�,L� ' / S' / �-. ...... Registered Architect and /or Engi neer _ ' Employing Electriciafi's Name 4.1/24- !- - ` 7 C No S$ /SO Street A /L / /T / Location and Legal Description Lot Block Subdivision Vi a Street and Number where work is to be performed—No. /c2. . 4✓4 �� Street A ° / � l State work to be performed and purpose of building (By Floors) M e 1� /`"�' '� ---^ New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Underground Type of Installation — Conduit Tubing B.X.L MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Amount of Permit $ (Signed) / ,Electric..) (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 Flon43 'Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con ractors 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. (Signe Date /._ 31-7r Amps Metal Moulding STATE OP FLORIDA, COUNTY OP DADE. I °°• Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated 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.