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262 NE 97 St (10)2 Owner/Lessee / Tenant 39140 /., s1C- Owner's Address A/E 7 Contracting Co. 4.—;s1 � I>° 4 144 � I''1 Qualifier 1 517 � � P 3 '✓ State # t,' ° ° ° ' ' w/1 Municipal # Competency # Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING E '•.T%• PLUMBING MECHANICAL ROOFIN PAVING FENCE SIGN WORK DESCRIPTION � � � � � f �� � �.. tr:v -A FEES: PERMIT 6 0 RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 2.621/a Afk S'7- Tax Folio if q ' C1" ° I -PR D Historically Designated: Yes No 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be d• e in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named cone for to do the w k stated. Date Notary er an or ' on•►. President Date My Commission Expires: qA i6t Master Permit # i L/ b Phone 3 9' 53 Address 5 7(/ VV G) /fk 5 aS# - Phone .1��' ° a{ S # CC 921872 une 4, 2004 ;,'ub:it Underwriters Signature of Notary as to My Commission Expires: Ins. Co. -B Date Date C.C.F. ' 11 0 NOTARY 0 — BOND TOTAL DUE APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering 1 SEP.04'2001 11:41 284 3968 THIS INSTRUMENT PREPARED BY ANDREW T. GERRiTS, ESQ. 6350 N. Andrews Avenue, SuIrc I00 For Lauderdale. Florida 33309 Parcel Identification No.: 3 206-013-04000 DEVELOPMENT 6 ALUMNI RELATIONS '4& ANTY DEED #1429 P.002/003 THIS INDENTURE, made this day of August, 200i., between, Deverly Ann Lychako, a single woman of 21428 S.W.Rai.ntree Street, Dualellon, Florida, party of the first part, and John C. Burch, Jr., whose post office address is: 262 N.E. 97th. Street, Miami Shores, Florida 33138, party of the second part. WIT'NE S5ETH That the said party of the first part, for and in consideration. of the stun of Teal. ($10.00) Dollars, to him in hand. paid by the said party of the second part, the receipt of which is hereby acknowledged, has granted, bargained and sold to the said party of the second part, his heirs and assigns forever, the following described land, situate and being in the County of Miami -Dade, State of Florida, to -wit: The West 1/2 of Lot 4, and all of Lot 5, in Block 30, of MIAMI SNORES SECTION 1, AMENDED, according to the Plat thereof, recorded in PIat Book 10, Page 70, of the Public Records of Miami - Dade County, Florida. and the said party of the first part does hereby fully warrant the tide to said land, and will defend the same against the lawful claims of all persons whomsoever. Subject to taxes for the year of this deed and covenants, conditions, restrictions and easements of record. The singular number as used herein shall equally include the plural. The masculine gender as used herein shall equally include the feminine and /or. neuter. ".• SEP.04'2001 11:41 284 3968 • IN WITNESS WHEREOF, the said party of th.e first part has hereunto set his hand and seal the day and. year first above written.. Signed, sealed and delivered izr the prese of: e ` m " ' i Sipnamreo I NOu'a 6fN (Nnrre of wfine al typed or primed) Sifpnaure {secs ir2 /- fori4C. e GI ( O i'1/,,,? Qsmie of Whoa A2 ryped CT printed) STATE OF FLORIDA )ss: COUNTY OF MIAMI -DA.DE ) My commission expires: ) The foregoing instrument was acknowledged before me Beverly Ann Lychako, who is (persona» _. . wn to (type of identif.cation)(as identification). r St of Florida � �,� ,�ao-or rrrrrtr, � es.q !r 0 OCC %523$ � 6 : • ∎ O P T 'JJ4JI / !c. " � ae DEVELOPMENT & ALUMNI RELATIONS #1429 P.003/003 thisday of August., 2001, by e)(or who has produced) 1- "43 ,-Td -76T-0 ITEM BATH 11.8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM( SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER REC.TTACLES A/C (WINO) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR CtAIN SERVICE REPAIRAETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING 1 INTERCEPTOR RANGE TOP UH3ERGROUNI TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSLRE VESSELS CLOTHES WASHER MOTORS 0- 1 IP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK. RESIDENCE MOTORS OVER 5- 8H TRANSPORTING ASSEMBLIES SINK. SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MQTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEM6 URINAL MOTORS OVER 25-100 FP COOLING ING TOWERS WATER CLOSET MOTS OVER 100 IP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GEENE.RATORS TRANSFORMERS • HEATER -NEW INST. ma 3. TORS WANSFORMERS -- HEATER - REPLACE GENERATORS TRANSFORMERS . LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL ' CUTLETS COMMERCIAL _ WATER SERVICE • SIGN TIRES . SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEKER SIGN TIME C10CK UTILITY-WATER FIXTLRES . SEPTIC TANK ANTENNA RELAY TELEVISION CUTLETS GRAINFIELD. 4' TILE/RES. VIOLATION .. PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. '& CATCH BASIN / ' 0(44 0 I SCHARGE WELL 00MESTIC WELL PfilVX: o d AREA GRAIN ROOF INLET -AgYi ;ea d SOLAR WATER HEATER 1 FIRE STANDPIPE POOL PIPING • LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) ^ r — GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOIfPANT THIS ADDENDUM. IF A FASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL • MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT ® APPLICATION FOR ELECTRICAL PERM - i - lA Permit No 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 Amount of Permit $ (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. J j SS. o J 0 61 - No Registered Architect and /or Engineer f� p Employing Electrician's Name No.... i) 0 Street �Y 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 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 obligations as an employer of labor under the Florida Workmen's Compensation Apt, being Section 5966, Compiled General Laws of Fl rida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) ("� C street ....i n— i — 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'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TL SERVICE PERM. MOTORG 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST 6© �A CHECK I � C °� 4,'t �� • MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT ® APPLICATION FOR ELECTRICAL PERM - i - lA Permit No 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 Amount of Permit $ (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. J j SS. o J 0 61 - No Registered Architect and /or Engineer f� p Employing Electrician's Name No.... i) 0 Street �Y 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 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 obligations as an employer of labor under the Florida Workmen's Compensation Apt, being Section 5966, Compiled General Laws of Fl rida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) ("� C street ....i n— i — 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. FLOOR NUMBER OF SIZES OF INSULATION OPEN OR CONCEAL'D NUMBER OF CIRCUITS OUTLETS MOTOR GEN. MAIN SUB BRANCH Basement First Second Third • Fourth Other Floors APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for issuance of permit for electrical installation as described below, and for inspection of same after installation: Owner Address Building Contractor Electrical Contractor Location of proposed work: Lot Block Details of proposed work: Number of Motors H P ousws. aiami Aores F L O R I D A Volts {i ii Amps. (SPACE BELOW FOR INSPECTOR'S USE ONLY) istra Date 193. _ Subdivision Building: Old or new Number of stories Used as Description of proposed work Phase MraoRs RECEPTACLES GENERATORS STOVER WATER M'TERS SIGNS BILLBOARDS Oi $ a.APPARATUB Additional Information Signature of Applicant Address (if other than owner or contractor) Work begun Inspected Work finished Final inspection , Inspector ;UILDING LECTRICAL - LUMBING MIAMI SHORES VILLAGE, FLORIDA DATE 194_ Contractor's License No. PERMIT N2 8617 Work to be performed under this Permit )weer of uilding rchitect : ontractor r Builder .egal Lot Bl. )escription ddress of uilding 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 appli- aion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any tans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 ::rmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and :gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statement; or specifications and that he assumes respon- bility for work done by his agents, servants or employees. Subdi- vision Value of Project Amt. of Permit 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. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 7 6' Permit No.. ....... Amount of Permit $ APPLICATION FOR ELECTRICAL PERMIT �f- Owner's Name and Address M"5 £ IVE MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT (Signed) Q � (Signed). Date . ..��' No 42 E Street 7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiv;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. 7 Registered Architect and /or Engineer. aim it 1t' m 14 k e Employing Electriciati's Name,,Z 43 434 • -risie No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No b a• P 6 Street 7 State work to be performed and purpose of building (By Floors) a , 'a 6 e .5 iv/ 4 sd 5' eA) New Building Remodeling Addition Repairs No. of Stories 0;1 service Und aground Size Feeders Conduit Main Sw Amps Main Fuses Amps e+t 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 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, work to be performed under this permit, as are licensed by Miami Shores Village. Muter Electrician. STATE OF FLORIDA, COUNTY OF 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•inepection 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 RECEEE P•T•s FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER H W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST �q c� CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.11 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK f 7 6' Permit No.. ....... Amount of Permit $ APPLICATION FOR ELECTRICAL PERMIT �f- Owner's Name and Address M"5 £ IVE MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT (Signed) Q � (Signed). Date . ..��' No 42 E Street 7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiv;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. 7 Registered Architect and /or Engineer. aim it 1t' m 14 k e Employing Electriciati's Name,,Z 43 434 • -risie No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No b a• P 6 Street 7 State work to be performed and purpose of building (By Floors) a , 'a 6 e .5 iv/ 4 sd 5' eA) New Building Remodeling Addition Repairs No. of Stories 0;1 service Und aground Size Feeders Conduit Main Sw Amps Main Fuses Amps e+t 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 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, work to be performed under this permit, as are licensed by Miami Shores Village. Muter Electrician. STATE OF FLORIDA, COUNTY OF 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•inepection 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 Owner's Name and Address Registered Architect and /or Engineer__— MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date__ ____�.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. Employing Electrician's Name_}_.____SJ,L r — _____No.__u1 ___&1.__________Street l ,_ Location and Legal Description Lot Block Subdivision_ Street and Number where work is to be performed— No._. .L_ ___J_ • E • Street J 7 .._ic ft State work to be performed and purpose of building (By Floors) New Building — ____________________Remodeling Addition Repairs No. of Stories C.. Service Overhead Si Underground ze Feeders Conduit_ Main Type of Installation — Conduit-- ______ —_ Tubing____________ B.X.L._— .________Metal Moulding Amount of Permit $ — ___: (5Z ss. (n/ No Street (Signed) _ -- Master Electrician. 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 sub - contractors employed by 1i:m in the work to be performed under this permit; and will post or cause to be p osted 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 1 i Main Fuses Amps 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, and he has carefully read the foregoing application, and that 1-e 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. CAB. SERVICE TEMP. SERVICE PERM. � � 7 4 , pL MOTORS • -1 HP MOTORS 1 -5 HP N EON TRANS. RADIO TOTAL CONTR. LIST // t ^-. f - i CHECK 4 ri f c° Permit No Owner's Name and Address Registered Architect and /or Engineer__— MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date__ ____�.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. Employing Electrician's Name_}_.____SJ,L r — _____No.__u1 ___&1.__________Street l ,_ Location and Legal Description Lot Block Subdivision_ Street and Number where work is to be performed— No._. .L_ ___J_ • E • Street J 7 .._ic ft State work to be performed and purpose of building (By Floors) New Building — ____________________Remodeling Addition Repairs No. of Stories C.. Service Overhead Si Underground ze Feeders Conduit_ Main Type of Installation — Conduit-- ______ —_ Tubing____________ B.X.L._— .________Metal Moulding Amount of Permit $ — ___: (5Z ss. (n/ No Street (Signed) _ -- Master Electrician. 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 sub - contractors employed by 1i:m in the work to be performed under this permit; and will post or cause to be p osted 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 1 i Main Fuses Amps 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, and he has carefully read the foregoing application, and that 1-e 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. i Company Job Address REQUEST FOR INSPECTION PHONE Inspection_ Time Ready A.M. P.M. Date Ready NO. STREET PART OF LOT LOT BL'K SUBDIVISION Signs. Billboards / Permit Fee . Outlets Motors Receptacles Generators Stoves Wat r Heaters Signs. Billboards v , Other Apparatus ' Permit Fee . // , ( . j - ELECTRICAL PERMIT N. B. —This Permit must be on display on the premises during the construction. Owner of Building Co r ractor or Electrician aiami cShores9 llage F L O & ID A OFFICE OF ELECTRICAL DEPARTMENT Miami Shores Village, Fla , 19 DESCRIPTION OF WORK NUMBER OF LO CATI O N 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 the plans and specifications unauthorized by this Department. 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 Floriclkall the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami Shores Village. a Dated , 19 r N? 477 , Electrical Inspector. (Seal)