665 NE 97 St (7)n
PERMIT 'N° 12236
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building ,►
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
Lot
1
I
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
DATE
Amt. of
Permit $
f I
Signed • BY - r
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.
195
Contractor's
License No
This permit is ranted 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.
BY AUTHORITY
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
n
( PERMIT N? 12035
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
(
Fl Work to be performed under this Permit
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Value of
Project $
DATE ► 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's
License No
Amt. of
Permit $
BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE 19
❑ PERMIT N9 230 Contractor's
License No.
❑ Work to be performed under this Permit
B1
Subdi-
vision
Value of II Amount of
Project $ I I 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 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. 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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY ABBOT PRINT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ( 1-) ( ( Job Address 0(0 e q 7 sr • Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 6y/ l /� �// / a✓� Master Permit #
Owner's Address Ii . Phone .Q) g 771 7 '
Contracting Co. rfloote ) 0C Address ap 9 - /t) a) 4O 5 r
Q ualifier,) fr) CYJ&f SS# �� - / Phone gq/ —/37 q
State # 6( 1 t g q Municipal # Competency # (b6 Ins. Co. l 1/ 7FO2D
Architect/Engineer Address �J f
Bonding Company A Address / V
Mortgagor
Permit Type (circle one): BUILDIN ELECTRICAL ,' LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Go 9 v .e/Gk - 4 , 2
WORK DESCRIPTION
- 07 3
Ft. Estimated Cost (value) 7®
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
constructi jy ore, I authorize the above -name ctor to do the work stated.
a • - I e o owne an .► ofrado President
Notary as to
My Commis
APPROVED:
ffm,
er and/or
on Expire
Date
C l123k/
OFFICIAL NOTARY SEAL
4,3, OFFICIAL
MARY P BRIGGS
2 11 0 COMMISSION NUMBER
4P Q CC74186
71 49 P.riv COMMISSION EXPIRES
F o - '' P DI 11,2002
Address
Signature of Contractor or Owner- Build
Notary as to Contra
My Commission E
OFFICIAL NOTARY SEAL
<, MARY P BRIGGS
COMMISSION NUMBER
Q CC741860
�� fa9Y COMM ISSIONI EXPIRES
or F‘,0 11,2002
FEES: PERMIT 0 ®�.Q RADON C.C.F. NOTARY 0 0 BOND
Zoning Building Electrical
TOTAL DUE
Date
13 0
Date
Mechanical Plumbing Structural Engineer
6AIRNEb, MOODY
V;ce President
MOODY/ ELECTRIC INC.
STATE CERT. #
EC0001199
TEL: (305) 891 -1374 669 N.W. 90th Street
FAX: (305) 758 -2000 MIAMI, FL 33150 -2166
' CONTRACTOR
New Construction
Nam% (1 g.71 ft. 1 6,
Address C (06 ...i c ST
H I Pri-4 1 S 4402t. S. n-- 3 3
Lice
Licea No. ■,
7 b a aoo/ ,P3
Home Telephone 305 .. If — goscs) 5
Address /
4 44V48 7r2 "3
Business Telephone 094, — (0 I 0 — 1 L ig
Telephone e) , . sr 7 7 Fax ... if r......n
i
Qualifier Name A
kI-64.fr5r k("
Demolish
' PROPERTY OWNER
,
New Construction
Name 51 Li ..., 4. SIAU„E.:1 13 ITI■
Address C (06 ...i c ST
H I Pri-4 1 S 4402t. S. n-- 3 3
2
Home Telephone 305 .. If — goscs) 5
Business Telephone 094, — (0 I 0 — 1 L ig
Fax
(...
TYPE OF MANAGEMENT ( 1 )
New Construction
Enclosure
Alteration
Repair
Alteration Interior
(...
Demolish
Relocation of Structure
Shell Only
Foundation Only
Addl Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLICATION
K Job Address:
Address
Folio Number/j3 61000 1/4 of Work f r 05-014 vv2/70
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property A04
Tenant Information
PERMIT TYPE ( )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt. City
PERMIT CHANGE (/)
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Zoning
Square Feet
Value of Wor
Tax Assessed/ ppraised Value
Flood Zone Base Floor Elev.
PERMIT APPLICATION
Master Permit No. /SP • 202- or
Subsidiary Permit No. 2/YD.D • c .79
it/640/( Y/o/R6a r4
State
Linear Feet
Zip
Units Floors
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE FLOR iDA, COUNTY OF MIAMI -DADE ST OF
It
f' of Contractor /
ature of Owner
1A)311 c -
W
Print Name
Sworn to and subscribed before me this /8
"Tr?
da of ZAZ
Signature of No ry Public - State
SEAL:
afentka Enrique Chau
* *My Commission CC706757
e4.1 Expires January 18, 2002
Florida
Personally known / OR, Produced Identification
Type of Identification Produced:
COUNTY OF MIAMI -DADE
Pr nt Name (�
Sworn to and subscribed before me this /6 day of -JAy - `,t2G
Signature of Nota ry blic - State of Florida
SEAL: 8 Enrique Chau
* *My Commission ct
' Expires January
PERMIT APPLICATION i
Personally known . / OR, Produced Identification
Type of Identification Produced:
Page 4
OFFICE USE ONLY
CHECKLIST
O OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
$
/ g,
( sq.ft. = x/1000
x(t.60)
$ (0.005 /sq.ft.)
$ (0.01 /sq.ft.)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
BY
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
/
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton )g.
l
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8-15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
/
Parking Lot Lights
Spas/Hot Tubs
/
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
i,
Receptacles
/0
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, ]Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
_
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
, Low -volt, Television
Service, Number of Amps
5Z0
Water Heater New
MECHANICAL
'I YPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE QTY.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan- Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE.
Drains, Roof
QTY.
TYPE.
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
RECEIVED AND REVIEWED BY:
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
DATE:
/
PAY
TO THE
ORDER OF
FOR
AV ELECTRIC CENTER CORP
495 W 15TH STREET
HIALEAH, FL 33010
( S lix I c-4_46 (-s
4UNION PLANTERS BANK
(
7(41
1000 2 9 1:06 700134 L 41: L 3 SOO, 5 79 210
- ..... .
.!.:_t ..... . ..... ....... ,
DATE /
.302-
2594
63-841/670
BRANCH 6215
1 $127,2_c
2s
/.d;. DOLLARS
Security *atoms
Wads on back.
Permit No
1
APPLICATION FOR ELECTRICAL PERMIT
Date
G
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,
Name and Address ,l..s '
Registered Architect and /or En - in ee t , �^
Employing Electrician's Name /
)
Location and Legal Descriptiorf Lot. "t'......F �' :` Bloc
Street and Number where work Is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
� C )
Street./
l
Street— ..,. ...._
Subdivision.
.Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead
Site Feeders Conduit Mai w Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE It
ectrical Inspector
The undersigned applicant for thus building permit does hereby certify that h understan• : and accepts his obligations as an em yer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compile• " eneral 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 sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
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' Is and /or workmanship.
(Signed)
(Signed) (./
Master Electrician.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
R ECE'P'T'S
FIXTURES
N O. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. HEAT.
CONN.
SPACE
H EATER
STRIP
H EATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
M OTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
''�
� � =
'
Permit No
1
APPLICATION FOR ELECTRICAL PERMIT
Date
G
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,
Name and Address ,l..s '
Registered Architect and /or En - in ee t , �^
Employing Electrician's Name /
)
Location and Legal Descriptiorf Lot. "t'......F �' :` Bloc
Street and Number where work Is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
� C )
Street./
l
Street— ..,. ...._
Subdivision.
.Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead
Site Feeders Conduit Mai w Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE It
ectrical Inspector
The undersigned applicant for thus building permit does hereby certify that h understan• : and accepts his obligations as an em yer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compile• " eneral 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 sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
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' Is and /or workmanship.
(Signed)
(Signed) (./
Master Electrician.
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date /D`71502 Time
Type Insp'n Oa/ A6
Permit No. G� 200
Name
Address (O GJ / / Jf 7 /
Company A Cee-g4, r
Phone # , 2 0 5 — 7 7b 9 /
For Inspector: /D'e-M.. Name & D
Approved ❑
Correction L❑✓ ��G�
Re- Insp'n Fee ❑
)--------
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildin ; Inspection Request
Date 1 al
Type Insp'n
Permit No.
Name
Cost ME 971,3
Address
Company
Phone # C76 0 J 5S 3
Inspection Date l ! / So
Approved ❑
Correction ;/"' ��d�
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 0 /
Type Insp'n t-LS
Permit No. - c330 — cS
Name
Address
Company
'Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
(7) 5 s 3 -- 3 v va--
)20 /� \c'a dy
Type Insp'n
Permit No.
Name
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection R
Date --/(? 92 Time
Address
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
,r
AS"AJg 97 S
355_ 77839' 7
4 4-47-02.. me & Date
1
Date V
Type Insp'n 4-744
Permit No. 'L 6 (;-f
4'izzjk
44. /2 f7S/'
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BUILDING DEPARTMENT
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