14180• -
SWITCH
OUTLETS -
LION?
UTLETB'
PLUG
RECE•P•T•8
FIXTURES
No. LAMPS
REPRIG.
OUTLET -
IRON
- OUTLET -
RANGE.-
- OUTLET
RANGE
CONN: -
WATER
HEATER
W. HEAT.
CONN. -
SPACE
HEATER
STRIP :
HEATER
TOTAL
CONTR.
LIST
CHECK
IC
ENT.
SW,
DIST.
CAB
SERVICE
TEMP.
SERVICE
FERN.
MOTORS
O•I HP
MOTORS
1.0 HP
NEON
TRANS.
RADIQ
TOTAL,
. L18T
-
-
•
-
• CHECK
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No.......1 Zk 0 Date. ,1 �„ •�J '`J' ,�
w ».
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.
ai9N1 �;
Owner's Name and Address /F OA $ Rersk�+ree>A,J a`w`11N°. l : itreet_ NE 9 •'S sue`
Registered Architect and /or Elneer _
Employing Electrician's Name-NOSY/kg. O.elsd. ._: L. 4 1 G , No 4.2.6 Street N
Location and Legal Description Lot. Block
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors). .._...........__.
New Building... '• , ......._Remodeg » w .:Addition t �
Amount of Permit $:• 4®
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me; the undersigned authority, a notary public, duly
appeared -.
SS.
MIAMI SHORES VILLAGE
•••:
Subdivision. ._.
i... _Street : 9 9-5°-49-f •
Repairs.
(Signed)
(Signed)..
authorized to administer . oaths
and take
•
No of Stories.
Service Overhead Su F ee de rs ----- w....Amps. .Main Fins. .Amps
Type of Installation — Conduit, Tubing B.X.L ;Metal Moulding ._. »..www .... ...: . .......... .... .
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 3966, Compiled General Laws ' of Florida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•iontractors 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 s,4b•contra , on w rk to perform under permit, as are
licensed by Miami Shores Village.
Master. Electrician. -
cknowledgments, personally
'My Commission Bapires .. .•-» -- .........». Public, State of Florida,
NOTE: A reinspectioa fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
materials and /or work,banship.
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. - •
Df
r
for
er
ion.
Lot
ll Bl,
Subdi-
vision
of
r
Value of
Project
$
Amt. of
Permit
$
UILDING
LECTRICAL
PLUMBING
ROOFING
Owner
Buildin
Archite
Contrac
or Build
Legal
Descrip
Addres
Buildin
MIAMI SHORES VILLAGE, FLORIDA
❑ PERMIT N° 14180
Work to be performed under this 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.
CONTRACTOR OR BUILDER
DATE 195 —
Contractor's
License No
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.
BY AUTHORITY