2883Pettait 62-
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
5 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 described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and ill 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 /distal': r 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.
Ovnierle)iante and Address. govs--did-1.4., ' 1 ‘` 1/4.4 '2 ft2 " No Street q ..2-f,, 6 o
Registered -Architect and/or Engineer
Emplo*ini. Electrician's Name ...
Location-and Legal Description Lot. Block
Street and Number where work is to be performed—No 6 # Street.. 9
No
4e,
Aincinit'nt Permit $
/7. (Signed) .
Subdivision.
State work to be performed and purpose of building (By Floors) LA/ i
New- Building._ Remodeling Addition Repairs... No. of Stories.
Servlce ,tive U rground Size Feeders Conduit. .Main Sw .Amps. .Main Fuses.. -Amps
nde
Type of Installation—Conduit Tubing B.X L .Metal Moulding
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 of
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be
licensed by Miami Shores Village.
My Commission Expires
(Signed)
Street 7 Lk
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
therein by him stated are true.
Electrical Inspector.
s obligations as an employer of
rida Permanent Supplement, and
contractors employed by him in the
the work such public notice or notices
performed under this permit, as are
STATE OF FLORIDA, }
as.
COUNTirt OF DADE.
&fore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
sign the same, and that all facts
Notary Publlc, 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.
Starrett
Ounrre
LIGHT
OWLETS
PLUG
RECE`P•T'S
FIXTURES
No. LAMPS
ROMIG.
ourixr
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SCCE
HEATER
STRIP
HEATER
TOTAL
LIST
1
omen
.
•
.
sw.
DIST.
CAE.
SERVICE
TEMP.
SERVICE
PERM.
i,/,..r-
, 0.--
MOTOR S
04 HP
MOTORS
1.15 HP
NEON
TRANS.
RAD**
To m,
Cownt.
LIST
if/
/ /
CHECK
4...
..
Pettait 62-
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
5 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 described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and ill 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 /distal': r 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.
Ovnierle)iante and Address. govs--did-1.4., ' 1 ‘` 1/4.4 '2 ft2 " No Street q ..2-f,, 6 o
Registered -Architect and/or Engineer
Emplo*ini. Electrician's Name ...
Location-and Legal Description Lot. Block
Street and Number where work is to be performed—No 6 # Street.. 9
No
4e,
Aincinit'nt Permit $
/7. (Signed) .
Subdivision.
State work to be performed and purpose of building (By Floors) LA/ i
New- Building._ Remodeling Addition Repairs... No. of Stories.
Servlce ,tive U rground Size Feeders Conduit. .Main Sw .Amps. .Main Fuses.. -Amps
nde
Type of Installation—Conduit Tubing B.X L .Metal Moulding
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 of
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be
licensed by Miami Shores Village.
My Commission Expires
(Signed)
Street 7 Lk
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
therein by him stated are true.
Electrical Inspector.
s obligations as an employer of
rida Permanent Supplement, and
contractors employed by him in the
the work such public notice or notices
performed under this permit, as are
STATE OF FLORIDA, }
as.
COUNTirt OF DADE.
&fore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
sign the same, and that all facts
Notary Publlc, 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.