8376State work to be performed and purpose
'slew Building Remodeling
of building (By Floors)
Addition Repairs
No of Stories
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
CO.
LIST
I I I
CHECK
ENT.
SW.
DIET.
CAB.
SERVICE
TEMP.
SERVICE
M.
MOTORS
0.1 HP
MOTORS
1-13 HP
NEON
TRANS.
-
- RADIO -.
TOTAL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLI I CATION FOR ELECTRICAL PERMIT
Permit No 7 3 7
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 .ahall 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 Addres
Registered Architect and /or E
Employing Electrician's
Nam o . X fr Street
Location and Legal Description Lot Bloclr / �ubdivision� �• sJ • !/
Street and Number where work is to be performed —No 6 D r• M • � t 1" Str e •
Overhead
service Underground S ize Feeders Conduit Main Sw, Amps. Main Fuses
Type of Installation— Conduit Tubing B.X.L.__._____Metal Moulding
Amount of Permit $
lectzical Inspector.
The undersigned applicant for this building permit does hereby certify that derstands and accepts his o bons as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5968, .pled 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 him in the
work to bee performed under this perniit; 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. (
(Signed) t. -� , „ / /'r
STATE OF FLORIDA,
COUNTY OF DADE. j
II
9, hd ✓a/o.
Date ./41//5/*167
No Street
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to pdminister 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.