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ELECTRICALMAGDALENA CALLED AND PAID RE- INSPECTION FEE $75.00 BY CREDIT CARD ON 12/30/05 W/ MONICA. Passed Inspector Comments / . X,- Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 01/03/2006 Inspector: Devaney, Michael Owner: PEREZ, JOEL Job Address: 1167 99 Street NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: L S CURTIS INC Building Department Comments Friday, December 30, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Pho : (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: <NONE> Phone Number Parcel Number 1132050180080 Lot: Phone: 305 -892 -0115 Page 2 of 2 1167 NE 99T 786 -486 -1962 FINAL ELECTRICAL Passed Inspector Comments 6 g ael /./As e r2.<- a,)- xi -.z it O H Go a tam/ — /� r7 r 4',I? 7 V ../.4 0,4./.4z- ire % S LIB e f ! l >`7" l 1 /C—¢S ' 0 4-- / 9 •►d (-, ?z e9 f 4 0 / 2 . - �k7 � iv % war - , k "- �� o �1� 7" 0 I7 QL 7 d ehz 1 t f ' 7-t, - N1/47" Se 5 1/W7 / / / `e° (/ S .I £' 4,—. � /-/� &, , / // E. Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 123 Inspector: Devaney, Mto Owner: None, None Job Address: 1167 99 ST Project: <NONE> Miami Shores Village, FL Contractor: L S CURTIS INC Building Department Comments Monday, December 12, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 e zo3,5-() Block: Permit Type: Imported Permit Inspection Type: Me Work Classification: <NONE> Phone Number Parcel Number 1132050180080 Lot: Phone: 305 - 892 -0115 Page 1 of 2 311 MIAMI SHORES VILLAG BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date81 I c Type Insp'n� k Permit No. PI—DE - Z 0 Name _Jo G I P YLZ Address 1 1(c:;"7 He E 9 q ST' Company / L S Cur-Hs INC. Phone # ( ) 456 - /96 Z Inspection Date Ea 1 3 I J Approved Correction Re- Insp'n Fee Contractor L S CURTIS INC Local Phone: 305 - 892 -0115 Parcel # 1132050180080 Electrical Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: EL2005 -20 Printed: 3/16/2005 Applicant: JOEL PEREZ Owner: PEREZ JOEL JOB ADDRESS: 1167 NE 99 ST Contractor's Address: 20341 N. E. 30 AVE. 108 -6 Legal Description: REV PL MIAMI SHORES SEC 8 Page 1 of 1 Fees: Description Amount FEE2005 -3456 Building Fee $225.00 FEE2005 -3460 CCF $0.60 FEE2005 -3461 Training and Education Fee $0.20 FEE2005 -3464 Technology Fee $5.63 FEE2005 -3465 Submittal Fee ($50.00) Total Fees: $181.43 Total Fees: $181.43 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 7/17/2005 Construction Value: $800.00 Work: ELECTRICAL FOR GARAGE ENCLOSURE - CONVERT TO NEW BEDROOM AND BATH - MASTER BP2005 -63 PB 43-69 LOT 19 1 ?Pa Signed: (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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: BLK 178 LOT Miami Shores Village 4 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel': (305) 795.2204 Far (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Building Department Electrical Plumbing Owner's Name (Fee Simple Titleholder) 7-7 /e/Ze Z Phone # 16.1" 9 Owner's Address /76 ' 7 e 'rT 1 City ,/ , , jD.Aei State ,7' Zip ,/, P 7 Tenant/Lessee Name Phone # Job Address (where the work is being done) /l 6 me 79 ft City Miami Shores Village County Miami -Dade is Building Historically Designated YES NO Contractor's Company Name ' f (;),,, 72J Phone # 7)'6 </:40 Contractor's Address City/9 e477-)/t,f State j=' f Zip y,?/mod Qualifier State Certificate or Registration No ,.t!' 000 24 $ Value of Work For this Permit Type of Work: pion Describe Work: Total Fee Now Due $ (Continued on opposite side) ation DNew Permit Fee $ 7 - 4— • v411 Training/Education Fee $ v r p Structural Plan Review. $ Permit No. / 5 ^- LO Master Pernik No. 05-43 3 Mechanical Roofing zip .f// f/ Certificate of Competency No. C Oek) Yr"' 7)_ Architect/Engineer's Name (if applicable) Phone # • * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * * * * * * * * * * * * ** CCF $ t (4 • CO /CC Submittal Fee $ Notary $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Square Footage Of Work: 0 Repair/Replace ❑ Demolition Teclmology Fee $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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 construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _, by , day of ,,6 , 20/7 -� , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 as identification and who did tak oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: rp, Meliudu K. ktielsberg , % Commission # DD088207 a' Expires March 8, 2006 My Conunission Expires: My Comm "� n res: Bonded Thru " .un• Atlantic Bonding Co., Itv, ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 7/ Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT ,S-- FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER / U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS QVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 I-P VIOLATION INDIRECT WASTES - ' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS ,? 7 l A/C UNIT STRIP HEATER S GJGV / FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COM+IERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS J DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. tir - 7694 740 q CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RAGE METER SET (GAS) GAS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED; THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL BUILDING PERMIT APPLICATIO FBC 2001 Job Address (where the work is being done) Miami Shores Village Buildin De • a tm.ent 10050 V.Rii : , „� t� Al res, Florida 33138 de1: (305) 795.2204 ax: (305) 756.8972 Is Building Historically Designated YES NO Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Titleholder) 4 Owner's Address tits ' IJ E �7 `�" - ' City MI cum; evina bras s State F L- Zip 3 3 c S Tenant/Lessee Naine Phone # 11‘01- NE qal -'fit City Miami Shores Village County Miami -Dade Zip Permit No. dCOs' O Master Permit No. 0-C Mechanic� 3 � Roof l'g Contractor's Company Name erkyv1J2 r Phone # Contractor's Address f&4A. ' -5 4 4 0 4 City State Qualifier State Certificate or Registration No. Certificate of Competency No. Arclutect/Engineer's Name (if applicable) '�kLVbVt. 4 c • Phone # `$54 $ Value of Work For this Permit 1r'd• J Zip Square Footage Of Work: Type of Work: tgAddition ❑Alteration ❑Ne ❑ Repair/Replace ❑ De on Describe Work: �6f4/C4-7 et ttiaP G►A,1r� e is-1_4-6s are_ .- ejjy4 itir T Lute. ) irt * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Pr Permit Fee $ CCF $ CCC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (Continued on opposite side) Miami Shores Village BUILDING PERMIT APPLICATIO FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Owner's Address (16 ' it'Vt., - City Mi G.tM) cv' tna b'e s State Fa— Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village is Building Historically Designated YES NO Contractor's Company Name 4-6A..,2 it ALTYLI2f Phone # Contractor's Address t.L / City State Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) M. • :1 1+llr 4o Phone # $ Value of Work For this Permit c%i(9. Type of Work: Addition ❑Alteration ❑New Describe Work: &Wel d AA.d 444..Gt41JS Total Fee Now Due $ (Continued on opposite side) Buildin De • artment 10050 et: (305) 79 ° .2204 DEC Electrical Plumbing Mechanical ' e(' Phone # t i(a 1..41". +-. County Miami -Dade 7�- , Florida 33138 56.8972 Permit No. t ' O ' ( -F� Master Permit No 0 , Zip 3 Phone # Square Footage Of Work: Zip `15y ❑ Repair/Replace Roofing 3 8'1 sZta — 3 /LZ ❑ Demolition detet tl k /4.4.64) ****************************F Submittal Fee $ P►n Permit Fee $ CCF $ CO/CC Notary $ Training/Education Fee $ Technology Fee Scanning $ Radon $ Zoning B ond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lende r's Address City attlibt lQl Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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 construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Sign: P Own r or A instrument was ackn t ifrrovr O r; O lt ersonally /nown to me ent • ledged befo - e this • -S�y p Ex Signature The day o who NOTARY P , APPLICATION APPROVED BY: Chc 05/13/03 pc 3eic 'No/4 State e ttO Zip 0 5 has produced l/ OF GLO Signature pp Contractor (C-The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Ginny H. Go is sion #DD3 ires: May 26,12f9a: onded Thru Atlantic Handing ( ' :. Commission Expires: My Commission Expires: / g ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ITEM BATH TR18 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AWPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEM3LIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- .. A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS ' A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COM€RCIAL WATER SERVICE SIGN TUBES . SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA ' RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. - - CATCH BASIN ; E . ' tV i ie HUG DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING 1 " ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL F L.S. Curtis R 20341 NE 30th Ave., #108 M Aventura, FL 33180 I STREET 1665 NE 137th Terrace cm' N. Miami Beach STATE Florida ■ Arco Construction We hereby submit specifications and estimate for: As per plan: This prig does not include: Cost of permit, cost of utilities, cost of trenching, Lighting fixtures, lighting controls, painting or plastering of interior or exterior. All wiring to be done in romex. We hereby propose to furnish labor and materials - complete in accordance with the above specifications. for the sum of __Six Thousand, Nine Hundred -----dollars (S ___- 6900.00 ) with payment to be made as follows: All material is guatantccd to be as specified. All work to be completed in a workmanlike manner ame n:Lim to standard practices. Any alteration or from above specifications involving extra costs, will be executed only upon written orders, and will become an extra cherge over and above the agreements contingent taro strikes, accident or dalaye beyond ow control. This provers! mhjest tot aeeq,tancc days and it is void thereafter at the option of the undersigned. ACCEPTANCE OF PROPOSAL The above prices. specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will he madc as outlined above. ACCEPTED: DATE Signature and Ccnraaon Forms form sro. 6= 1 PROPOSAL SUBMITTED TO: Authoriccd Signature PROPOSAL Page No. 1 of 1 Pages PHONE 305 - 892 -2379 I f7E 2/25/2005 JOB NAME Perez STREET 1167 NE 99th Street cm' Miami Shores Signature 'STATE Florida _ - Permit No ,1 Application is hereby made for the approval of the detailed statement a the plans and speck" herewith hmltted for the h structure herein described This application is Made in compliance arid cotiormity wkh the Buil Mini tirdinanceOl Shores V and all provisions of the Laws of the State of Florida, on ordinances ef Miami Slims VOoge end aW fit#1110 siklietelforet di* of Miami Shores Village shall be complied wb whether herein specified or not, A eopy if oPPreiked Phrts J Onstfikatiods Matt 11110d building during progress of work. Owner's Name and Mdress. ....L.WL..)L dJj O .No. . .... fo• Al Registered Architect and/or Engineer.. Employing Electrician's Name 1- ey 5 Wericit In- C. Nu 1.10 Latilpt • . Block— — — Street and Number where work is to be performed—No—,1":07 State work to be performed and purpose of building (By Floors) ......... ......... ...... ...... . . . New Building Remodeling _Addition ..„ ..... of tr location and Legal Description Lot CONTR. LIST CHECK =1W Service Overhead Size Feeders ..., Amps.— Conduit-- .Main $w . . . BX.L. '44ain Underground Type of Installation—Conduit . Tubing— . .14.1* Si..re,11aW-Td..I.V.......tfkgti4O IV Amount of Permit S. 020 0 0 APPUCATION FOR WICalriti (Signed) The undersigned applicant for this building permit does hereby certify thy he nodentands wad wants his obligations as labor under the Florida Workmen's Compensation Act, hang Setdora 066i Co nviiid Swami Laws *f ileitis Permanent s has complied with the provisions thereof, and Will require Sailiss lasiggiaso from IN 'eters or sishormectteture einPlnrul work to be performed under this permit; and will post oo to be posted for iniatetion on the site of the, work soh "Min stoke or as are required by the Act, The un4ersigned agrees * ploy only rah atheostraitioss on win* to be petionned under 4iis pi licensed by Miami Shores Village. k (tA STATE OF FLORIDA, COUNTY OP DADE. o It 1 . aro V V orlak. SOO mat MIAMI SHORES Viii4A1 ELECTPilCAL INISPOCTION DaVkAltittlItter to me well known, and who, being by me first duly sworn, upo of the above described construction, and he has carefully read- therein by him stated are true. Dae ss oostroosoo o soossostrosstrostrsostro o s o s so ...oasts. • Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aekno oats and says that he ie ties.ostaseoes.trossessosOSS. °in Volleatios, and drag he did ogn p ••• trso sios . • •• • oa My Commission. Expires Notary Public, State of Florio NOTE r A re-inspection fee of $1.00 will be abode when au tnirispnetIon is made meson' by iarproper notice for italyeetions ear materials and/or workmanship, Permit No Owner's Name and Address MIAMI SHORES VILLAGE EUCCTRICAL INSPlECTION DEPARTNOW APPLICATION FOR IEUCOTRIOAL PERMIT Registered Architect and/or Engineer Employing Electrician's Name..4e.40.1W....0 Location and Legal Description Lot. Street and Number where work is to be performed—No. / 6 New Building Remodeling Addition. CONTR. LIST CHECK CONTR. LAST CHECK Amount of Permit $ SS. My Commission Expires ft. No.. Block.. / 2 Al a ... (Signed).- Application is hereby made for the approval of the detailed stateia ent. a the plane sal specifications herewith sobatitte structure herein described. This application is made in Compliance and conformity *eh the Bing Or/Bence of Miami Shores VitialA and all provisions of the Laws of the State of Florida, ali ordioance,s of Isfiami •rola and soitulagona of 'the Building go of Miami Shores Village shall be complied with, whether herein specified or not. A eopP of approved plans and SpfligiCadDIIS must he bigt ttt building during progress of work. .Streo P 41-1- AhMie No Itreet. 1 asA sa a.. Y.. • 1 State work to be performed and purpose of building (By Floors) — • • - No. of Stories,— 11111111101 SWITCH LIGHT PLUG FIXTURES MIMIC. OUTLETS OUTLETS RECE'P'T's NG. LAMPS OWLET ENT. SW. MOO IRON OtITLET WAVER lit'. NOM COM. ttitivrea Site Feeders.#/ Conduit. 4Maiti Sw. 2 Service Overhead Type of Installation—Conduit Tubing Jai.- ..... • .•• ••■•. . . . ■•••••••.. . . Ilicetrica The undersigned appl c for this building permit does hereby certify that he und,retkds arid aikott Ids obligations as art ern' labor under the Florida • orkmen's Compensatloa At being Seed= 5966, Compiled General Laws ail Florida Permaseat %peewit slier 'Li has complied with the provisions thereof, and will require similar compliance from all coatrooms or sulavistractors employed by him k 41;141* work to be performed under this permit; and will post or cause to be posted for inspection ori the site et tie omit suelt public notke et steNies as are required by the Act. The undersigned agrees' to employ only such sub.contractom, war* to be periorated wide this Pormisi licensed by Miami Shores Village. STATE OF FLORIDA, } COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorked to administer °At and lot acknowledgments, p appeared............................ ...................... ...... ....... -....-........-......— ..... ........... to me well known, and who, being by me first duly sworn, upon oath deposes and aye that he is of the above described construction, and he has carefully read the foregoing application, and that he did eign the same, and that ulI foots therein by him stated are true. I Notary Public, State of rktrida NOTE: A r apection fee of $1.00 will be made when such re-inspection is made necessary by improper Rorke for iimpeetioft, materials and/ workmanship,