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ELECTRICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date S Job Address 4 N l `l c • Tax Folio /7 5 • ,&'/.3 • 'fee ' Square Ft. Legal Description Low + Block 33 �ssee / Tenant b ( W 1,1 N $ , W c2 \G. * t' (El -C.EtJ kiet Master Permit # 1/ / Owner's Address <PI C ( t4 E QQ - 9 313f Phone 3ti C • 7 57. S O s? WORK DESCRIPTION Contracting Co. Ink 1$ • 0 L gnature of owner; Co 00034 2rt;U j12C Linde r RStat'3 I iotary as to W' er and/or Commission Expires: FEES: PERMIT ,,5 i ` RADON APPROVED: Zoning Mechanical o President Date ctg Historically Designated: Yes No Address -r �Gt/ IJ' SS# / Phone of T.�'0 -e Qualifier / State # f Pd0 P Competency a223 Municipal # Com ten # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING CTR1i PL BIN MECHANICAL ROOFING PAVING FENCE SIGN [e -S Estimated Cost (value) 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 construction and zoning. Furthermore, I authorize the above -named contra tor t• do th y ork stated. � 2 i . _L6( /. /A / Signature of Contractor or 0 Notary as t•rK•' tracts or My Commission Expires: uilder Date 5 .. 4 • Date it. C.C.F. ° 6 0 NOTARY BOND TOTAL DUE Building Electrical Plumbing Engineering ITEM BATH TUB UNIT I lli 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 AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS ANO 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 If HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTCRS 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 MOTCRS OVER 25-100 HP CODLING 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 SWIMAING POOL - OUTLETS COMldERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 4" TILE/RES. VIOLATION . PUMP 5 ABANDON SEPTIC TANK _ RE SOAKAGE PIT W. FT. - TTION G ct.'y.. CATCH BASIN DISCHARGE WELL /1/L�v /�/ / DOMESTIC WELL AREA DRAIN ...Z.f4 PrG &. 46- ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING . LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING 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 Date 10P 1 /93 Job Address 29 NE al 0 T l-} Sr . Tax Folio Legal Description Owner / Lessee / Tenant W6LT o< JEP."J E „Sol lei Master Permit # Owner's Address 21g N L �'l c n1' .Sl Contracting Co. Address Qualifier SS# - - Phone State i'k Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDINe ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION hl° Ip c.e. b o X 1,007„ bre tcei✓ Square Pt. Estimated Cost(value) $5 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 do e in compliance with all applicable laws regulating construction and zoning. Furthermore, I autholrixe the above lamed coxutractor to do the work stated. Signature of owner and /or Condo President Date: /Oiall1,5 ��• to as to Owner a My Commission Expire : ** * • PERMIT APPLICATION FOR MIAMI SHORES VILLAGE " %, ". JOSEPHINE CHURCH nag cfte.a AP4 30.1 PAI t ; p°: No. CC197545 Phone 5i ( O Signature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner- Builder My Commission Expires: * * * * * * * * * * * * * * ** FEES: PERMIT ,W,DD RADON C.C.F. NOTARY f W TOTAL DUE APPROVED: Fire Other Zoning Building Electrical Mechanical Plumbing Engineering Date `1 -/ 3 Job Address 29 JJJ7 9I S/ Tax Folio /1 302O 13 0 741 3 Legal Description Owner / Lessee / Tenant Owner's Address qq /C c99 S r Contracting Co. P C; / / ,: . Qualifier c. % A ) L. - G//775 SS# Phone 0 3 - 2 _ z State # &OOf3 `/ Municipal # 6 5. ' 5 Competency 4>` Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 1 / fl e G/' 7c-i Square Ft. Estimated Cost(value) 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 construction and zoning. Furthermore, I auth'.r the abc*e- named /contractor to do the work stated. Sig Dat Notary as t My Commissi ** * FEES: PERMIT 31 1 (� " APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 7y-- £ ,z3 r ature of owner and /or Condo President :gm /ol'c6►4cD4si• ent COMMISSION NUMBER Q CC255237 PAY COMMISSION EXP. OF ;A.. JAN. 261997 Zoning r - q1c, t{' b PFFIdIAL NOTARY SEAL 1 12 • SCOTT W DAVIS ``S' * COMMISSION NUMBER g 'IV a Q CC255237 F *Y COMPAWSION Et1fP. ** yy ( r�o JAN. 26,1997 v� RADON C.C.F. ` NOTARY TOTAL DUE 1 L+ 66 Mechanical Address * * * .J fr'. / /:e /r) Master Permit # Phone Sig ture o.f_Contractor or Owner- Builder Date Notary as t My Commissi Engineering slo Is er Fire Other Building Electrical IA Y 3Y to 73 Plumbing, . ........ Amount of Permit $ Permit No.. /— c.0 ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT STATE OF FLORIDA, } SS. COUNTY OF DADE. Overhead Service Underground Size Feeders Owner's Name and Address. Roland Staff ord .No 299 N.E. 99th Street.. Registered Archi • ect 'd/or Engineer Employing Electrician s Name. HPrt...g Location and Legal Descriptioi ot . 1.65 MIAMI SHORES VILLAGE No 3115 N th .street. Block. Subdivision. Type of Installation—Conduit. . . . .B.X L . . . . .Metal Moulding. . (Signed) Date 8-13-68 Application is hereby made for the approval of the detailed statement of the p ans and specifications het...with submitted for the bulding or other structure herein described This arplication is made in complia . and conformity with the Building Ordinance of Miami Shores Village, Florida, and all . ro isions of the Laws of the State of Plot-tea all ordinances of Miami Shores Village and all -:-ules and regulations of h Building Division of Miami Shor ... Village shall be complied with, whe.her he ein spect ied or not. A copy of approved plans and specifications must be kept at building during ogress of wor Street and Number where work is to be performed—No . ..299 N.L. . 99th St. .Street. .......... . . State work to be perfo.med and purpose of building (By Floors) New Building Remodeling .. Addition . Repairs No. of Stories .... ..Co iclint. Main Sw Amps .Main uses • -- • ••••• ......... ......... (Signed) El: Inspector. The und rs'gned applicant for building permit doe p hereby ce-tify that he understands and accepts his obligations as an employer of lab° und. r the Flo ;da Workmen's Compensation Act being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has ompl'A ith the provisions thereof. and will require similar compliance from all contractors or sub-contractors employed by him in the work to be p rformed under this permit; and will post o cause to be posted for inspection on the site of the wo k suc public notice or notices as are requir d b. the Act. The undersign, d agrees to iploi only such sub contractors on work to be rfor ed under this permit, as are '.cei by Miami Shores Village Master Electrician. Amps 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 construaion, and he h, carefully read the foregoin,, 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 workma SWITCH OUTLETS LIGH OUTL:- s PL JO REC 'P'T'S FIXT.,RES NO LAMPS REFRIG. OPTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATEr1 TOTAL CONTR. LIST 1 1 CHECK ENT. S% . 0151. SE v re T 'MP. serw,o, PERM MOTORS 0.1 HP MOTORS 1-5 HP N N TRANo. /1^010 TOTAL CONT LI T CHE PC . ........ Amount of Permit $ Permit No.. /— c.0 ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT STATE OF FLORIDA, } SS. COUNTY OF DADE. Overhead Service Underground Size Feeders Owner's Name and Address. Roland Staff ord .No 299 N.E. 99th Street.. Registered Archi • ect 'd/or Engineer Employing Electrician s Name. HPrt...g Location and Legal Descriptioi ot . 1.65 MIAMI SHORES VILLAGE No 3115 N th .street. Block. Subdivision. Type of Installation—Conduit. . . . .B.X L . . . . .Metal Moulding. . (Signed) Date 8-13-68 Application is hereby made for the approval of the detailed statement of the p ans and specifications het...with submitted for the bulding or other structure herein described This arplication is made in complia . and conformity with the Building Ordinance of Miami Shores Village, Florida, and all . ro isions of the Laws of the State of Plot-tea all ordinances of Miami Shores Village and all -:-ules and regulations of h Building Division of Miami Shor ... Village shall be complied with, whe.her he ein spect ied or not. A copy of approved plans and specifications must be kept at building during ogress of wor Street and Number where work is to be performed—No . ..299 N.L. . 99th St. .Street. .......... . . State work to be perfo.med and purpose of building (By Floors) New Building Remodeling .. Addition . Repairs No. of Stories .... ..Co iclint. Main Sw Amps .Main uses • -- • ••••• ......... ......... (Signed) El: Inspector. The und rs'gned applicant for building permit doe p hereby ce-tify that he understands and accepts his obligations as an employer of lab° und. r the Flo ;da Workmen's Compensation Act being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has ompl'A ith the provisions thereof. and will require similar compliance from all contractors or sub-contractors employed by him in the work to be p rformed under this permit; and will post o cause to be posted for inspection on the site of the wo k suc public notice or notices as are requir d b. the Act. The undersign, d agrees to iploi only such sub contractors on work to be rfor ed under this permit, as are '.cei by Miami Shores Village Master Electrician. Amps 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 construaion, and he h, carefully read the foregoin,, 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 workma BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL 06 PLUMBING ❑ PERMIT N? 10345 ROOFING ❑ Work to b e perfo med under this Permit p c ift I- +► Architect < < i i °'" Contractor IA A e E 4 ( e' r A r r 1 ( �. 1/ -= -) _ fc. 'C-- 7~ Owner of n 4 Building Legal Lot Description 11 B1 Address of -72 9 c- 9 r) Building 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 ab ve assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby w�h�,yyt�her shown on the planf or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, ; ervan or empl5yees. 0 I ' IV Signed �'"-� /Y ` " (INSPECTOR) BY In consideration of the issuance to me of this permit I !ee to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, dratigs, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work one by either, myself my agent, strvant or employee. i CONTRACTOR or BUILDER Date 7 Contractor's License No. Subdi- vision Sq Ft Value of 11 Amount of / Project $ 11 Permit $ / BY AUTHORITY 19 r BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building 4 V Architect Contractor or Builder Legal Description. Address of Building Lot ❑ DATE f" /:‘` 195 i' PERMIT 'N° 12031 Contractor's ❑ License No ❑ Work to be performed under this Permit MIAMI SHORES VILLAGE, FLORIDA Bl. V CONTRACTOR OR BUILDER Subdi- vision Value of Project $ Amt. of 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. • J .,.... , - " , . r,...s 'a.. �.. Signed , �1.. t, ..- t. IN8PECTOR In consideration of the issuance to me of this permit I agree to perfohn the work covered hereunder i;?��'compliance with all ordinances and regulations pertaining thereto and in strict conformity 'with the plans, drawings, statements or specifications submitted to,Ole proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent servant ormtlployee. BY AUTHOIUTY MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No ss. (Signed , Date /i r Application is hereby made f r the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. is 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. Owner's Name and Address....e.l...... et. / i." l 1 +f 'o' 1 / No T .Street ! .e- Street a Registered Architect and /or Engineer Employing Electrician's Name.. '_ r / L r� ,r..... ' " (C N Location and Legal Description Lot ...� �/ /1 / Block Subdivision Street and Number where work is to be performed—No... _M4 s'tt 9'' Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories i £ i~ Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ L..,3 �i' 0? (Signed) 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 5966, Compiled General 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 arc licensed by Miami Shores Village. Master Electrician. STATE OF FLORIDA, l COUNTY OF DADE. I j 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. y Commission Expires Notary Public, State of Florida NO A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty mat s and /or workmanship. 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. CONTR. LIST —L J — L — O r °..` L n 1` CHECK ,1 b t / '''.JI.s ,✓ ///'��) lam, `.-° e) ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1-5 HP N EON TRANS. RADIO TOTAL CONTR. LIST / T ! r ...f J / CHECK '4C) I ,. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No ss. (Signed , Date /i r Application is hereby made f r the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. is 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. Owner's Name and Address....e.l...... et. / i." l 1 +f 'o' 1 / No T .Street ! .e- Street a Registered Architect and /or Engineer Employing Electrician's Name.. '_ r / L r� ,r..... ' " (C N Location and Legal Description Lot ...� �/ /1 / Block Subdivision Street and Number where work is to be performed—No... _M4 s'tt 9'' Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories i £ i~ Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ L..,3 �i' 0? (Signed) 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 5966, Compiled General 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 arc licensed by Miami Shores Village. Master Electrician. STATE OF FLORIDA, l COUNTY OF DADE. I j 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. y Commission Expires Notary Public, State of Florida NO A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty mat s and /or workmanship. Permit No Owner's Name and Address Employing Electrician's Name M" Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed purpose of building (By Floors) licensed by Miami Shores Village. STATE OF FLORIDA, l COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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. Registered Architect and /or Engineed! it Block • (Signed) No Street Street Date The undersigned applicant for this building permit does hereby certify that he udderstands 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 as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to { ! (/ Street Subdivision / New Building h.' Remodeling Addition Repairs No. of Stories Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding ••v Amount of Permit $ (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are Master Electrician. 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 materials and /or workmanship. 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 CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TE SERVICE PERM. MOTORS 0-1 HP MOTORS 1•5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK ) f SM Permit No Owner's Name and Address Employing Electrician's Name M" Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed purpose of building (By Floors) licensed by Miami Shores Village. STATE OF FLORIDA, l COUNTY OF DADE. I ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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. Registered Architect and /or Engineed! it Block • (Signed) No Street Street Date The undersigned applicant for this building permit does hereby certify that he udderstands 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 as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to { ! (/ Street Subdivision / New Building h.' Remodeling Addition Repairs No. of Stories Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding ••v Amount of Permit $ (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are Master Electrician. 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 materials and /or workmanship.