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ELECTRICALJob Address 27 3 Ng q q' Ser Tax Folio Notary as My Co Legal Description Historically Designated: Yes Owner ;see /Tenant O ,L,S1 JA-(i�Ic 1 Owner's Address TO g l S! Phone Contracting Co. NAN £L& iC-' I IOC Address ( o "1 bo go sr Qtkiifier (101 /� 9 ' / /_ state # O� 1 I "I unicipal # - Competency # I l�J01i Ins. co. de - Address Signature 1 I11Ig1 d/or Condo President Date wner and/or Condo Pres ssion Expir PERMIT APPLICATION FOR MIAMI SHORES VILLAGE , p,RY PO6 OFFICIAL NOTARY SEAL O (.i MARY PATRICIA BRINGS : _ 4. COl`AC1ISSIOw. NUMBER ix • U1.1 Q CC335256 7r Q LW COMMISSION EXP. FEES: PERMIT 7}''''4 RADON `c OF F .° JAM. 31 199 lq APPROVED: Zoning Building Mechanical Master Permit # No X10 8 3 SS# - Phone gq/ - 75 75 Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING QECTRICAL) PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 4 U� ,i)e ,9 /c el 7071 WORK DESCRIP'T'ION c 5e A ed/e e 624/6 ‘e, e/77 / 5 i� � • Square Ft. Estimated Cost (value) 4iX e 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 contractor to do the work stated. Notary as to C My Commission E C.C.F. NOTARY Signature of Contras or Owner- Builder tractor or Owner - Builder Y P06 OFFICIAL NOTARY SEAL �- DARN' PATRICIA BRIGGS xy ¢:OC uraSlORI NUMBER CC333259 cis p.1+ F �Y COMMISSION EXP. of FL JAM. 31 1993 BOND TOTAL DUE � 7/J Date / /7/7 Date. Electric Plumbing Engineering ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BICET LIGHT OUTLETS CENTRAL HEATING 0I0IASHEF1 RECEPTACLES A/C (WINO) OISKSAL 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 UNDERGRO1I40 TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNCRY TRAY WATER HEATER U.F. PRESSLRE 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 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 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SLPPL Y TO: _ AIR CONDITIONERS !Z evp. J' STRIP HEATER A/C UNIT 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 UTIL ITY_SEWER _ SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY �. TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION • PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCi 3ASIN D I SC WELL DOMESTIC WELL AREA CRAIN ROOF INLET SOLAR 'MATER HEATER FIRE ST»cPIPE . POOL PIPING LAWN SPRINKLER SYSTEM r GAS RA.`GE METER SET (GAS) GAS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION '(A:i APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL ti Date l Q I (S Job Address 2-73 -1U& q? sr Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant o 5 / 1 s'LL, de-/ Owner's Address qp p /� Contracting Co. MOO a-Ecreic hoc. c. Qualifier \- o) MOM(' 1OM( State # 6(,- OOO / / 9 9 Municipal # Architect/Engineer Bonding Ccmpany Mortgagor Permit Type (circle one): BUILDING Signa PERMIT APPLICATION FOR MIAMI SHORES VILLAGE No Master Permit # Phone 374-' 39 2(., Address t0(O q /Ja) 9or SS# _- x `7 / /31 y Competency # 660 2_ Ins. Co. fed / /7o Address Address Address LECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (value) E SANCHEZ 1 .1 MY COMMISSION B CC 243214 �� EXPIRES: November 24 1996 °''' bonded Thu Notary Public Underwriters Notary as to 0 My Commiss FEES: PERMIT ' RADON Notary as t' Contractor o My Commission Expires: C.C.F. f e NOTARY APPROVED: Zoning Building Electric Mechanical 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 re:.: ' g construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of Contractor or Owner- I3 ;Jlder TOTAL DUE 3g 1 : `b . PU OFFICIAL PNOTAFIV SEA O !. VARY PATRICIA BRIGGS Tr .O."7C71�'i.^ ...UMaC.t ' CC33g258 LIV COUMISSION EXP. OFFL JAN. 39 1998 /0 e ly� Plumbing Engineering ITEM BATH TUB 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 AMPS AO i 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 MOTCRS 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 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 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 _ 1 HEATER - REPLACE GENERATORS TRANSFORMERS - LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY - WATER FIXTLRES SEPTIC TANK ANTENNA -, . RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION . SOAKAGE PIT CU. FT. CATCH BASIN . 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 PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL $ Pa&c1i s1De1 f ► oa-,p \+ 61-tort, 34t 2 /0 1 Z" RIGID k)tw D-1-cc -f (1 Zoo A PA-O& 14) M d- soV 125 PAk t. SPan.� TR H) /4 EMT 1 P At��� S PAe SPaee A �°i v Pt/ OFFICIAL NOTARY .SEAL 2 ) e■ MARY PATRICIA ®RI3S tr I t . COMMISSION, fiSLIFISESCI �... c r . CC335259 c ts ran RP JAN. COMMISSION elm. � JAN. 39 1998 1 5 4)(1o' I 5 4 K10 Py9-1, 3 Iv / SO. F7 pc' ) 7 Kw. RE}RZEPATOR • g DCW. APPL,IA1t'"CES 3 , o KW. ns►roosHEN ( ; '� Vat. GARBAGE OtSPO5l1L K.W. CLOVES WASHER K.N. . 0 KW. K.W. ROME 1 DRYER A •0 K.L weal HI go 1 S KM, Irf=11 K.N. ¶RMH 60 PACT0R y K.W. GAit DOOR MOTOR. r " K W . JACUZZI BOWER MR. KW. IRONING BOARD 1. r K.N. POOL. EOUWPWENT KW. SPRVO9�ER F 7 K.N. LANDSCAPE UTFS KM. SF' C'APAZRY t �ti� (� u �►w L 5 , K.W. clAu b Ku. KW. =N. CONNECTED LOAD worowslocosa MST 10 IC.W. A 100 7h— 10.0 KC etzgr a 40 z /VDKAt. ate® u TOTAL A91O t. 9 CA .W. / 240 V. .(7.2 )c) 9F6' a.414). Form 155 Date , 192 ' FOR FIXTURE WORK ONLY ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI Desiring your Certificate of Approval, application is hereby made for an inspection of the electrical installa- tion in the premises stated below, for which the. undersigned agrees to correct any infractions of the National Electrical Code and the City Rules pointed out by Inspector. LOCATION AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED, OR APPLICAT ON WILL BE.RETURNED. Lot Number t' �'' 4 Block Number - �/' ^ 1 Street and Number ' -- ") r -' ' Side Owner Occupant Occupied a4 Building —New or Old (underline which). Work — Additional or New (underline which). SPECIFICATIONS FLOOR Basement 1st Floor 2d Floor . 3d Floor 4th Floor 5th Floor 6th Floor 7th Floor £3th Floor Attic NUMBER OF LIGHTS Received by Inspector A CERTIFICATES Progress Will inspect again Rough Wiring FINAL /No Corrected Temporary Days Approved Letter Date Issued DEFECTIVE Time Allowed: APPLICATION No CEILING OUTLETS SPACE BELOW FOR INSPECTOR'S U � 6 a 1_. �' Inspected Correct Location Correct Equipment f Days Electric Light Co Fee remitte Remarks • BRACKET OUTLETS REMARKS • Work will be started L will be finished / Dr , Addres sign here) e _ Street O LY NUMBER OF CIRCUITS Inspector BUILDING ELECTRICAL PLUMBING Owner of Building _ Architect Contractor or Builder. Subdi- MIAMI SHORES VILLAGE, FLORIDA DATE 194 . Contractor's License No. PERMIT N9 2730 Work to be performed under this Permit ‘egal Lot Bl. escription Address of Building This permit is granted to the contractor or builder named above to cons rucr 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. 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 regula- tions 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. CONTRACTOR OR BUILDER vision Value of Project Amt. of Permit BY AUTHORITY u Permit No ___ _ _ U) Owner's Name and Address - Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot___ c: i G / ( f Street and Number where work is to be performed —No 4.,- Amount of Permit $ The undersigned applicant for this building permit does hereby to under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. ss. My Commission Expires 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 ate of Florida. all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall b cortf lied with, whe er herein specified o '+not. A copy of approved plans and specifications must be kept at building during progress of wo . ✓ /—/ VAr No._ No. Block Service Overhead Size Feeders Conduit____ Main Sw.__ Underground Type of Installation— Conduit Tubing B.X.L. (Signed) i %1i _Metal Moulding • Date Street Street____ Subdivision_ f _ Sweet _ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition.. Repairs Amps. Main Fuses_ _______________Amps. No. of Stories__________ Electrical Inspector. rtify that he under4�t�fds and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of th wo> such public notice or notices as are sub- contractors, n w lbr' performed under th' .41W t: as are 6 M aster Electncan. Notary Public, State of Florida STATE OF FLORIDA, k COUNTY OF DADE. 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 be is of the above described construction, that he has carefully read the foregoing application. and that he did sign the same, and that all facts therein by him stated are true. NC)TE: 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 O UTLETS PLUG R ECE'P'T'S FIXTURES NO.LAMPS REFRIO. OUTLET IRON O UTLET RANGE OUTLET RANGE CONN. WATER H EATER W. HEAT. CONN. SPACE H EATER STRIP H EATER TOTAL CONTR. LIST CHECIC ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -8 HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK u Permit No ___ _ _ U) Owner's Name and Address - Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot___ c: i G / ( f Street and Number where work is to be performed —No 4.,- Amount of Permit $ The undersigned applicant for this building permit does hereby to under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. ss. My Commission Expires 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 ate of Florida. all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall b cortf lied with, whe er herein specified o '+not. A copy of approved plans and specifications must be kept at building during progress of wo . ✓ /—/ VAr No._ No. Block Service Overhead Size Feeders Conduit____ Main Sw.__ Underground Type of Installation— Conduit Tubing B.X.L. (Signed) i %1i _Metal Moulding • Date Street Street____ Subdivision_ f _ Sweet _ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition.. Repairs Amps. Main Fuses_ _______________Amps. No. of Stories__________ Electrical Inspector. rtify that he under4�t�fds and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of th wo> such public notice or notices as are sub- contractors, n w lbr' performed under th' .41W t: as are 6 M aster Electncan. Notary Public, State of Florida STATE OF FLORIDA, k COUNTY OF DADE. 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 be is of the above described construction, that he has carefully read the foregoing application. and that he did sign the same, and that all facts therein by him stated are true. NC)TE: 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. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No._____ -+! 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 con lied with, whether herein specified or' not. A copy of approved plans and specifications must be kept at building during progress of work. gaff'' '- , <. Owner's Name and Address `' ' - '..(-1' k „ No.________— ______— _— _____ —_. Street Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot Street and Number where work is to be performed —No No _______ ------ - ______ – — -- StreeL-- --- _____ _- ____- ---- --- - - -- _Block -- ______ Subdivision ___ -- __-__-- _— ___________ —. d `./ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition .._______________________ Repairs Service Overhead Size Feeders_____ Conduit — Main Sw._ -- Amps. — _ Main Fuses_ Underground m p Type of Installation— Conduit Tubing_________ _ B.X.L. Metal Moulding Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ss' My Commission Expires (Signed) (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 com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors 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 under signed agrees to employ only such sub - contractors, on wo o be performed under thi rmtt; as are licensed by Miami Shores Village. .. �. -r': i r Date Street • Notary Public. State of Florida No. of Stories Amps. /,' - - -_— — __ Master Electrical 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. H EAT. CONN. SPACE HEATER STRIP HEATER TOTAL. CONTFt. LIST w CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No._____ -+! 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 con lied with, whether herein specified or' not. A copy of approved plans and specifications must be kept at building during progress of work. gaff'' '- , <. Owner's Name and Address `' ' - '..(-1' k „ No.________— ______— _— _____ —_. Street Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot Street and Number where work is to be performed —No No _______ ------ - ______ – — -- StreeL-- --- _____ _- ____- ---- --- - - -- _Block -- ______ Subdivision ___ -- __-__-- _— ___________ —. d `./ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition .._______________________ Repairs Service Overhead Size Feeders_____ Conduit — Main Sw._ -- Amps. — _ Main Fuses_ Underground m p Type of Installation— Conduit Tubing_________ _ B.X.L. Metal Moulding Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ss' My Commission Expires (Signed) (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 com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors 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 under signed agrees to employ only such sub - contractors, on wo o be performed under thi rmtt; as are licensed by Miami Shores Village. .. �. -r': i r Date Street • Notary Public. State of Florida No. of Stories Amps. /,' - - -_— — __ Master Electrical 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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.