ELECTRICALPermit No 4.`. o3
Owners Name and Address.. ► tl� GL.
Amount of Permit $
86.
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 Engineer �.}�
Employing Electrician's Nam ...�'..!<?!Y$ ... Nog.. 7 . 4. -' AP 7 Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
(Signed)
Date 7-
No.. . ' • .1.6..Street
Ele rival Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and a !ts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Law f 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 be performed under this permit; and will post or cause to be posted for inspection on the site of the work suc public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to ,b p rformed -hider this permit, as are
licensed by Miami Shores Village.
� 4
(Signed)..
Mastef Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. 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.
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
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DI8T.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
M OTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
_______
T—
CHECK
_
qq
02. O O
Permit No 4.`. o3
Owners Name and Address.. ► tl� GL.
Amount of Permit $
86.
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 Engineer �.}�
Employing Electrician's Nam ...�'..!<?!Y$ ... Nog.. 7 . 4. -' AP 7 Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
(Signed)
Date 7-
No.. . ' • .1.6..Street
Ele rival Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and a !ts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Law f 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 be performed under this permit; and will post or cause to be posted for inspection on the site of the work suc public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to ,b p rformed -hider this permit, as are
licensed by Miami Shores Village.
� 4
(Signed)..
Mastef Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. 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.
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.
4 ;7
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.
Owner's Name and Address_ . No
Registered Architect and /or Engineer Employing Electrician's Name __-___ %' --4✓ Q - - /
Location and Legal Description Lot
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Block Subdivision_
e;;3
Street and Number where work is to be performed— No.__ , l _ Street__.
State work to be performed and purpose of building (By Floors) ?t '_ _ _'`
New Building_______ _ ____________Remodeling__ _____________ Addition Repairs No. of Stories_ ___
Service Overhead Underground Size Feeders Conduit_ Sw. Amps Main Fuses —Amps
Type of Installation— Conduit_ _Tubing B.X.L._______ Metal Moulding
Amount of Permit $___
STATE OF FLORIDA, l
COUNTY OF DADE. 1?
ss.
(Signed)*
(Signed)
Street____ - , r=
a� -, Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that 1 )understands and accepts his orations 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 sub - contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted 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.
„r
Date — -- — — —
•
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
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
4 ;7
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.
Owner's Name and Address_ . No
Registered Architect and /or Engineer Employing Electrician's Name __-___ %' --4✓ Q - - /
Location and Legal Description Lot
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Block Subdivision_
e;;3
Street and Number where work is to be performed— No.__ , l _ Street__.
State work to be performed and purpose of building (By Floors) ?t '_ _ _'`
New Building_______ _ ____________Remodeling__ _____________ Addition Repairs No. of Stories_ ___
Service Overhead Underground Size Feeders Conduit_ Sw. Amps Main Fuses —Amps
Type of Installation— Conduit_ _Tubing B.X.L._______ Metal Moulding
Amount of Permit $___
STATE OF FLORIDA, l
COUNTY OF DADE. 1?
ss.
(Signed)*
(Signed)
Street____ - , r=
a� -, Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that 1 )understands and accepts his orations 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 sub - contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted 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.
„r
Date — -- — — —
•
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'7111
FIXTURES
NO. LAMPS
REPRICE
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/
r lf. d 6
CH sca
=
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
Otr
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL,
CONTR.
Liar
CHECK
.....
Ri" /7o/6 -1 A
Permit No if 745 '?7
Location and Legal Description Lot
STATE OF FLORIDA, }
COUNTY OF DADE.
ss.
My Commission Expires
MIAMO SHORES
ELECTRICAL INSPECTION DEPARTMENT
PLICATION F
R ELECTROO
ILLAGE
A .
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, Fiurida,
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.
p k ploc
Owner's Name and Address / - No
Registered Architect and/or Engineer
Employing Electrician's Name 6 14 6 iee - REA D/ E4Fe7,eg, /ve. No /4
Block g/ Subdivision.
1,1
Street and Number where work is to be performed—No .2 76
State work to be performed and purpose of building (By Floors)
Amount of Permit $ 4 4 (Signed)
561-Jimmy /zi6
L PERMOT
Date ( 1— — V
Street /1).. B-
9t s7
New Building Remodeling Addition Repairs No. of Stories
• _ service Overhead Size Feeders Conduit Main Sw Amps
Underground
Type of Installation—Conduit Tubing B.X.L Metal Moulding
(Signed)
Street -
Street & S , ue .
mw-AJD.eo
of film fin S&VES
0,4
Main Fuses
Amps
Electrical/Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permane Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors em oyed 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 are
licensed by Miami Shores Village.
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.
Notary Public, State of Florida
Master Electrician.
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.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 7/ /V E ?(J t Tax Folio
Legal Description Historically Designated: Yes t/ No
/ Tenant ' Y n Master Permit # 4 /0&7 7
c 7(O / V 6 ��5�� Pho r 7- � , g/g'
Owner's Address � / � /f� -per
Address l � /(/ 36 E /4/ 5
Qualifier au 1 l ' SS#c - - gPhone ??'9 43 7 3
Ins. Co. 414 D iezdas WI 5
Contracting C
state # O 0 / 0
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILD
WORK DESCRIPTION
5 kezi`i
Square Ft:
4( v j/
Estimated Cost (value) '',00 0 0
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 -nam n actor to do the work stated.
j 1 /Y' 1 1 / Signature of owner and/or Condo President late Signature of Contractor or Owner- Builder � Dgte
Notary as to Owner and/or Condo President Date
My Commission Expires:.
FEES: PERM[T3J ®® RADON
Municipal # Competency #
Address
Address
Address
G ELECTRICAL UMBING MECHANICAL ROO ING PAVING FENCE SIGN
1(■ ` J Y7 f ( / & Yt. "en .5 e K Y
)*CK t
C.C.F. s �U NOTARY
Notary as to Contractor or Owner- Builder
My Commission Expires:
F,,
BOND 40 ‘Cs
TOTAL DUE
Date
APPROVED:
Zoning Building Electrical 3
Plumbing Engineering
ELECTRICAL. INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PER ' IT
Permit No
4c7_,�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subxMtted 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
Owner's Name and Address ` No
Registered Architect and /or Engineer
SS.
Employing Electrician's Na
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Additiun l Repairs No. of Stories
Amount of Permit $ c '
MIAMI SHORES VILLAGE
(Signed)
Date
Street
Street 9
i
1 Service Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
9 of Installation— Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of lorida 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 subcontractors, on work to be performed under this permit „as are
licensed by Miami Shores Village. - –
(Signed).. - .ter L' t _
Master' Electrician.
STATE OF FLORIDA, }
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 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.
ACE
H ATER
STRIP
HEATER
TOTAL
CL
LIST
(�
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
O .
, ��L
J /
MOTORS
0.1 HP
MOTORS
1.8 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
IST
CHECK
ELECTRICAL. INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PER ' IT
Permit No
4c7_,�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subxMtted 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
Owner's Name and Address ` No
Registered Architect and /or Engineer
SS.
Employing Electrician's Na
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Additiun l Repairs No. of Stories
Amount of Permit $ c '
MIAMI SHORES VILLAGE
(Signed)
Date
Street
Street 9
i
1 Service Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
9 of Installation— Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of lorida 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 subcontractors, on work to be performed under this permit „as are
licensed by Miami Shores Village. - –
(Signed).. - .ter L' t _
Master' Electrician.
STATE OF FLORIDA, }
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 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.
FLOORS
FIXTURE ONLY
NUMBER OF
Total
Outlets
SIZE OF
Size Service
Conduit
No.
Circuits
Lights
Ceiling
Brackets
Mains
Subs
Branches
asement—
irst_
:cond_
hird_
ourth_
Form 246
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALA. SPACES MUST BE FILLED OR APPLICA-
TIQN WILL BE RETURNED' ; '
.10 k Number Subdivision ivision � ��`'��
" Side
Owner �� �� �- � Occupant
Occupied as
Building —New or Old (underline which).
Street and Numb
B
F
S
T
Lights
Ceiling
Contract6r ;
Received by Inspector
Brackets
Progress
Will Inspect again
Rough Wiring
FINAL L,00" No
Corrected
Temporary _Days
Date Issued
APPLICATION ' /- SfC
DATE ( I% / 193
Electrical Department of the pity of Miami
Desiring your Certificate of Approval, application is hereby made
for an inspection of the electric installation in the premises stated be-
low, for which undersigned agrees to correct any infractions of the
National Electrical Code and the City Ordinance pointed out by Inspector.
H. P. of each motor Volts Total Amps Phase
Receptacles
Kind of Installation Open or Concealed
Switches
Work — Additional, New, Alteration or Repair.
SPECIFICATIONS"
Stoves I Water Heaters
I-710 0
Knob, RX., BX., Mldg Conduit
REMARKS
Inspection Wanted
By a Addresq
SPACE BELOW FOR INSPECTOR'S USE ONLY
Inspected
-') Fee remitted '
Signs I Other Apparatus
Inspector
t Y
FLOOR
NUMBER OF
SIZES OF
INSIILATION
OPEN OR
CONCEALED
Number of
Circuits
Outlets
Motor
Gen.
Main
Sub
Branch
sement_
t
�J
w�� .
i �,
r _4 .1/1.-
e
i :
(
:ond—
ird--
urth—
ler Floors.
Outlets
°a
Th
Fo
! Ot
OPP
18
rp .4 and umber'
upied as��
ing - -New or Old (underline which).
of each motor
mber of Motors H P
�i MARKS °
—k will be started L
Inspector
"ITFICATES
APPLICATION
Electrical Department of the City of Miam
Desiring your Certificate of Approval, application is hereby made
for an inspection of the electric installation in the premises stated be-
low, for which undersigned agrees to correct any infractions of the
National Electrical Code and the City Rules pointed out by Inspector.
OID DELAY I� FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICA-
Iii' TION WILL BE RETURNED
Motors Receptacles Generators Stoves Water Heater: Signs Billboards Other Apparatus
I I I
1
^,neatest Number of Lights on One Branch (Nature of Work) Open — Concealed Knob— Mldg.— Conduit
Address
qnt sign here) j l Street
SPA E ELOW FOR INSPECTORS USE ONLY
Inspected ) f
Correct Location
Correct Equip
DEFECTIVE
Time
- )wed
Da
Volts
lOs
LO CATION
Will be finished
DATE
Work — Additional or New (underline which).
SPECIFICATIONS
Occupant
Amps Phase
/ — _ OE - c 2)
Electric Light Co
Fee remitted
(emarks
j Inspector