ELECTRICALDate S � clg Aob Address 3 D 7 /U Tax Folio //3020 61/3 T
Legal Description //�J�/ff / /
Lessee / Tenant/r(U'�'�� ✓ Gf11YGi.P-e-
Owner's Address ✓X(Z/)O( 6/ oNyv -3 Phone '7
G n
Contracting Co. �T Address /o a 3
Qualifier ;) C.hIn( SS #
�00�
Phone q— 777n
•
State 1 * *iiei Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL) PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION /1,�6 vP k II C €•Nl
1— opYa(J7ci 13— ) o.LY
Square Ft. Estimated ?3?)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAX 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
authorize
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
I ci
er and /or Condo Pr
G
z . '6JANET M. GRAN
COMMISSION #
� '` EXPIRES OCT l §
p
Signature of
Date:
APPROVED:
Notary as to Owner and /or Co
My Commission Expires:
FEES: PERMIT 0 RADON
Zoning
Master Permit # '377 mac/
with all applicable laws regulating construction and zoning. Furthermore, I
the above -named contractor
to do the work stated.
Signatu
Dat
Mechanical
retractor or Owner- Builder
=JANET M. GRAHAM
MMISSION a CC235039
XPIRES OCT 13, 1399
t 44
ary as to Contractor or Owner- Builder
My. Commission Expires:
* * * * * * * * **
C.C.F. • a NOTARY TOTAL DUE "/0.00
Fire Other
Building Electrica /C/ Y *'
Plumbing Engineering
Permit No Date
Application is here y made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiv ;ida,
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. M.. 3 Cj� .. ... No d/ ° 7 /1...f,,.Street 9 2
APPLICATION FOR ELECTRICAL PERMIT
Registered Architect and /or Engineer
No.. /.
Employing Electriciafi's Name./3 ... I'll..
Location and Legal Description Lot
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Amount of Permit $
lt DO
6 6.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Block Q Subdivision
Str et
Addition Repairs No. of Stories /
7
Street 4 ... ��
Service Overhead Size Feeders Conduit Main Sw Amps. 0 . Main Fuses . Amps
Underground
Type of Installation — Conduit Tubing B.X.L. Metal Moulding
,a..
}� b
(Signed) —! �� � 7
� �� ��
_ — � ,,�?
Electrical Inspector
The undersigned applicant for this building permit does hereby eel tify 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 Flor a' Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-co ;actors 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 thi permit, are
licensed by Miami Shores Village.
s ue ^ ,
(Signed) (.... �7� -G�ttt / -
lectrician.
aster
r
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
RECCE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H
W. HEAT.
CONN,
SPACE
HEATER
STRIP
HEATER
I' '
I l¢t'Cfj'+
�f}I OTAL�
CONTR.
LI {T
/ V
/ c
ref
� �_� it
CHECK
cLit_C-
it
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
(/A"-.5
Li v�
CHECK
at
tt
• d
v`
..
Permit No Date
Application is here y made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiv ;ida,
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. M.. 3 Cj� .. ... No d/ ° 7 /1...f,,.Street 9 2
APPLICATION FOR ELECTRICAL PERMIT
Registered Architect and /or Engineer
No.. /.
Employing Electriciafi's Name./3 ... I'll..
Location and Legal Description Lot
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Amount of Permit $
lt DO
6 6.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Block Q Subdivision
Str et
Addition Repairs No. of Stories /
7
Street 4 ... ��
Service Overhead Size Feeders Conduit Main Sw Amps. 0 . Main Fuses . Amps
Underground
Type of Installation — Conduit Tubing B.X.L. Metal Moulding
,a..
}� b
(Signed) —! �� � 7
� �� ��
_ — � ,,�?
Electrical Inspector
The undersigned applicant for this building permit does hereby eel tify 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 Flor a' Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-co ;actors 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 thi permit, are
licensed by Miami Shores Village.
s ue ^ ,
(Signed) (.... �7� -G�ttt / -
lectrician.
aster
r
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.
MIAMI SHORES VILLAGE
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith suiitted 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.
Permit No
Owner's Name and Address.
ELECTRICAL INSPECTION DEPARTMENT
Y/ APPLICATION FOR ELECTRICAL PERMIT
No 3V
Date
0-°
Street M>i/. ?9,4/1 I... `
Registered Architect and /or Engineer
Employing Electrician's Name_.._ No . f Street S,
Location and Legal Description Lot x Block Subdiv
Street and Number where work is to be performed —No (/ J Street._
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service undezead . ,.3
Size Feeders.MWCodduit..1.Vcvlain Sw
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. 11
SS.
(Signed).
Amps Main Fuses / Amps
a
(Signed)
Elec cal Inspector.
• The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation. : s an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perma Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors e....yed 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.
Ot tri-eeti-
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
ti --
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEAfER
STRIP
HEATER
TOTAL
LIST
if"
6
CHECK
ENT.
SW.
CAS.
SERVICE
TEt:P.
SERVICE
PERM.
-/ , 7
MOTOR ^u
0.1 HP
MOTORS
O R S
MOREON
N
TRANS.
I
RADIO
o /� ►
TOTAL
C LIST
LIST
/
., /
/
1
o / '
CHECK
MIAMI SHORES VILLAGE
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith suiitted 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.
Permit No
Owner's Name and Address.
ELECTRICAL INSPECTION DEPARTMENT
Y/ APPLICATION FOR ELECTRICAL PERMIT
No 3V
Date
0-°
Street M>i/. ?9,4/1 I... `
Registered Architect and /or Engineer
Employing Electrician's Name_.._ No . f Street S,
Location and Legal Description Lot x Block Subdiv
Street and Number where work is to be performed —No (/ J Street._
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service undezead . ,.3
Size Feeders.MWCodduit..1.Vcvlain Sw
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. 11
SS.
(Signed).
Amps Main Fuses / Amps
a
(Signed)
Elec cal Inspector.
• The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation. : s an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perma Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors e....yed 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.
Ot tri-eeti-
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
❑ MIAMI SHORES VILLAGE, FLORIDA ds, z�
DATE
❑ PERMIT N9 7881
nI+L V4) sz. - t t-
Architect
Contractor ; - .r
or Builder 4 • -- � S W L
Contractors �� Q
License No.
Work to be performed under this Permit
19
A4, if /
Legal Lot Subdi_
Description II B1 vision
Address of ` �j' fi C T Value of Amount of �] -�
Building J.) ! Project $ 1 Permit $ j
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 above assumes the responsibility for a thorough knowledgg..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 respon-
sibility for work done by his agents, servants or employees. ..,,_
Signed / l -Y �. �' INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complia e with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper atitho ties of Miami Shores Village. In as
cepting this permit I assume responsibility for ar11 work done by either, myself, my agent, servant or employee.
n
CONTRACTOR OR BUILDER
BY AUTHORITY MOT
NO.
STREET
PART OF LOT
LOT
BL'K
SUBDIVISION
Fiillb s
Other Apparatus
Fee
Outlets
Motors
Receptacles
Generators
8 +pire6
Water Heaters
Fiillb s
Other Apparatus
Fee
♦
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building ,
Contractor or Electrician
ores Village.
Dated , 4- -t ) 19
Miami cfhores
F L O R ID A
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla ,
NUMBER OF
LO CATI 0 N
DESCRIPTION OF WORK
N° 214
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
this Department. ^3
kl
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
le Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
ate of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and �,Jj„ules a regulations of the Electrical Department of Miami
•
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building
Contractor or Electrician
STREET
PART OF LOT
LOT
BL'K
NO.
Out1
Motors
Receptacles
Generators
Stoves
DESCRIPTION OF WORK
Water Heaters
ddtiami tfhores�illage
F L O A 1 D A
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla , 19
LO CATI 0 N
NUMBER OF
Signs
Billboards
Other Apparatus
SUBDIVISION
N° 210
Permit Fee
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
this Department.
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
Shores Village.
Dated , 19 (Seal)
NO.
.; o 7 ‘,0
T
STREI'
&.
/�' /
1
PART OF LOT
LOT
f-2,,)
BL'K
I- 11
SUBDIVISION
: )
Other Apparatus
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
t
Permit Fee
1/ /'
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the. construction.
Owner of Building
•ractor or Electrician
aiami cShores9llage
F L O II I D
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla , •
Shores Village.
J
Dated / ).:// $ r 4 19
DESCRIPTION OF WORK
NUMBER OF
LOCATION
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations r u ` . n any chap a in the plans and specifications unauthorized by
th' epartment. . t
19
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and ri esAnd regulations of the Electrical Department of Miami
•
N° 210
•
a.,
, Electrical Inspector.
(Seal)
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus ,
. `
# YerlrfC Fee
•
.. -
l ore
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building
Conlpor or Electrician
aiami cShores91llage
F L O H ID A
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla , 19
LOCATION
N° 214
•
STREET
PART OF LOT
LOT
BL'K
NO.
DESCRIPTION OF WORK
NUMBER OF
SUBDIVISION
JD
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
k iami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
,rtment.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
pplication and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all.rules and regulations of the Electrical Department of Miami
s Village. } t
Dated
, Electrical Inspector.
1
19 f - (Seal)
FLOORS
FIXTURES ONLY
NUMBERS OF
TOTAL
SIZE OF
SIZE SERVICE
CONDUIT
NO.
CIRCUITS
- - --- - -- - -- -
LIGHTS
CEILING
BRACKETS
OUTLETS
MAIN
SUBS
BRANCHES
BASEMENT
ik
1J L)
- --
FIRST
SECOND
THIRD
FOURTH
A. 83
ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your certificate of Approval, application is hereby made for an inspection of the electric
installation in the premises stated below, for which undersigned agrees to correct any infractions of
the National Electrical Code and the City Ordinance pointed out by Inspector.
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICATION
WILL BE RETURNED
1 '
LOT NUMBE� BLOCK NUMBER / M i SUBDIVISION ° ` / 1
fr
STREET AND NUMBER_ -- - rit SIDE /�
io • _
i
OWNER t' _(" 1( C 't— 1 OCCUPANT
OCCUPIED AS
BUILDING - NEW OR OLD (UNDERLINE WHICH)
H. P. OF EACH MOTOR
CEILING BRACKETS I RECEPTACLES
' G 6l /6
KIND OF INSTALLATION
BY
RECEIVED BY INSPECTOR
PROGRESS
WILL INSPECT AGAIN
ROUGH WIRING
FINAL No.
CORRECTED
TEMPORARY DAYS.
DATE ISSUED
SWITCHES
OPEN OR CONCEALED
REMARKS
APPLICATION No
y e
WORK -- ADDITIONAL, NEW, ALTERATION OR REPAIR
SPECIFICATIONS
VOLTS_ TOTAL AMPS PHASE
STOVES WATER HEATERS I SIGNS I OTHER APPARATUS
/ 6
INSPECTED
DATE
v
f E
193
_KNOB, RX., BX., MLDG., CONDUIT, METALLIC TUBING
INSPECTION WANTED
ADDRESS
SPACE B OW FOR INSPECTOR'S USE ONLY
A
1
FEE REMITTED
INSPECTOR
FLOORS
FIXTURES ONLY
NUMBERS OF
TOTAL
SIZE OF
SIZE SERVICE
CONDUIT
'
No
CIRCUITS
LI T
CEILING
BRACKETS
OUTLETS
MAIN
SUDS
BRANCHES
BASEMENT
d
7
_____
FIRST
..
SECOND
THIRD
FOURTH
A. 63
ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your certificate of tApproval, application is hereby made for an inspection of the electric
installation in the premises stated . below, for which undersigned agrees to correct any infractions of
the National Electrical Code and the City Ordinance pointed out by Inspector.
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICATION
- � / WIILL BE RETURNED
LOT NUMBER r BLOCK NUMBER/ V SUBDIVISION
STREET AND NUMBER 3_ + - ,'
OWNER
OCCUPIED AS
BUILDING - -NEW OR OLD (UNDERLINE WHICH)
H. P. OF EACH MOTOR__
CEILING - BRACKETS 1 RECEPTACLES
KIND OF INSTALLATION
CONTRACTO
APPLICATION
' r ,
SWITCHES I STOVES I WATER HEATERS
OPEN OR CONCEALED
REMARKS
>' f
INSPECTION WAFTED
BY ADDRESS `.„,,' •
OCCUPANT
WORK -- ADDITIONAL, NEW, ALTERATION OR REPAIR
SPECIFICATIONS
VOLTS__ _ ____ _ _ TOTAL AMPS PHASE__
SPACE BELOW FOR INSPECTOR'S USE ONLY
SIGNS OTHER APPARATUS
_KNOB, RX., BX., MLDG.. CONDUIT, METALLIC TUBING
RECEIVED BY INSPECTOR INSPECTED
PROGRESS REMARKS
WILL INSPECT AGAIN
ROUGH WIRING
FINAL NO
CORRECTED
TEMPORARY DAYS. FEE REMITTED
tl
DATE ISSUED
INSPECTOR