399 NE 98 St (14)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 3 9 9 /f/i 2 " r Tax Folio
Legal Description Historically Designated: Yes No
O S " Owner/Lessee / Tenant S G ✓,D Q R. R a G G / O Master Permit # ' 3
Owner's Address 3 2 7 NE 9 5T-
Phone
Contracting Co. 77?, C iT / EL 1 GT CGS /&k.
Qualifier 'C .. T _ /3. 7i o n! 3 ss# Phone 6 ya -
State # C .0 e o/ 36 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRIC LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION R� /n AcO 27J 6 /J
Square Ft yrJ�
s/
Signature of owner and/or Condo President Date
FEES: PERM[T �✓' OHO RADON
Address 6 oZ S /(/ A} //.r
Estimated Cost (value) S
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 APPFIDAVIT: 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.
Signature of Contractor or 0 iL1 uilder
Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires: o,;lSAN K. ;";,)'(r)
,� .1 :!■irl 7 , 11r'd9
C.C.F. — NOTARY TOTAL DUE 4v
APPROVED:
Zoning Building Electrica /�'
Mechanical Plumbing Engineering
ITEM
BATH TIB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
9-
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
D I SHWASEHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE T5PQ2ARY
I
A/C (CENTRAL.)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
i
DUCT MCRK
FLOOR GRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
UNDER0ROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAWRY TRAY
WATER HEATER
U.F. PRESSLAE VESSELS
CLOTHES RASHER
MOTORS 0- 1 FP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MEGAN I CAL VENTILATION
SINK. RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK. SLOP
MOTORS OVER 8- 10 HP
ELEVATCNS/ESCAUTORS
TEMPORARY WATER CLOSET
MOT0RS OVER 10- 25 FP
,-
FIRE SPRINKLER SYSTEM6
URINAL
MOTORS OVER 25-1O0 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 1O0 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR COM) I T I ONERS
•
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
1 GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
L
HEATER- REPLACE
GENERATORS TRANSFORMERS
.
LAWN SPRINKLER-WELL
SPECIAL PURPOSE
SWIM4ING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TLBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
'
UTILLTY-SEWER
SIGN TIME CLOCK
UTILITY -RATER
FIXTIAES
SEPTIC TANK
ANTENNA
TELEVISION ()JTLETS
CRAINFIELD, 4' TILE/RES.
VIOLATION
& ABANDON SEPTIC TANK
RE I NSPECT I ON
SOAKAGE PIT 01. FT.
f ,J , rz - r'
/
CATCH BASIN
0 I SCiARGE WELL
DOMESTIC WELL
AREA DRAIN
G OOF INLET
0..AR RATER HEATER
IRE STANDPIPE
'COL PIPING
AWN SPRINKLER SYSTEM
SAS RAF&
DETER SET (GAS)
HAS P IP IW
-
-
(AN APPLICATION FOR BUILDING PERMIT MST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
DATE 194_
PERMIT N9 8985
Work to be performed under this Permit
Contractor's
License No.
Legal Lot Bl.
Description
Address of
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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 respon-
sibility for work done by his agents, servants or employees.
Subdi-
vision
Value of
Project
Amt. of
Permit
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 regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Contracto 1"
or Builder ``
Legal Lot
Description
Address of , M
Building` tI t.
MIAMI SHORES VILLAGE, FLORIDA
❑
DATE 19 (---•..,
a PERMIT N9 4260 Contractor's v ,
❑ License No. ' '
0
❑ Work to be performed under this Permit_
Architect
CONTRACTOR OR BUILDER
B1
4'
Subdi-
vision
4
Amount of t w
Permit $
Value of
Project $
This permit is lanted 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 knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statejnents or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. F �r
;
Signed :` r' '. ✓ '` - ' ;c'�'? INSPECTOR
In consideration of the issuance to me of this permit I agree to . perform the work covered hereunder in co ipliance with all ordinances aad regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee -'
v .
BY AUTHORITY ♦inOT '
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 9136
Work to be performed under this Permit
Subdi-
vision
DATE 195
Contractor's
License No
Legal Lot Bl.
Description
Address of
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 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 regulations
pertaining thereto ar.ic. 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
Value of
Project $
Amt. of
Permit $
BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE 194.—
PERMIT N° 8845
Work to be performed under this Permit
Owner of
Building
Contractor's
License No.
Architect
Contractor
or Builder
Legal Lot Bl. Subdi-
Description vision
Address of Value of Amt. of
Building Project 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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil 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 respon-
sibility 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 regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assurne responsibility for all work done by either myself, my agent, servant or employee.
BY AUTHORITY
❑ PERMIT N? 14939 Contractor's
❑ License No
❑ Work to be performed under this Permit
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect _
Contractor
or Builder
Legal Lot II Bf.
Description
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
DATE 195
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 com.pliance 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, szrvants 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 regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No.
- L •
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.
o t ? Owner's Name and Address____ ._ No_ Street____ ?__ -e .,
Registered Architect and /or Engineer
Employing Electrician's Name — _ —p__� �t No _Street_
Q ___ — __ — _
Location and Legal Description Lot___________ - --__ __ ' _ - Block _ Subdivision
Street and Number where work is to be performed —No.
Service Overhead Size Feeders Conduit Main Sw.
ce
Underground
Amount of Permit $!
STATE OF FLORIDA,
COUNTY OF DADE.
}
APPLICATION FOR ELECTRICAL PERMIT
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
(Signed)
Street
State work to be performed and purpose of building (By Floors)
New Building.. _Remodeling Addition $epairs No. of Stories
Amps. _Main Fuses
Type of Installation— Conduit_ Tubing ____— _ B.X.L._______ Metal Moulding ........ _..... __ .........
____________,___ ____ _______
(Signed) - - - e
Date- - - - - - ---- --------- __-- - - - -._
le trical Inspector.
ons as an employer of
anent Supplement, and
The undersigned applicant for this building permit does hereby certify that understands and accepts his obli
labor under the Florida Workmen's Compensation Act, being Section 5966, i y . iled General Laws of Florida P
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 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.
Master Electrician.
-Amps
Before me, the undersigned authority, a notary public, duly a uthorized 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 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
N EON
TRANS.
RADIO
Q
TOTAL
C L ST
/_.
1 "�- �l
�� /
� � � ,
✓ I
?/
CHECK
..s t
Permit No.
- L •
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.
o t ? Owner's Name and Address____ ._ No_ Street____ ?__ -e .,
Registered Architect and /or Engineer
Employing Electrician's Name — _ —p__� �t No _Street_
Q ___ — __ — _
Location and Legal Description Lot___________ - --__ __ ' _ - Block _ Subdivision
Street and Number where work is to be performed —No.
Service Overhead Size Feeders Conduit Main Sw.
ce
Underground
Amount of Permit $!
STATE OF FLORIDA,
COUNTY OF DADE.
}
APPLICATION FOR ELECTRICAL PERMIT
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
(Signed)
Street
State work to be performed and purpose of building (By Floors)
New Building.. _Remodeling Addition $epairs No. of Stories
Amps. _Main Fuses
Type of Installation— Conduit_ Tubing ____— _ B.X.L._______ Metal Moulding ........ _..... __ .........
____________,___ ____ _______
(Signed) - - - e
Date- - - - - - ---- --------- __-- - - - -._
le trical Inspector.
ons as an employer of
anent Supplement, and
The undersigned applicant for this building permit does hereby certify that understands and accepts his obli
labor under the Florida Workmen's Compensation Act, being Section 5966, i y . iled General Laws of Florida P
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 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.
Master Electrician.
-Amps
Before me, the undersigned authority, a notary public, duly a uthorized 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 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.
t X
V
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
ISTTR
i 1
/ %
�/��j ,
G �0 fL
Q
G711V
p�
/
®
• n
g &/ �y
7 ECK
ENT.
SW.
_OF
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1•5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
.''
) '
''
• . ;
'.'
/
11 O Yi
•
CHECK
® o
_/1'
jOO
S
APPLICATION FOR ELECTRICAL PERMIT
Permit Nn_ (1 � Date___ ___ _ __.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the/fuilding or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shor s 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
Registered Architect and /or Engineer__
Employing Electrician's Name__ 4 .- _/2_J _k-
Location and Legal Description Lot___ ie • Q
Service Overhead Size Feeders
Undergveniel
Type of Installation— Conduit_
-
�
® ATE OF FLORIDA,
MIAMI SHORES VILLAGE
41
ELECTRICAL INSPECTION DEPARTMENT
1
Street and Number where work is to be performed— No. ______.
State work to be performed and purpose of'building (By Floors)
Tubing_ — _.B.X.L.__ _________Metal Moulding
(0Aiunt of Permit $
The undersigned applicant for this building permit does hereby
g2 t or under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
s complied with the provisions thereof, and will require similar compliance from all contractors or
6 rk to be performed under this permit; and will post or cause to be p osted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work
5 aensed by Miami Shores Village.
/7,
No .5" d / - -- Street=_ • 4__--
No .- ---- -- __________ --_________
G Block 4 / Subdivision ___ J
Street___
New Building " Remodeling Addition Repairs No. of Stories
�
Conduit -� w -_ -- -Main Sw._ _�f_C_ - - - -- Amps•`' t
accepts his obligations as an emp
Electrical spector!
certi y� tTiat he understands and
to
Main Fuses__ —' — ___Amps
er of
of Florida Permanent Sup went, and
sub - contractors employe y him in the
of the work such public notice or notices
be performed under this permit, as are
r
(Signed)_
Master Electrician.
} ss.
9PUNTY OF DADE. JJJ
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
1 \ppeared_
l 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.
Permit No
Amount of Permit $__
STATE OF FLORIDA,
COUNTY OF DADE.
- 1* • I
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 Narne and Address__
Registered Architect and /or Engineer.
New Building _Remodeling__ _ _______________________Addition
}
APPLICATION FOR ELECTRICAL PERMIT /
—_— Date y1
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
(Signed)
No. l C� Street - [-w
Employing Electrician's Name___ c_
Location and Legal Description Lot
Street and Number where work is to be performed —No Street____
State work to be performed and purpose of building (By Floors)
• No Street___
Block Subdivision
Repairs No. of Stories
Overhead
Service Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation— Conduit_ ...... __________Tubing B.X,L,__ —__ Metal Moulding__________= ____________________________ _O ,
ctrical Inspector.
The undersigned applicant for this building permit does hereby certify that 1 /nderstands and accepts his , tons as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Com ed General Laws of Florida rmanent 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.
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
� '
O
-
CHECK
a
- r- -
•��? /�
L'
� )J
V
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
.TORS
•\ 1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
- CONTR.
LIST
CHECK
Permit No
Amount of Permit $__
STATE OF FLORIDA,
COUNTY OF DADE.
- 1* • I
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 Narne and Address__
Registered Architect and /or Engineer.
New Building _Remodeling__ _ _______________________Addition
}
APPLICATION FOR ELECTRICAL PERMIT /
—_— Date y1
ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
(Signed)
No. l C� Street - [-w
Employing Electrician's Name___ c_
Location and Legal Description Lot
Street and Number where work is to be performed —No Street____
State work to be performed and purpose of building (By Floors)
• No Street___
Block Subdivision
Repairs No. of Stories
Overhead
Service Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation— Conduit_ ...... __________Tubing B.X,L,__ —__ Metal Moulding__________= ____________________________ _O ,
ctrical Inspector.
The undersigned applicant for this building permit does hereby certify that 1 /nderstands and accepts his , tons as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Com ed General Laws of Florida rmanent 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.
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.
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Date
•
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
Registered Architect and /or Engine
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to
Amount of Permit $
STATE ( 0 1 0 1 FLORIDA,
COUNTY OF DADE.
}
4.
SS.
MIAMI SHORES VILLAGE
L . ...►°C�.. Noi 1) 2L
(Signed)
No.3
L'
Block Subdivision
be performed —No 3 .- '
The undersigned applicant for this building permit does hereby certify that he understands 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
licensed by IvMiam Shores illage.
Street
Street. .
et
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Q /
Overhead
,
Service Underground Size Feeders Conduit_G. Main Sw Amps Main Fuses Amps
�
Type of Installation— Conduit Tubing te B.X.L Metal Moulding
(Signed)
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
aster 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
REFR I G.
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
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
i f(I P
CHECK
'
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Date
•
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
Registered Architect and /or Engine
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to
Amount of Permit $
STATE ( 0 1 0 1 FLORIDA,
COUNTY OF DADE.
}
4.
SS.
MIAMI SHORES VILLAGE
L . ...►°C�.. Noi 1) 2L
(Signed)
No.3
L'
Block Subdivision
be performed —No 3 .- '
The undersigned applicant for this building permit does hereby certify that he understands 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
licensed by IvMiam Shores illage.
Street
Street. .
et
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Q /
Overhead
,
Service Underground Size Feeders Conduit_G. Main Sw Amps Main Fuses Amps
�
Type of Installation— Conduit Tubing te B.X.L Metal Moulding
(Signed)
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
aster 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.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No ,, D 0 O Date •I 14 .f )
k il
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oI other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fioada,
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. n p
Owner's Name and Address
M' 1''K���b' N.- 9 Street 1 J
Registered Architect and /or Engineer -/
Employing Electrician's Name.. 1.7 l h ` rY �'�' 1:�, /C- q. ?. No L. )A..4CStreet «' r
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
Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation -- Conduit Tubing ......................B.X.L Metal Moulding
Service Overhead
Amount of Permit $ (Signed)
STATE OP FLORIDA, )
t
COUNTY OF DADE.
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 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
M
I 11
� .a ..: n.0 P H" / – �'" r'- 9 -
Master Electrician.
ss.
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
H
W. HEAT.
CONN.
SPACE
H
STRIP
H
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
/� � � •1 /.I P �
I --'� f S (� f
�11
(
` /L ' SC •M1
--
MOTORS
0.1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
K)
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No ,, D 0 O Date •I 14 .f )
k il
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oI other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fioada,
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. n p
Owner's Name and Address
M' 1''K���b' N.- 9 Street 1 J
Registered Architect and /or Engineer -/
Employing Electrician's Name.. 1.7 l h ` rY �'�' 1:�, /C- q. ?. No L. )A..4CStreet «' r
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
Underground Size Feeders Conduit Main Sw Amps Main Fuses Amps
Type of Installation -- Conduit Tubing ......................B.X.L Metal Moulding
Service Overhead
Amount of Permit $ (Signed)
STATE OP FLORIDA, )
t
COUNTY OF DADE.
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 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
M
I 11
� .a ..: n.0 P H" / – �'" r'- 9 -
Master Electrician.
ss.
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.
4L 2
Permit Z�
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
Registered Architect and /or Engineer
Employing Electrician's Name "/�
Amount of Permit $
APPLICATION FOR ELECTRICAL PER
SE.
r
e . {
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No
Street
1 t
1;
.Date t
t
No 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
' ? - 4 4 R, .'
(Signed) I r
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi ,obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•c tractors 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)
Master Electrician.
STATE OF FLORIDA, 1
COUNTY OP DADE. I
Before ime, 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
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
So))
__.fi
Dt,
__/___
CHECK
ENT
SW.
DIST.
CAD.
SERVICE
TEMP.
SERVICE
PERM.
d) _j' i
l`
- ,
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
CHECK
4L 2
Permit Z�
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
Registered Architect and /or Engineer
Employing Electrician's Name "/�
Amount of Permit $
APPLICATION FOR ELECTRICAL PER
SE.
r
e . {
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No
Street
1 t
1;
.Date t
t
No 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
' ? - 4 4 R, .'
(Signed) I r
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi ,obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•c tractors 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)
Master Electrician.
STATE OF FLORIDA, 1
COUNTY OP DADE. I
Before ime, 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.
Registered Architect and /or Engi eerr� pL/' � vC
Employing Electricia6's Name. .. Engi
. !l, Z �c
New Building Remodeling Addition.
Service Overhead
Underground Site Feeders
Type of Installation — Conduit Tubing
se.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
/ APPLICATION FOR ELECTRICAL PERMIT 7'
Permit 3 Date ! �G/
i
Application is hereby made for the approval of the detailed statem nt of the plans and specifications herewith au miffed for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulation. 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.. •.. rilldtz612
J9
No ...�:
Location and Legal Description Lot Block
Street and Number where work is to be performed —No
1 ,
State work to be performed and purpose of building (By Floors) / r2l. ' t1.14
Street , " t 7)
6 a t 4,
Subdivision
reet C 9 ?J �.
p air s Lt No. of Stories
Conduit Main Sw. Amps Main Fuses Amps
B.X.L Metal Moulding
(Signed)
Muter Electrician.
Amount of Permit $ '...s . (Signed) ....... W l/..... ............
The �cIrsigned app r an this buil rng 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 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 t ice of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on or to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OP DADE. I ,�J
Before me, the under. ed authority, a n ry public, duly authorized to administer oaths
.
appeared .> ...... .:.. `- --.. i )
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the........ r!. tom. t'..C ..I
of the abov etia r n cti91 h ugly read the foregoing application, and that l)e "did sign the same, rind tat h all facts
therein by h ee�atte4 1 5(0%931103 NOISSIWWO) AW
:.r yI 1v V0I11O1i lO 31d1S )I1df1d AT/ION C_./,a4
Notary Public, State of Florida
Electrical Inspector.
acknowledgments, personally
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.
SWITC:H
0
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO LAMPS
RErRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER `.W.
HEATER
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
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Registered Architect and /or Engi eerr� pL/' � vC
Employing Electricia6's Name. .. Engi
. !l, Z �c
New Building Remodeling Addition.
Service Overhead
Underground Site Feeders
Type of Installation — Conduit Tubing
se.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
/ APPLICATION FOR ELECTRICAL PERMIT 7'
Permit 3 Date ! �G/
i
Application is hereby made for the approval of the detailed statem nt of the plans and specifications herewith au miffed for the building of other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulation. 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.. •.. rilldtz612
J9
No ...�:
Location and Legal Description Lot Block
Street and Number where work is to be performed —No
1 ,
State work to be performed and purpose of building (By Floors) / r2l. ' t1.14
Street , " t 7)
6 a t 4,
Subdivision
reet C 9 ?J �.
p air s Lt No. of Stories
Conduit Main Sw. Amps Main Fuses Amps
B.X.L Metal Moulding
(Signed)
Muter Electrician.
Amount of Permit $ '...s . (Signed) ....... W l/..... ............
The �cIrsigned app r an this buil rng 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 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 t ice of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on or to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OP DADE. I ,�J
Before me, the under. ed authority, a n ry public, duly authorized to administer oaths
.
appeared .> ...... .:.. `- --.. i )
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the........ r!. tom. t'..C ..I
of the abov etia r n cti91 h ugly read the foregoing application, and that l)e "did sign the same, rind tat h all facts
therein by h ee�atte4 1 5(0%931103 NOISSIWWO) AW
:.r yI 1v V0I11O1i lO 31d1S )I1df1d AT/ION C_./,a4
Notary Public, State of Florida
Electrical Inspector.
acknowledgments, personally
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.
I3
1/
3
I /16)-11