ELECTRICALDate !/ l / */ Job Address 3gq /(J. �9 4A, • Tax Folio / 3 6 .20(- (3 , 5 e/-'.0
Legal Description , 2!, 3 , a44)
/M
Owner Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
State Pi
Siiignature
DZ 'ate .
** * * *
F PERMIT
AP pppOVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
WORK DESCRIPTION
Nciotary as to Owner
M31y Commission Expi
'°q
unN IT
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAr PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
of owner
/— e ,d--e - ,d
Square Ft. Estimated Cost(value) cN2A?0
WA TO OWER: YQV XV T RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
Sin MAY R IN YOUR ?zYINC TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
T 70 OBTAIN FINANCING, CONSUL`: WITH YOUi - LENDIZR OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permi- tc do work and installation as indicated above, and
°Sn the attached addendum (if applioat'le) . _ cer _y that all work will be performed to meet the
s' ;tatidards of all laws regulating construction in :Ids jurisdiction. I understand that separate
p"termits are required for ELECTRICAL, PLUMBING, SIGN:, POOLS, ROOFING and MECHANICAL WORK.
OhWNER'S AFFIDAVIT: I certify that al' ~h° `o- egoin€ information is accurate and that all work will
bhe done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
atauthorize the above - named contractor to do the work: stated.
ALAILAil .Aede /
L
anc
AL� &.r .1.1iY SEAL
< SAI.::Ii� M H:ldSCH
li � CUMMISS:OIN NUMBER
CC343646
0140. 0
M. 1 'r . 30
T. * h �' � r Y COMIIISS QN XP
RADON
Competency Ip Ins.Co. / V-- t-ee -J
Fire
C.C.10 ;
Signature of
Date:
Mas ter Permit IP, 970
Phone 7!_52 /959
9
Address f f 2 W 4 7L
.5) #20iPhone 9 L .5 .--- 62/ 1/4 .36 ---
/`O
Co.* ractor or Owner- Builder
AC
tary as to
My Commission `xp}.r-
,-. TdO7ARY SEAL
' SAMNA M HIRSCH
y s ' COMMISSION NUMBER
� * CC:3 8646 *
c2. , MY COMMIIS!sIUN EXP
MAfi. 1 799 0
NOTARY r
**
�. nl0�
Zoning Building Electrical MP
Other
Mechanical Plumbing Engineering
4(2 0 0 7)1
Owner's Name and Address
Registered Architect and/or En knee'.
Employing Electriciati's Name.. CI
Amount of Permit $
MIAMI SHORES VILLAGE
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 oi 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 progreu of work.
u5sat, v%ss
ELEC_A
Location and Legal Description Lot
Street and Number where work is to be performed—No 3gcl
No
No 5 Street
Block Subdivision
Street kia q sr
State work to be performed and purpose of building (By Floors) 2 t- 4/e C
New Building Remodeling Addition Repairs No. of Stories
Overhead
Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation—Conduit Tubing B.X.L .Metal Moulding
(Signed)
Street
pktv,Z9-0 kt.1 . 33)43
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he unde tands and ace acc4pts 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 s -contractors employed by him in thc
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 b performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Master Electrician.
STATE OF FLORIDA, }
U .
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
0
LIGHT
OUTLETS
PLUG
RECE••'T'S
FIXTURES
NO. LAMPS
REMO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H
W. HEAT.
CONN.
SPACE
HEATER
STRIP
H
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM .
At c
1100
MOTORS
0-1 HP
MOTORS
1-0 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
I LititlAibe.
CHECK
4(2 0 0 7)1
Owner's Name and Address
Registered Architect and/or En knee'.
Employing Electriciati's Name.. CI
Amount of Permit $
MIAMI SHORES VILLAGE
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 oi 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 progreu of work.
u5sat, v%ss
ELEC_A
Location and Legal Description Lot
Street and Number where work is to be performed—No 3gcl
No
No 5 Street
Block Subdivision
Street kia q sr
State work to be performed and purpose of building (By Floors) 2 t- 4/e C
New Building Remodeling Addition Repairs No. of Stories
Overhead
Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation—Conduit Tubing B.X.L .Metal Moulding
(Signed)
Street
pktv,Z9-0 kt.1 . 33)43
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he unde tands and ace acc4pts 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 s -contractors employed by him in thc
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 b performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Master Electrician.
STATE OF FLORIDA, }
U .
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.
MIAMI SHORES VILLAGE
Office aas.
CERTIFICATE OF t PECTION
i
THTS CERTIFIES AT
by / ,r
for ') '
Other Apparatus
has been inspected and current is authorized to be turned on until otherwise notified, for:
Size of Service [ ry . _ Number of Lying Circuits /
1
Range _ 2, _5 ` watts. Water Heater
Power: Connected oadd H. P. Space Dater
RMCAL INSPECTOR;
FLOORS
FIXTURES ONLY
NUMBER OF
TOTAL
OUTLETS
SIZE OF
SIZE IIERVI-
CONDUIT
Na.
f IRC"UIT
LIGHTS
CEI
BRACKETS
M AIN
S UDS
*RANCHES
BASEMENT
! v
/L NG
'7
' C $
(2.
1 1
__
FIRST
SECOND
THIRD
FOURTH
A-63
J,
3 3
DATE ` e 1 QS .
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 In-
spector.
APPLICATION
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICATION
WILL BE RETURNED.
LOT NUMBS NU B R _ � $ _ DIVISION
STREET AND
OWNER
OCCUPIED AS
BUILDING- -NEW OR OLD (UNDERLINE WHICH)
H. P. OF EACH MOTOR VOLTS TOTAL AMPS PHASE
CEILING
7
MASTER ELECTRICIA
BRACKETS
(Y
BY
RECEPTACLES
ROUGH WIRING
FINAL No
CORRECTED
TEMPORARY DAYS.
DATE ISSUED
SW ITCH(S
/3-
FEE REMITTED
SPECIFICATIO
STOVES
OCCUPANT
WATER HEATERS
DDRESS
SIDE
RECEIVED BY INSPECTOR INS- TED
PROGRESS
REMARKS • WILL. INSPECT AGAIN Off " _
>`/ &
SIGNS
SPACE BELOW FOR INSPECTOR'S USE ONLY
NO
WORK -- ADDITIONAL, NEW. ALTERATION OR REPAIR
OTHER A*PA
4
KIND OF INSTALLATION OPEN OR CONCEALED KNOB. RX.. BX.. MLDG.. CONDUIT, METALLIC TUQINtC
REMARKS
„ow
_ 10f1/
iirt,i�th
'! it
filfm
AP” Jr
ff
INSPECTION W N ED /�/'/��
• MEM
INSPECTOR