815 NE 99 St (12)Inspection Date: 01/08/2007
Inspector: Perez, JanPierre
Owner: HAYNES, EZRA AND EMILY
Job Address: 815 99 Street NE
Project: <NONE>
Contractor: MAYOLI A/C & REFRIGERATION INC
Friday, January 5, 2007
Miami Shores Village, FL 33138-
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP-23701
Permit Number: MC -8 -06 -2043
Block:
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060340100
Lot:
Page 2 of 2
<
\i ‘ fi vit
Passed
Inspector Comments
t Mi1
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 01/08/2007
Inspector: Perez, JanPierre
Owner: HAYNES, EZRA AND EMILY
Job Address: 815 99 Street NE
Project: <NONE>
Contractor: MAYOLI A/C & REFRIGERATION INC
Friday, January 5, 2007
Miami Shores Village, FL 33138-
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP-23701
Permit Number: MC -8 -06 -2043
Block:
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060340100
Lot:
Page 2 of 2
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -23696
Permit Number: MC -8 -06 -2043
Inspection Date: 09/25/2006
Inspector: Perez, JanPierre
Owner:
Job Address:
Project: <NONE>
HAYNES, EZRA AND EMILY
815 99 Street NE
Miami Shores Village, FL 33138-
Contractor: MAYOLI A/C & REFRIGERATION INC
Building Department Comments
Thursday, September 21, 2006
Block:
Permit Type: Mechanical - Residential
Inspection Type: Rough Duct
Work Classification: New
Phone Number
Parcel Number 1132060340100
Lot:
Page 2 of 2
Passed
Inspector Comments
1. Ca
�J
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -23696
Permit Number: MC -8 -06 -2043
Inspection Date: 09/25/2006
Inspector: Perez, JanPierre
Owner:
Job Address:
Project: <NONE>
HAYNES, EZRA AND EMILY
815 99 Street NE
Miami Shores Village, FL 33138-
Contractor: MAYOLI A/C & REFRIGERATION INC
Building Department Comments
Thursday, September 21, 2006
Block:
Permit Type: Mechanical - Residential
Inspection Type: Rough Duct
Work Classification: New
Phone Number
Parcel Number 1132060340100
Lot:
Page 2 of 2
Issue Date: 8/7/2006 Expires: 02/03/2007
Owner's Name: EZRA AND EMILY HAYNES
Permit Type: Mechanical - Residential
Work Classification: New
Job Address: 815 99 Street NE
Comments:
Additional Information
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Contractor(s) Phone
MAYOLI NC & REFRIGERATION IN
Primary Contractor
Yes
Tons: 31/2
Classification: Residential
Additional Info:
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, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do
the work stated.
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: MC -8 -06 -2043
Phone:
1132060340100
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 12,000.00
Required Inspections
Rough
Rough Duct
Ventilation
Smoke Test
Hood
Smoke Det Test
Final
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions /Alterations
Technology Fee
Total:
Amount
$7.20
$2.40
$5.00
$420.00
$10.50
$445.10
Invoice Number
MC - 8 - 06 - 25798
Total:
Amt Due
$445.10
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be additional
restrictions applicable to this property that may be found in the public records of
this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES .
Nrmou,A30 ftbl
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address �j t
City p4; f3- ,5 —5 State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Contractor's Company Name
City tri J +'►') ; State
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 4 d 0.- 0 O
Type of Work: ❑Addition ❑Alteration
Describe Work: l Pql.-
44 ✓la s .
Submittal Fee $ / Permit Fee $
Notary $ 5.0)
Scanning $
Training/Education Fee $
Bond $ Code Enforcement $
Structural Review. $
Miami Shores Village
Building Department
Vu 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Is Building Historically Designated YES NO r-A—
Contractor's Address / 9, C ` ,,. / 3 A ✓
Qualifier Name i9Ke.— / g w& D yy , A D
State Certificate or Registration No. C4 C a g 6 3
Plumbing
99 s%
County Miami -Dade
Square /•LinearuFootage Of Work:
i�2 A vs obl `rsvne8
['New
Radon $ DPBR $
Double Fee $
Permit No. MO,06 9.OLt3
Master Permit No.
Phone #
Si.
Phone #
Zip 3 3 i '� S
Phone #
Certificate of Competency No.
Phone #
Total Fee Now Due $
Rmcmgval
AA 1E 0 PI R6
B Y: ..
Mechanical ) Roofing
Zip
Phone #
Zip
2)s' y8'sig�
- a r 9 a G
Repair/Replace ❑ Demolition
CCF $ 9.20 CO
Technology Fee $ 't ,� V
Zoning $
4 45, fo
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS. and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature C2'6
Owner or Agent
The foregoing instrument was acknowledged before me this IS The foregoing instrument was acknowledged before me
day of TO pi, , 20 , by c ,?o b. 61-thro , day of
who is personally known tome or who has produced
As identfcation•and -whc dithake ....."...t
z ',>.,;;, , MELISSAGONZALEZ
°. � Notary Public - State of Florida
+ • M Commission Expires Aug 24, 2009
,a, +� .' ' Commission # DD465486
1 ' Bonded By NatIonal No Assn.
NOTARY PUBLIC:
(Revised 02/08/06)
APPLICATION APPROVED BY:
who is personally known to me or who has produced
Sign : – —
Print: ',� ' Q i cS�01 `� fba My Commission Expires: Au , 24 '
NOTARY
Sign:
Print:
My Com
*************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
as i
bou
ation and who did;$$ke an /3 J
o . -•. e ms; , , �� '
o , _ �enr» ssion,; . `)231
Expires: Ju: 1 3, 20;
0§; BondedThru
Iantic Bonding Co. In!
* * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
ITEM U
UNIT F
FEE I
ITEM U
UNIT F
FEE I
ITEM U
UNIT F
FEE
IDET L
LIGHT OUTLETS C
CENTRAL H
I SHWASHER R
RECEPTACLES �
�� Kw
) ISPOSAI S
SERVICE TEMPORARY A
A/C (CENTRAL) 3 .
)R INK I IC • FOUNTAIN .
. SERVICE SIZE I N AWS C
..—
FLOOR DRAIN S
SERVICE REPAIRAETER CHANGE R
�a
GREASE TRAP A
APPLIANCE OUTLETS P
PROCESS AND PRESS PIPING
INTERCEPTOR R
RANGE TOP U
UIDERGROUND TANKS
LAVATORY O
OVEN A
ABOVE GROUND TANKS
LAUNDRY TRAY W
WATER HEATER U
U.F. PRESSURE VESSELS
CLOTHES WASHER M
MDTCRS 0- 1 FP S
STEAM BOILERS
SHOWER M
MDTCRS OVER 1- 3 HP H
HOT WATER BOILERS
SINK. POT /3 COMP. M
MOTORS OVER 3- 5 HP M
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP' T
i 0D
SINK, SLOP M
MfJTCRS OVER 8- 10 HP E
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET M
MDTCRS OVER 10 25 Ha F
FIRE SPRINKLER SYSTEM
I)RINAL M
MOTORS OVER 25-100 H' C
COOLING TOWERS
WATER CLOSET M
MJTCRS OVER 1C0 HP V
VIOLATION
WASTES A
A/C WIDOW V
W
SUPPLY TO: A
AIR CONDITIONERS
A/C UNIT S
STRIP HEATER
SPRINKLER . G
GENERATORS TRANSFORMERS
HEATER NEW . G
GENERATORS TRANSFORMERS
- REPLACE G
GENERATORS TRANSFORMERS
SPRIN KLER - WELL S
SPECIAL PLRPOSE I
I
POOL O
OUTLETS COWERCIAL
SERVICE S
SIGN TUBES
CONNECTIONS '
'.SIGN TRANSFORMERS
-SEWER
N SIG TIME CLOCK
-WATER F
FIXILRES
E
TAW
'
'ANTENNA .
TELEVISION CUTLETS
S
R
0
1
I
:AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OP.TAINED, OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
. nICO 6 — a0.
1132060340100
PERMIT NO
�f3 TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal description of property and street /address: Lot. 14 and the East II of Lot 13, Block 169 of
"Miami Shores Section Eight" according to the Plat thereof, as recorded in Plat Book 14,
Page 33 of the Public Records of Dade County, Florida 815 N.E. 99th Street, Miami Shores
2. Description of improvement: Replace Air Conditioning Unit
3. Owner(s) name and address: Carol S. Stobs
815 N.E. 99th Street, Miami Shores, FL 33138
Interest in property: ) b O %
Name and address of fee simple titleholder:
4. Contractor's name and address:
Carol S. Stobs
5. Surety: (Payment bond required by owner from contractor„ i y),
Name and address:
Amount of bond $
6. Lender's name and address:
9969 N.E. 4th Ave. Road, Miami Shores, FL 33138
Carol S. Stobs
9969 N.E. 4h6TATiteOFRoadIPA1, 171 ifse, a FL 33138
ter F BY CERTIFY that this is a true_ py of the
da of
this offs
eon
/II my hand and Official Seal.
IARVE i VIN, CLE' . fCircuir . '. f
/I , i
",ro' .grit' .�ti1!ialf D.C.
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address: Donald W. Stobs, Jr.
9505 N.E. 5th Ave., Miami Shores, FL 33138
1 1111111111111111111 111111 1111111111111111111
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address: Beth Ann Stobs
580 N.E. 92nd Street, Miami Shores, FL 33138
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different d specified)
Signature of Owner
Print Owner's Name Carol S. Stobs Carol S. Stobs
Prepared by
Sworn to and subscribed before me this day of Sept. 20 06
Notary Public s . _. ��.. _I
Print Notary's Name S VCairai . l t
My commission expires: AVOr 29 i ZCa
123.01 -52 PAGE 4 8/02
Address:
580 N.E. 92nd Street
Miami Shores, FL 33138
,,,,,,r n ' , ,,, MELISSA i]ONZALEZ
�
�� %1 ,•, Notary Public • st;.te of Honda
• � • 4My Commission Expires Aug 24, 2009
� '` Commission 6 D0465486
�
Bonded By National Notary Assn.
C:=FIl'4 2006R 1004 637
OR Bk 24923 P9 2676; (1.Ps)
RECORDED 09/19/2006 13 :01 :23
HARVEY RUVIN? CLERRK. OF COURT
MMIAh1I -DADE COUNTY► FLORIDA
LAST PAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Date... 7 1 — l7 '~ 7 Hi
Owner's Name and Address t ( 'C l . eV . _.— No....-4.!, S.. __. street_ 42r L _2'4
R egistered Arehiteat and /or Engineer. ,,,,,.r,,,,,,,, f'l ,.,,,,, . ,,,n,, ,,,, ,,,,•„„,,,,,.,,,,•<,,,,,,,,.,,,
Name and address of licensed contractor_J� �a_1 -.t' LOP ' lLn .1.1 !�' 4 l4 7-4 'l%
Location and legal description of lot to be built on:
Lot_.._.__.— Block Subdivision _---- •-- •.---- ._..._......._.
Street and Number where work is to be done . S i i z ._.-2 -L'2! (r`
State work to be done and purpose of building (by floors) -__ ,L '�1/ . 3 ' — 7) /
--- y✓tf_C,
MIAMI SHOR
BUILDING INSP DEPARTMENT
Disapproved Date
4. Date
(Signed)
Building Inspecto
Chairman
Member ..--- _ -_ - -_
Member -..
Council Approved
S VILLAGE
Distance to next nearest building — ._._____Size of Building Lot
Maximum live Load to be borne by each floor
_-- _- -_ - -__ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories 1... .
To be constructed of Kind of foundation_- _._ -._ Roof Covering
Estimated Total cost of improvements $ o- 60 Q._ Amount of Permit $ L ot 1?
Zone cubage required _Plan Cubage
I hereby submit all ie . • .3 an I sp j ifacations for said building. All notices with reference to the building and its construction may
be sent to u A.___ -.- 1-
The undersigned applican' •r 4 s building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida W • men'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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon actors, on • k perform • under this
permit, as are licensed by Miami Shores Village. / ,
Remarks_ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments; personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No.. / 7 7 Date
( e 1. 7 2JRead, Sworn to and Subscribed before me.
Notary Public, State of Florida
mmi on Expires.
to me well known,
P NING BOARD ..-- .- ._---
Member
Member
Member
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged 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 S d.!•'e.CJ 1/ Q O
Date.... l / 7
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 4"-
L
Registered Architect and /or En ineer
Employing Electrician's Name... d - _ C G -rC ?r1 e--
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No eX� Street ,( 9' `
State work to be performed and purpose of building (By Floors) " /2L �3 �// C 2�
Cc
New Building Remodeling Addition Repairs No. of Stories
No.....(1 /iS
No 5/ 6 C
Street
Street
G
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $ f (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. } 88.
(Signed) 1 4.)
rival
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig..0 s as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P . nent 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 tb4 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.
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'7'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIET.
CAB,
SERVICE
TEMP.
SERVICE
PERM.
/1
L'CAJT.QF7L 9 L°
/x. N� •
MOTORS
04 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No S d.!•'e.CJ 1/ Q O
Date.... l / 7
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 4"-
L
Registered Architect and /or En ineer
Employing Electrician's Name... d - _ C G -rC ?r1 e--
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No eX� Street ,( 9' `
State work to be performed and purpose of building (By Floors) " /2L �3 �// C 2�
Cc
New Building Remodeling Addition Repairs No. of Stories
No.....(1 /iS
No 5/ 6 C
Street
Street
G
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $ f (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. } 88.
(Signed) 1 4.)
rival
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig..0 s as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P . nent 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 tb4 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.
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.