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MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL
Permit No .. � Date. .. ».
Application: is "hereby'I!made for the approval of the detailed statement of the plans and "specifications herewith or the budding or other
structure herein`' descrilied. 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 a l rules and regulations of tide 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. i
Owner's Name and Address.
Registered Architect and /or Engineer
Employing Electrician's Name No.. // ».Street
Location and Legal Description Lot Block.. .Subdivision. :i
.....Street....„..,
,!
Street and-Number where work is to be performed No.
State work to be performed and purpose of building (By Floors) "
New Building .. .Rem*deling. Addition. .Repairs.
SINITCH
ENT.
SW.
LIGHT
OUTE78
Disr.
4a.
pt.uo
RECE•P•rs
SERVICE
TEMP.
FRXTUREB
No. LMWS
SERVICE
PERM.
RANGE
OUTLET
RANGE" WATER`. W. HEAT.
CONK. HEATER CONN.
SPACE
HEATER
MOTORS
0.7.'
MOTORS
1.5 HP
NEON
TRANS.
STRIP
HEATe
RADIO
Overhead » ,.pimps
v ice Underground i Size Feede rs,... » .. . Conduit» •. » Main swM .Am p$,... r » ,•,.Main Fug .,1 •»
Type of Installation-Conduit.. .. Tubing... »..B.R.L » Mebi Moulding
STATE OF FLORIDA,
COUNTY OF DALE.
PERMIT
Stories
-.street/flit/1'
ToTAi.
TOTAL
Amount of Permit $... (Signed)..
Eiecti-ic 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 - suu•contractors emplyyed by hint 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 bel performed under permit, as are
licensed by Miami Shores Village. / f'i
Electridan.
Before me, the undersigned authority, =a notary " public, `duly authorized to administer oaths and take acknowlttdgments,
to me well known, and who being ITV me first sworn, u oath deposes and that he i s the...--..
.- above desiaibe g duly �. Fog epo �
of the
... «. »....»..»... ... . _.«.....».... »..: .
d 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.
appeared... -.
y •..•_ ._» .
Commission Expires Notary. Public, State of Florida
NOTE: A re-inspection fee of $1 .00 will die made when such re- inspection is made necessary by necessary notice for iinspection, or faulty
materials and /or workmanship.