ELECTRICAL PERMITPermit No Nt:
• : -
Employing Electrician's Name
Amount of Permit $ ....L� s ��
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date .........
Application is hereby 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, Fiu: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. e Owner's Name and Address / ...." - '� ' ` �.� – e e, /1 Street
Registered Architect and /or Engineer
Location and Legal Description Lot Block
Street and Number where work is to be performed —No ' . I ..w.
State work to be performed and purpose of building (By Floors)
New Building.., Remodeling Addition Repairs No. of Stories.. ./
Service Overhead Site Fccders.. �.k' :..Conduit Main Sw ' "' Am Main Fuses Amps
Underground p
Type of Installation -- Conduit Tubing
ss.
A " d
L(�
(Signed)
B.X.L .Metal Moulding
Electrical Inspector.
The undersign cant for this building permit does hereby certify that he understands and accepts his obligations u 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 subcontractors 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)
No. ...a��_��� Street
7
Street
Subdivision
Muter Electrician.
STATE OF FLORIDA, 1
COUNTY OF DADE. I
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•inspedion is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLETS
LIONT
OUTLETS
PLUG
RLCE'P'T's
FIXTURES
NO LAMPS
REPRIO.
OUTLET
IRON
OUTLET
RANG[
OUTLET
RANG[
CONN.
WATER
HATER
W. HEAT.
CONN.
SPACE
HEATCR
STRIP
NEATER
TOTAL
CONTR.
LIST
-
7
;., /
G �.�
C
I
r f
7
y)
Q CO
ENT.
SW.
DIsT.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
{�p!
2 S 06 9
•
Permit No Nt:
• : -
Employing Electrician's Name
Amount of Permit $ ....L� s ��
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date .........
Application is hereby 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, Fiu: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. e Owner's Name and Address / ...." - '� ' ` �.� – e e, /1 Street
Registered Architect and /or Engineer
Location and Legal Description Lot Block
Street and Number where work is to be performed —No ' . I ..w.
State work to be performed and purpose of building (By Floors)
New Building.., Remodeling Addition Repairs No. of Stories.. ./
Service Overhead Site Fccders.. �.k' :..Conduit Main Sw ' "' Am Main Fuses Amps
Underground p
Type of Installation -- Conduit Tubing
ss.
A " d
L(�
(Signed)
B.X.L .Metal Moulding
Electrical Inspector.
The undersign cant for this building permit does hereby certify that he understands and accepts his obligations u 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 subcontractors 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)
No. ...a��_��� Street
7
Street
Subdivision
Muter Electrician.
STATE OF FLORIDA, 1
COUNTY OF DADE. I
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•inspedion is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILL
Date to 111( s Job Address ( 110-- N t . / 0 / _ S T, _ Tax Folio /l — � O�(�C O / + 67/)
Legal Description t21 !9 — 1./ee14 S
'"a
X OCwn see / Tenant Ink/al/6 L!¢ T. J72 - Master Permit #
)C Owner's Address s i 1 O f, t o 19i N I Ptr I t S 4i-o'3 I e Phone X. 7S 4- (.4
yd y�S Address /O -f S ��wt.e/�.r �c 4h'
Contracting Co. /) % se -, ,
Qualifier T O C % / SS# 6) L-/— 7 7 7o
State # L F 0 O U 17 1 1 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor _ Address
I— CvvTro
Permit Type (circle one): B DIN ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I , I t ► _ � � / _ + t ! % G L 2 C'�G�` 0-0 / : ; l l A
Square Ft. Estimated Cost (value)
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 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. Furthermore, I authorize the above -named contractor to do the work stated.
ignature f owne''d/or ndo President
-Notary as Owner and/or r d) * o President
My Commission Expires:
PRY P06 OFFICIAL NOTARY SEAL
- SUE CARLOZZI
� * COMMISSION NUMBER
� ..'il1 Fi Q CC409566
- " "^ Q MY COMMISSION EXP.
e OF FA OCT. 28,1998
FEES: PERMIT � RADON
in�a -595
Date
Historically Designated: Yes No
C.C.F. ' " NOTARY
APPROVED:
Zoning Building
Mechanical
"'
Signature of Contractor or r'lwner- Builder
Notary as to Contractor or r- Builder
My Commission Expires:
&P gY PO e OFFICIAL NOTARY SEAL
ei SUE CARLOZZI
* COMMISSION NUMBER
1:Ui Q CC409566
9 ! "� QU MY COMMISSION EXP.
` �OF FA OCT. 28,1998
Electrical AI
TOTAL DUE 33
3 , �
`.
Date
in45/9_S
Date
Plumbing Engineering