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1177 NE 100 St (4)MIA � , ES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date \\\' 91O Type ‘ itlAt Permit No. ).005 150 Address /�,`,T_ Nu Compan Ala.' Al6 Phone # 1%44 C \ VANIk). Inspection Date Name Approved Correction Re- Insp'n Fee A\ *5 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/3/2005 Applicant: J. C. Owner: RODRIGUEZ JOB ADDRESS: 1177 NE 100 Contractor BLUE BREEZE AIR CONDITIONING Local Phone: 305 - 865 -1220 Parcel # 1132050190350 Mechanical Permit Permit Number: MC2005 -150 RODRIGUEZ J. C. ST Contractor's Address: 655 NW 118 ST Legal Description: MIAMI SHORES SEC 8 REV PB 43 - 67 LOTS 13 & 14 Fees: FEE2005 -14080 FEE2005 -14081 FEE2005 -14082 FEE2005 -14083 FEE2005 -14084 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $238.00 $4.20 $1.40 $5.95 $3.00 $252.55 Total Fees: $252.55 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 4/30/2006 Construction Value: $6,800.00 Work: REPLACE EXISTING AIR CONDITIONING UNIT WITH A NEW ONE Signed: (INSPECTOR) Signed: (Contractor or Builder) BY: Page 1 of 1 BLK 177 LOT SIZE NOV 0 3 PAID 19S 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 responisibility for all work done by either myself, my agent, servants or employes. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: ( S7 i a u x� (lT 36.8972 J 7 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electr Owner's Name (Fee Simple Titleholder G tad^ ► S vi i Phone # 3 OS 7S y - 3 V`j / Owner's Address , City// t# i' Sh o r- State F r Zip 33 I 3 b / t ,/ //A. Tenant/Lessee Name /r7 /0v5-+ Job Address (where the work is being done) / / 7 7 /V c. / 64 S t City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name Give., ( re P it Contractor's Address t)vJ its? � City ret State Qualifier I�t't 'tgS ' T t I 0 State Certificate or Registration No. C AC 14i 13 2 Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit (v D `— Type of Work: DAddition ['Alteration Describe Work: 2e la vC e k, �• r) r� Total Fee Now Due $ - S Z • J (Continued on opposite side) 4fc. oNa -.7 . C Permit No. N1C5 ISO aster Permit No. ['New Plumbing Mechanical Roofing 8C 7.r1 7' /? Phone # FI Zip Zip Phone# 3 oS – is GC - J lI Certificate of Competency No. Square Footage Of Work: x Icc * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 3 31 “ .) Repair/Replace ❑ Demolition Submittal Fee $ P Permit Fee $ 23 a DD CCF $ 4 • ZO CO /CC Notary $ Training/Education Fee $ 1 , 4—C) Technology Fee $ • 95 Scanning $ 3 . 0 0 Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City St Zip Signature Owner or Agent The foregoing ' strument was acknowledged before me this Z day of0 vT , 20 or by SL CZ a Sri who is personally known to me or who has produce4)F /p dam, )n' ' 5' License, As identification and who did take an oath. P . / 2 ( 0 4 1 1 . 3 - 6 0 . 3 7 q' NOTARY PUBLI EXPIRES 02/03/2008 My Commission Expires: o z.- o3 ' .Z008 BONDED 1-- f.33- NOTARY1 ******* * * * * * * * * * * * * * * * * * * *** * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03 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: 1 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 . osted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of ch posted notice, the inspection will ; approved and a reinspection fee will be charged. Signature Contr The foregoing instrument was acknowledged before me this-7/ day of OCM -e , 200j , by /f/f s law) iJai , who is personally known to me or who has produced P erSvna/t/ xnou'tas identification and who did take an oath. NOTARY PUBLIC: ** * * * * * * *** * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning Sign: /� /�1N �y,Z ,2� . - - - - ORLANDO OLIVO, JR. Sign: 7,x5 DIARY PUBLIC - STATE OFFLORIDA / __NOTARY PUBLIC - STATE OF FLORIDA t _ ; 'a0 Print: arl�hd� Q # DD287299 Print: 67r /G p cfiV EXPIRES 02/03/2008 b unubi I HRU 1. 888- NOTARV1 My Commission Expires: 7 03 —,& Of ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDENDUM TO BUILDING PERMIT APPLICATION ,>LCATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS E. THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL / E M UNIT 3ATH TUB FEE ITEM UNIT SWITCH OUTLETS FEE ITEM SPACE HEATERS UNIT FEE 31DET LIGHT OUTLETS CENTRAL HEATING I Kw' i RECEPTACLES A/C (WIND) )ISHWASHER 1 SERVICE TEMPORARY A/C (CENTRAL) C">' DISPOSAL DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/ETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR I RANGE TCP UNDERGROUND TANKS LAVATORY ABOVE GROUND TANKS LAUNDRY TRAY ,, WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER j MOTORS 0- 1 HP STEAM BOILERS SHOWER MJTORS OVER 1- 3 HP HOT WATER BOILERS MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, POT /3 COMP. SINK; RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS /ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEM URINAL I MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET 1 MOTORS OVER 100 HP VIOLATION INDIRECT WASTES I A/C WINDOW I REI.NSPECTJON WATER SUPPLY TO: I AIR CONDITIONERS I A/C UNIT I STRIP HEATER FIRE SPRINKLER I GENERATORS TRANSFORMERS I 'HEATER -NEW INST. I GENERATORS HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE I SWIMfi1ING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS _ *.SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK • ANTENNA RELAY • I TELEVISION OUTLETS DRAINFIELD, 4 TILE/RES. I VIOLATION PUMP & ABANDON SEPTIC TANK I REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN: I ROOF INLET SOLAR WATER HEATER I FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM' I I GAS RANGE I � ( I METER SET (GAS) C D D GA, I:Ik• I I ADDENDUM TO BUILDING PERMIT APPLICATION ,>LCATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS E. THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL AMP Size ADDRESS: Circuit Breaker 3( S CU Circuit flreaker # 24( A size ires 0 44 Circuit Breaker Panel AIR CONDITIONING EQUIPMENT EXACT CHANGE OUT AFFIDAVIT FORM ALL INFORMATION MUST BE FILLED IN ACCURATELY. THE FOLLOWING INFORMATION REPRESENTS THE EXISTING CONDITIONS: Company Name Notary Required Branch Circuit Mitre Size Branch Cirait Wire Size tY S /0h/�05 Miami Shores Village AMP Size kir Handier Disconnect MAP Size L to Condenser Unit Disconnect Qualifier Name ?A`l l 3 C O f/ o SA ORLANDO OLIVO, JR. NOTARY PUBLIC - STATE OF FLORIDA COMMISSION # DD287299 EXPIRES 02/03/2008 BONDED TNRU 1- 88B- NOTARYI Disconnect Mounting Location information: Mounted on AHU unit? Yes ✓ No Above Base Flood Level? Yes es No Clear workspace 30" wide & 36" front? Yes '/ No Mounted on C/U unit? Yes Above Base Flood Level? Yes ✓ No Clear workspace 30" wide & 36" front? Yes ✓ No Low voltage thermostat wiring is installed in a separate raceway from the power wiring? Yes ✓ No THE FOLLOWING REPRESENTS THE NEW EQUIPMENT: NAME PLATE INFORMATION: —ANEW AIR HANDLER UNIT _- _---- _ =_ - -: _ _ - -- NEW CONDENSER UNIT =tr No ✓ MINIMUM CIRCUIT AMPACITY? • MINIMUM CIRCUIT AMPACITY? 2_2, . MAXIMUM OVER CURRENT Si? ZE 6 J . MA30M )M OVER CURRENT. Sm? J . ELECTRIC HEATER KW SIZE? .e (LW' I as qualifying agent for the air conditioning equipment installation at the above address location hereby attest: The above information provided for the existing electrical conditions and the nameplate information provided for the new equipment is accurate and truthful. Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL- SINGLE FAMILY Beds /Baths: 3/3 Floors: 1 Living Units: 1 Adj Sq Footage: 3,222 Lot Size: 17,550 SO FT Year Built: 1950 Legal Description: MIAMI SHORES SEC 8 REV PB 43- 67 LOTS 13 & 14 BLK 177 LOT SIZE IRREGULAR OR 21395 -2954 062003 1 Year: 2005 2004 Land Value: 5396,166 $295,324 Building Value: $248,225 $227,927 Market Value: $644,391 $523,251 Assessed Value: $538,949 $523,251 Homestead Exemption: $25,000 $25,000 Total Exemptions: $25,000 $25,000 Taxable Value: $513,949 $498,251 Folio No.: 11- 3205- 019 -0350 Property: 1177 NE 100 ST Mailing Address: JUAN CARLOS RODRIGUEZ &W MARGARET 1177 NE 100 ST MIAMI SHORES FLA 33138 -2601 ,Miami -Dade My Home Show Me: Property Information Search By: Select Item T TeX only Ll Color Aerial Photography - 2004 Digital Orthophotography - 2003 My Home idade. r Property Appraiser Tax Estimator Summary Details: Property Information: Sale Information: ale Dat e: X2 1395-2954 ale 2003 Date: 003 ale Amount: 530,000 Assessment Information: ACTIVE TOOL: SELECT Aerial Photography - AirPhoto USA 2004 : V' We appreciate your feedback, please take a minute to complete our survey. My Home 1 Property Information 1 Property Taxes 1 My_ Neighborhood 1 Property Home 1 Using Our Site 1 About 1 Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, please click here to let us know. 0 E -mail your comments, questions and suggestions to Webmaster Web Site © 2002 Miami -Dade County. All rights reserved. Page 1 of 2 141 `Q l® Q 116 ft http: / /gisims2.co. miami - dade.fl.us /myhome /propmap.asp ?app= none &bytool= ADDR &cm... 10/31/2005 . Miami -Dade County. Real Estate Tax Information Real Estate "Tax Information miamidade.gov Show Me: Property Taxes Search By: Select Item Detail Tax Information: Real Estate Tax Info 2005 Taxes Prior Years Taxes Due 2005 Ad Valorem 2005 Non -Ad Valorem 2005 Back Assessments 2005 Enterprise Folio 2005 Historical Abatements 2006 Quarters Payments 2005 Tax Notice /Memorandum © 2002 Miami -Dade County. All rights reserved. Real Estate Tax Information Today's Date: 10/31/2005 Last Update: 10/21/2005 Year: 2005 Folio Number: 11 32050190350 MIAMI SHORES Owner's Name: JUAN CARLOS RODRIGUEZ &W MARGARET Property Address: 1177 NE 100 ST Mailing Information : JUAN CARLOS RODRIGUEZ &W MARGARET 1177 NE 100 ST MIAMI SHORES FLA 331382601 To view 2005 Tax Notice /Memorandum click here Amounts due if paid by 11130/2005 in U.S. funds 2005 Taxes $ 13599.291 To pay by e-check please click on PAY NOW button below. Please use Regular Checking Accounts. For example: Line of Credit and /or Equity Accounts cannot be processed. PAY NOW j If payment is not received by the specified date the total amount due is subject to change. Legal Description : MIAMI SHORES SEC 8 REV PB 43 -67 LOTS 13 & 14 BLK 177 LOT SIZE IRREGULAR OR 21395 -2954 062003 1 Amounts due are subject to change without notice. E -mail your comments, questions and suggestions to Webmaster Page 1 of 1 Contac p mial (30E Dowr 140 V R Mian South 1071( R Mian Off 8 :00 ; Rel: Ta Prop Florid; Rt Property Tax Home I Real Estate Tax Info 1 2005 Taxes I Prior Years 1 2005 Non -Ad V 2005 Back Assessments 1 2005 Enterprise Folio 1 2005 Historical Abatements 1 2006 Quarter]' 2005 Tax Notice /Memorandum Miami-Dade Home I Using Our Site I About .... Phone Directory 1 Privacy I Disclain http: / /egvsys.miamidade.gov :1608 /wwwsery /ggvt/txcaw01.dia ?folio = 1132050190350 10/31/2005 • NOTICE OF COMMENCF.MENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERPMTNO. (50 TAY, FOLIO NO 11 -. I 6 C STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED nereoy gives notice that improvements wiIFe made to certain real property. and it accoroance with Chapter 713, Fiorioa Statures, the toliowina information is provided In this Notice of Commencement. 1. Legal description of property and street /address: tArG ckOreg S« 8 CV po, I.o S I; A 14 r1Ltz PE to ve(AK, ',Laic. \ rf ')313K Sionature o Print 0 Sworn to F hy wne- pr's NamLJ Nc ar:' Print Notar.., Nam Ivn: cc,T- expire._ o4/9,J/e 2. Description of improvement: C "A'6P A u 1 11111111 111111111111111111111111111 1111111111 CFN 20105R11.1. 3941.9 OR Bk 23926 P9 1029; (199) RECORDED 11/03/2005 14 :11:12 HARVEY RUVIN► CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE 3. Owner(s) name and address: ( frc� OA ►J CAP l0d ✓ oe'N 1 160 S Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: ilb(. ef4. A'"(( Lk) j( g S t t /} r t , F ( 331 Vg 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon wnom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 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: wITNE HAR By 11 ano suoscnpec oeTOre me this / da \' o e..... 94,- 2 /z 361 -`{).3 .60 , ?7 0 ORLANDO OLIVO, JR. NOTARY PUBLIC - STATE OF FLORIDA COMMISSION # D0287230 (eleir714.) (7////0 EXPIRES 02/03/2008 BONDEDTHRU 1.888.Nn' ^ STATE OF FLORIDA, COUNTY OF DADE 9. E xpiration date of this Notice of Commencement: (t4e E ex RE t original different e i ci -d) 1 opy of the the of AD 20 Seal. cui and County Courts D.C. F recarec o Acores:: BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building MIAMI SHORES VILLAGE, FLORIDA ��/ ❑ DATE d ir 1944 tik PERMIT N9 7683 0 0 Architect Contractor or Builder Legal Description Lot Contractors Fe 3 g License No. C� Work to be performed under this Permit Bl. 8 /-., R 47.E 7 '7, Subdi- vision Value of Project $ Building 1177 .w► 1 CF I Amount of *ot 4 Address 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 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 statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed . 110C -- .: INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder ,..compliance with all dinances 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 no cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 4150T Permit No.. 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 / �. t No /1 77 Street / 019 Registered Architect and /or Engineer 7 Employing Electrician's Name Location and Legal Description Lot STATE OF FLORIDA, 1 COUNTY OF DADE. J s '' MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 1 Block (Sign No Street and Number where work is to be performed —No.,. State work to be performed and purpose of building (By Floors).c.-Y " ' Date Vie/J Street Subdivision New Building Remodeling Addition Repairs No. of Stories Service Underground Overhead Size Feeders nduit Main Sw Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) 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 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 t work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub on work to b performed under this permit, as are licensed by Miami Shores Village. /!- 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 O UTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET FeANOE OUTLET RANGE CONN. WATER H EATER W. HEAT. CONN. ACE HATER STRIP H EATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE M. MOTORS 0.1 HP MOTORS 1.0 HP N EON TRANS. RADIO TOTAL CONTR. LIST , / .� s }C�/����J �.�idl / �� / / � / / ��c...„9-0,-e....4 6 1.„ e � "" � l / CH I i/ Permit No.. 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 / �. t No /1 77 Street / 019 Registered Architect and /or Engineer 7 Employing Electrician's Name Location and Legal Description Lot STATE OF FLORIDA, 1 COUNTY OF DADE. J s '' MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 1 Block (Sign No Street and Number where work is to be performed —No.,. State work to be performed and purpose of building (By Floors).c.-Y " ' Date Vie/J Street Subdivision New Building Remodeling Addition Repairs No. of Stories Service Underground Overhead Size Feeders nduit Main Sw Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) 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 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 t work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub on work to b performed under this permit, as are licensed by Miami Shores Village. /!- 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.