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1226 NE 100 St (7)Date Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Address 4, r/ A (� j DO S Company w / ✓ ��%�' `l �. Phone # 7 cc-9 For Inspector: 1 Approved Correction Re- Insp'n Fee Time Q ItTame &Date a a o tea. -s) `-1 P Poki- MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 \/ Bu Inspection Request Date 1 ( 1 Type Insp'n '< '+ Id I1 1 Permit No. 1..� I O1 - Name 1 a O 1^ D i O ' Address 12 1 J c os) I Company Phone # Inspection Date 1 11 _ Approved Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buildi g In pection Request ill Date �C/ � " � Type Insp'n /) j1— ?V R-Lc %E� Permit No. gi Name ( A j ■ Address /On r t Company Phone # Inspection Date Approved Correction Re- Insp'n Fee PRO PERTY OWNER f 1-rI4 C . Lnim ,■ Enclosure Alteration Exterior Name 11L(, NI & I Oo s t si r" / - ptntl S Address Shell Only Foundation Only Add'I Attachment Home Telephone ZbY . . . ) c ' ' ° 19'- -9 Add'l Detachment Other Business Telephone 1 u s- 1 r t 4 1 - Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. A PPLICATION Job Address: \ 1)- (' N 1_ l 00 Address Folio Number 1 /bescription of Work VQ okrt C tivt ct I t,.,,tiF pi v--c er, Lot Block F k r " n . , ti , - . 1 ti, V- %zc , l -e, -i l t--(l i A L 2 atiTt-I` -11 Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property ✓Value of Work )- 3 cx. Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax City Tax Assessed/Appraised Value / t rr" S Heft-4- c Fc 1311b- State PERMIT APPLICATION Master Permit No. Subsidiary Permit No. Zip Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 11%1PORT;ANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE °' )Itnature of Owner S;_ ature of N Print Name Sworn to and subscribed before me this l l day o Lary Public - • to I orida Signature of Notary Public - State of Florida In- + © O .!1 .. SEAL: eD. C% , 1Gn < Personally known OR, Produced Identification r ' ® - Personally known OR, Produced Identification SEAL: C Type of Identification Produced: 1Q/ c sb..f• (-0 \) 7 Print Name PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Sworn to and subscribed before me this day of 1 Type of Identification Produced: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: EL2002 -192 Printed: 6/11/2002 Page 1 of 1 Applicant: HERSCHEL CONKLIN Owner: CONKLIN HERSCHEL JOB ADDRESS: 1226 NE 100 ST Contractor Local Phone: O2Q'JT't 4 l3s Sa Electrical Permit Contractor's Address: Permit Status: Approved Permit Expiration: 12/8/2002 Construction Value: $2,300.00 Work: UPDATE SERVICE WIRE NC UNIT FIXTURE IN KITCHEN INSTALL 2 OUTLETS BY: Parcel # 1132050090060 Legal Description: 5 53 42 EARLETON SHORES PB 43 -80 LOT 6 BLK 1 LOT SIZE 75.000 i3S -S d Total Fees: - $9+01Q Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 application 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 responsibility for work done by his agents, servants or employees. 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. (Contractor or Builder) BY: KEITH C. CONKLIN WEST PALM ST LAKES IR 0 6 98 33 406 Pay to the order of Z . B ^4 NA • O��® • 4 " 2-1 710 111001 617$32 7 Dat ) /.70710000131:111001617 C - - -___- 10 49 /3 �5_U Dollars B AP Gentlemen: A 1eal owner of subject property, I request the cancellation of permit number 1 -(5 4 cl o issued /to C - ► - - , for the folio win reason: C TRN rkQrkmi4-40v. 9 TG a 7oS +po nPci 1 HOLD HARMLESS Miami Shores Village Building and Zoning Department Miami Shores, Fl 33138 RE: Property located at (address and legal description) 11)- (C3 U (4 , fL 3 3 1 3 y Date C(fr/ov ✓f)ate of last inspection: I hereby apply as owner -bu der, or authorize (new contractor) to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. Very truly yours, (owner's signature) 1` L i nt- C f/--( (print name) Prime contractor (only if subcontractor holds permit or if change of qualifier). (signature) (print name) STATE OF FLORIDA COUNTY OF DADE: The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this day of ,� - Do Notary Public, State of Florida at Large _ • ' , 014„ iC Pair:; -J. J! OF R • CN" M BUILDING 0 MIAMI S OR ELECTRICAL PLUMBING 0 PERMIT ROOFING 0 MECH Owner of Building 0 Ki Architect Contractor or Builder Legal Description Address of Building • ri( Lot 6 BI.) /p226 VE/P0 St 49490 CONTRACTOR or BUILDER BY GE, FLORIDA 7- /5 Date Contractor's License No. , a u vision //420C-00 00 Sbdi- Sq. Ft.: Value of Project $,„2 ,300 Work to be performed under this Permit e c_0441- • -pvytuA ti /35_ Permit: CCF: Notary: Bond: Amount of /37 0 Radon: Permit: / 20 • 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. "." ( - , -- . ..- - i ," - - - ....a--- Sipe. '' e 7 '`. / - ,.. °- -- - e- 7, ":e - , (INSPECTOR) BY In consider on o e.listians4 to me of this permit I agree to perform the work covered hereunder'in compliance with all ordinances and regulations pertaining therfito and __strict co9f6rmity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In acc,nytIsis pe issu Ksponsi • • rk done by either, myself, my agent, servant or employee. 0930A200,07/25/01TOTL 137.30 AUTHORITY ELECTRICAL .I'I'i,E Minimum Fee (En'. 'L1.PI. Dryer QTy. .LVPI Outlet, Appliance on'. TyI Service Repair Q . LV .. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL T1'1I: Minimum Fee QTY. TYPE Condensate Drain Q'I'Y. TYPE Generator ()Ty. TVI'I Refrigeration, Tons Q'I'Y. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUNIB1NG ,LYI,I,, A/C Condensate QTY. ' FY PI; Drains, Roof Q ' I ' V . i ' V i 'i' Miscellaneous Fixture QTY .I'YI'I Soakage Pit Q.I.Q. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CIIE('KLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary REVIEWED AND PREPARED BY: ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ t, go $ o ( x .ft. x/1000 (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) Cl BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ , D SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE • ATE: // 3c�,t- ta CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address r2- 2- 6 rn- i c Tax Folio Legal Description /I Historically Designated: Yes No Owner/Lessee / Tenant /�t ( CD N k ( IA ) Owner's Address 1 `2 2 b M lots I Contracting Co. II rl) rt4 0 I (c.. Qualifier C A2 ( V "ice u Master Permit # ( 'V19 Phone Address L b'v AC RC. c ss# Phone 4 ' 11 ( State # Municipal # Competency # 97) ° Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING CLECTRICALl PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION VPCLJQ Se RN) 1c To 2oa Ai f tvG ri g �il4 I 44 a 6,- ( .. . 4 II F /w i'Cr (C eti / Sly ( 2 6- o ct 7e �44u ►6 Square Ft. Estimated Cost (value) , 2 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 • in compliance wi r all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stat::� ature of owner an ar Condo President I II rt_ '_ Eat °. � � F No : , y .'r: aP 1495 My o c: p XPIRES: Marc 6 , 2002 ilb RF,A; 6b1 Thru Notary Public Underwriters FEES: PERMIT /71 X 7 .f J RADON Da APPROVED: Zoning Building Mechanical Plumbing Signature of Contractor or Owner- Builder tBr No r'� a: ::' 4 X? s "i � • '�'' 3 o„d � � 5 My n Blows: March 24, 2002 ,.. Bonded Thru Notary Public Unrienvriters C.C.F. , NOTARY V ' BOND Electrical iO 77 3 TOTAL DUE 1, /9,1Z,LY Date Structural Engineer • ITEM BATH TU3 UNIT FEE ITEM SNITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) CRINKIhG FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE 24) 47 REFRIGERATION CREASE TRAP APPLIANCE OUTLETS. PROCESS AND PRESS PIPING • INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 IF MECHANICAL VENTILATION SINK, RESIOENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS T;4PCRARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS CATER CLOSET MJTCRS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SLFPLY TO: AIR CONDITIONERS 1 A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE S'WIM% POOL CUTLETS COM4,IERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TAM( ANTENNA BELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. ;LW VIOLATION & ABANDON SEPTIC TANK REI`S?ECTION SOAXAGE PIT CU. FT. t CsP- 4 AI F iiTTP( 6 x® :A T CH BASIN F-.►. O u r .-7 O DISCHARGE WELL :CMESTIC WELL AREA CRAIN IOCF INLET - CLAR WATER HEATER 'IRE /3i / STANDPIPE CL PIPING -AWN SPRINKLER SYSTEM :AS RANGE ETER SET (GAS) :AS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. 03TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING Owner of Building�'`�� MIAMI SHORES VILLAGE, FLORIDA DATE 1 PERMIT N? 15441 .�v ❑ Work to be performed under this Permit .� 195 Contractor's ' License No Architect Contractor or Builder • n Legal Lot II :Bl Description. Address of Value of Building i • �•; i , "" f ,I Project $ 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 application 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 drawin s or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. s"• i. t� BY 4, - CONTRACTOR OR BUILDER Signed• Subdi- vision Amt. of Permit $ ! 4 w INSPECTOR 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, statenufnts or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by eit?fer, myself, my agent, servant or employee. BY AUTHORITY Permit No 1 51 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 Guy Hickman No 1201 N W Street 102nd St Registered Architect and /or Engineer Employing Electrician's Name Lewis 0 Wagner No 9 930 Street Central $1 Vd Location and Legal Description Lot Street and Number where work is to be performed — 120 N $ -" Street 100th St State work to be performed and purpose of building (By Floors) Wir16 Residence New Building Remodeling Addition Repairs No. of Stories ■ litivlain Sw Amps 100 Main Fuses Amps Type of Installation -- Conduit X Tubing - B.X.L Metal Moulding Service Overhead Size Feeders # 1 Conduit Underground Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. APPLICATION FOR ELECTRICAL PERMIT 55. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Block., Subdivision (Signed) Date Icy 12th/..53 (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 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. Mast0t, 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'T'S FIXTURES No. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST 16 , � 20 25 16 1 1 1 / 2 CHECK � 1 � Je $ JO ® .s' . l `� /may . mil ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS NEON 1•5 HP TRANS. 1 RADIO TOTAL CONTR. LIST 9 % 1 Despseall i ,) CHECK `0,0 r cj ) F c si (l 1 Druer A z� Permit No 1 51 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 Guy Hickman No 1201 N W Street 102nd St Registered Architect and /or Engineer Employing Electrician's Name Lewis 0 Wagner No 9 930 Street Central $1 Vd Location and Legal Description Lot Street and Number where work is to be performed — 120 N $ -" Street 100th St State work to be performed and purpose of building (By Floors) Wir16 Residence New Building Remodeling Addition Repairs No. of Stories ■ litivlain Sw Amps 100 Main Fuses Amps Type of Installation -- Conduit X Tubing - B.X.L Metal Moulding Service Overhead Size Feeders # 1 Conduit Underground Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. APPLICATION FOR ELECTRICAL PERMIT 55. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Block., Subdivision (Signed) Date Icy 12th/..53 (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 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. Mast0t, 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.