230 NE 101 St (11)Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 7- 9 -G Y
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. �^ A
Owner's Name and Address ! ' ` No ' O Street 4 ° �.. f a I 41
Registered Architect and /or Engineer
�''
Employing Electrician's Name / 1 e e f_i"s'tK . No
STATE OF FLORIDA, l
COUNTY OF DADE. I j
88.
My Commission Expires
,2- 3
Amount of Permit $ (Signed)
(Signed)
/0 7 5 —
Street
Location and Legal Description Lot Block Subdivision
Street..,/ ?...L . ' / C )
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
No. of Stories
Notary Public, State of Florida
L.
Se rv i ce Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Electrice Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo d•! Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-con dors 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 ork 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.
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
R ECE'P'T'S
FIXTURES
N O. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. HEAT.
CONN.
ACE
H ATER
STRIP
H EATER
TOTAL
CONTR.
LIST
1
?,
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1•3 HP
N EON
TRANS.
RADIO
TOTAL.
CONTR.
LIST
CHECK
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 7- 9 -G Y
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. �^ A
Owner's Name and Address ! ' ` No ' O Street 4 ° �.. f a I 41
Registered Architect and /or Engineer
�''
Employing Electrician's Name / 1 e e f_i"s'tK . No
STATE OF FLORIDA, l
COUNTY OF DADE. I j
88.
My Commission Expires
,2- 3
Amount of Permit $ (Signed)
(Signed)
/0 7 5 —
Street
Location and Legal Description Lot Block Subdivision
Street..,/ ?...L . ' / C )
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
No. of Stories
Notary Public, State of Florida
L.
Se rv i ce Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Electrice Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo d•! Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-con dors 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 ork 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.
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.
Permit No
14
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 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.
Owners Name and Address =,1. / T� No 3 Street 'P . °/ 'S7
Registered Architect and /or Engineer _
Employing Electrician's Name 7 U..' L� l a '� C • No 6 Streetlfr f?/ //7 S -7-;
Location and Legal Description Lot Block Subdivision _
Street `il� 4 ('° / 57
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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 $ (Signed)
Ele ncal Inspector:
The undersigned applicant for this building permit does hereby certify that he understands and accepts 1., obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or su. •ntractors 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 e work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OF DADE. I 8''
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.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS MOTORS N EON
0.1 HP 1.5 HP TRANS.
RADIO
TOTAL
CONTR.
LIST
/
7.'/'? ��
CHECK
Permit No
14
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 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.
Owners Name and Address =,1. / T� No 3 Street 'P . °/ 'S7
Registered Architect and /or Engineer _
Employing Electrician's Name 7 U..' L� l a '� C • No 6 Streetlfr f?/ //7 S -7-;
Location and Legal Description Lot Block Subdivision _
Street `il� 4 ('° / 57
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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 $ (Signed)
Ele ncal Inspector:
The undersigned applicant for this building permit does hereby certify that he understands and accepts 1., obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or su. •ntractors 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 e work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OF DADE. I 8''
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.
MIAMI SHORES VILLAGE, FLORIDA ,
BUILDING DATE''-r ! / 194..C.7 194�
ELECTRICAL 1 PERMIT N9 1249 Contractor's
PLUMBING •tense No. 2-
Work to be performed under this Permit( (- t k t + f
1
Owner of
Building
Architect
Contractor
or Builder /may
Legal Lot or?' 2 ,
Description
Bl.
Subdi-
vision
1/ I
Address of ' r /; Value of Amt. of <"' c to
Building
r - --•
,.% \ � / Project ...- - Permit
� C • � •' .
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.
r
Signed. ` l t`^�e By
!
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 regula.
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. Iii''cceptin this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
,.
CONTRACTOR OR StlII!IDEA BY AUTHORITY
Owner's Name and Address
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No.___ T --
Application is hereby made for the approval
structure herein described. This application is
and all provisions of the Laws of the State of
of Miami Shores Village shall be comuLaryt
building during progress of w . 4 . r p
ss.
A
My Commission Expires
l
MIAMI SHORES VI LLAG E
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 9/
of the detailed statement of the plans and specifications herewith submitted for the building or other
made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
h, whether herein specified or not. A copy of approved plans and specifications must be kept at
Registered Architect and /or � nginee __
Employing Electrician's Name _ ; r _� J � � - , No Lj ,Le
Location and Legal Description Lot • 9 / I SO Block
0 3 Street and Number where work is to be performed —No. / Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
Service Overhead Size Feeders . Conduit / Z Main Sw.
Underground
(Signed
No I Street
(Signed) . �� %�
j,
Subdiv, y ion_ • 94
Alf f -
Street_
Notary Public, State of Florida
No. of Stories
Amps. /17/ p __________ Main Fuses Amps.
Type of Installation— Conduit Tubing B.X.L. Metal Moulding
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 com-
plied 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 public notice or notices as are
required by the Act. The under signed agrees to employ only such sub-contractors`' work o be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
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, 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.
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
`� /e
® C�
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Owner's Name and Address
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No.___ T --
Application is hereby made for the approval
structure herein described. This application is
and all provisions of the Laws of the State of
of Miami Shores Village shall be comuLaryt
building during progress of w . 4 . r p
ss.
A
My Commission Expires
l
MIAMI SHORES VI LLAG E
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 9/
of the detailed statement of the plans and specifications herewith submitted for the building or other
made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
h, whether herein specified or not. A copy of approved plans and specifications must be kept at
Registered Architect and /or � nginee __
Employing Electrician's Name _ ; r _� J � � - , No Lj ,Le
Location and Legal Description Lot • 9 / I SO Block
0 3 Street and Number where work is to be performed —No. / Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
Service Overhead Size Feeders . Conduit / Z Main Sw.
Underground
(Signed
No I Street
(Signed) . �� %�
j,
Subdiv, y ion_ • 94
Alf f -
Street_
Notary Public, State of Florida
No. of Stories
Amps. /17/ p __________ Main Fuses Amps.
Type of Installation— Conduit Tubing B.X.L. Metal Moulding
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 com-
plied 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 public notice or notices as are
required by the Act. The under signed agrees to employ only such sub-contractors`' work o be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
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, 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.
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.
BUILDING
•
•
•
ELECTRICAL :
The following
Inspector's Report: - /
•
•
•
JOB • C- ADD: 2 C9 d
: WORK
: DONE BY:
. - _. i'LCt 1
REQUEST F R
: INSPECTION
• .
WAS MADE WILL BE READY
PLUMBING e 07—j7/6'
.
ready for Inspection:
NOTE: REQUESTS FOR INSPECTIONJS MUST BE MADE BY THE CONTRACTOR
PERFORMING THE WORK.
JOBS
•
BUILDING
ELECTRICAL
PLUMBING
•
f
• WORK
. DONE BY
•
• REQUESTED
AD: 2
•
•
•
• •
•
•
•
•
• :
The fofi vpng is ready for Inspection:
Inspectv' s Report:
`o /
WILL BE READY
■
MIAMI SHORES VILLAGE PERMIT
No. /
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
THIS CERTIFIES THAT the wiring and apparatus installed at
by " " Address
for owner, and occupied as
has been inspected and current is authorized to be turned on, until otherwise notified, for :
Size of Service Number of Lighting Circuits
Range watts. Water Heater watts
Power: Connected load H P. Space Heaters watts
Other Apparatus
ELECTRICAL INSPECTOR.
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
MIAMI SHORES VILLAGE PERMIT
No./ 'f?
THIS CERTIFIES THAT the wiring and apparatus installed at 1.,_ " 1 e n 1 0 `�
b qS
Address
for owner, and occupied as
has been inspected and current is authorized to be turned on, until otherwise notified, for:
Size of Service Number of Lighting Circuits
Range watts. Water Heater watts
Power: Connected load H P. Space Heaters watts
Other Apparatus
ELECTRICAL INSPECTOR.
STATE OF FLORIDA,
COUNTY OF DADE.
85.
My Commission Expires
•
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No.__1___
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 co ' h, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of w
Owner's Name and Address
Registered Architect and /or ' ngine _ __
Employing Electrician's Name _A_ -t , ` .,. No Street
Location and Legal Description Lot eri_10- /' _Block_
0 �l__ �.!
Street and N tuber where work is to be performed—No 3_
State work tc be performed and purpose of building (By Floors)
a
New Building "°''''''' ' Remodeling Addition Repairs No. of Stories
Overhead
�" /
Service Underground Size Feeder # Con / '�:__ Main Sw._l__ Amps. _ Main Fuses Amps.
Type of Installation— Conduit Tubing B.X.L. Metal Moulding _
— -- - ---- ---------------- - - - - -- — — — — ♦—
Amount of Permit $_ (Signed) _J.
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 com-
plied 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 public notice or notices as are
required by the Act. The under signed agrees to employ only such sub-contractors; 'On worl ,to be performed under this permit, as are
licensed by Miami Shores Village.
No. ' Street
y
(Signed)
Date__ __
Street_
Subdivisio
10 —
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, 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.
Notary Public, State of Florida
Master Electrican.
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
S O U TTLET TS S
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
/ `
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
H EATER
'�
STRIP
HEATER
TOTAL
R (�
CONTR.
LIST
,f
�
6
h
f
1
!J�
/
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP,
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1-5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
STATE OF FLORIDA,
COUNTY OF DADE.
85.
My Commission Expires
•
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No.__1___
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 co ' h, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of w
Owner's Name and Address
Registered Architect and /or ' ngine _ __
Employing Electrician's Name _A_ -t , ` .,. No Street
Location and Legal Description Lot eri_10- /' _Block_
0 �l__ �.!
Street and N tuber where work is to be performed—No 3_
State work tc be performed and purpose of building (By Floors)
a
New Building "°''''''' ' Remodeling Addition Repairs No. of Stories
Overhead
�" /
Service Underground Size Feeder # Con / '�:__ Main Sw._l__ Amps. _ Main Fuses Amps.
Type of Installation— Conduit Tubing B.X.L. Metal Moulding _
— -- - ---- ---------------- - - - - -- — — — — ♦—
Amount of Permit $_ (Signed) _J.
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 com-
plied 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 public notice or notices as are
required by the Act. The under signed agrees to employ only such sub-contractors; 'On worl ,to be performed under this permit, as are
licensed by Miami Shores Village.
No. ' Street
y
(Signed)
Date__ __
Street_
Subdivisio
10 —
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, 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.
Notary Public, State of Florida
Master Electrican.
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.