ELECTRICAL PERMITDate
Type Insp'n
Permit No. E
MIAMI SHORES VILLAGE
BUILDING DEPARTMIT
305- 795 -2204
B ilding Inspection Reque
Nam; f
Address o�-S - C - l D URA-
Companyft
Phone # 3C'S - ? ?5 - (O 23
Inspection Date
Approved
Correction
Re- Insp'n Fee
❑ ".9,1"/2- O L�
f
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Re.uest�
Date
Type Insp'n
Permit No. E L. 0 O.6
Strq l a
-- °>S`\ )" (o(_A
30� pps -4 ? ?D
1 7 IK
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
Permit No
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 be kept at
building during progress of work.
Owner's Name and Address
%178(
APPLICATION FOR ELECTRICAL PERMIT
Pit2 .gip/
Registered Architect and/or Engineer
EA-160/ e7.eCe7r2tC
�7 f0
Emplo Elee 'ciatt
1 t16rand' Legal Des rT on Zo
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
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
C — t77 f Z- •
f u D .0f, - - —
Block
Amount of Permit $.. (Signed)
(NOTARY PUBLIC. STATE OF FLORIDA.
MY COMMISSION EXPIRES::�APii1L 21. : .1. ”2„
�ONm QO' ry a ejo Cl tfge R W RITERS.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection
materials and /or workmanship.
Date 1— ! — ge •
specifications must
Street /0/ ,1;7
/ 7L
Street... � �
'/ /
S ubd ivisio n......
N /G /D./ 57
Repairs No. of Stories
O nderground Site Feeders Conduit./ Main Sw..... ) Amps / S� • Main Fuses. e •Amps
Type of Installation— Conduit.. .' ? L • 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 complied 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 undersigned agrees to employ only such subcontractors, on work to be � ttformed under this .e , as are
licensed by Miami Shores Village.
(Signed) j t�� e-•
Master Electrician.
STATE OF FLORIDA, 1
COUNTY OF DADE. I 6e.
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' 'si(iu the same, and that all facts
therein by him stated are true.
'4. -, -/
otary Pub1i4 State of Flo
is made necesiary by isnpropei notice r for/fnspection, or faulty
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T•S
FIXTURES
NO. LAMPS
RIFRIO.
OUTLET
-
7
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
NEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/11
��
CHECK
, '2 ' .
X ,,/
/
1
/
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
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 be kept at
building during progress of work.
Owner's Name and Address
%178(
APPLICATION FOR ELECTRICAL PERMIT
Pit2 .gip/
Registered Architect and/or Engineer
EA-160/ e7.eCe7r2tC
�7 f0
Emplo Elee 'ciatt
1 t16rand' Legal Des rT on Zo
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
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
C — t77 f Z- •
f u D .0f, - - —
Block
Amount of Permit $.. (Signed)
(NOTARY PUBLIC. STATE OF FLORIDA.
MY COMMISSION EXPIRES::�APii1L 21. : .1. ”2„
�ONm QO' ry a ejo Cl tfge R W RITERS.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection
materials and /or workmanship.
Date 1— ! — ge •
specifications must
Street /0/ ,1;7
/ 7L
Street... � �
'/ /
S ubd ivisio n......
N /G /D./ 57
Repairs No. of Stories
O nderground Site Feeders Conduit./ Main Sw..... ) Amps / S� • Main Fuses. e •Amps
Type of Installation— Conduit.. .' ? L • 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 complied 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 undersigned agrees to employ only such subcontractors, on work to be � ttformed under this .e , as are
licensed by Miami Shores Village.
(Signed) j t�� e-•
Master Electrician.
STATE OF FLORIDA, 1
COUNTY OF DADE. I 6e.
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' 'si(iu the same, and that all facts
therein by him stated are true.
'4. -, -/
otary Pub1i4 State of Flo
is made necesiary by isnpropei notice r for/fnspection, or faulty
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted or 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 Build ing Division
of Miami Shores Village shall be complied with, w!}ether 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 ✓
Registered Architect and /or Engineer
Employing Electrician's Name .K"'/rz, re_ i
Location and Legal Description Lot Block Subdivision
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 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 $
APPLICATION FOR ELECTRECAL PERMIT
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
1 io Street
(Signed)
(Signed)
Date / /a
No 2.6 /V& Street 7 v
Electn Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accep is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of ' orida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or s• • 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.
70,E
7,t : 9 ,........ m.
Muter Electri �`
STATE OF FLORIDA, }
COUNTY OP DADE. s' '
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 MOO will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLLTs
LIGHT
OUTLETS
PLUS
REOL'P'T's
FIXTURES
NO. LAMPS
I It
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
$� A CE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.4 HP
N [ON
TRANS.
T
/
�p 1�
RADIO
TOTAL
CONTR.
LIST
J / f
I /"GX.S/`
�./1
P'
Lin /
� (/ v
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted or 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 Build ing Division
of Miami Shores Village shall be complied with, w!}ether 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 ✓
Registered Architect and /or Engineer
Employing Electrician's Name .K"'/rz, re_ i
Location and Legal Description Lot Block Subdivision
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 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 $
APPLICATION FOR ELECTRECAL PERMIT
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
1 io Street
(Signed)
(Signed)
Date / /a
No 2.6 /V& Street 7 v
Electn Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accep is obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of ' orida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or s• • 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.
70,E
7,t : 9 ,........ m.
Muter Electri �`
STATE OF FLORIDA, }
COUNTY OP DADE. s' '
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 MOO will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
.Architect
Contractor
or Builder
Legal • Lot
Description
Address of
Building
11
/1 4' ?`./
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE
PERMIT '11T? 11847 Contractor's
License No
Work to be performed under this Permit
BL
Subdi-
vision
Value of
Project $
Amt. of
Permit $
195
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.
Signed: BY
I to INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with alf 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 responsibility for all work done by eit er, myself, my ggegt, servant or employee.
F`
BY AUTHORITY
Permit No 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.
Owner's Name and Address No Street
Registered Architect and/or Enyeer
Employing Electrician's Name..nf.:
Street and Number where work is to be performed—No..
STATE OF FLORIDA, }
COUNTY OF DADE.
APPLICATION FOR ELECTRICAL PERMIT
Amount of Permit $ V
SS.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No..7
Location and Legal Description Lot Block Subdivision
7, "7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Overhead
Service Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation—Conduit Tubing B.X.L Metal Moulding
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to
licensed by Miami Shores Village.
Street..f
(Signed)
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
//
(Signed)
Street? 4' d &
a /
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.
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
di
/
/
CHECK
yd
• .„„r
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No 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.
Owner's Name and Address No Street
Registered Architect and/or Enyeer
Employing Electrician's Name..nf.:
Street and Number where work is to be performed—No..
STATE OF FLORIDA, }
COUNTY OF DADE.
APPLICATION FOR ELECTRICAL PERMIT
Amount of Permit $ V
SS.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No..7
Location and Legal Description Lot Block Subdivision
7, "7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Overhead
Service Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation—Conduit Tubing B.X.L Metal Moulding
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to
licensed by Miami Shores Village.
Street..f
(Signed)
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
//
(Signed)
Street? 4' d &
a /
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.
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.
e
•
MIAMI SHORES VILLAGE
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
THIS CERTIFIES THAT the wiring and apparatus installed at 20*
by 1 y- -.1 {, * , . Address
for + r - ' ,t / r c r w owner, and occupied as
has been inspected and current is authorized to be turned on, until otherwise notified, for:
4 . e,..4.0 Size of Service : < ` ° . x - f Number of Lighting Circuits Ev
Range 1 .T .,,..:-.1,, - , C, , ' ; watts. Water Heater Y watts
Power: Connected load ..Y H P. Space Heaters X watts
Other Apparatus ,W
ir
9
PERMIT
No.
•
L CTRIL'"AL INSPECTOR.
NO.
STREET
PART OF LOT
LOT
BL'K
SUBDIVISION
Water Heaters
Signs
t
Billboards
y
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
Permit Fee
+
'
r
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building
Contractor or Electrician
Dated , 19—
aiami Aores9 llage
F L 0 R 1 D A
OFFICE OF ELECTRICAL DEPARTM'ENT
Miami Shores Village, Fla ,
DESCRIPTION OF WORK
NUMBER OF
LO CATI 0 N
N° 634
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
this Department.
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
ahe Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
Ttate of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
whores Village.
(Seal)
O.
- Motors
0
STRET
PART OF LOT
LOT
BL'K
SUBDIVISION
/� #
4
/.
• /
I I x �I
, i
1.C��
''W"
Outlets
- Motors
0
Receptacles
Generators
Stoves
Water Heate
Sir
°
~
Billboards
Other Apparatus
f
*
Permit Fee
r At
r
try
✓
�Pf
�0
P..;
sr
�.
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building - 6 '
w
Dated
••'
Miami Shores Village, Fla ,
Contractor or Electrician, -)44 " �. "- : - `" ` e
LOCATION
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
an the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
.s Department.
t 1 -'
, Electrical Inspec or.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
ite of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
ores Village.
�e
aiami chores9llage
F L 0 A t D A
OFFICE OF ELECTRICAL DEPARTMENT
DESCRIPTION OF WORK
NUMBER OF
- � 00' 193
N° 634
•
10r 7 4/I ��� (Seal)
4 , 4 4
o; --'qsutdral•f ,
"`L."
N.Ltesopes, ,
RECEPTACLES
vo
4.114111.111100113
STOVES
WATER I-I'TERS
2041;V
..-
BILLBOARDS
OTHER APPARATUS
MAIN
/
BRANCH
,
, , , •'4
r
0.5..:1/.0
I I
/712
L.
First
.
'
FLOOR
ti 1 NUMBER OF j n ) '
, SIZES OF
U
INSLATION
0 N P C EN EA L
CO
NUMBER OF
.ourteri
=giV
MAIN
SUB
BRANCH
,
, , , •'4
r
0.5..:1/.0
I I
/712
L.
First
.
Second
-
Third
Fourth
Other
Floors
/
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for issuance of permit for electrical installation as described below, and for
inspection of same after installation:
193
Date
, (ti ,/
Owner \, ' z 7,
' , ' Address ,
-, , /t
Building Contractor j
'64 Electrical Contractor i., A 4 r ‘/ --`•'''/
17
t /A i i tz i (/), ' i• -
_-; -,- ,,
‘k. i0 *--
■ 77,
i ,‘
f '
a ' . " .
Location of proposed work: Lot 4 te,;,;;; k
oc
Details of proposed work:
Number of Motors
A ,
Additional Information
Signature of Applicant
H P. ,k( Volts
Address (if other than owner or contractor)
1
Work begun 7, i " ' /
/? =
i
Work finished
aiami
F 1. 0 It 1 D A
if
Subdivision
Building: Old or new bFr of stories Used as
Description of proposed work
(SPACE BELOW FOR INSPECTOR'S USE ONLY)
Inspected
Phase
/fr
y
Final inspection (
[inspector