456 NE 100 St (11)Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Dater.(/ /e /t , I1
Application is hereby made for the approval of the detailed statement of the plane and specifications herewith submitted for the building 01 other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address RC . V!...... K.PR 1 /4 No l 'A v Street /1/4 /10Q J7'
Registered Architect and/or Engineer ,pQ q 9
Employing Electrician's Name.... /! EAR ... • /�(�/ /LFS No........... /....Y..Q Street. 1 1/C — l3D 5T
Location and Legal Description Lot Block Subdivision
i 'r6 If
Street /41't
State work to be performed and purpose of building (By -aviote
ifLFC
New Building Remodeling Addition Repairs No. of Stories
Street and Number where work is to be performed —No
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground /
Type of Installation — Conduit Tubing....( B.X.L .Metal Moulding
Amount of Permit $ I CI " (Signed) it
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.
STATE OF FLORIDA,
COUNTY OF DADE. T °°'
My Commission Expires
(Signed)
Cc /a, 3 '
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorised 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
RECE•P'T'S
FIXTURES
NO LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
R ANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
O / `
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.11 HP
N EON
TRANS.
RADIO
.
TOTAL
CONTR.
LIST
CHECK
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Dater.(/ /e /t , I1
Application is hereby made for the approval of the detailed statement of the plane and specifications herewith submitted for the building 01 other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address RC . V!...... K.PR 1 /4 No l 'A v Street /1/4 /10Q J7'
Registered Architect and/or Engineer ,pQ q 9
Employing Electrician's Name.... /! EAR ... • /�(�/ /LFS No........... /....Y..Q Street. 1 1/C — l3D 5T
Location and Legal Description Lot Block Subdivision
i 'r6 If
Street /41't
State work to be performed and purpose of building (By -aviote
ifLFC
New Building Remodeling Addition Repairs No. of Stories
Street and Number where work is to be performed —No
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground /
Type of Installation — Conduit Tubing....( B.X.L .Metal Moulding
Amount of Permit $ I CI " (Signed) it
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.
STATE OF FLORIDA,
COUNTY OF DADE. T °°'
My Commission Expires
(Signed)
Cc /a, 3 '
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorised 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.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
DATE .f 194
PERMIT N. 4516
Work to be performed under this Permi
CONTRACTOR OR BUILDER BY
Legal Lot it; .. c od Bl.
Description 1 / Z' '�' 9
Address of j .' ..'• �' t , I f Value of Amt. of `
Building t Z ..+'' ,i Project 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 . opli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in comp 'mice w any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit m y be yoked
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 up. ich this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the or. ' .. nces and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the state ents is or specifications and that he ass es respon-
sibility for work done by his agents, servants or employees. ,.
INSPECTOR e ' /111:1
,:! } jt f
Signed • ►.•� h Rv
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 respon bility for all work done by either myself, my agent, servant or employee.
4 / -' ...),.... , , I P. 62. et-vcs........--
Subdi-
vision 4J
Contractor's
License No
if ;';
AUTHORITY