290 NE 101 St (10)SECTION
BY
DATE
Zonin:
_.......wou..
,Ie,41W-
Electrical
•
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
6 (__
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ ' fl ( sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
$
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
TOTAL $ b 06 It
DATE:
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
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
9
A/C Central 1-3 Ton
Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
- Piping, Flammable Liquid
Signs
AJC Central 8-I5 Ton
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Pressure Vessel
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
AJC 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/P180
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
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY. 'TYPE
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
AJC Central, Tons
QTY.
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
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
'TYPE
Soakage Pit
QTY.
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, "'e- 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 2
IMPORTANT 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.
1.
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.
Print Name
Swom to and subscribed before me this day of N0 v
Signature of o,tit
StaB�9d�Q. Flingos
:WI . # CC 778945
SEAL: 'e{ , , , 4 Expires OCT, 25, 2002
%).'�'se,p�,' BON_ DED THRU
'Wino` ATLANTIC DahOING 6• iSiC
Personally known OR, Produced Identification
Type of Identification Produced: r- D • L •
ST
gnature of Contractor / Qualifier
&1 c9 . W . P % ti o 5
Print Name
Sworn to and subscribed before me this 30 day of No 4
8,13 o
Thoress M. Ffingns
Signature of Notary Public - State !:. ;: « -Commission # CC 778945
SEAL:
PERMIT APPLICATION
OF FL 1 RID MIAMI -DADE
r.
Expires OCT. 25, 2002
.?� BONDED THRU
's;7 ATLANTIC BONDING CO., INC.
Personally known OR, Produced Identification
Type of Identification Produced:
CONTRACTOR
' t
Nam MA••1 I
Name ( it, e LI.e._Ckr C ‘11,....
Address
Home Telephone JbS _ 750j.- 7 (5S 7
License No. lg
Fax
Address PO (3.0K teaa5‘.
Q : (-t, 3 6
—
a ase
Telephone3cE_ C Fax
Relocation of Structure
Qualifier Name Gero 6.) ; `'2�°
S
Foundation Only
PRO' 1 Y OWNER
' t
Nam MA••1 I
ritI Iii AD
Address
Home Telephone JbS _ 750j.- 7 (5S 7
Business Telephone ... _
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'I Detachment
Other e e po.1 e e lQ —kc • c_ f e4 v'% �C2
I/
Step 1.
Job Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
I • / Dog
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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 submitted
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.
APPLICATION
acI ® $101 s irn i P " (S‘‘st. CL,
Address Apt. City State ` Zip
Folio Number — �20 6 'D 3 °� escription of Work ?e,Q\,Arce, C (41 1r-�� 4 W l �
Block
Lot
Subdivision PB PG Zoning Linear Feet
Current Use of Property 5 ` d Q__ LG Square Feet Units Floors
Proposed Use of Property 5 Value of Work ��• OD Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
ubsidiary Permit No. U, J
°'-91534 ( Ck G Sod G�
( -PERMIT APPLICATION
ENGINEER
Name
License No.
Address
Telephone
Fax
z
0
0
4•1
PAY TO THE
ORDER OF
't_C(
F & F ELECTRIC INC 01
P.O. BOX 162256
MIAMI, FL 33116-2256
305-275-6641
fr) 0 r e 3 ■A, k
%
MEMO 0 el- C r Pi
MELLON UNITED NATIONAL BANK
MIAMI, FLORIDA
63-9641670 - 9
11.00 94 6 40 1:06 ?00 9 6461: 009 2448 ?He
$
UOLLARS le
'
•
' ; • ; 1;.;
, • a , • ';
r
r •••!:"
•
•
Permit No /
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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. L
Owner's Name and Address h C . e f^s^ Q!I No ,L'1 0 Street... L— / 1? / s T
Registered Architect and/or Engineer �y,
Employing Electrician's Name...�l / aii eL.. ... �PL %l /..C........-iq.t • No 1 1 1- 0 1 � Street.. 41i2.4#k.l. e
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 7 0 1" Street p� ,�c
State work to be performed and purpose of building (By Floors) � j.7L P.L�._.. 11/4lc?..:[,l.oj'!
New Building Remodeling v Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P p
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
t1
Amount of Permit $ — (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his gations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•con ctors 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 sub •contractors, on work to be performed under thi ermit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. 1 ss'
My Commission Expires
(Signed
//, 3 - 7
Date
Notary Public, State of Florida
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 rvinspection 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
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB
SERVICE
TEMP.
SERVICE
PERM.
/
A �/�
Q'
//�� /
41 S�IOS,J
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL.
CL
LIST
--.140./
CHECK
Permit No /
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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. L
Owner's Name and Address h C . e f^s^ Q!I No ,L'1 0 Street... L— / 1? / s T
Registered Architect and/or Engineer �y,
Employing Electrician's Name...�l / aii eL.. ... �PL %l /..C........-iq.t • No 1 1 1- 0 1 � Street.. 41i2.4#k.l. e
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 7 0 1" Street p� ,�c
State work to be performed and purpose of building (By Floors) � j.7L P.L�._.. 11/4lc?..:[,l.oj'!
New Building Remodeling v Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P p
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
t1
Amount of Permit $ — (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his gations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub•con ctors 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 sub •contractors, on work to be performed under thi ermit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. 1 ss'
My Commission Expires
(Signed
//, 3 - 7
Date
Notary Public, State of Florida
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 rvinspection 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.
APPLICATION FOR ELECTRICAL PERMIT
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 C7L _ S 4
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Descriptio
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
V e ° No.__.C_ akie •
---- ------ --------------- - - - - -- No.1�.���� st_" +_� -i - - -- Street__1' � r �i p
Subdivision ° _m `� °
0 Block •°
Street and Number where work is to be performed —No-__ 1 ____'s
State work to be performed and purpose of building-_(By Floors)
New Building / Remodeling Addition Repairs
- -------------------- -- - - - - -7 -- - --
Amount of Permit $_ / e
My Commission Expires
(Signed)
(Signed)
Date e_ _
Street// e
Street `a t — -- --- - - --
No. of Stories_ __/
Overhead y ®A
Service Undergrou Size Feeders 1 Conduit 0— Main Sw. Amps. 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, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
STATE OF FLORIDA, }
COUNTY OF DADE. ss.
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
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.
1 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.
L IST
(/ f
,'
y !!,-
�-' /
/
/
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
_
da
CHECK
APPLICATION FOR ELECTRICAL PERMIT
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 C7L _ S 4
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Descriptio
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
V e ° No.__.C_ akie •
---- ------ --------------- - - - - -- No.1�.���� st_" +_� -i - - -- Street__1' � r �i p
Subdivision ° _m `� °
0 Block •°
Street and Number where work is to be performed —No-__ 1 ____'s
State work to be performed and purpose of building-_(By Floors)
New Building / Remodeling Addition Repairs
- -------------------- -- - - - - -7 -- - --
Amount of Permit $_ / e
My Commission Expires
(Signed)
(Signed)
Date e_ _
Street// e
Street `a t — -- --- - - --
No. of Stories_ __/
Overhead y ®A
Service Undergrou Size Feeders 1 Conduit 0— Main Sw. Amps. 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, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
STATE OF FLORIDA, }
COUNTY OF DADE. ss.
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
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
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE , . ... 1941_
PERMIT N9 2315
Work to be performed under this Permit
Signed•
Contractor's
License No.
Subdi-
vision
BY
INSPECTOR
Architect
Contractor -- „i /
or Builder 4 i t 1 6 , 0 ,... •;,,- I, --t --11
Legal Lot h 6 • -- j BI.
Description a+
Address of ° 1.' - 1 ` ( Value of Amt. of / a/ y1-
Building 7 / f. / f... ,:�, -''' Project Permit i f 1
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 tIe or drawings or in the statements or specifications and
hat he assumes responsibility for work done by his agents, servants or employees. -_ �
By
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordi ' nces and regula-
ons pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
`illage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. ,
! AUTHORITY
•
MIAMI SHORES VILLAGE
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
PERMIT
No.
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.
c / '7
JOB:
ELECTRICAL
PLUMBING
Inspector's Report:
J�
,07r: •Le tea sr
BUILDING :
•
/5/1
WORK
• DONE BY:
::
AD:
: REQUESTED
The following is ready for Inspection:
/� L �� /; , •
G
: WILL BE READY
• d /D/-/
r
1
1
Permit
STATE OF FLORIDA,
COUNTY OF DADE. I
SS.
MIAMI SHORES VILLAGE
My Commission Expires
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
(Signed)
Notary Public, State of Florida
Date _ 41t c -ills'
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 mt(st be kept at
building during progress of work. � �y r -
Owner's Name and Address _ CY___ k. �
_ _ 22Z�el // V; No.__ .C__e/ j_'J_l_ !____ Street__/0j isr
Registered Architect and /or Engineer _
Employing Electrician's Name +ir' No ts' iiv_,.._ Street_ b 1
Location and Legal Descriptio ot___ ..4.17 d ! Block ..2__ Subdivision_ _ 'f
Street and Number where work is to be performed —No. _ ,� f j -- --- .__________________ Street__ _ �_'�'' _ ____— __________
State work to be performed and purpose of building (By Floors)
New Building r Remodeling Addition Repairs
No. of Stories___
Service Overhead • Size Feeders* l Conduiti Main Sw. Amps. Main Fuses Amps.
Underground
Type of Installation— Conduit Tubing_ B.X.L. Metal Moulding
Amount of Permit $ 4 (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 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 work to be performed under this permit, as are
licensed by Miami Shores Village.
do 4 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
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/I
0/
/
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
a
•
CHECK
Permit
STATE OF FLORIDA,
COUNTY OF DADE. I
SS.
MIAMI SHORES VILLAGE
My Commission Expires
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
(Signed)
Notary Public, State of Florida
Date _ 41t c -ills'
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 mt(st be kept at
building during progress of work. � �y r -
Owner's Name and Address _ CY___ k. �
_ _ 22Z�el // V; No.__ .C__e/ j_'J_l_ !____ Street__/0j isr
Registered Architect and /or Engineer _
Employing Electrician's Name +ir' No ts' iiv_,.._ Street_ b 1
Location and Legal Descriptio ot___ ..4.17 d ! Block ..2__ Subdivision_ _ 'f
Street and Number where work is to be performed —No. _ ,� f j -- --- .__________________ Street__ _ �_'�'' _ ____— __________
State work to be performed and purpose of building (By Floors)
New Building r Remodeling Addition Repairs
No. of Stories___
Service Overhead • Size Feeders* l Conduiti Main Sw. Amps. Main Fuses Amps.
Underground
Type of Installation— Conduit Tubing_ B.X.L. Metal Moulding
Amount of Permit $ 4 (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 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 work to be performed under this permit, as are
licensed by Miami Shores Village.
do 4 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.