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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.