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825 NE 100 St (6)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bui ding Inspection Request Date Z Type Insp'n Uqr Permit No. �i I 0C-1 ► Aq Name CUq 1 Address 62( , "E 00 Company S3 Q Phone # jms ` (� 4 // Inspection Date 16 Approved 7 Correction ❑ Re- Insp'n Fee ❑ 5' -- ;9 3 V ���'= &'u 5 3 7/ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ Date Type Insp'n Permit No. Name A � r, Address 62S 1 �� . 100 3 Company Phone # Inspection Date e l ci Approved Correction Re- Insp'n Fee 0 'a/tes 6( PQc Date Type Insp'n Permit No. Name Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305- 795 -2204 Building Inspection Req Inspection Date Approved Correction Re- Insp'n Fee D �I tL0 -l4/ °1 C V -thy F .3G tU / 0 0 .x' vS /. ; -53/ MIAMI SHORES VILLAGE c5\\ BUILDING DEPART 305- 795 -2204 tr Building Inspection Re Date / Type Insp'n L, EP1/4AQ 1C1 Permit No. E L C9ODL( - t 4C Name V I ( Address ga S 46 10 r Company Fi `S &(L Phone # 305 _ $64 — S3(1 Inspection Date Approved Correction Re- Insp'n Fee 8' 7/044 ❑ /.40' r • BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department MAY 2g 2004 Master Permit No. Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) "'/ /?m/ Sore V //1ez7e. Phone # Owner's Address es ■/6 2nd aM'tr City tl ? ?"rlr' 1-7 arcs State f'Lew-v:det.. Zip 33 /30 Tenant/Lessee Name Howie. OrL)', County Escrow Fee Education/Training Fee $ ts C o-u/' Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES NO City er lei /Y1/ Qualifier C/G /7Q0( wed/ Architect/Engineer's Address City M /m/' $ Value of WoCk For this Permit Number of: Bays Type of Work: Describe Work: ['Addition 00 Phone # 2 NE /Od sT Permit No. Z: r y Roofing /�/� M9S -� 786 --4o2 -4 /0000 RISC- 4yi e. //4. County Miami -Dade Zip 33 /35 Contractor's Company Name P/5 g'Lez7%'Ya Phone # Sag-- 644 - // Contractor's Address /0 /2s NW //6 Plkiy / Strat/i #14 State L Zip 33 / 78 Architect/Engineer's Name (if applicable) 0/'ko Pere . Phone # 844 S31/ /o/2 S' Al w 116 kiay d Sa c /fie ft 14 State R. Zip 33/78 Stories Alteration *, * * * ** * * * * * * * * * *** * * * *** F ees * * * * * * ** * * * * * ** * * * * * * * * * ** * * ** I D 0 c) Families Bedrooms ❑New ❑ Repair/Replace rit_w sere /c-e and 44i71711i71 7) fern 2is 44=71.,r& Permit Fee $ Notary $ Tech $ 2K Scanning $ ,S ,. 0 0 Code Enforcement $ /-� Bond $ Struct. $ Minus Plans Check Fee $ .. — Total Fee Now Due $ `) C l i CR Baths Radon $ c.)-6a /Y Mme.; re/'/Yrs 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 5 9 / 8 Square Footage Of Work: ❑ Demolition (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certi for the first inspection which occurs seven (7) da inspection will n,bt be approved a reinspection Signatur Owner or Agent The foregoing instrument was acknowledged before me this 4 The fo day of /lAy , 20 bV by day who is personally known to me or who has produced who is As identification and who did take an o Jhgttttea11utgq i �op, CA $ # 118.20 0 9�; o mSJ NOTAR chc7n /03 ' APPLICATION APPROVED BY: opy of the recorded notice of commencement must be posted at the job site the building permit is issued. In the absence of such posted notice, the e charged. Sign: Print: ATitj() •):;•,, M 4 Wolfs.' — : ®, : EXPIRES. Api 25, 2006 y . #Db 072450 � P � i` 'lb Bonded� 0 � c ommission Expires: ...k � i j9. 9 a � Public�ed.• ************ * ** *** * * *,t * *,t ** ** * * *** ***** *, tart * * * *ft�r� // * ( **************, t**** ,t * *,t *,t * * * *,t *,t ** *,t *** ** *** (Certificate o � t cy Holder) ans Examiner Engineer Zoning instrument was • knowledged before me thi 20� by State Certificate or Registration No. g G DOO .9.54:70 Certificate of Competency No. *************4 4 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** * * ** ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .. y [EM NTH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE IOET LIGHT OUTLETS CENTRAL HEATING ISHWASHER RECEPTACLES A/C (WIND) ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) KINKING FOUNTAIN SERVICE SIZE IN AMPS 400 DUCT WORK 'SCR DRAIN SERVICE REPAIR/IETER CHANGE REFRIGERATION TEASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING YTERCEPTOR RANGE TOP UNDERGROUND TANKS AVATORY OVEN ABOVE GROUND TANKS AUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS LOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS HOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS INK, POT/3 C06P. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION INK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES INK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS EM'ORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS RINAL MOTORS OVER 25-100 HP COOLING TOWERS ATER CLOSET MOTORS OVER 100 HP VIOLATION DIRECT WASTES - A/C WINDOW REINSPECTION ATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMAING POOL OUTLETS COMERCIAL WATER SERVICE SIGN TUBES EWER CONNECTIONS SIGN TRANSFORMERS TILITY -SEWER SIGN TIME CLOCK" TILITY -WATER FIXTURES EPTIC TANK ANTENNA ELAY TELEVISION OUTLETS RAINFIELO, 4' TILE/RES. VIOLATION UMP S ABANDON SEPTIC TANK REINSPECTION OAKAGE PIT CU. FT. es Un/ 2 xfu� ATCH BASIN 7 �j�1C/S w�4 �1Cft.tr 10 ISCHARGE WELL {n°l/'zt / OMESTIC WELL f_/ f'i n� T ryJe.L' I k / AEA DRAIN �fer' / OOF INLET , . OLAR WATER HEATER ; . . . IRE STANDPIPE 001 PIPING AWN SPRINKLER SYSTEM AS RANGE ETER SET (GAS) AS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION 5 4o, , e6 ?�,Qus AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ECEO V ED JUL 0 6 20! 00 ��o°omo�000 Electrical A Owner's Name (Fee Simple Titl older)�� LSC�1\ CC.94,Zkd Phone # - 1 C 1S - 2_3(c.0 Owner's Address . CCI IC) 'fit Z g\ i City l -` `.t S State FA Zip 33�� p � \ Tenant/Lessee Name LT- Phone # 30C l� 3 60 J t ob Address (where the work is being done) � : % -C. c/ City Miami Shores Villa _e j am a rse Zip sets Is Building Historically Designated YES Contractor's Company Name O ` 1 L Phone # .S* 1- 1U11 Contractor's Address 53 k0 S.0 6.0 - )ve City ___ State I L- • Qualifier State Certificate Notary $ Scanning $ Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) Architect/Engineer's Name (if applicable) Phone # >0$ Value of Work For this Permit OCO 22S Certificate of Competency No. Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: ( AI.00EI35 CCw_is oD ipa{k . =iAV lg, * * * * * * * * * * * * * * * * * * * * * * * * * *P ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $`0‘041 ?510 Permit Fee $ Training/Education Fee $ Radon $ Zoning Structural Plan Review. $ Plumbing Master Permit No. Zip Permit No. 3P0Lt • Mechanical Roofing Square Footage Of Work: CCF $ Technology Fee $ Bond $ CO /CC Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit.must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. . "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commenc: ent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t absence suc j o, ed notice, the inspection will not be approved and a reinspection fee will be charged. Signatur Owner or Agent The foregoing instrument was ac levied re me this The forego day of , 20 04 , by , day of who is personally known to me or who has produced who is Chc 05/13/03 NOTARY PUBLIC: Sign: '32f). C Print: 'Res Q �e � G o My Commission Expires: APPLICATION APPROVED BY: As identification and who did take an oath. • ••M�S►ON'•. =1r: May 11 ;90 ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** • • r,;gs N0D211258 • ••12ni�p lST" a ��� attire ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Git 6-(A, - 1 it - 3 /6'1 TARY PUBLIC: Contractor g instrument was acknowl ,200 f gecl • �r =! sonall known to me or who has produced as identification and who did take an oath. *= 0***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning 3058888552 Jul 23 04 03:16p Fisk electric 3058888552 p.1 Jul 15 04 02:27p Fisk electric NOTICE OF COMMENCEMENT A RECORDED COPY WRIST BE POSTED ON THE JOB SIR AT TIME OF FIRST INSPEGy,.... PERMIT NO L J-000I -lt/? TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following information is provided In this Notice of Cornmencetnent. 1. Legal description of property and street/address: I/"C4` k: ! �� ` —CL kk C U : 'Tei.`JlJ.S Cs 5 - 825 KDE1 fl- s 313 • - ;1>Z35.at @a41)40b A 2. Description of improvement: ��.kCJ_ S 3.Owner(s) name and address: Interest In property: Name and address of fee simple titleholder: 4. Contractor's name and address: r t:". cc-? ' /0 /as MA/ 1161,41.. 5. Surety: (Payment bond required by owner from contractor, if any) /WA Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner u provided by Section 713 13(1)(a)7.. Florida Statutes, r Name and address: 7. .. �► d L �` = _ S ., +: 8. In addition to himself, Owners designates the follo s •,: In Section 713.13(1)(b), Florida Statutes. Name and address: %:'r i nrES 71 ' . fARVE By Expiration date of this Notice of Commencement: (the e dlfferen to Is specified) 27- Signature of Owner ]� Print Owner's Name f''� \_ •;:L.a Swom to and subscribed before me this t e l day of \ LA , 20 _c_ !78 on whom notices or other documents may be served as i... • re: •,r ,ne G 1J noee Prepared by Rr\L , - t, r�- ` , address: Notary Public 1, A1C'� 1 VA, . ` � r ��� � � . ss c �y ~ O • �� Print Notary's Name r, .J I_ 4 ► S • �. F r �,t t� My commission expires: f air} i i 21)0 "7 = 12101-52 PAGE40t2 ®•�/ • 100211256 s$ ��, :2:14: r I1NLIIIIIIIIUIi1IIII1II1111IU1 f_:FN 2004-R 2x327 OR Bk 22510 Ps 3908; - (1P.e' RECORDED 07/23/2004 13127047 HARVEY RUVIH? CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE and County Cal u / D otie: ✓ 'Vate of recording un es a Contractor FISK ELECTRIC COMPANY Local Phone: 305 - 844 -5311 Parcel # PARC2004 -17 Legal Description: Electrical Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: EL2004 -149 Printed: 7/14/2004 Applicant: MIAMI SHORES Owner: VILLAGE JOB ADDRESS: 825 N. E. 100 ST. VILLAGE MIAMI SHORES Page 1 of 1 Contractor's Address: 10125 N. W. 116 WAY, SUITE 13 Fees: Description Amount FEE2004 -6994 Building Fee $1,750.00 FEE2004 -6995 CCF $30.00 FEE2004 -6996 Training and Education Fee $10.00 FEE2004 -6997 Technology Fee $43.75 FEE2004 -6998 Scanning Fee $15.00 Total Fees: $1,848.75 Total Fees 1,8448.75 Total Receipts: $0.00 lI7 t8 Permit Status: APPROVED Permit Expiration: 11/24/2004 Construction Value: $50,000.00 Work: ADDING NEW SERVICE AND LIGHTING FOR 7 TENNIS COURTS Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: t3UtLUING / ZONING DEPARTMENT" SECTION BY DATE ZONING • ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL CRITIQUE SHEET JOB ADDRESS '' / f/&-- /O0 S APPLICANT 2 tier c 6 ? X43 Cj ,G7S PHONE # APPUCATION lD ( x/ 6 SHEET OF MISCELLANEOUS DATE ZUJVING COMMENTS PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE 1. Subjact to cocnpflance with aft Federal, State, County, Wage rutes end regulations. VlHage essunta; no responstbWQty for accuracy oflor resutts frac these ptans. 2. This copy of plans must be avellabte oc building cite or no inspection will be conducted INITIALS (��o L, 9Gl ���i c?r a4jec l 77i scd e p(Q" Acre f 1 /0 / � / Legal Description Square Ft. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE / D�s Date 2/ Job Address 4 T Folio Owner / Lessee / Tenant Owner's Address �s Phone Contracting Co. ��7 2'C° t /Y6 /C Address j SS# > Phone .e5 y 2 State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDINGCTRICALI PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: ** * Master Permit # * Mechanical Plumbing. Estimated Cost(value) * A -- ractor or Owner-Builder Signat Date: 3 Notary as t My Commissi * ,6w,. Oc2 er S TT W DAVIS 11 a , .OMMISSION NUMBER CC255237 i4tt rO62MISSION EXP. 199 FEES: PERMIT RADON C.C.F. J NOTARY APPROVED: Fire Other Zoning Building Electrical Engineering ** TOTAL DUE , z.(1)7?-- Permit No /3j Owner's Name and Address... °�- ',s Registered Architect and /or Engineer Employing Electrician's Name.... S ,e APPLICATION FOR ELECTRICAL PERMIT Date //3/ /P14# 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. Amount of Permit $ / C •-� 55. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block Street and Number where work is to be performed —No r State work to be performed and purpose of building (By New Building � Remodeling Floors) Addition Repairs No. of Stories Conduit � -Main Sw No Serv Overhead ead d Size Feeders 1 ' Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed). (Signed) No 3 Street Street.. Street Subdivision Amps Main Fuses ti4 /4 S� . Electric. spector. 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. Master Electrician. Amps STATE OF FLORIDA, COUNTY OF DADE. 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 REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. A HEA TER STRIP HEATER TOTAL CONTR. LIST / (/ / 6 / 6 t M S - ` L CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS O.1 HP MOTORS 1•3 HP NEON TRANS. RADIO TOTAL CONTR. LIST ���j CHECK Permit No /3j Owner's Name and Address... °�- ',s Registered Architect and /or Engineer Employing Electrician's Name.... S ,e APPLICATION FOR ELECTRICAL PERMIT Date //3/ /P14# 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. Amount of Permit $ / C •-� 55. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block Street and Number where work is to be performed —No r State work to be performed and purpose of building (By New Building � Remodeling Floors) Addition Repairs No. of Stories Conduit � -Main Sw No Serv Overhead ead d Size Feeders 1 ' Type of Installation— Conduit Tubing B.X.L Metal Moulding (Signed). (Signed) No 3 Street Street.. Street Subdivision Amps Main Fuses ti4 /4 S� . Electric. spector. 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. Master Electrician. Amps STATE OF FLORIDA, COUNTY OF DADE. 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.