990 NE 100 St (11)/ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date G j /7 / Job Address qq I / 00 ST Tax Folio (1 — Z O 6 —(934— 0 / t9O
Legal Description /gm e e(, yQ, COJ,?2- 5124 Historically Designated: Yes No
Owner/Lessee / Tenant &JC / / Sou714- j e /2 cater C , Master Permit # 7 4 gai
Owner's Address / 000 N W 6 S 7
Contracting Co. 14 8/60/721c C S)! STE kt S G / ,
Qualifier C,ki2 k n 5A
State # D 0 /Z - &3 Municipal # Competency # C // Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /ODA f /e'6772i S 72 we E , c9 - u7 u /PH T
Square Ft. Estimated Cost (value) 4 9 G 0
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 ted. /)
My Commission Expires:
FEES: PE
Y L /\. e ��
SEAL
O � P tiv AG 44 OFFICIAL NOTARY
;� y COMMISSION NUMBER
:S ..BUG. ' CC928698
71. ,w A . MY COMMISSION EXPIRES
OF Fl APRaz,2pM-
HT 1vu�Vl1
f r0
O( -i o -ol
Signature. If owner N and/or Co President Date
I Id I li ill
otary as to Owner . i f, or Condo President 1 ate
Phone P r- 5q 4 - 402-
Address // Z (LO see) (1 p S7 R/,/,‘,41, g3345--
s-
SS# / ) Phone 3 n 2 -7q- - -r 7 =08
4'1B
Signature of Contractor or Owner- Builder
Notary as to Contractor Owner- Builder
My Conunission Expires:
O � P ttV PVC`, OFFICIAL COMMISSION NUMBER
CC928698
SANDRA PEDROSO
^ *
G. '
7� ',,, • O
F Os MY COMMISSION EXPIRES
// OF f�
C.C.F. . b ° NOTARY — V 130N1)
APR. 17,2004
2/0 /
Date
falo
Date
Electrical
TOTAL DUE k./
&79
APPROVED:
Zoning Building
Mechanical Plumbing Structural Engineer
ITEM
BATH TU3
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGiiT CUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPCRARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AI+PS /00/4
/
DUCT WORK
FLOCK DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0— 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1— 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3— 5 FP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5— 8 FP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8— 10 FP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10— 25 NP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-1C0 FP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 FP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SLPPLY 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
SWIM4ING POOL
OUTLETS COM4
WATER SERVICE
EWER
SIGN TUBES
CONNECTIONS
ffILITY
SIGN TRANSFORMERS
—SEWER
ITILITY
SIGN TIME CLOCK
—WATER
:EPTIC
FIXTURES
TANK
ANTENNA
ELAY
RAINFIELD, 4' TILE/RES.
TELEVISION CUTLETS
VIOLATION
UMP E ABANDON SEPTIC TANK
OAXAGE
REINSPECTION
PIT CU. FT.
ATCH BASIN
ISCHARGE WELL
OMESTIC
WELL
,REA DRAIN
OOF INLET
OLAR WATER HEATER
IRE STANDPIPE
AL PIPING
sNN
SPRINKLER SYSTEM
iS
�-
RANGE
:TER
SET (GAS)
lS PIPING
- ADDENDUM TO BUILDING PERMIT APPLICATION
(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
� ;-- /q‘ p
Application is hereby made for the approval of e detailed statement of the plans and specifications herewith bmitted for the building o1 other
structure herein described. This application is e 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, building during progress of work. ,
whether herein specified or not. A copy of approved plans and specifications must be kept at
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERM T
Owner's Name and Address
Registered Architect and /or Eng•
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No I.
Block Subdivision
Street nz ...1
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition L
Date
No q U Street
Repairs No. of Stories
Service Overhead Size Feeders Conduit
Underground
Type of Installation — Conduit Tubing B.X.L
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OP DADE. as.
My Commission Expires
Main Sw Amps Main Fuses Amps
Metal Moulding
ectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob Lions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
15f7 / ` 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.
Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
6
CHECK
E NT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
M OTORS
O.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
_
_ —
_
_ ..
� ;-- /q‘ p
Application is hereby made for the approval of e detailed statement of the plans and specifications herewith bmitted for the building o1 other
structure herein described. This application is e 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, building during progress of work. ,
whether herein specified or not. A copy of approved plans and specifications must be kept at
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERM T
Owner's Name and Address
Registered Architect and /or Eng•
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No I.
Block Subdivision
Street nz ...1
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition L
Date
No q U Street
Repairs No. of Stories
Service Overhead Size Feeders Conduit
Underground
Type of Installation — Conduit Tubing B.X.L
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OP DADE. as.
My Commission Expires
Main Sw Amps Main Fuses Amps
Metal Moulding
ectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob Lions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
15f7 / ` 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.
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 ❑ MIAMI SHORES VILLAGE, FLORIDA
Date_ 19 Ea
ELECTRICAL E
PLUMBING ❑ PERMIT N° 9857 Contractor's
License
ROOFING ❑
Owner or ;;'N 2.
Building 'uL'
❑ Work to be performed under this Permit
Architect
Contractor
Builder 4 41 C•-` r cr +il►.
Legal Lot ii
Description 11 B1
Address of 9? i /
Building
CONTRACTOR or BUILDER
7-
BY
'fie a. Is 4 1 4444 ` , id,‘
�, c.. #G. to ,fir
Subdi-
vision
Sq Ft 00
Value of I Amount of
Project $ 11 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 applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servant or employees.
Signed } (INSPECTOR) BY
In consideration of the issuance to me of this permit a ree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, d wings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all wo ° done by either, myself, my agent, servant or employee.
AUTHORITY
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date April 3,1968
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 Dr. Zighelboim No 990 Street N.B. 100th St.
Registered Architect and /or Engineer & P1! ELECTRIC CZ3. " INC. 99 N.W. 166th St.
Employing Electrician's Name No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Same as above Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P P
Type of Installation — Conduit Tubing B.X.L Metal Moulding
.00 3
Amount of Permit $ (Signed)
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
SS.
(Signed)
Electrical • ector.
ccepts • 's obligations as an employer of
of orida Permanent Supplement, and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
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
therein by him stated are true.
did sign the same, and that all facts
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.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
,
CHECK
....
I
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.15 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
1
3.00
CHECK
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date April 3,1968
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 Dr. Zighelboim No 990 Street N.B. 100th St.
Registered Architect and /or Engineer & P1! ELECTRIC CZ3. " INC. 99 N.W. 166th St.
Employing Electrician's Name No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Same as above Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P P
Type of Installation — Conduit Tubing B.X.L Metal Moulding
.00 3
Amount of Permit $ (Signed)
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
SS.
(Signed)
Electrical • ector.
ccepts • 's obligations as an employer of
of orida Permanent Supplement, and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
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
therein by him stated are true.
did sign the same, and that all facts
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.
BUILDING n
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Contractor
or Builder
Legal
Description
Address of
Building
Lot
E PERMIT IT? 12205
MIAMI SHORES VILLAGE, FLORIDA
❑ Work to be performed under this Permit
Architect
7;1 0 . Nr\ ,
CONTRACTOR OR BUILDER
Bl.
1 .. Q:) '• .
Subdi-
vision
Value of
Project $
?;;.2.&L4 " / - • r ? +�.•.
DATE / -' ' J / 195
,
Contractor's
License No
4.- - e. !'
Amt. of
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 application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. y. f ,^+ . BY L %J
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 responsibility for all work done by either, myself, my agent, servant or employee.
BY " AUTHORITY
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 /- eu9 //4 e_ige> 4 ° 4 4.(j.t... No Street
Registered Architect and /or Engineer
/ ,.
Employing Electrician's Name / . / � .. /nl % �,_ No / (im Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No ( () Y) ' 2 . Street / &
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Overhead
Service Feeders. �.. ..Conduit.// Main Sw.._. / C V Amps Main Fuses Amps
Underground
•
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. 11
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APQLICATION FOR ELECTRICAL PERMIT
O, Date / it !
Type of Installation—Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he ul1'derstands 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 sub - contractor; on'work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
(Signed)
(Signed)
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or .w6rkmanship.
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.
/c- u ��
2
El C
o g.,
CHECK
,S1
/
./ a
•
ENT.
SW.
'DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
n
/�,�Id. t r. atA DIO
TOTAL
CONTR.
LIST
, 1
/
/�
J.1 Pa
/
/
i
CHECK
00
d. .,�'
/'
�� /y
/.
/'SD
�•.�)
f.
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 /- eu9 //4 e_ige> 4 ° 4 4.(j.t... No Street
Registered Architect and /or Engineer
/ ,.
Employing Electrician's Name / . / � .. /nl % �,_ No / (im Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No ( () Y) ' 2 . Street / &
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Overhead
Service Feeders. �.. ..Conduit.// Main Sw.._. / C V Amps Main Fuses Amps
Underground
•
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. 11
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APQLICATION FOR ELECTRICAL PERMIT
O, Date / it !
Type of Installation—Conduit Tubing B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he ul1'derstands 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 sub - contractor; on'work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
(Signed)
(Signed)
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or .w6rkmanship.
7
C.
7