ELECTRICAL PERMITPermit
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
Registered Architect and /or Engineer _ — ____�__�____ Q____j_ _______________
Employing Electrician's Name _� 1 NO ..._9_ i e_t_ Street____ ` •'______
Location and Legal Description Lot Block _____ Subdivision____ _ _______________
1 ' U
Street and Number where work is to be performed —No {'__ ' L- 1 Li L!_ Street_ _1 6) , __.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.. Repairs
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
APPLICATION FOR ELECTRICAL PERMIT
ss .
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No
(Signed)
tit
Service Overhead Size Feeders #J Conduit:_ 1d Main Sw. I.f _ Amps.
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Date !?
Main Fuses Amps.
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 bim 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 w to be performed under this permit, as are
licensed by Miami Shores Village. -�
(Signed)
• 4e—IL
Massir Electrican.
No. of Stories
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.
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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.
Owner's Name and Address
Registered Architect and /or Engineer _ — ____�__�____ Q____j_ _______________
Employing Electrician's Name _� 1 NO ..._9_ i e_t_ Street____ ` •'______
Location and Legal Description Lot Block _____ Subdivision____ _ _______________
1 ' U
Street and Number where work is to be performed —No {'__ ' L- 1 Li L!_ Street_ _1 6) , __.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.. Repairs
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
APPLICATION FOR ELECTRICAL PERMIT
ss .
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
No
(Signed)
tit
Service Overhead Size Feeders #J Conduit:_ 1d Main Sw. I.f _ Amps.
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
Date !?
Main Fuses Amps.
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 bim 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 w to be performed under this permit, as are
licensed by Miami Shores Village. -�
(Signed)
• 4e—IL
Massir Electrican.
No. of Stories
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.