1270 NE 102 St (14)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address / 02. 70 N /O Z `S r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant � ;vl.(iu,4 IA/ /HELL-6' '- Master Permit # 3n74.
Owner's Address (,><- 7 0 /)/1E (a ? � Phone :7 3 6 7 C/
Contracting Co. j3w '».t E«cT■ Curt' ' CT F Sd F ,z. Address
Qualifier 7 / c rf6 df 2b V,/ CA. /Z t (E t` SS# Phone C qSs/) .�QT ' 5/(747 Y
State # 5C O 0 0 / Z 7/ Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDIN a ELECTRICA PLUMBING MECHANICAL ROOFING PAVING ,FENCE SIGN
WORK DESCRIPTION Ge..)//. //Y[
Square Ft. Estimated Cost (value) ad
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 zonin Furthermore, I authorize the above -named contractor to do the work stated.
Si i ature of owner and/or Condo President Date
FEES: PERMIT
APPROVED:
Zoning
Mechanical
t
?p-2
otary as to Owner and/or Condo President__ Date
My Corm "isigi1Exptret,t n
• cc �.; Co,
t ' Go lti
RADON
PP (t._ Ga y / < ya
C.C.F.
q77/ tl/ , s
gnature of Contractor or Owner- Builder Date
otary as to Contractor or Owner - Builder
My Commission Expires:
rt c
eb 9 »
d
v ' O C .,:..
NOTARY
Building Electrical
TOTAL DUE
Date
Plumbing Engineering
S
/27 /a02sar
A/44 J O 4f
G / 2L 4'
37. 6 Z /Ne
(-
A
WALL
ITEM
BATH TUB
UNIT FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
'.,
CENTRAL HEATING
DISHWASHER
RECEPTACLES
/
A/C (WIND)
DISPOSAL
_
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
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 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
RE INSPECTION
WATER 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
.
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
J
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILE/RES.
VIOLATION
PUP & ABANDON SEPTIC TANK
RE INSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
•
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 /// Job Address /(,J 7 Tax Folio
Legal Description ROBERT 9Lessee/Tenant ROBERT /// 141-6,- -
Owner's Address 1,9-70 ke OP Sr
/?mar,/ ELECTED J /NG
Contracting Co.
Qualifier i )H-10 Z mnoo Ci
State # eCooDlleig Municipal #
0
law
7
Si a ature % of owner and/or Condo President
Notary
My Co
Owner and/o
sion Expires:
Date
:4
0 OFFICIAL NOTARY 'SEAL
e: MARY PATRICIA BRIGGS
* COMMISSION NUMBER
CC335258
F MY COMMISSION EXP.
OF F\P JAN. 31
Historically Designated: Yes No
Address
ignature o
0 �
' NOTARY
FEES: PERMIT 3,S ' ea RADON C.C.F.
APPROVED:
Zoning
Mechanical Plumbing
Building
Master Permit #
Phone /Sg Sb7>1
( rv» 905r
SS# 89 -/37 y
Competency # /6602- Ins. Co. % /� /IELEICC/ -C/
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION O0 A17)P 6eeoic6 UPG&'?L)
Square Ft. Estimated Cost (value) I42 70:00
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.
AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
nstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
1
Contractor or Owner- Builder
3 80q6
r
1 �
Notary as t•` ontractor
My Commission Expire
2 12
�y�r I.I p
E S P`" � �t FICIAL NOTARY SEAL
2 MARY PATRICIA *RIGGS
+'} * COMMISSION NUMBER
CC335258
� OF Flip MY COMMISSION EXP.
JAN. 31 1999
TOTAL DUE J �-
7 / 1 95
Date
to
Engineering
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIN))
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DIET YORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
I
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGAOUN) TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
EWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 CORP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK. RESIDENCE
_ MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER 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
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
_ SIGN TIRES
SEWER CONNECTIONS
_
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
.
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
RE INSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA ORAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
4
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
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BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE /2 -. + - 1945
PERMIT N? 7881
Work to be performed under this Permit
e
Subdi-
vision
Value of
Project
BY
Contr to >�,
License No.
'
Amt. of
Permit
. c
e.e BY
Architect`
Contractor
or Builder
Legal
Description
Address of
Building
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 appli-
cation 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, servants or employees.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform work covered hereunder in compliance with 4,4rdin
pertaining thereto and in strict conformity with the plans, drawings, statements , r specifications submitted to the proper authoriti s of Nil
In accepting this permit I assume responsibility for all work done y either myself, m agent, servsnt or employee.
AUTHORITY
and aiegpiaf'pnl
i Shorts' Village
Amount of Permit
Permit No._
STATE OF FLORIDA,
COUNTY OF DADE.
appeared_
Owner's Name and Address____
Registered Architect and /or E • eer
Employing Electrician's Name_ _
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
}
ss.
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.
y
New Building________________ -- _________-_Remodeling Addition.
Street
•
Date 7-ii-
No 1_!i1___ Street ___ s 1
Street__ W )
No 0
Block { 85 Subdivision_
/d am
Repairs No of Stories
Service Overhead Size Feeders __ � Conduit_l__ _Main S w._— ____________________Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing _____ B.X.L.__ — Metal Moulding
= — - - - -- -- - - - - -
(Signed)
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
therein by him stated are true.
trical Inspector.
The undersigned applicant for this building permit does hereby certify that (understands and accepts his obli• ins as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ' -anent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
„0-di,v4
• Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
the same, and that all facts
My Commission Expires 1 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. I ST
LI ST
/ /11
`�
3 1
114
a '
1
/ I 4v""0
/
6 --
I
7 3 '
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
J
CHECK
'' ) _/
Amount of Permit
Permit No._
STATE OF FLORIDA,
COUNTY OF DADE.
appeared_
Owner's Name and Address____
Registered Architect and /or E • eer
Employing Electrician's Name_ _
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
}
ss.
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.
y
New Building________________ -- _________-_Remodeling Addition.
Street
•
Date 7-ii-
No 1_!i1___ Street ___ s 1
Street__ W )
No 0
Block { 85 Subdivision_
/d am
Repairs No of Stories
Service Overhead Size Feeders __ � Conduit_l__ _Main S w._— ____________________Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing _____ B.X.L.__ — Metal Moulding
= — - - - -- -- - - - - -
(Signed)
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
therein by him stated are true.
trical Inspector.
The undersigned applicant for this building permit does hereby certify that (understands and accepts his obli• ins as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ' -anent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
„0-di,v4
• Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
the same, and that all facts
My Commission Expires 1 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.
Permit No. ____
MIAMI
Owner's Name and Address___ —'�!-, —_—
Registered Architect and /or Eineer_
Employing Electrician's Name_94_ '4,_r
Location and Legal Description Lot
Street and Number where work is to be performed —No
"1
SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/ 17st.ni
Date. - — cc — q 9
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.
No. / Street / (02- 31,
No 3 Z 0 Street_ _?VW
Block / $ �^ Subdivision _ r
Street___ S r '
State work to be performed and purpose of building (By! Floors)
New Building_________________ —__ Remodeling ______________'_________ Addition ______ ________________________Repairs No. of Stories
Service Overhead Underground Size Feeders
Type of Installation — Conduit ____ -- ______— _Tubing_______ -- -_B.X.L._ —. Metal Moulding
Amount of Permit $___- ___-- - - - -__ _--- _- -_ - - -- -- _-- - -� - -- ( Signed)___
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that (understands and ac his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws Florida Permanent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
Conduit __•_- -- __Main Sw._______ Amps._____ ..... ___ -- ....... _Main Fuses__ ..... __ ...... _ ______Amps
(Signed) 9c1.0-AAmv4
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 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
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
4
-
411,
s.
CHECK
/
1
4— _. •
_
Permit No. ____
MIAMI
Owner's Name and Address___ —'�!-, —_—
Registered Architect and /or Eineer_
Employing Electrician's Name_94_ '4,_r
Location and Legal Description Lot
Street and Number where work is to be performed —No
"1
SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/ 17st.ni
Date. - — cc — q 9
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.
No. / Street / (02- 31,
No 3 Z 0 Street_ _?VW
Block / $ �^ Subdivision _ r
Street___ S r '
State work to be performed and purpose of building (By! Floors)
New Building_________________ —__ Remodeling ______________'_________ Addition ______ ________________________Repairs No. of Stories
Service Overhead Underground Size Feeders
Type of Installation — Conduit ____ -- ______— _Tubing_______ -- -_B.X.L._ —. Metal Moulding
Amount of Permit $___- ___-- - - - -__ _--- _- -_ - - -- -- _-- - -� - -- ( Signed)___
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that (understands and ac his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws Florida Permanent 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
Conduit __•_- -- __Main Sw._______ Amps._____ ..... ___ -- ....... _Main Fuses__ ..... __ ...... _ ______Amps
(Signed) 9c1.0-AAmv4
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 workmanship.