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501 NE 102 St (7)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date $ °2f ( V Job Address d /U. (.02_ Tax Folio /I 9,20be/70940 Legal Description /14 W /' '� N1)PL 711Yka er Permit # ,..0/46e7 Owner / Lessee / Tenant -/v1 EC., ©u) &A) S Owner's Address 56 1 Contracting Co. M 04,1:› �d GGT C_ Address ■l Poo Qualifier State# EG0o0/19q Competency1 Architect /Engineer Bonding Company Mortgagor A) /4 Permit Type (circle one): BUILDING 10 WORK DESCRIPTION SE+►ZUIG6;" � �� — /43 65.0e..ES Square Ft. Estimated Cost 1 D 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 niid zoning. Furthermore I authorize the above -named contractor to do the work sta, -d. Signutuvz oelOw:i.er and/or Condo President te; of ri 1 to Owner and /os My Comm?iz sign Expires: * , h '.0 * PERMIT FEE: APPROVED: Zoning Mechanical PUBLIC STATE OF FLORIDA * * SSII Phone Fire Building Plumbing Phone Co G I DV "i et 2- -/ Ins. Co. -41— Address Address Address PLUMBING MECHANICAL PAVING FENCE SIGN f Contractor or Owner - Be 1d?er Notary F s to Contractor Contractorm IdEXP 60 FLORIDA My Commission Expires: BONDED TNRU e�P�ER J Ifd * * * * * c NS . UN* Other ctrig" F 9 Engineering ti BUILDING ELECTRICAL PLUMBING f i MIAMI SHORES VILLAGE, FLORIDA DATE ` 1941_ Contractor's License No PERMIT N9 1804 Work to be performed under this Permit Owner of Building '` ' Architect Contractor or Builder Legal Lot BI. Description Address of Building Subdi- vision Value of Project 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" respt sibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawi o ity'the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed /%•:!:-'- CONTRACTOR OR BUILDER SPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Mia »kShores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. • AUTHORITY ` v BY BUILDING ELECTRICAL PLUMBING Owner of Building MIAMI SHORES VIILLAGE, FLORIDA PERMIT N9 1874 Work to be performed under this Permit Architect Contractor or Builder Legal Lot Bl. !Description "address of l Juilding Subdi- vision Value of Project DATE 194 t ! e Signed• V By INSPECTOR Contractor's License No 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 pplication herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance iith any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may , e 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 pon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of he ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings ,6r in the statements or specifications and hat he assumes responsibility for work done by his agents, servants or employees. In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- ions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores tillage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY MIAMI SHORES VILLAGE Office of Electrical Inspector CERTIFICATE OF INSPECTION PERMIT No. THIS CERTIFIES THAT the wiring and apparatus installed at by a.- Address for 2 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. • THIS CERTIFIES THAT the wiring and apparatus installed at MIAMI SHORES VILLAGE Office of Electrical Inspector CERTIFICATE OF INSPECTION t PERMIT No. - / 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 r ' ELECTRICAL INSPECTOR. /t1L/ JOB: BUILDING ELECTRICAL : PLUMBING • Inspector's Report: • WORK : DONE BY: si n, "7- • REQUESTED The following is ready for Inspection: .AD: C • • • WILL BE READY JOB: AD: BUILDING ELECTRICAL PLUMBING : • • • • Inspector's Report: - WORK • DONE BY • REQUESTED The following is ready for InspectibL: r f WILL BE READY \ JOB: BUILDING ELECTRICAL PLUMBING • • • • • • • AD: ,/ > o ff Inspector's Report: - /` • WORK DONE BY • -- • REQUESTED WILL BE READY The following is ready for Inspection: ' -• t aly .Z -I- c • • • • Permit Owner's Name and Address 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. Registered Architect and /or Engineer ___ Employing Electrician's Name __ /_____�__ No. 1 Li Location and Legal Description Lot Block Street and Number where work is to be performed —No •�. State work to be performed and purpose of building (By Floors) No Street Street New Building Remodeling Addition Repairs Service Underground Size Feeders Conduit I Main Sw Type of Installation— Conduit Tubing B.X.L. Metal Moulding Amount of Permit $ The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. S S. 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. My Commission Expires (Signed) �= P Date-- -- - - -7 �. Street Subdivision__ Amps. Main Fuses Amps. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are t , (Signed) x 1 Mas er Electrican. Notary Public. State of Florida No. of Stories Electrical Inspector. 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 1 T 1 v 1 1 1 / I CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit Owner's Name and Address 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. Registered Architect and /or Engineer ___ Employing Electrician's Name __ /_____�__ No. 1 Li Location and Legal Description Lot Block Street and Number where work is to be performed —No •�. State work to be performed and purpose of building (By Floors) No Street Street New Building Remodeling Addition Repairs Service Underground Size Feeders Conduit I Main Sw Type of Installation— Conduit Tubing B.X.L. Metal Moulding Amount of Permit $ The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. S S. 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. My Commission Expires (Signed) �= P Date-- -- - - -7 �. Street Subdivision__ Amps. Main Fuses Amps. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are t , (Signed) x 1 Mas er Electrican. Notary Public. State of Florida No. of Stories Electrical Inspector. 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 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. Owner's Name and Address __ -- +_ -1 . Registered Architect and /or Engineer Employing Electrician's Name V--- ---",--040- N - �_____________ . Street___— _ Location and Legal Description Lot J`,5 L__ f_1_ f Block______ , Subdivision_ _ `.. Street and Number where work is to be performed —No c ° g \ - Street a Is —, State work to be performed and purpose of building (By Floors) New Building Remodeling Addition ___ Repairs__________ ______ No. of Stories Amount of Permit $_ Service Overhead Size Feeders Conduit Underground Type of Installation— Conduit Tubing The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, SS. 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. My Commission Expires MIAMI SHORES VI LLAG E ELECTRICAL INSPECTION DEPARTMENT Date__ B.X.L.______________.Metal Moulding (Signed) No Street Main Sw. Amps. _ Main Fuses Amps. (Signed) Electrical Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are Notary Public. State of Florida aster Electrican. duly authorized to administer oaths and take acknowledgments, personally 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 �/ J ENT. SW. DIST. CAB. SERVICE TEMP. f SERVOCE M. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK % Permit 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. Owner's Name and Address __ -- +_ -1 . Registered Architect and /or Engineer Employing Electrician's Name V--- ---",--040- N - �_____________ . Street___— _ Location and Legal Description Lot J`,5 L__ f_1_ f Block______ , Subdivision_ _ `.. Street and Number where work is to be performed —No c ° g \ - Street a Is —, State work to be performed and purpose of building (By Floors) New Building Remodeling Addition ___ Repairs__________ ______ No. of Stories Amount of Permit $_ Service Overhead Size Feeders Conduit Underground Type of Installation— Conduit Tubing The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, SS. 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. My Commission Expires MIAMI SHORES VI LLAG E ELECTRICAL INSPECTION DEPARTMENT Date__ B.X.L.______________.Metal Moulding (Signed) No Street Main Sw. Amps. _ Main Fuses Amps. (Signed) Electrical Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are Notary Public. State of Florida aster Electrican. duly authorized to administer oaths and take acknowledgments, personally 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. Application is hereby made for the approval structure herein described. This application is and all provisions of the Laws of the State of of Miami Shores Village shall be complied building during progress of work. - J Owner's Name and Address _____ f__ __ ? __1___. Registered Architect and /or Engineer Employing Electrician's Name MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No.__f__ Date ss. My Commission Expires of the detailed statement of the plans and specifications herewith submitted for the building or other made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division with, whether herein specified or not. A copy of approved plans and specifications must be kept at • No Street— — — — -- — Location and Legal Description Lot 1 ‘'1 Block_ �.1 `� Subdivision__ t_ Street and Number where work is to be performed —No 'E 14 ��4 � ��, Street___ y ``________________ —__ N. d.. No State work to be performed and purpose of building (By Floors) New Building Remodeling Amount of Permit $_ (Signed) Addition Repairs (Signed) — —� • Notary Public, State of Florida 3 h/ Street No of Stories Service Overhead Size Feeders Conduit Main Sw. Amps. Main Fuses Amps. Underground 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. aster Electrican. 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, 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'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE H EATER STRIP HEATER TOTAL CONTR. LIST CHECK ..r : . ENT. SW. DIST. CAB. SERVICE TEMP. . SERVICE' prk M. t MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Application is hereby made for the approval structure herein described. This application is and all provisions of the Laws of the State of of Miami Shores Village shall be complied building during progress of work. - J Owner's Name and Address _____ f__ __ ? __1___. Registered Architect and /or Engineer Employing Electrician's Name MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No.__f__ Date ss. My Commission Expires of the detailed statement of the plans and specifications herewith submitted for the building or other made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division with, whether herein specified or not. A copy of approved plans and specifications must be kept at • No Street— — — — -- — Location and Legal Description Lot 1 ‘'1 Block_ �.1 `� Subdivision__ t_ Street and Number where work is to be performed —No 'E 14 ��4 � ��, Street___ y ``________________ —__ N. d.. No State work to be performed and purpose of building (By Floors) New Building Remodeling Amount of Permit $_ (Signed) Addition Repairs (Signed) — —� • Notary Public, State of Florida 3 h/ Street No of Stories Service Overhead Size Feeders Conduit Main Sw. Amps. Main Fuses Amps. Underground 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. aster Electrican. 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, 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. • Permit No.___ /__ -- - -__ __ � - 7 - 7 -- -------------- - - -- Amount of Permit $ F "fry MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT f New Building Remodeling Addition Repairs (Signed) (Signed) My Commission Expires Notary Public. State of Florida Date 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 No. Street Registered Architect and /or Engineer Employing Electrician's Name ___________— ��— __ No. Street__— Location and Legal Description Lot____- -- __._Block Street and Number where work is to be performed —No Street_____s_____ —_�_ State work to be performed and purpose of building (By Floors) No. of Stories Service Overhead Size Feeders L ' i Underground Type of Installation— Conduit Tubing B.X.L. .Metal Moulding Conduit • �__'' Main Sw. Amps. ______— _______ 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 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. ..r I Masier Electrican. STATE OF FLORIDA, COUNTY OF DADE. t 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. 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 I -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK • Permit No.___ /__ -- - -__ __ � - 7 - 7 -- -------------- - - -- Amount of Permit $ F "fry MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT f New Building Remodeling Addition Repairs (Signed) (Signed) My Commission Expires Notary Public. State of Florida Date 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 No. Street Registered Architect and /or Engineer Employing Electrician's Name ___________— ��— __ No. Street__— Location and Legal Description Lot____- -- __._Block Street and Number where work is to be performed —No Street_____s_____ —_�_ State work to be performed and purpose of building (By Floors) No. of Stories Service Overhead Size Feeders L ' i Underground Type of Installation— Conduit Tubing B.X.L. .Metal Moulding Conduit • �__'' Main Sw. Amps. ______— _______ 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 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. ..r I Masier Electrican. STATE OF FLORIDA, COUNTY OF DADE. t 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. 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.