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74 NE 111 St (9)Date a- C) 00 Job Address 7 4 N E Legal Description Owner/Lessee / Tenant root K P ie -W C 't- . Owner's Address 7 4 Ai Contracting Co. - -P YaSQ, ec ili c aJ S,0 i2Cle: Qualifier CO t i FIKEW 6 a i/1-2 ce tel State # Z'S O 00 0 a '? S Municipal #�— Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDIN ELECTRIC WORK DESCRIPTION /VW / So qt 6 cLa. /4-00, 00 Square Ft. Estimated Cost (value) 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 certifythat 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 ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio and zonin urthermore, I authorize the above -named contractor to do the work stated. J / Si My Commssion Expires: FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE and/or Condo President Date .•w' r.s Luis Fernandez Commissio ' C 906269 are" t�, 17, 2004 er an ,r`rdAagarig ng Co. Inc 3// - 7 0 c Tax Folio -- RADON C.C.F. / • ?'O NOTARY Historically Designated: Yes APPROVED: Zoning Building Electrical Mechanical Master Permit # # a 0 ( Phone Address S4 6 S q , c iu SS# Phone 30K- a a---7 Competency # Ins. Co. P-1- C.:, Address Address Address PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Notary : ontractor or Ownef My Commission Expires: No uil Date uis Fernandez mission # CC 906269 PR March 17, 7(1(14 Bonded Thru Date Atlantic Bonding Co., Inc. BOND TOTAL DUE ja Plumbing Structural Engineer 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 1 d ✓rb DUCT WORK FLOOR DRAIN SERVICE REPAIR/IETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS 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 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS TE)PCRARY 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 G /,° 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 UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA • RELAY TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP S. ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN 6 / 1 .6 KA.0 4TaA/add 1 9 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 .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 4 ' JERSEY ELECTRIC CORP. CC# 18818 5461 S.W. 143 AVE. MIAMI, FL 33175 LOAD CALCULATION PANEL SCHEDULE "A" All wiring shall be single phase 240/120V 10 KAIC 150 AMP MAIN CIRC DESCRIPTION WIRE COND POLES AMPS KW 1 -7 Lighting & Receptacle * * * 14 1/2 1 15 4.2 8,28 Small Appliance 12 1/2 1 20 3.0 9 Refrigerator 12 1/2 1 20 1.2 10,12 Oven/ Range Gas 3#6 3/4 2 50 12.0 11 Dishwasher 12 1/2 1 20 1.2 14,16 Dryer 3 #10 1/2 2 30 5.0 15 Washer 12 1/2 1 20 1.5 17,19 Waterheater 10 1/2 2 30 4.5 18,20 Sprinkler pump 12 1/2 2 20 0 25 SUB TOTAL KW 32.6 FIRST 10KW @ 100 %DEM 10 REMAINIG 22.6 KW @ 40% DEM 9 TOTAL DEMAND FACTOR 19.0 21,23 AHU w/ 9.6 KW HT STRIPS 6 RMX 2 60 9.6 22,24 A/C Compressor 8 RMX 2 40 27 -29 30 -32 TOTAL KW TOTAL KW 28.6 /240 VOLTS = 120 amps * * * 1400 SQ. FT. LIVING AREA X .003 kw /sq. ft. = total kw JOB ADDRESS 74 NE. 111 ST. JOB NAME Ana Kirwan 28.6 CO 18618 • r. ERSEY ELECTRIC CORP. Jo b nricb Os 74ti,e 111 Eit. o A \ £ei b� ft•w.4ttAke nil 3# NE RiSet T AgRn' O JIM ro� u pgp• gt• 0 k- 1j'q1& 2•+1 'Pat w. 3461 S.W. 143 AVENUE MIAMI, FL 33175 (305) 227 •1 i %f tquoillvvtot Geoot . Z'' Ryid qjtse less 4J/e,v raw 3 " ; id. c e.'' th si :t 0A, 1 6czei to Q 02- c.-e1. w. 144 4ose 13;15 S;ifiRZS V;; 1 BY .... ............,______*___....___. i i ( ,s".;•:isq:Ai.. , ;."'rrri'r . wors.■•••••••••••■•••. •••■■••e■•••••■■•■••••••■••••■•.... ORES VIUGE AS!'3UFS 1,10 RESPONSIBILMES FOR ACCURACY OF DR RESULTS -ROM THESE PLANS. 4TH Ii-ft' SOUTH FLORIDA BUILDING CODE AS ADOPTED BY IS REQUIRED. THE ARCHITF.GT, BUILDER & SUB ARE CHARGED WITH THE KNOWLEDGE OF ALL BUILDING *voii.4"ciONg WPFIFEP O OT SPECIFICALLY INDICATED HEREIN. SIJET COMPLW WITH P11. FEDERAL STATE AND GOWN RUISS AND REGULATIONS. ■•••■•■■■••• ...■••■•■ DATE • • Permit Application is hereby made f t 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. F L P r Owner's Name and Address _!�__� __�_ _- _— __ L cop, o. 7_ �_ Street � - Registered Architect and /or Engineer Employing Electrician's Name G- a -r d d.(3�.;_" !� CI___ � ______ Street___L__ .1-0' f I' �� �� Location and Legal Description Lot w_— __ _ Block— ____— ______ —____ Subdivisi __ _— ___ ______ Street and Number where work is to be performed —No Street !1L_ __— ���_._ S State work to be performed and purpose of building (By Floors) New Building Remodeling Addition..__________ Repairs Service Overhead Size Feeders______________ Conduit____— Main Sw._____ — Amps. Main Fuses_ _ Amps. Underground Type of Installation— Conduit Tubing ____ B.X.L. Metal Moulding Amount of Permit $ STATE OF FLORIDA, ) COUNTY OF DADE. J as. APPLICATION FOR ELECTRICAL PERMIT Date 2 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. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT (Signed) (Signed , �fv i r .4>' 6k11 e Notary Public. State of Florida i No. of Stories Master Electrican. 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. 4 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 �' Vr ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit Application is hereby made f t 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. F L P r Owner's Name and Address _!�__� __�_ _- _— __ L cop, o. 7_ �_ Street � - Registered Architect and /or Engineer Employing Electrician's Name G- a -r d d.(3�.;_" !� CI___ � ______ Street___L__ .1-0' f I' �� �� Location and Legal Description Lot w_— __ _ Block— ____— ______ —____ Subdivisi __ _— ___ ______ Street and Number where work is to be performed —No Street !1L_ __— ���_._ S State work to be performed and purpose of building (By Floors) New Building Remodeling Addition..__________ Repairs Service Overhead Size Feeders______________ Conduit____— Main Sw._____ — Amps. Main Fuses_ _ Amps. Underground Type of Installation— Conduit Tubing ____ B.X.L. Metal Moulding Amount of Permit $ STATE OF FLORIDA, ) COUNTY OF DADE. J as. APPLICATION FOR ELECTRICAL PERMIT Date 2 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. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT (Signed) (Signed , �fv i r .4>' 6k11 e Notary Public. State of Florida i No. of Stories Master Electrican. 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. 4 MIAMI SHORES VILLAGE, FLORIDA DATE BUILDING `4 ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder PERMIT N? 4994 Work to be performed under this Permit Subdi- vision Contractor's License No. � Jre 2 . 4 it ✓ 4 1947_ Legal Lot Description Address of Building This permit is granted to the contractor or builder ed a ove to construct the building or to install the equipment o devi a described in the appli- cation herefor in strict compliance with all ordinances pe fining ereto and w th 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 assuages' the, psponsibility or a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or dra¢;iings- b{,�rrtht =tta a ecifications and that h assumes espon- sibility for work done by his agents, servants or employees. ��' Signed• i f ,'� V `, y hereunder In consideration of the issuance to me of this permit I agree to perform the work , overed hereunder in compliance w' 1 ordinances ati6Tis pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper au�ies of Miami io illage. In accepting this permit I 3 assume responsibility for a work done by either myself, my / agent; servant or employee. - • CONTR TOIIWOR BUILDER By AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot 7 MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N2 4593 Work to be performed under this Permit Contractor's License No. 7_/ 1 194! / 315 vision y 11 `` /1/ re Value of l' Amt. of / u /{/ +r l/�, Project Permit f 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 w th 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 drains or in statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. 611 yV By ip -erk INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with �prdinances re d atVons pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper author of Miami Mores Village. In accepting this permit ssume responsi yi for all work done by eithes elf, my agent, servant ore .loyee. CONTRACTO 1 ER J 1 .. BY AUTHORITY BUILDING ELECTRICAL • PLUMBING Owner of Building PERMIT N? ' 4593 Work to be performed under this Permit Architect Contractor or Builder Legal Lot / Bl. r , Description Address of '7 ag 4/ "1/ ze r Building MIAMI SHORES VILLAGE, FLORIDA Subdi- vision Value of Project DATE 4.1"4-.4.00-1frel Contractor's License No 1` » t� {Arc Amt. of Permit i- 194k r This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device scrib s a the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in ..mp anc with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Per 't . ay be evoked 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 whi 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 draw' s or in the tatements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. '°`� By 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 ume responsib' ' for a work done by either myself, my JJ agent, servant or env oyee. CONTRACTOR • *WU '.' R BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor - j ' or Builder f1 Legal Lot Description CONTRACTOR OR BUILDER MIAMI SHORES VILLAfE, FLORIDA DATE / 7 194_ yd h' PERMIT N° 4994 Work to be performed under this Permi f i c .L +v ).e J' PA" permit is granted is the understanding that the contractor or builder named above assum regulations pertaining to the work covered hereby whether shown on the plans or draw - sibility for work done by his agents, servants or employees. Signed. Contractor's License No Subdi- vision ,._ ......� a .--- Address of f 4 7 1 " , ue of Amt. of f ' L Building • ,..•. Project Permit 1♦ 1, , This P ermi't is granted to the contractor or builder named abge to construct the building or to install the equipment or device'described in the appli- cation herefor in strict compliapce 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 withoggt authorization. A further condition upon which this e responsibility fgE a thorough knowledge of the ordinances and gs or n- the "stater .e ar ejifications and that he assumes respon- ♦ IN .E€'FOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and gulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami SI res Village. In accepting this permit I assume responsibility for a work done by either myself, my agent, servant or employee. i � By BY AUTHORITY e Or /J - 6 ;. Ate ) o0 Pr II o ic -5e6) i9ca Permit No.____ ____ Amount of 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 /6 � _l _ '___ No. 7.1 L_ Street _/ J Registered Architect and /or Engineer APPLICATION FOR ELECTRICAL PERMIT MIAMI SHORES VILLAGE Service Overhe Size Feeders_ __I Conduit._ Main Sw _ O P _ Amps. Underground p Type of Installation— Conduit Tubing____ B.X.L. Metal Moulding ELECTRICAL INSPECTION DEPARTMENT Date r Subdivision_Cee • 2 - - -e,/4 Employing Electrician's Name 44 su b"_ « Ay fhLf(— ' No. "' s ,® e e 2 • Location and Legal Description Lot ______— Block_ Street and Number where work is to be performed— No._ __ ,2± i' Street_24j_ State work to be performed and purpose of building (By Floors) New Building V Remodeling Addition.. Repairs ___ No. of Stories._______ _ n Main Fuses_ i 1? Amps. se6 (Signed) c olTh trica 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. STATE OF FLORIDA, I COUNTY OF DADE. ss. My Commission Expires 6 1 -� (Signed) � _� Master Electrican. 7 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. 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 3 / r� / /9 /�,. C / 94 g CHECK A p .7 ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. IST LIST CHECK e Or /J - 6 ;. Ate ) o0 Pr II o ic -5e6) i9ca Permit No.____ ____ Amount of 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 /6 � _l _ '___ No. 7.1 L_ Street _/ J Registered Architect and /or Engineer APPLICATION FOR ELECTRICAL PERMIT MIAMI SHORES VILLAGE Service Overhe Size Feeders_ __I Conduit._ Main Sw _ O P _ Amps. Underground p Type of Installation— Conduit Tubing____ B.X.L. Metal Moulding ELECTRICAL INSPECTION DEPARTMENT Date r Subdivision_Cee • 2 - - -e,/4 Employing Electrician's Name 44 su b"_ « Ay fhLf(— ' No. "' s ,® e e 2 • Location and Legal Description Lot ______— Block_ Street and Number where work is to be performed— No._ __ ,2± i' Street_24j_ State work to be performed and purpose of building (By Floors) New Building V Remodeling Addition.. Repairs ___ No. of Stories._______ _ n Main Fuses_ i 1? Amps. se6 (Signed) c olTh trica 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. STATE OF FLORIDA, I COUNTY OF DADE. ss. My Commission Expires 6 1 -� (Signed) � _� Master Electrican. 7 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.