25361�
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date. ft)r
.7)(4'
Permit No.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 complie 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 Enginee
Employing Electrician's Name R �% - —� - No 69 Street.
Location and Legal Description Lot Bloc Subdivi;
No /�
Street
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors).
New Building ... Remodeling Addition
Street ...
Repairs No. of Stories.
Service Underground Overhead Size Feeders Conduit .Main Sw .Amps .Main Fuses Amps
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 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 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- contractorl 3 on work to performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. 135'
(Sig ter 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
TrT-
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
S� ACE
HLTATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
, P
MOTORS
1.8 HP
NEON
TRANS.
RADIO
TOTAL,
CONTR.
LIST
CHECK
Service Underground Overhead Size Feeders Conduit .Main Sw .Amps .Main Fuses Amps
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 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 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- contractorl 3 on work to performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. 135'
(Sig ter 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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
DA 'i'B c"` + 19
Owner of
Building - s
heal Lot I S
ption Bl. vision
Address- o "" w' Value of o �'
Building Project
This permit is granted to the Contractor or builder named above to construc t Cho building or to t or $ foss
herefor in strict compliance with all ordinances pertaining thereto and with the.. onderstanding that will ,
drawings, statements or specification that may have been submitted to and approved by the proper a a
time if the work is not done in compliance with such ordinances or if the plans . changed without au on. te
granted is the understanding that the contractor or budder named above assumes the responsibility for a ugh a i titxir
pertaining to the work covered herehl Whether shown on the ply or drawings or in the statements or sp Lorca �t
done by his agents, servants
In consideration of the issuance to me of this permit I to perform the work
pertaining thereto and in strict conformity with the plans, drawings, statements or spedfi
cepting lids permit i assume ressionsibility for ali work done by either, myself, my agent, serve