9217MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Dap 1"/7— �.i d
Permit No
Application is hereby ma :e 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 ' ,� : F i No. Street
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot / ('1 -
Street and Number where work is to be performed —No
State ovork to be .performed and u ose f b ild'
No
Block
rp. O A ing (uy a W1.110il
New building Remodeling_ _ Addition Repairs No. of Stories___- _-____
SWITCH LIGHT PLUG FIXTURES REFRIG. IRON RANGE RANGE WATER W. HEAT. SPACE STRIP TOTAL f OUTLETS OUTLETS RECK'P'T'S NO. LAMPS OUTLET OUTLET OUTLET CONN. HEATER CONN. HEATER HEATER
CONTR / / / / __ _
LIST
CHECK
ENT. DIST. SERVICE SERVICE MOTORS MOTORS NEON RADIO TOTAL
SW. CAB. TEMP. PERM. 0-1 HP t -S HP TRANS.
CONTR
LIST
CHECK'
I
Overhead
Service, Size Feeders � Conduit JJ Main Sw. � 40 Amps.
Type ii of Installation— Conduit Tubing B.X.L. Metal Moulding
d et Main Fusee Amps.
Amouht of Permit $ / -"—Z) (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he rstands and accepts his obliges as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen .1 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 rk to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
(Akerr
Master Electrican.
STAVE OF FLORIDA,
COUIsiTY OF DADE. j ss'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me kvell 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 be 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.
p r
Overhead
Service, Size Feeders � Conduit JJ Main Sw. � 40 Amps.
Type ii of Installation— Conduit Tubing B.X.L. Metal Moulding
d et Main Fusee Amps.
Amouht of Permit $ / -"—Z) (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he rstands and accepts his obliges as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen .1 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 rk to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
(Akerr
Master Electrican.
STAVE OF FLORIDA,
COUIsiTY OF DADE. j ss'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me kvell 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 be 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
Owner of
Building , •x . r,.
MIAMI SHORES VILLAGE, FLORIDA,.,.
0-PERMIT
N° 9217
Contractor's
License No
rformed under this Permit
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Value cf
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 the responsibility f a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or 'n the statement or specifications and that he a =es responsibility for work
done by his agents, servants or employees.
Signe: ,� �' '. BY
INSPECTOR.
In coloration of the issuance to me of this permit I agree p dorm the work covered hereunder in compliance with
pertaining tt� tere)o and in strict conformity with the plans, drawings, at ents or specifications submitted to the proper autho
In accept• s permit I assume responsibility for all work done bjr ei her, myself, my agent, servant or employee.
CONTRACTOR OR B