12122Q-
49,e,4
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No
Date.....`l
Application is hereby made for the approval of the detailed statement of the plans and specifications her 'th 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 compli ed7with, 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 En
Employing Electrician's Name
Location and Legal Description Lot
No.... ;feCt4/9"
No 31'3/ '
Street.
r,
Block Subdivision
Street and Number where work is to be performed —No Street.
State work to be performed and purpose of building (By Floors)
New Building Remodeling .Addition Repairs. No. of Stories
�Sernce Underground Size Feeders Conduit. Main Sw Amps. Main Fuses .Amps
3lj° -34
ype 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 of ations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridarmanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con rs 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 subcontractors, on work be perf • rmed under this permit, as are
licensed by Miami Shores Village. 0 . ,
! 1
/
COUNTY OF DARE. f ss'
STATE OF FLORIDA,
(Signed).
ctiician.
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 reinspection 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
O.1 HP
MOTORS
1.S HP
NEON
TRANS.
RADIO
TOTAI,
CONTR.
LIST
_
I
•- /2 T.9
%
nV 4 /
._
CHECK
..
4-
Ft
/�— _
�Sernce Underground Size Feeders Conduit. Main Sw Amps. Main Fuses .Amps
3lj° -34
ype 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 of ations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridarmanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con rs 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 subcontractors, on work be perf • rmed under this permit, as are
licensed by Miami Shores Village. 0 . ,
! 1
/
COUNTY OF DARE. f ss'
STATE OF FLORIDA,
(Signed).
ctiician.
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 reinspection 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.