6267((a r'�(c-`,1._ /@e
/ c / r
„t .L e „d( ,.'M.VAM!
y
to-ti ELECTRICAL
.. APPLICATION
Permit N
F
SHORES O RES VI LLAC
INSPECTION DEPARTMENT
FOR ELECTRICAL 1
LlCam" '° P am, A
y- /
E
ERMIT
r
D o
a
Application is hereby made for the approval of the detelled
structure herein described. is application is made in
and all provisions of the awe of the State of Florida, all
of Miami Shores Village shall be complied with whetter
building during progress of work.
®
Owner's Name and Address
statement of the plans and specifications
compliance and conformity with the Building
ordinances of Miami Shores Village and all sales
herein specified or not. A copy of approved
No b 1
herewith submitted for the building or other
Ordinance of Miami Shores Village, Florida,
and regulations of the Building Division
plans and specifications must be kept at
Str '
Registered Architect and /or Engineer
Employing Electrician's Name l� � . ,\� ,t No C ,
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed -N¢
State work to be performed and purpose of building
Ne't Building Remodeling
Street
(Bly Floors)
Addition..___ Repairs No. of Stories
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO.LAMPS
REFR
OUTLET
O
IRON
OUTLET
RANGE RANGE
OUTLET CONN.
WATER
HEATER
W HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
Us"'
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE.
PERM.
MOTORS
;O -1 HP
MOTORS
1 -8 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
- {
Service Size Feeders L Conduit
Conduit
Main Sw. Ma Main Fuses Amps.
Underground
Type of Installation — Conduit_ Tubing
_
B.X.L. Metal Moulding
Amount of P .,'t $ it �; .�. 6°' At
le( ' ��^�) ,(9 Signed)
The undersig , • applicant for this building permit
under the Florida Wo kmen's Compensation Act, being
plied with the provisions thereof, and will require s'
performed under this permit; and will post or cause toIbe
required by the Act. The under signed agrees to eniilby
licensed by Miami Shores Village.
Electrical Inspector,
does hereby certify that he understands and accepts his obligations as an employer of la'6or
tion 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
r compliance from all contractors or sub -co tractors employed by hire in the work to be
posted for inspection on the site of th work such public notice or notices as are
only such sub -cont , • rs, on work performed under this permit, as are
r r.----,.,,, f
S.,
STATE OF FLORIDA, }
COUNTY OF DADE. es.
Before - me, the undersigned authority, a notar
appeared
Master Electrican.\
public, duly authorized to administer oaths and take acknowledgments, personally
to me well known, and who, being by me first duly s4'Orn,
of the above described construction, that he has Cate
therein by him stated are true.
upon oath deposes and says that he is the
111ly read the foregoing application, and t he did sign the same, and that all facts
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be ,,a
materials and /or workmanship.
11
Notary Public. State of Florida
ie when such re-inspection is made netessa by improper notice for inspection, or faulty
BUILDING
ELECTRICAL
PLUMBING
MIAMI SHORES VILLAGE, FLORIDA
DATE
Contractor? a,
License
Work t performed under this Permit {y
Owner of
Building ,. - ",•i�` -d%� 1 [ '} �. '+� }"- ""
i
PPERMI'T N° 6267
1948
Architect
Contractor
or Builder
Legal Lot
Description
Bl.
Subdi-
vision
Address of (b. Value of
Building r r► Project
This -permit is �' ' #- above to construct the building or to install the equi ment or device described in the appli-
cation herefo r p ante with a ordinances • ertaining 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 or a thorough knowledge of the antes and
regulations pertaining to the work covered hereby whether shown on the plans o ' drags or in star em nts or spec fi ons and that he`ass es respon-
sibility for work done by his agents, servants or employees.
Signed. I A` }'r By
INSP
In consideration of the issuance to me of this permit I agree to p the work covered hereunder in compliance with all ordinances and re�gguktions
pertaining thereto and in strict conformity with the _plans, drawings, s ements or specifications submitted to the proper au ies of Miami S rdJW71a ;
In accepting this pe t I assu esponsibility , all work done by either myself, my agent, servant or employee.
BY
AUTHORITY
4
al
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date % ' r
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 i L LX �±•___�__________W___________ No 7 �� Street _�_ ¢ _M_ S• __ ...
Regisstred Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot________________ __________________Block Subdivision _______________ ___._–________
Street and Number where work is to be performed—No � 7 � �'� Street_ �� rg S?
State work to be performed and purpose of building (By Floors) _____________— ___�_��
NI�w Building Remodeling Addition ..______________________ Repairs____
No of Stories_ _____
______
(
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
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Overhead
Service Underground Size Feeders______________ Conduit______._____ Main Sw._ ____________ Amps. .Main Fuses__ _ __ Amps.
Type of Installation— Conduit Tubing B.X.L. Metal Moulding
�? c _ RE 4j Z--
Amount of Permit $_ 2.• "Q
• (Signed)
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. ss'
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
FRED F-IA T CHER
(Signed
Before me, the undersigned authority, a notary public, duly authorized
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_______-_____ ___-_____w_____________-_______
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.
aster Electrican.
to administer oaths and take acknowledgments, personally
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.