8155MIAMI SHORES VILLAGE
BUILDING
ELECTRICAL
PLUMBING
ERMIT N? 8155
Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
7
Subdi-
vision
Value of Amt. of
Project 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 appli-
cation 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'authorzation. 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 drawings or in the stat ents or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. r.
In consideration of the issuance to me of this permit I agree to perform
pertaining thereto and in strict conformity with the plans, drawings, stateme
s p _ . it I assn - respo , ibility for all work done by either m
.11:1714k
CONT CTOR 0 ' BUILDER
S , OR
e ork covered hereunder in compliance with all or s and regulations
s ., specifications submitted to the proper authorities ' '`' ' Shores Village.
f , my agent, servant or employee.
y
BY
AUTHORITY
.0 C
MIAMI SHORES VILL
ELECTRICAL INSPECTION DEPART
APPLICATION FOR ELECTRICAL
. y
Permit No i? h, y 1
E
E T
PERMIT
Date q— I (K."' 4'
Application is hereby made for the approval of the detailed statement of the plan and specifi tio.
structure herein described. This application is made in compliance and conformity with the B '
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village an
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of a pr
building during progress of work.
�/ q
Owner's Name and Address i� �/ 9 No.
herewith submitted for the building or other
Ordinance of Miami Shores Village, Florida,
rules and regulations of the Building Division
ved plans and specifications must be kept at
v
Street / P" '..1g.. S(
Registered Architect and/or Engin
Employing Electrician's Name., A %t('.. //4E� £ C No. S d
'/
Street S 1,_/,
--
Location and Legal Description Lot
Subdivision
___Block__
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 Re ai>iIIS_____.
No. of Stories______
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATE
HEATE
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
di
CHECK
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTOR Ii
1-5 HPPP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Service Overhead Size Feeders Conduit l Main Sw. Amp .
Main Fuses Amps
Underground
Type of Installation— Conduit Tubing A.X.L. Metal Moulding
Amount of Permit $ (Signed)
The undersigned applicant for this building permit does hereby certify that he understan
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gener
has complied with the provisions thereof, and will require similar compliance from all contr etc
work to be performed under this permit; and will post or cause to be p osted for inspection or th
as are required by the Act. The undersigned agrees to employ only such su. tract. .n o
licensed by Miami Shores Village.
I 14
(Signed)
Electrical Inspector.
Ind accepts his obligations as an employer of
aws of Florida Permanent Supplement, and
s or sub- contractors employed by him in the
site of the work such public notice or notices
k : be performed under this permit, as are
'II"' 114 0
f _
-.
STATE OF FLORIDA,
COUNTY OF DADE. f
Before me, the undersigned authority, a notary public, duly authorized to administ ?r
appeared_
Master El - , `cian.
oaths and take acknowledgments, personally
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he '
of the above described construction, and he has carefully read the foregoing application, and
therein by him stated are true.
the
t he did sign the ° same, and that all facts
My Commission Expires N
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessiy
materials and /or workmanship.
tart' Public, State of Florida
by improper notice for inspection, or faulty