8400MIAM $ SHORES VI LL
ELECTRICAL INSPECTION DEPART
APPLICATION FOR ELECTRICA
Permit No A°
E
GE
T
PERMIT
Date le, — $7
Application is hereby made for the approval of the detailed statement of the plans and specifi
structure herein described. This application is made in compliance and conformity with the Bu'
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of
building during progress of work.
Owner's Name and Address __. /,� % 4 / 7 A No 6 V
,P.5/—
kio : herewith submitted for the building or other
d' Ordinance of Miami Shores Village, Florida,
a rules and regulations of the Building Division
ap roved plans and specifications must be kept at
He . Street
,�
Registered Architect and /or Engineer te
Employing Electrician's Name C i A No ' •• * Street
, _
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No 6p, -5 Stmt 7/ '
. ---,
State work to be performed and purpose of building I' (By Floors)
New Building Remodeling Addition �--.'"-- ' epa re 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
. HEAT.
CONN.
SPACE
HEATER
- STRIP
HEATER.
TOTAL
CONTR.
LIST
7
ge
/A
/:?
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 Hr
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Service Overhead Size Feeders Conduit Main Sw. Amp a. Main Fuses Amps.
Underground
Type of Installation --- Conduit_ Tubing B.X.L. Metal Mouldil��
r
Amount of Permit $ - 2-°'' ' (Signed)
,5
4 ' + �' - i '° '
electrical Inspector.
The undersigned applicant for this building permit does hereby certify that , nderstands an accepts his oblig ins as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled plural Laws of Florida Permanent. Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractor, 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 he work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. FR ED HATC H ER
(Signed) 1
• 01 Master Electrican.
STATE OF FLORIDA,
COUNTY OF DADE. 1 es�
Before me, the undersigned authority, a notary public, duly authorized to a r oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that 1 e 1s tho
of the above described construction, that he has carefully read the foregoing application, d that he did sign the same, and that all facts
therein by him stated are true.
—.....
My Commission Expires N to Public. State of Florida �� --
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made neccssa by improper notice for inspection. or faulty
materials and /or workmanship.