PAINTPr" " - r APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Da / Job Address 42.E 4 V. 9 7 "ti --(1.. ,,' ax Folio( ( 1 ,.•:, ., Q 9 ' " d -.
.rte ; -
Leg ion A1/4(:-- %)' ,- a Oft -i.,; t P e'z Permit #
y �
Owner / Lessee / Tenant �i u/ 7( 2 4 1
‘ .J ?1/ Jt
? 74- . iz� e ma —
Owner's Address � �� ' � Phone ��`� � � U (
Address
Contracting Co.
Qualifier .v -C /ja
State#
Architect /Engineer
Bonding Company
Mortgagor
WORK DESCRIPTION
Square Ft.
Signature of 0 ner and /or Coudo4resident
Date:
Competency #
SS#
PERMIT FEE: APPROVED: Fire
Zoning Building
Mechanical Plumbing
Address
Address
Address
Phone
Permit Type (circle one) . B BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
)
Estimated Co
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
.•7
Signature of Contractor or Owner- Builder
Date: � / / s/t2/ ,f
i
f1
Notary as to Contractor or Owner - Builder
Notary as to Owner and /or Condo President
My Commission Expires: My Commission Expires: mix
* * *
Ins. Co.
Electrical
Engineering
7x)( �7
l
0
•
FOR
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/28/2002
M. Bronwyn Beightol
623 NE 97th St.
Miami Shores, ft. 33138
Applicant: BRONWYN
Owner: BRONWYN
Contractor Address:
Local Phone: Cellular:
Building Permit
Permit Number: BP2002 -641
BEIGHTOL
M
Parcel # 1132060171870 Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOT 15 & W1/2 LOT 16 BLK 101 LOT SIZE
Job Address: 623 NE 97 ST
Fees: Description Amount
FEE2002 -1810 Building Permit Application Fe$60.00
FEE2002 -1811 CCF $0.60
FEE2002 -1812 Notary Fee $5.00
Total Fees: $65.60
Permit Status: Approved Permit Expiration: 9/24/2002 Construction Value:
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fan ict tcn nn ..d -k w� 1�n r1
PAY TO THE •c,
ORDER OF
POWER 1 CREDIT UNION
3 6450 W 21 CT
- HIALEAH, FL33016
V a q
63- 6020/2660
1: 266080 2041: 4 34470 L830011 0800
IIIIIIIINIP
0800
DATE
1 $
DOLLARS —
BY:
$600.00
Page 1 of 1
Total Fees: $65.60
Total Receipts: $0.00
• the equipment or device described in the application herefor in strict compliance with all
with any plans, drawings, statements or specifications that may have been submitted to
is not done in compliance with such ordinances or if the plans are changed without
• ctor or builder named above assumes the responsibility for a thorough knowledge of the
ings or in the statements or specifications and that he assumes responsibility for work done
BY:
.k in compliance with all ordinances and regulations pertaining thereto and in strict conformity
*res Village. In accepting this permit I assume responisibility for all work done by either
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: 3 . a 1, 0 `)
OWNER'S NAME: q y e s . %g-;- �6,1 PHONE: " os 3S`I - 0) -4 C
ADDRESS: b'n M E cn - S.1 .
********************************** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to hP
Walls 't��A-ae
Fascia ' L / w�x1 -
Drip Cap/Drip Edge N 1
Soffit
Roof N A
Flower Bins N I R
Shutters 1A�;,k
Awnings (L"\
Chimney
Doors and door jams 1 .1,-cf -
Garage Doors N 1 A l
Railings
Fences N 1A
Decorative Metal
All brick (simulated or regular) 0 Ica
Stucco Banding N I R
Any other stucco features I Pk
Accessory Buildings A
Other Alc - '..At
OWNER'S AFFIDAVIT: I certify that all the f__
and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
samples.
✓t om
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
aC4/4 3/)
Building Offici
g Date
Butte Beige HC -47
linen white
cu
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
This instrument prepared by:
Dana K. Sadaka, Esq.
Lawyers Advantage
8211 W. Broward Blvd, Suite 110
Plantation, FL 33324
Folio Number:11- 3206 - 017 -1870
THIS QUIT -CLAIM DEED, made the 15th day of October, 2001, A.D. between the
Grantors, Shawn E. Beightol, a single man and M. Bronwyn Beightol, a single
woman whose address is 623 NE 97 Street, Miami Shores, Florida 33138 of the County
of Miami -Dade, State of Florida, and the Grantee, M. Bronwyn Beightol, a single
woman whose address is 623 NE 97 Street, Miami Shores, Florida 33138.
WITNESSETH that the Grantors, for and in consideration of the sum of TEN DOLLARS AND
00 /100 ($10.00) and other valuable considerations to Grantors in hand paid by Grantee, the
receipt of which is hereby acknowledged, has granted, bargained and quit - claimed to the Grantee
and Grantee's heirs and assigns forever, the following described land situate, lying and being in
the County of Broward, State of Florida, to wit:
TO HAVE AND TO HOLD, the same together with all and singular the appurtenances
thereunto belonging or in anywise appertaining, and all the estates, right, title, interest, lien,
equity and claim whatsoever of Grantors, either in law or equity, for the use, benefit and profit of
the said Grantee forever.
IN WITNESS WHEREOF, the Grantors have hereunto set their hands and seals the day and
year first above written.
SIGNED, SEALED AND DELIVERED in the presence of:
Lot 15 and West Y2 of Lot 16, Block 101, AMENDED PLAT OF MIAMI
SHORES SECTION 4, according to the Plat thereof, as recorded in Plat
Book 15, Page 14, of the Public Records of Miami -Dade County, Florida.
STATE OF FLORIDA
COUNTY OF BROWARD
. . pU a
Dana K. Sadaka
i:,�. • ,;� "�� ,Commission u CC 934573
L15 v tlantic$
A Expires March T A, 2003
gNt , ` off: 13ononddcd ing u h Inc.
S <L A..
Shawn E. Beightol
The foregoing instrument was acknowledged before me this 15th day of October 2001 by Shawn
E. Beightol and M. Bronwyn Beightol, who are personally known to me, or have produced a
valid drivers license as identification; an oath was not taken.
WITNESS my hand and official seal in the County and State last aforesaid.
AtIVI
otary Public
Name Printed
My commission expires:
MIAMI SHORES VILLAGE^
Paint Color Approval and Agreement
DATE:
OWNER'S NAME: t PHONE
ADDRESS: q 1st ')3 . E f
X XX X X .4
XXXX *x x*
X X
Building Official Date
* * *x *
>4>4>4>4>4
1:1:1
P-700
BENJAMIN MOORE®
ADDRESS OF SITE: OS N cnt
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
)4 '4 *
All Elements on the site must be listed and indicate the color to be painted.
Walls q>1.A4,\olsz cry
i ,
Fascia , Ne
Drip Cap/Drip Edge N A
Soffit
Roof rh Pt
Flower Bins Pt
Shutters
Awnings
Chimney Q_
Doors and door jams iv IA
Garage Doors r I Pt
Railings
Fences I fl■
Decorative Metal LIN en t.rA k -
All brick (simulated or regular) ml A
Stucco Banding f'■
Any other stucco features
Accessory Buildings fu
Other (\-NaVoA
( 3)4 , -\01L ,
OWNER'S AFFIDAVIT: I certify that all the foregoing info Is accurate
and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I authorize the above-named contractor, if applicable, 4..o
do the work stated. Furthermore , the paint colors will be as per the attached
samples.
Signature o • wner Date Signature of Contractor Date
******************************************************************
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
2020-10
COLORPREVIEW '
v \dn
4/23/01
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning De ,artment.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
PERMIT APPLICATION
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. 1, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. 1 understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior tweve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB sr in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
SEAL:
state ef;Fl
Zr
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of O Signature of Contractor / Qualifier
�dov�v) \J j.-,C.
Print Name _ _ r \ Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification `" Personally known OR, Produced Identification
Type of Identification Produce .1 II- Pad tJ sy a °b 9-4:CO33 Type of Identification Produced:
PROPERTY OWNER
New Construction
Name Cr) / t c o rNL -s\y. i Z) 2C. S\ \
Enclosure
Address 671 3 N t✓ q /.ti.. '‘' •
fry, aM; 4- 3\ , .res , 1= L 3313
Alteration Exterior
Home Telephone
% 5 .1 s4 - 0,-42 s
'
Business Telephone
3 - 8 q a , s A x.. 14
Demolish
Fax
SOS - 89a • Sb9 to
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
✓
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other f �0 2, -^-MS_
✓
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1:
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
t„a3 Ali
Address
Folio Number 11- 3 a o to - O l'} - 18 o
Lot 15 � d w la ck I-4
Subdivision PB 15 PG 1
Current Use of Property^^
Proposed Use of Property
Tenant Information
Block 10\
Apt. ' City
Zoning
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
re s
Description of Work
si cl A;ca
FL-
State
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. f P c 90(1 ,1 (Q '+l
331'38
Zip
Linear Feet
Square Feet I/ 3 Units Floors
I 'iue of Work d 0 -' Bldg Value
Tax Assessed/Appraised Value � D { ,. 1 a
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE:
Service Repair
TY.
A/C Central 1 -3 Ton
Cooling Tower
Fan
Heating Strips, each
Outlet, Wall
Vent Hood, Cost
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Cap - Fixture
Signs
Fountain
A/C Central 8 -15 Ton
Pump and Abandon
Fixture - Fluorescent
Sprinkler System
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Cap - Sewer
Parking Lot Lights
Gas - Natural
Spas/Hot Tubs
Pump, Fire Stand
A/C Central 20+ Ton
Temporary Toilet
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
Clothes Washer
FPL - Load Central
Gas Piping
Posts
Pump, Replace - Pool
Swim Pool, Commercial
Urinal
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Discharge Well
Chiller
Ice Maker
Generators, etc.
Pum s, Sum i
Receptacles
Utilit - Water
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Drainfield, 4" Tile/Res.
Lavatory
Demolition
Septic Tank
Low -volt, Intercom/Teleph.
Water Heater New
Repair Circuits
Drains, Area
Meter Set (Gas)
Dishwasher
Sewer Connection
Low -volt, Television
Water Re -pipe
Service, Number of Amps
Minimum Fee
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE:
Generator
QTY.
TYPE: QTY.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Cap - Fixture
Air Handler, Tons
Fountain
Ductwork, Cost of
Pump and Abandon
Piping, Flammable Liquid
Sprinkler System
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Sewer
Gas - Natural
Bath Fan - Vented, #
Pump, Fire Stand
Fireplaces, Number of
Temporary Toilet
Pressure Vessel
Gas - Propane
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TypE
Miscellaneous Fixture
Q'T'Y.
TYPE QTY.
Soakage Pit
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pum s, Sum i
Utilit - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond '
O PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
(p 0
Metropolitan Dade County (C.C.F.) $ t e)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine $
Zonin : Review $
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
DATE
)/a 7/C
-5(-24
(sq.ft. = x/1000
x0.60)
(¢.005 /sq.ft.)
(4.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ 4__c_ V 6
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishorirsvillage.com