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PL-18-2270r 4, Miami Shores Village OCR 3 18 Building Department i 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 =— Tel: (305) 795-2204 Fax: (305) 756-8972 j� [� INSPECTION LINE PHONE NUMBER: (305) 762-4949 '{ �'e v`r IS— 30 Cl 3 FBC Z01q . BUILDING Master Permit No._j)C. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1199 NE 102nd Street City: Miami Shores _County Miami Dade Folio/Parcel#: 11-3205-019-0010 Is the Building Historically Designated: Yes NO X Occupancy Type: _ Load: Construction Type: _Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):anelia shaheed/ nihar patel Pnonert.248-561-1523 Address:1199 NE 102nd Street City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: NA Plionell: NA Emil. ailenalove@hotmail.com / nihar.patel248@gmail.com CONTRACTOR: Company Name: J(1N CbS 5 RU1 GC 5 - Phonett� J (A•i7 ' 1� Z Address- ��_ ,lj�%. 4 ST- City: f-W /d - - _— sr.rt /�L - zip. Qualifier Name.: �DSE � „�z��i%//g/z E _Phonell: re� / � � 'aD0l State Certification or Registration #: Certificate of Competency it: DESIGNER: Architect/Engineer: _ _ _ _ Phonvil: Address: _ City: Stine: _ Zile: Value of Work for this Permit: Square/Linear Footage of Work: _ Type of Work: El Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition Description Description of Work: _ 4 -/'. 6,- Ty'N K -1 A; 6 /--eH SwMC' Specify color of color thru tile: Submittal Fee $ _ Scanning Fee $ Technology Fee $__ Structural Reviews $ C- o Permit Fee $ Cl� Radon Fee $ Training/Education Fee $ CCF $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ / C3 CO/CC $ (Revi,vd02/?•1/20I,',) I Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City St.ite Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that if separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuonre of a building permit with an estimated value exceeding 52500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which orcurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature j OWNER or AGENT The foregoing instrument '.vac, acknowledged bchire me this 28 day of September 20 18 by Aneila Shaheed who.i' per,onally knovin-to me or who has produced identification and who did take, an oath Sign a t u re --------" T� CON7 RAC:"fOft the foregoing instrument was ,i(.knowledged before me this I day of D 20 /4 by __(�►p� �a2(�Gt��, who is persomlfy known to me of who has produced identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1�1 Sign: �"� %'--- - Sign:_ Print: Simone Mattar Print: „p,, t Seal: .'' ;•, Sf1�10.JE I\•t�NTTAR Seal- :St.tt,: „i rfoilda-Pj �r„I F'uLhc �cml:nlssion r1 CiG 2 i 11Nt3 i �VCif.1'' • I�Ji o y Co -mission Extnru ; May 15. 2022 APPROVED BY Ei ll lcl __ Plans Examiner Structural Review rf, N a�••.n"•.,, -ANA.UBAIRD ` (Try Public - State of Florida • Commission ,r GG 046432 ;= My Comm. Expires 2020 naaDe�uIc(n1t3aa. l�S1 o+.9'4*>F•i ,F#t 44♦ ttt#####4 Zoning Clerk (Revised02/2.1/20 t •: ) CERTIFICATE OF LIABILITY INSURANCE14�1101=018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A staterrlerd on this certificate does not confer rights to the certificate holder in lieu of such endorseme s PRODUCER Jamerson McLean Corporation P.O. Box 621149 825 Executive Drive Oviedo FL 32762 MILeT Billie Tucker PHONE 800.399.8640 F'I'x 407-36N508 L blilleffimcleaninsurancecorn AFFORDING E mugm A: United States Fire Insurance Company 21113 INSURED Sungas Corporation of Florida Sungas Services Company, Grill N Propane 295D N.W. 24th Street Miami FL 33142 • Zenith Insurance Company00984 INSURER C INSURER D INSURER IINSURERFe COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ImLTR TYPE OF INSURANCE POLICY NUMBER ftyMaOMW EFF POLICY D� LIMITS A GENERAL LureurY X COMMERCIAL GENERAL LIA wrry CLAIMS -MADE X❑ OCCUR 506494645-7 09M3018 09fi31i019 EACH OCCURRENCE A 1000 000 DAMAGE TO RENTED r) ExP one 100 000 000 PERSONAL & ADV RVURY $1000 000 GENERAL AGGREGATE 000 = GENT TE LIMIT APPLIES PER: X POLICY PRO- POLICY PRODUCTS - COMPIOP AM $000,1NO i A AUTOMOBILE LIASIU[TY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIREDAUTDS X NON -OWNED 506.894645.7 M312018 09103019 oowrewr� SINGLE LnJrr 1000 000 BODILY INJURY (Per petmn) S BODILY INJuRY (Per accident) s PROPERTY DAMOWE $ i A X UMBRELLA LIAR 10=55 Lure X OCCUR CLAIMs.MADE 523.808926.2 0910312018 09J0M19 EACH OCCURRENCE 0,000,000 -AGGREGATE s4,00,000 X I RETENnoN0 s B WORKERS COMPENSATION AND ANY EMPLOYERS'LII BILSTYIF OFFx eri1l,EMeEx IXCLUDED7 PwWe ovy in NH) tr under OF OPERATIONS below NIA ZM182716 09103=8 091=19 105- E.L. EACH ACCIDENT $1.000 000 E.L. DISEASE - EA EMPLOY 1000 000 E L DISEASE • POLICY LIMIT 1000 000 A INLAND MARINE 506494645-7 09V0312018 003019 Scheduled Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Auac6 ACORD 101, Additional Rwnwks Sehsdule. N man space Is roqui'eM LOG 13545 LP GAS CONTRACTOR rFRTIFIr-ATF HALnFR CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELMMED IN 10050 N.E. 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE K> Fax' 305 7Wa72 019W2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: LGO1847 Business Mailing Address SUNGAS CORP OF FLORIDA 2950 NW 24TH ST MIAMI, FL 33142-7090 Licensed Location Address SUNGAS CORP OF FLORIDA 2950 NW 24TH ST MIAMI, FL 33142-7090 The above -named business has complied with the registration requirements of Chapter 527, Florida Statutes. Each business location of a company must be licensed. AN LP Gas licenses must be renewed annually, or take advantage of the new option to renew up to three (3) years. Any license that expires is considered to be inoperative and could be subject to penalties and/or fines. Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proof of licensure to any consumer, owner, or end user upon request when engaged in the business of servicing, testing, rao idng,*i, maintaining or installing LP Gas systems and/or equipment. A COPY OF THIS LICENSE SHOULD BE RETAINED FOR YOUR RECORDS. For future correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed location address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-5700 Cut Here State of Florida Department of Aqricuiture and Consumer Services Division of Consumer Services License Nurllber: LGO1847 Bureau of Liquefied Petroleum Gas Inspection Effective Data: September 1, 201a (850) 921-1600 F-rpIratton Oats: August 31.2019 POST LICENSE Tallahassee, Florida CONSPICUOUSLY Liquefied Petroleum Gas License LP GAS DEALER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license is issued under authority of Section 627.02, Florida Statutes, to: SUNGAS CORP OF FLORIDA 2950 NW 24TH ST ADAM H. FUTNAM MIAMI, FL 33142-7090 COMMISSIONER OF AGRICULTURE Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 3239"700 License Number: LG13545 Business Mailing Address SUNGAS SERVICES COMPANY 2960 NW 24TH ST MIAMI, FL 33t42-7008 Licensed Location Address SUNGAS SERVICES COMPANY 11710 WILES RD CORAL SPRINGS, FL 33076.2169 The above -named business has complied with the registration requirements of Chapter 527, Florida Statutes. Each business location of a company must be licensed. All LP Gas licenses must be renewed annually, or take advantage of the new option to renew up to three (3) years. Any license that expires is considered to be inoperative and could be subject to penalties and/or fines. Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proof of licensure Wany consumer, owner, or end user upon request when engaged In the business of servicing, testing, rejAidng, maintaining or Installing LP Gas systems and/or equipment. A COPY OF THIS LICENSE SHOULD BE RETAINED FOR YOUR RECORDS. For future correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed location address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services P.O. Box 6700 Tallahassee, Florida 32399-6700 Cut Here State of Florida Department of Agriculture and Consumer Services Division of Consumer Services License Nwfter. LG13MS Bureau of Liquefied Petroleum Gas Inspection Eff dW 15ata: September 1, 2018 (860) 921-1600 Expiration Date: August 31, 2019 POST LICENSE Tallahassee, Florida CONSPICUOUSLY Liquefied Petroleum Gas License LP GAS DEALER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license Is issued under authority of Section 527.02, Florida Statutes, to: SUNGAS SERVICES COMPANY 11710 WILES RD ADAM H. PUTNAM~ CORAL SPRINGS, FL 33076-2159 COMMISSIONER OF AGRICULTURE 0 e f • , 0I M2 Local Business Tax Receipt Miami -Dade County; State of Florida —THIS 15 NOTA BILL —DO NOTPAY 274738 EL, B BUSINESS NAME&OCATION RECQIPr NO. SUNGAS.COW OF FLORIDA RENEWAL EXPIRES 2950 NW 24TH ST 274738 SEPTEMB R 30, 2079 MIAMI FL 33142 Must be displayeer at pleoeof bushee% Pursuant to County Code Chapter &A — Art, 9 & to OWNER 8*C. TYIM OF BUSINESS SUNGAS CORP OF F.LK'! 205 DEAtERlDISTRIINSTALLATION PAYMENT RecimiD 000003137 By rAx COLLACTOR $450.00 07/09/2018 CHECK21-18-060336 r This Lood Bwiness Tarr Receipt only eotdirms peymera of the Local Business Tax. The Rebsiprh not a Romeo, . permit era certification of the haidees gqmMke at%to do hindhoaa. Holder musest comply with any povermuenfal or nongovernmental repulatory lows and requirements which apply to the busins. The RECEIPT NO, Am mudUdlipfayed on all commercial vehicles —MIaW—Dads Code Sec sa-276. For more lrrformation, visit WNWA