PL-18-2270 (3)r
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,, tSeal: .'' ;•, Sf1 10.JE I\•t NTTAR Seal-
St.tt,: „i rfoilda-Pj r„I F'uLhc
cml:nlssion r1 CiG 2 i 11Nt3i VCif.
1'' •
I Jio y Co -mission Extnru ;
May 15. 2022
APPROVED BY Ei lllcl __ Plans Examiner
Structural Review
rf, N
a••.n"•.,, -ANA.UBAIRD
Try Public - State of Florida
Commission ,r GG 046432
My Comm. Expires 2020naaDeuIc(n1t3aa. l S1 o+.9'4*>F•i ,F#t 44 ttt#####4
Zoning
Clerk
Revised02/2.1/20 t •: )
CERTIFICATE OF LIABILITY INSURANCE141101=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.
ImLTRTYPE 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 povermuenfalornongovernmentalrepulatorylowsandrequirementswhichapplytothebusins.
The RECEIPT NO, Am mudUdlipfayed on all commercial vehicles —MIaW—Dads Code Sec sa-276.
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