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MC-16-1072 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-257290 Permit Number: MC4-16-1072 Scheduled Inspection Date: May 23,2016 Permit Type: Mechanical -Commercial Inspector: Perez,JanPlerre Inspection Type: Final Owner: , Work Classification: Repair Job Address:9601 NE 2 Avenue Miami Shores, FL 33138-2721 Phone Number (954)348-0479 Parcel Number 1132060134060 Project <NONE> Contractor: PETRO SOLUTIONS Phone: (305)883-8687 Building Department Comments REPLACE EXISTING FUEL DISPENSERS Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-Inspection fee is paid May 20,2016 For Inspections please call: (305)762-4949 Page 15 of 36 petro Per ,.Gustavo Aristizaba 15970 W.State Road 84 .' Sunrise, FL 33326 954-295-6926 Mobile 954-389-5 Z PetroPer �t.����:,. 33��::.-€ ��-' S.: 3 r £ rpt" � 3• •� - • Miami Shores Village 3 3€ 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 10126/2016 ,.i!}� ,:'!_ ted:��}. �• >.3;.3 Project Address Parcel Number Applicant 9601 NE 2 Avenue 1132060134060 Atlantic Oil Incorporated Miami Shores, FL 33138-2721 Block: Lot: Owner Information Address Phone Cell Atlantic Oil Incorporated 1308 E Atlantic Boulevard (954)348-0479 Pompano Beach FL 33060- 1308 E Atlantic Boulevard Pompano Beach FL 33060- Contractor(s) Phone Cell Phone Valuation: $ 20,000.00 PETRO SOLUTIONS (305)883-8687 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:REPLACE EXISTING FUEL DISPENSERS Inspection Type: Classification:Commercial Final Approved:In Review Review Electrical Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Scanning:8 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $12.00 Invoice# MC-4-16-59487 DBPR Fee $9.00 04/28/2016 Credit Card $624.00 $50.00 DCA Fee $9.00 Education Surcharge $4.00 04/21/2016 Credit Card $50.00 $0.00 Permit Fee $600.00 Scanting Fee $24.00 Technology Fee $16.00 Total: $674.00 In consideration of the 'ssuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and i conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELEC C PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID I : 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 z 'n Futhermore,I authorize the above-named contractor to do the work stated. April 28,2016 Authorized t Ignature:Owner / Applicant / Contractor / Agent Date Building 0epaftment Copy April 28,2016 1 1 STER MECH Miami Shores Village711 Building Department APR 201 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 - INSPECTION LINE PHONE NUMBER:(305)762-4949 S M glI 1� F``B/IC 20114 BUILDING cAtL V pj Master Permit No. PERMIT APPLICATION Sub Permit No. F-IBUILDING F-1 ELECTRIC F-1 ROOFING Ej REVISION EXTENSION ORENEWAL F-JPLUMBING 0 MECHANICAL PUBLIC WORKS E] CHANGE OF CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9601 NE 2 AV City Miami Shores County Miami Dade Zip: 33138 Folio/Parcel#: 11-3206-013-4060 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ,AN-,c ew /Mc ql�- 3ti�-c�ti3q OWNER:Name(Fee Simple Titleholder): INC Phone#: Address: 9601 NE 2 AVENUE City: MIAMI SHORES State: FLORIDA Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: PETRO SOLUTIONS Phone#: 305.883-8687 Address: 5200 NW 77TH COURT City: DORAL State: FLORIDA Zip: 33166 Qualifier Name: PHILLIP A LEE Phone#: 305.883 .8687 State Certification or Registration#: PCC1256883 Certificate of Competency#: DESIGNER:Architect/Engineer: JORGE FIALLO FIALLOI S M DESIGN Phone#: 305.877.1845 Address: 10010 SW 83 ST City: MIAMI State: FL Zip: 33173 Y Value of Work for this Permit:$ `o® Square/Linear Footage of Work: Type of Work: ElAddition ❑ Alteration ElNew Ix Repair/Replace ❑ Demolition Description of Work: REPLACE EXISTING FUEL DISPENSERS Specify color of color thru tile: Submittal Fee$ ��` Permit Fee$ CCF$ CO/CC$ Scanning Fee$ dr3 Radon Fee$ DBPR$'rm Notary$ Technology Fee$ 1 r.' C Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$62 s (Revisedo2/24/2014) `bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 a 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 Issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a cop a the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to c ent Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w rs seven (7) days after the building permit is issued. In the absence of such pasted notice, the inspection will not be d a reinspection fee will be charged. Signature Signature O � ER or AGENT CONTRACTOR The foregoing rument was acknowledged before me this The foregoing instrument was acknowledged before me this 7 day of AP C.,'/ 20 /6 ,by day of ePl L '20 1 ,by MAHMOUD SHEHADEHIs personally known o PHILLIP A LEE who is personally knownto me r who has produced as me who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1r1111u,,1 .�`'`p;DY J.Act Sign.-- Sign:/ �. •'�pMl3S • F ; Print: O% Prin 4,�9 �PµY AVB,, Seal: '?g:� CLAU •*= Seal: P° ��"�: Notary Public-State of Florida My Comm.Expires Apr 25.2016 �'!l �.`� a"�ylF ,o?°'� Commission#EE 192609 APPROVED BY Plans Examiner Zoning IJ Structural Review Clerk (Revisedo2J24/2014) 006911 mgil ,� � x y C§ t o � z r +` - � C .>;, s u✓ . ry„�G� K .Y a '. sr 1= { ,��, �`s »- ♦ d'; °✓i sa.�Ks. Y +X `• �, Y r kjy �y �i i, �i`2:4 �f ,� r hY ii r t U', x vk a:�,., t ti �,,+<, ✓"�? „a. F �, '��< d .ti �"it +`f ` � - '�.�'a *,`�s� %�y*�����✓;.:��.r����SNF Y�.°, w�:`,�. �tv S, v c�' �,���'s ✓r �d..t�„�,.x� ,,�,v � � � �' `.�b e � ,t �@.�i'i�'s'�,r 'f .�tk�, �� ✓` ".. �{ - 1 ssa .�:: y m. { �' 1 rr n`'. '' $' ✓ � �, ant ., `WWI on z�+tt,�ry'}, .r�2 nn ,t, .,,,l.�p � .fir'-��§�� ',�.�.M��'�',�'�:'�y 3x„����r� ,r �.£� fry" �,. � '�2':�`�;a C�„+"� �, ,, ,��.�,� F.,•+' .5: ° 'y ;���, zrr • � 'Y, x,.YCY ,7 �, i^.�S c� `,..*�,x.' .1 '� ,,.� { a`; *�' v,�, i- r� r., s <y',i 'c ��'` c�}�' Th`atw��,_E�"�'�'t����eu ori'" wx��� ag1 "�{iF'�;,����'` �� �.�`"t,.s,.�?✓ m�+� ,2 .Fs. ...:.J:kr Y;,:v'.' "�_.� �.: ��``�,raSi z',`�'����''r w'� v,� �vw �.� ,%2`fi.a�``7 � ,�. ''✓ ' di �'`�,.�,� 'h� � "`"�`.: '3Yr _ � S � r` �� ,„�rv�� 3"". �j'4-.�,✓�, ro r' �✓,�:. }.tZt,, ,r�rz�``���y.�k ,k'�z�'�"`r r F� �✓ �`�",t rt'*�.�s�ti: "' � 'Y z "`' �:.>���i�.,wr3� �Ya, �'�', ,�'t} '�� v,q-' � �I ,�y'r_:; :f ✓J ` h �.v,''� �S`"•Y r��� ,`a v� � a.cog �,L�3 .�,. '"K r s`�� _E 4"rf��A"' ':L'�a 'i,1 ,r, ,y, r� ✓ �'�` �� M` .ter.✓ �* �s z✓ . k M .,....,?.; .z '' xr E r✓. �xt*^��K �` <c 'n"t a ., xa v � � .:`-` _' ' `ice � n DWNE f u ft; ar $EC E OF' +A, 1T £ r�. EGE+i oloQg sauINC ass SP > Ey� cM 2 - 45.0077 CIT5— 0w 5rr.>, 176, r n a,'c Tit tRusin facet t BusWON Tax.Tire R k is not a t nse, +moi ho O V Hold [ g any gov�gtai , k awry toCUBQuire�rt00 iRo 60 fila li t � NO,-8 ust r d on all rciai= los 276 ✓ '� �Q S r� 006992 b 6 C s' T' 's i' 1 N01 N'kRyLL0, 0�PAY u F')? -v Wip, t1144tt F\F,n'"n R Ri�tY�``` _ E1t iM k ♦ X y''�t v, :,,r A. tS 1' \ ,kt.....C Z 4'0� 1 OVitNE t. ! SEC.TajOE OF 13UOIIb1E8l� PAYMEtTitsCElrI OIaiQN M. KHANT SOLtJ��I �INC 196 SUf�=GENEFIAL BLt�r�G�3I� C�DIx �TAX a uEcrnR ikeUt` 3 °r '{CBc1257 '32 5.00 01091204 5 * R£DITC tD-15-0,35176 Th Iia l t3usine T atilt o nfin pa f�testg �eLti t Busiaets Tax. The ReO is aot a Il ene. p�in�,o�'a oettifiq �f�e holt s uatificatita�4�1 . HoMe��at�t aa�ARt� any govse�t t regairereats ltt a ►i the b 4}` MST N0.ae�e3ntast be�hed oa all snercial ve �ctes—AAlati=lda1 8e- . Foxafion,�l ,_.. ................................._ ......._. . i i i 8 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF f LORIDA DEPARTMENT Of U&DESS AND PRaFE88I0NAI_ACULATIAN y I t 1 IDUSTRY LICENSING:80 k ? s N ;.x r m � doe eF QLLU�AI11 S`OM E,$1�STEMS QON �; r POP N d b: 0 w,I:S CERTIFIER S e ow " UteyravI�ns,e# per FS, do AU AU �^Y" �1�5•r.>�. �. '� a�� � � TRtSaTN . 5� ��� v^�(��,. � *k. \ � "�*✓`KL�� a "+K 3, � Ate'� a« x � K :� � Z '� ❑ • s , ..:r ,N ISSUED: 07/2M014 ISPI RYAS REQUIRED BY LAW SEQ# L1407280001194 __.... RICK SCOTt GOVERNORKEN LAWSON, SECRETARY w�.,«2r--rs �v-r w ✓A .. QF FLORIDA .; DEPARTMENT aF:�UIIESS AMD PRaFEI+(}MAL.REGUI.ATION R CONST -0T I>tiIDU6 ..RYI IC LASING QA a a yq TO UiLi1N CQNTt�ACTOR � . aloes.-IS CERT MED*" ,. 1� ME ✓� F' tw'1.. r�.'�.!xG".•I �R +>•+r L. ;[l0Q 1((n``r��"-hh�� "z yin ,v. �Ka av,y v. �4�" ,.,�. <�,� ,, r r gym, ` �� ''� `b� x�T"L •r .� ,�c �..m �3 '� '�" ,1 na; .,.+sry, �d as r, �x r. ". a`Ra�`"?, maw �g �• >4. . 4. ,�s �`,:� ,a�`�x,✓''"^�. �0��4:����'a�ae2,"'" s k"�� ,� .., .,"i,;0.. x � �..., M.,... � � ' � nw�s„ ' ��z "`c�gd`:,_ � g 4� ,�!"� �' ,�" ���qa .y:s�a � y( a t;as ..yw, 3`+"1',);4u4� �' t.,��-, �3'�4;s4 �x,,��* ",��i� x`3 k>`' .�`[��' ��`"`��� ��, ® _ ■ �. " � tea•' g g h � � � i�,. \. /25 ..�.`., Mwr.�n. ,.�A,. >✓.;',r; � ad#'ru.'uww.,+:a�$.. n:»a,5, ISSUEM 07/28/2014 DISPLAY AS REQUIRED BY LAW - SEQ# 114072WO00801 llc. REO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/13/2016 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 policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ME cT Lindsi Gainey ext 311 BB Insurance Marketing Inc PHONE 888-728-0817 FAx .954-452-0450 10167 W Sunrise Blvd,3rd Floor Plantation FL 33322 E-MAIL ADDRESS:Lindsi@bbimi.com INSURER(S)AFFORDING COVERAGE NAIL 0 INSURERA:Rockhill Insurance Company 28053 INSURED ORION-5 INSURER B:Ma fre Insurance Company of FL 34932 Orion Merchant Solutions,Inc. INsuRER c:Zenith Insurance Company 13269 DBA Petro Solutions&Petro Solutions,LLC. 5200 NW 77th Court INSURER D: Doral FL 33166 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:161860224 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 CONTRACT OR 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. INSR TYPE OF INSURANCEADDLBUBR POLICY EFF POLICY EXP LIMTfB LTR INSD V4VD POLICY NUMBER D A X COMMERCIAL GENERAL LIABILITY ENVP001415-03 3/4/2016 3/4/2017 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTEff- CLAIMS-MADE FX OCCUR PREMISES Ea $50,000 MED EXP Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY El SECT F LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILJTY4150150011776 7/25/2015 7/25/2016 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) AALL UTOSS AUTOSU� BODILY INJURY For accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WOR103R8 coMPENSATION Z127425301 10/10/2015 10/10/2016 x I PER AND EMPLOYERS'LIABILITY STATUTE ER Y ANY PROPRIETORIPARTNERIEXECUTIVE ❑ 00 NIA EL EACH ACCIDENT $1,000,0 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEd$1,000,000 If esunder S6describeDRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 A Poliuflon E1415-03 3/412016 3/48017 Aggregate 2,000,000 Occurrence 2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Wholesaler&maintenance contractor for service station equipment and credit card processing company with locations at 5200 NW 77th Court Doral,FL 33166,7781 NW 52 St.Doral,FL 33166 and 1494 NW 78th Ave.Doral, FL 33126. PCC1256883 BC1257332 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILI_ BE DELIVERED IN Miami Shores Villages Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores FL 33138 AUTHORIZED RESENTAME ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ilk CFH :2 01fslr 8077$9? OR SK 29954 Pss 2113--2114 Mss) RECORDED 0210812016 14=44913 DEED DOC 'FAX $19Y200.00 Return to: SURTAX $141400.00 Leonard Oshinsky,Esq. HARVEY RUVIND CLERK OF COURT Leonard Oshinsky,P.A. IIIANI-RADE COUNTYr FLORIDA 350 East Las Olas Boulevard,Suite No.970 Fort Lauderdale,Florida 33301 Instrument Prepared By: Christopher P.Kelley,Esquire Christopher P.Kelley,P.A. 11098 Biscayne Boulevard,Suite 205 Miami,Florida 33161 Folio No.11-3208-013-4060 WARRANTY DEED , THIS INDENTURE, Made this q 7q day of /e fir"!:,Z , 2016, Between MIAMI SHORES SERVICE STATION, INC,, a Florida corporation, GRANTOR, and ATLANTIC OIL INCORPORATED, a Florida corporation, whose post office address is 1308 East Atlantic Boulevard Pompano Beach, Florida 33060, GRANTEE, WITNESSETH, That said GRANTOR, for and in consideration of the sum of Ten and 00/100 Dollars, and other good and valuable considerations to said GRANTOR in hand paid by said GRANTEE, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said GRANTEE, and GRANTEE'S successors and assigns forever, the following described land, situate, lying and being in Miami-Dade County, Florida to-wit: Lots 11, 12, 13, and 14, Block 30, an Amended Plat of MIAMI SNORES SECTION NO. 1, according to the map or plat thereof, as recorded in Plat Book 10, at Page 70, of the Public Records of Miami-Dade County, Florida. SUBJECT TO: Covenants, restrictions, and public utility easements of record, if any; taxes for the year 2016 and subsequent years; existing zoning and governmental regulation. and said GRANTOR does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. IN WITNESS WHEREOF, GRANTOR has caused these presents to be executed Page 1 of 2 OR BK 29954 PG 2114 LAST PAGE Warranty Deed Miami Shores Service Station,Inc.0 Atlanto Oil Incorporated in its name and its corporate seal to be affixed by its proper officer thereunto duly authorized, the day and year first above written. Signed, seated, and delivered in our presence: MIAMI S ES SERVICE STATION, INC., a Flori a c r oratio By: s signature C S bRLANDI III President 13677 Caloosa Boulevard 14Palm Beach, Florida 33418 Print i fitness signature Print STATE OF FLORIDA ) COUNTY OF MIAMI-DADE I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared CHARLES ORLANDI III, as President of MIAMI SHORES SERVICE STATION, INC, a Florida corporation, who produced � �>fealoi as identification, and who executed the foregoing instrument and he acknowledged executing the same freely and voluntarily, under authority duly vested in him by said corporation and that the seal affixed thereto is the true corporate seal of said corporation. , Witness my hand and official seal in the County and State last aforesaid this day of February, 2016. h000 W. 6�, O ARY PUBLIC, Mate of FLORIDA at Large My Commission Expires: LEONARD osHINSKY PNOTARY PUSUC Page 2 of 2 STATE OF FLORIDA Comm#EE167994 Expires 4/18/2816 2/23/2016 Property Search Application-Miami-Dade County f E S it Address Owner Name Folio SEARCH: 9601 ne 2 av Suite Q Back to Search Results PROPERTY INFORMATION Folio: 11-3206-013-4060 Sub-Division: MIAMI SHORES SEC 1 AMD Property Address 9601 NE 2 AVE Miami Shores, FL 33138-2721 Owner MIAMI SHORES SERVICE STATION INC Mailing Address 9601 NE 2 AVE MIAMI SHORES, FL 33138-2721 Primary Zone 6400 COMMERCIAL-CENTRAL Primary Land Use 2626 SERVICE STATION : SERVICE STATION-AUTOMOTIVE IL http://www.miamidade.gov/propertysearch/#/ 1/8 2/23/2016 Detail by Entity Name L � Detail by Entity Name Florida Profit Corporation MIAMI SHORES SERVICE STATION, INC. Filing Information Document Number 692682 FEI/EIN Number 59-2107247 Date Filed 06/26/1981 State FL Status ACTIVE Last Event NAME CHANGE AMENDMENT Event Date Filed 08/23/1996 Event Effective Date NONE Principal Address 9601 N.E. 2 AVENUE MIAMI SHORES, FL 33138 Mailing Address 9601 N.E. 2 AVENUE MIAMI SHORES, FL 33138 Registered Agent Name & Address CHRISTOPHER P. KELLEY 11098 BISCAYNE BLVD., STE 205 MIAMI, FL 33161 Name Changed: 01/22/1997 Address Changed: 01/22/1997 Officer/Director Detail Name & Address Title VPS SUZETTE ORLANDI 13677 CALOOSA BLVD PALM BEACH, FL 33418 Title PD CHARLES ORLANDI III http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=MIAMI SHO... 112 2/23/2016 Detail by Entity Name 13677 CALOOSA BLVD PALM BEACH, FL 33418 Title TD ORLANDI, MARK 9601 N E 2 AVE MIAMI SHORES, FL 33138 Annual Reports Report Year Filed Date 2013 01/15/2013 2014 01/30/2014 2015 01/10/2015 Document Images 01/10/2015 -- ANNUAL REPORT View image in PDF format 01/30/2014 -- ANNUAL REPORT View image in PDF format 01/15/2013 -- ANNUAL REPORT View image in PDF format 01/06/2012 -- ANNUAL REPORT View image in PDF format 01/25/2011 -- ANNUAL REPORT View image in PDF format 02/18/2010 -- ANNUAL REPORT View image in PDF f . - ---_—_�- -_— rmat ..o 03/24/2009 -- ANNUAL REPORT View image in PDF format 02/01/2008 -- ANNUAL REPORT View image in PDF format .........._._._..-- 04/25/2007 -- ANNUAL REPORT View image in PDF format 03/07/2006 -- ANNUAL REPORT View image in PDF format 04/18/2005 -- ANNUAL REPORT View image in PDF format 04/28/2004 -- ANNUAL REPORT View image in PDF format 05/09/2003 -- ANNUAL REPORT View image in PDF format 04/02/2002 -- ANNUAL REPORT View image in PDF format 04/28/2001 -- ANNUAL REPORT Viewimage in PDF for ...—..�.._ —_. ......._ ...... 04/25/2000 -- ANNUAL REPORT View image in PDF format j 03/10/1999 -- ANNUAL REPORT View image in PDF format 03/24/1998 -- ANNUAL REPORT View image in PDF format 01/22/1997 -- ANNUAL REPORT View image in PDF format 02/19/1996 -- ANNUAL REPORT View image in PDF format 02/17/1995 -- ANNUAL REPORT View image in PDF format 0:oovdaht ( and Priv cv Policies State of Fcr da,Depattmetlt .^,`Stat.: http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=l nitial&searchNameOrder=MIAMISHO... 212 4/20/2016 Detail by Entity Name h Detail by Entity Name Florida Profit Corporation ATLANTIC OIL INCORPORATED Filing Information Document Number P15000003250 FEI/EIN Number 47-3112517 Date Filed 01/09/2015 State FL Status ACTIVE Principal Address 1308 E. ATLANTIC BLVD. POMPANO BEACH, FL 33060 Mailing Address 1308 E. ATLANTIC BLVD. POMPANO BEACH, FL 33060 Registered Agent Name & Address OSHINSKY, LEONARD 350 E. LAS OLAS BLVD. SUITE 970 FORT LAUDERDALE, FL 33301 Officer/Director Detail Name & Address Title D,P SHEHADEH, MAHMOUD 1308 E. ATLANTIC BLVD. POMPANO BEACH, FL 33301 Title D,S SHEHADEH, AHMAD 1308 E. ATLANTIC BLVD. POMPANO BEACH, FL 33301 Title D/T Hamed, Taher http://search.sunbiz.org/Inquiry/Corporati onSearch/SearchResultDetail?inqui rytype=EntityName&di rectionType=Initial&searchN ameOrder=ATLANTICOIL%20... 1/2 17/2016 Miami-Dade County Building Department e-Permitting Search: _ f it MIAMI DARE MUNICIPAL INSPECTION REQUIREMENTS AND RECORD 04/07/2016 MUNICIPAL NO.2016-035368 FOLIO: 1132060134060 JOB SITE ADDRESS 9601 NE 2 AVE PROPOSED USE GAS/SERV STATION/AUTO REPAIR/CAR WAS /REPLACE 4 DISPENSER LEGAL MIAMI SHORES SEC 1 AMD PB 10-70 LOTS 11-14 INC BLK 30 ! APPLICATION TYPE REPAIR 0 SQFT 1 UNITS 1 FLOORS C 16 _ 42 OWNER NAME MIAMI SHORES SERVICE STATION INC �� CONTRACTOR ORION MERCHANT SOLUTIONS, INC QUALIFIER LEE PHILLIP A PERMIT TYPE MUNICIPAL MECH APR ��+ CATEGORIES 0009 MUNICIPAL GAS TANK AND PUMP DATE: 4/07/2016 PROCESS NUMBER: M2016007077 NEW*AMOUNT PAID 277.60 kms, / DERM 1 UGT REPAIR/MO 265.00 DERM 1 UP FRONT FEE-80.00 DERM 1 MIN COMM REV(90.00 FIRE 18500 ALTERATIONS & 117.00 FIRE 1 ABOVE/BELOW G 114.40 UPMU 1 UPFRONT FEE F 25.00 4/ 7/2016 16:49 BNZWEB1 181604071294 WEBIPAS 277.60 MUNICIPAL INSPECTION REQUIREMENTS AND RECORD 04/07/2016 MUNICIPAL NO.2016-035368 PROCESS NO. M2016007077 FOLIO: 1132060134060 JOB SITE ADDRESS 9601 NE 2 AVE PROPOSED USE GAS/SERV STATION/AUTO REPAIR/CAR WAS /REPLACE 4 DISPENSER REQUIRED INSPECTIONS INIT DATE FIRE 0009 FIRE-ABOVE/BELOW GROUND TANKS 209 FIRE FINAL �..� . . 0000 0000.. .. 0000 0000.. 0000 0000% 0000.. 0000 .. MUNICIPAL INSPECTION REQUIREMENTS AND RECORD 04/07/2016 ' 0000 . .. 0000. MUNICIPAL NO.2016-035368 PROCESS NO. M2016007077 FOLIO: 1132060134060 0000.. ..:..� JOB SITE ADDRESS 9601 NE 2 AVE0 .. .. 0000.. PROPOSED USE GAS/SERV STATION/AUTO REPAIR/CAR WAS /REPLACE 4 DISPENSER 0000.. . . . TO SCHEDULE A FIRE INSPECTION, PLEASE VISIT THE WEB AT ""." 0000.. WWW.MIAMI DADE.GOV/BUILDING OR WWW.MIAMI DADE.GOV/FIRE. YOU WILL """ .. 0 0000 0 0 NEED TO PROVIDE YOUR TEN DIGIT MUNICIPAL INSPECTION NUMBER AND ' ' INSPECTION TYPE. THE INSPECTION TYPE CAN BE FOUND ON YOUR INSPECTION REQUIREMENTS AND RECORDS CARD. IF YOU HAVE ANY QUESTIONS OR CONCERNS REGARDING AN INSPECTION, SCHEDULING A PRELIMINARY INSPECTION, OR LOAD BANK TEST INSPECTION, PLEASE CALL FIRE PREVENTION AT 786-331-4800. IF YOU HAVE ANY QUESTIONS OR CONCERNS REGARDING A PLAN REVIEW, PLEASE CALL FIRE ENGINEERING AT (786)315-2771. http://egvsys.co.m i am i-dade.fl.us:1608/W W W SERV/ggvt/BNZAW 922.DIA?PROS=M20160070T7 1/2 I "7/2016 Miami-Dade County Btdiding Department -BE ADVISED THIS IS NOT A PERMIT. PERMIT IS TO BE ISSUED BY )UR CORRESPONDING MUNICIPAL BUILDING DEPARTMENT. 4 Back to Main Menu BLDG Home Pace I BLDG Main Menu I BLDG Permit Menu I BLDG Plans Processing Menu I Insoedon Types I Address Fomat Home I A§W I Phone Directory I Privacy E-mail your comments,questions and suggestions to Webmaster This page was last edited on: February23,2004 Web Site®2004 Miami-Dade County. AU rights reserved. .. 0000 • • 0000 0000•• •• • 0000 • 0000•• 0000 0000•• 0000•• • • • 0000•• 0000 •• • • • 0000 • •• 0000• 0000•• • • 0000• • • 0000•• •• •• • 0000•• 0000•• • • • • • • • 0000•• •••••• 0*00 •• • 0000 • • • • • httpJ/egvsys-co.miami-dade I.Lis:l6Oa W W WSERV/ggvUBNZAWW-DIA?PROS=M2016007077 2r2 1A�It MIAMMDUM eeeEm ��to PLAN REVIEW AND DEVELOPMENT APPROVALS DIVISION ENGINEERING SECTION UST SYSTEM CONSTRUCTION PLAN APPROVAL CONDITIONS Date: April 7, 2016 PC#: M2016007077 Facility: MIAMI SHORES MOBIL DEP#: 8505412 Address: 9601 NE 2 AVENUE UT#:0437/File#:6380 Miami Shores, FL 33138 Folio # 11-3206-013-4060 Approval is hereby granted for Underground Storage Tank (UST) modifications as following: • Replacement of four (4) dispenser with new GASOLINE WAYNE OVATION DISPENSERS (3+0) Product Dispensers set atop of existing dispenser sumps (no underground work, work inside dispenser sump). New Emergency Shut- offs/Shear valves to be properly secured and level with top of fuel-island, as shown on detail. Piping run and design to remain the same, and sloped back to the tanks. All equipment to be installed will be FDEP approved. All other existing equipment and required equipment (i.e., tank systems & equipment and existing compliance monitoring wells) will remain the same. The following conditions are hereby incorporated as part of the construction plan approval granted by the Office of Plan Review and shall supersede the scope of work proposed in the approved plans if discrepancies exist. Additional approval may be required from other DRER-DERM sections and other governmental agencies having jurisdiction over the facility. 1. An inspection must be scheduled with the DRER-DERM Storage Tank Program Inspection Coordinator at (305) 372-6600 two (2) business days in advaA8V4)f the000** inspection of any UST related excavation. At the time of the schedblod insp on all applicable components must be properly removed and readily--Jscessibs•for the..-:- inspection. •••••• ;....; .... . .. ..... 2. An original set of the most recent DRER- DERM approved AJST.plans must be.:.." maintained on-site for inspection throughout the construction procdtes. •••••• 3. All work, must be performed by a Certified Contractor possessing a.valid ond6rrel" ..., license as a Pollutant Storage System Specialty Contractor is9wed by Jtke;•FloridV"": Department of Professional Regulation. All work must be completed in ;t� o' rdance with the approved plans, The Certified Contractor shall insure that all manufacturers specifications, applicable requirements of Chapter 24 of the Miami-Dade County Code, Chapter 62-761 of the Florida Administrative Code, American Petroleum Institute Recommended Practice #1615, Petroleum Equipment Institute Recommended Practice #100, National Fire Prevention Association Standard #30 and any M2016007077 �� Page 1 of 2 AMI-DADS COUP EI RONMENTAL PLAN P.FV$E'a°d r � requirements imposed by the fire department or any other governmental agency having jurisdiction over the facility are followed. Additionally, the Certified Contractor shall insure that all applicable safety requirements are met. 4. If major changes to the approved plans occur during construction of the facility, modification plans showing these proposed changes must be submitted and be approved by the Office of Plan Review prior to the DRER inspection. Major changes include but are not limited to change in siting of underground tanks, change in piping material (i.e. flex to ridgid, ridgid to flex), piping layout affecting leak detection system. 5. Minor changes noted during an inspection may be subject to a plan modification submittal, based on the inspector's request. A re-inspection will not be granted until the approval of these modification plans is given by the Office of Plan Review. 6. The DRER recommends that all free floating product and/or other liquid waste exposed in an excavation be recovered and disposed of properly. The DRER recommends that all the excavated contaminated soil (as defined by Chapter 62-770, FAC, effective date September 23, 1997) not be returned to the excavation and be disposed of properly if the removal will significantly impact the restoration requirement of the site. 7. If undocumented soil or groundwater contamination is encountered during construction, a Discharge Report Form (Form 62-761.900 (1) FAC) must be submitted to this Department within 24 hours of discovery. 8. All liquid wastes must be disposed of by a DRER Permitted Liquid Waste Transporter within ninety days of recovery. Contact the DRER Liquid Waste Transporter or at (305) 372-6804 for more information. All storage tank system components removed must be properly cleaned and disposed of in accordance with American Petroleum Institute RP 1604 and National Fire Protection Administration 30. All petroleum contaminated soil must be disposed of in accordance with the applicable portions of Rule 62-770.300, Florida Administrative Code and the May 1998 issue of the Florida Department of Environmental Protection (FDEP) "Guidelines for Assessment and Remediation of Petroleum Contaminated Soil". Solid waste encountered during storage tank system removals must be disposed in accordange vjith ar%opprove�-,,-- DRER Solid Waste Disposal Plan within ninety days of excavatiorf.--' : :--- -. ...... .... ...... 9. A DRER Dewatering Permit must be obtained prior to dewaterJJ§:any 9 c'avatior;.-...: Contact the DRER Water Control Section at 372-6681. For sitft.v0h cotita"tnated.... groundwater, a pretreatment system will be required. C© $sq th1-POIIutiOR-:- Remediation Section at 372-6700 for additional information. •• •' ••'•:• 10. Within sixty days of the proper disposal of any free floating product and 6vt;Ufsively.... contaminated soils, submit to the DRER PRS all analyticals, receipts and And in�- an Interim Source Removal Report in accordance with Chapter 62-770, FAC" TFF cc:Sabrena Thomas-DRER M2016007077 Page 2 of 2 CFN:20160137616 BOOK 29988 PAGE 3333 DATE:03/07/2016 12:15:22 PM HARVEY RUVIN,CLERK OF COURT,MI/-RADE CTY NOTWE OF COMMENCEMENT A MWM ter WW BE PUM 0910 JOB M ATTat{i£GF east 0JWW ;t PERNIfTpO, TAX FOLIO11-3206-013-4060 • STATE OF FLOR10k COUNTY OF MIAMI-BADE: THE UNOERSKWED harebY gives notice that&nplWOWAnts W:A bs matin to cadWn teat pr*Wty,ane to r=*f4L- a vAM Chapter 713.F>orfda Seaftfift tato bIlOWing rlotriWOr N provitted in thea Notice of SpAoe above Asa for use Of ting oases t.t.egat resin at property 9601 NE 2nd AV MIAMI SHORES Fl, 33138 r and somt/acdress: _HEX SHORES SEC 1,. _. 2 OesexiptRon of�r�Irovufrrtet>G _D 9PENSER NiIAHI SHORES SE I L �MI'A1�;l+5:?i'RE 3.OtaFltu tllime alta address: Cnne era addrgss of fee sl�%ge tt WkWde<: �. � IC}N_ MO -fes'' '� 3=6 and 4- 3 0 . tuunoer: .$ - _ ----r-- -�- 5.Suety:(Payment Mond rMAred by o1y tom contraotar,:r aryl •. . .••• Nems,mWoo 8 and pho w ruunber ..._ ,.__ •••--•t•• •••••• • Amount ptbwd� •s•••• • • • s.Lemieft rants and address MOM .._.. j ••• whom notions or odar docume•ttra '�served b3 • T Persons wNtLn the Stela Flor&!a dtlxi by OwTrern •••• • •• ••••• Sectwn 713.t3(1p)7.,Florida Statutes.H/A • • Name.acdress and numb: Oiem m deader the kUov*V pis)to mcetve a COPY of the LienoroNofto a s provkmd in Sect•on •• 8.in atOr►to hirr�, • • • 713.13(1)M FImWa Statutes. • • • • 6496% k me,address end;hors manbar: A ---- - .._.►.-- --•- -------or • 9.gxpimw date of th.s NofiW oe CommeneWrseris: _. �_---• _ s.- * !_ Fxa wV�ratkn Qom iD f year#aA am darn or eaeaWNa class•a t�Ie i6 i;peadsR WAWMa TOOWWk ANY PAymOTS MAW 8Y Tf 2 OWNER AFIEWINE EJWWA IGN OFT1`9 NOTICE OFG0MME VCWM IT ARF COWDEND tAAPROM PAYA+95NTS UNM GHAPTM 713,PART 4=TION?mm t AWMA$TATUM,.ANO CAN REMAX IN YOUR PAV"?WIC£FM mmovemmm TO YOUR PAOpEWY.A NOTUM OF COMMBICF.IMT W JST IS R1100RIM ANO PCTBD ON TKE.O$WE GEFOPLE TME- -M PECTKK IF You INTEND TO OR3TAiAt F*JPXWM CONIAIL?NTH YOUR t ENtIBt OR AN Ai^fOR�Y BEFORE COtJ}Mt?t�ihG tvQiilc OR RECORWNG Y06R NOT=OF CObAtW£ MW.NT SWAUNO)of )or - �i l OtEperNirector/PacatarNW01 er Print Name P"NWas- T4te/Otftea STATE OF FLORIDA COUNTY OF WAMI-WIDE .t,�!•a'tTr c j L r The before me ttue_-%0 day of y" �fNtput SY �� i for — -- -- � '5". ktmwn.or -3 produced the*ftwing type d dWentitieatlor: , j- 0 ` Signature of Notary Pubes: _. .... -• Pilot Namic Prepared by: : 4.ft `m Cs i •• VAVPICA Petro Pe_ I fsatie t else . U, ,t tmo. a hist and beael. 954.295.6926 �i,�� �.• :luau tf►9 in it ere into•!a rule tit of my Iato�dga "or (s)or Owrcr(s)-s AtNtated 0"kwj0mdwfiWtnwA&WaqW w W sWmd above: tatttt+ f�f`, yLr By ttla� •ws•a m