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SGN-16-595 --q a () L % �e Miami Shores Village EED Building Department - 04 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 `-- INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC20 BUILDING Master Permit No. SS��1 ��` ✓ t PERMIT APPLICATION Sub Permit No. QBUILDING ❑ELECTRIC ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING [:]MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9601 NE 2 Ave City Miami Shores County Miami Dade zip: Folio/Parcel#:11-3206-013-4060 Is the Building Historically Designated:Yes NO Occupancy Type: Load: ��C['o//nsst�ru�ction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder). /Yz " �� 'e- C i L -1NGOPhone#:�6/� ° //® Address:9601 NE 2 Ave City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: lil)OUI Phone#: Email: CONTRACTOR:Company Name: Donnie Bennett Lighting Maintenance Phone#: 561-688-1511 Address: 4645 Southern Blvd City: West Palm Beach State: Fl Zip: 33415 Qualifier Name: Donnie Bennett Phonne#: 561-688-1511 State Certification or Registration M.`ES 12000358 Certificate of Competency#: (Q"�j y DESIGNER:Architect/Engineer. �rF��:s `��i A`r�/ (� _,, Phone#:3w—s / 3!/ Address Imp Io 5&z4'f�c— \,-�t City: �t State: V=C- zip: Value of Work for this Permit.,$ ao Wil.�ly Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration KNew ❑ Repair/Replace ❑ Demolition Description of Work: Jt�1L, c'S `T Specify color of color thru tile: (� �y� Q Submittal Fee$ Permit Fee$ GOO-CD CCF$ ` '(SoCO/CC$ Scanning Fee$ Radon Fee$ • CA) DBPR$� Notary$ Technology Fee$ ®� Training/Education Fee$ 1-4, a) Double Fee$ Structural Reviews$ C Bond$ TOTAL FEE NOW DUE$_ (Revised02/24/2014) 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$25W,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 attac ent. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whit c s seven (7) days after the building permit is issued. In the absence of such posted notice, The inspection will not be appr e d a reinspection fee will be charged Signature Signat 0 NER or AGENT CONTRACTOR The foregoing' strument rwas acknowledged before me this TheforLegoing instrument was acknowledged before me this day of �.!rJ' ,20 by �' " darty of R20 /A by who is personally known to t-1101� who is personally known to me or WN?o hates produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC. NOTARY PUBLIC: Sign: tt Sign: P Print: W_ �6— Print: �✓ Seal: St41E�E(,�A . Seal: GIl6ERT S SL�eC G0.eEat State 0000411public- 01 Nodda pob11C- 19A085 + 4�'v"a'Me"'.� Nota(11 FF 191068 misalon 0 2019 ����` Pug��c,� Notate lselot►� ,2019 20 ,g Com dant . COm� lies Jan Rssn. = mm.ExPltas +�..+a•ss e�+��yas �+�+►..*�.r4.,�rars . r � n�•�.. APPR I/co o Plans Examiner Zoning Structural Review Clerk z (Revised02/24/2024) CFN 2016ROO77692 OR 8K 29954 Pss 2113-2114 Wss) RECORDED 02/08/2016 16 14:44p0 Return to: DEED DOC TAX $191200.00 Leonard Oshinsky, Esq. SURTAX $14 t 400.00 HARVEY RUIINY CLERK OF COURT Leonard Oshinsky, P.A. MIAMI--DADE: C OUNTY r 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.11-3206-013-4060 WARRANTY DEED THIS INDENTURE, Made this ' day of e fir-'G , 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 001100 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 SHORES 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 Atlantic 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, sealed, and delivered in our presence: MIAMI S ES SERVICE STATION, INC., a Floria c r oratio By: s signature cROCts bRLANDI III President � 13677 Caloosa Boulevard i,'th ! Palm Beach, Florida 33418 Print o� fitness signature 1'en'rxl' 1 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 ��vtyira, �1w_r �rcea 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. hw� 610 O ARY PUBLIC, Mate of FLORIDA at Large My Commission Expires: LEONARD OSHINsxY Page 2 of 2 NOTARY PUBLIC STATE OF FLORIDA Comm#EE167894 Expires 4/18/2096 `5 0 I ' also p�nM Miami Shores Village Building Department �loamA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRA TOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A.�OPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ■mm■■■sm■■■m■■i■ ■mm■mmmmmm�mm■R■ mm■mmmm■m■ ■■ ■■■■ ■■ ■m■mmm■ ■ ■■■mm■ ■mm■mm■■m■mmm 1 BUSINESS NAMEC : / BUSINESS ADDRESS: STATE ZIP BUSINESS PHONE:6b I I (Y� l `� FAX NUMBERLA 4 1 CELL PHONE 9 � QUALIFIER'S NAME:& QUALIFIER'S LIC NUMBER: � � 0STAVE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 . V 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BENNETT, DONALD ARZA DONNIE BENNETT LIGHTING MAINTENANCE CO 4645 SOUTHERN BLVD SUITE J WEST PALM!BEACH FL 33415 Congratulations!With this license you become one of the nearyl one million Floridians licensed by the Department of Business and --— Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to Improve the way we do business in order to ES12000358 ISSUED: 07/09/2014 serve you better. For information about our services,please log onto wiww.myflorldailcense.com. There you can find more information CERT.SPECIALTY ELECTRICAL CONTR about our divisions and the regulations that impact you,subscribe BENNETT,DONALD ARZA to department newsletters and learn more about the Department's initiatives. BONNIE BENNETT LIGHTING MAINTENANC CERTIFIED AS: Our mission at the Department is:License Efficiently,Regulate Fairly. SIGN ELECTRICAL SPECIALIST We constant)y strive to serve you better so that you can serve your Customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Exjfttkm daW:Auc 31,2016 L14D7010001974 DETACH HERE RICK SCOTT;GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ES12000358 The SPECIALTY ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ASA SIGN ELECTRICAL SPECIALIST BENNETT, DONALD ARZA DONNIE BENNETT LIGHTING MAINTENANCE CO ° 4645 SOUTHERN BLVD ,. . SUITE J WEST PALM BEACH FL 33415 - o • �G O ISSUED: 07101/2014' DISPLAY AS REQUIRED BY LAW- SEQ L1407010001974 .'o ANNE M. G A N N O N R.O.Box 3353,West palm Beach,FL 33402-3353 "LOCATED AT** L,�t1 CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel:(561)355-2264 Serving Palm Bench County 4645 SOUTHERN BLVD#1 WEST PALM BEACH, FL 33415- Set virtg yoat. 0000 TYPE OF BUSINESS OWNER CERTIFICATION6 I RECBPT>BDATEPAID AMT PAID BILL# 230107 CW ELECTRICAL SPECIALTY SENNETT DONNIE E81200M I 815.841893-07/QHS SM.60 B4d1ism This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 2095/2015 LOCAL BUSINESS TAX RECEIPT DONNIE BENNETT LIGHTING MAINTENANCE CO LBTR Number: 200405822 DONNIE BENNETT LIGHTING MAINTENANCE CO EXPIRES: SEPTEMBER 30, 2016 4645 SOUTHERN BLVD STE J WEST PALM BEACH,FL 33415-2122 This receipt grants the privilege of engaging in or all 1121111121111111 a la taaa @a t 8ta t tas ta@as ta t managing any business profession or occupation a within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. �'L A� CERTIFICATE OF LIABILITY INSURANCE °Aoy20°"6""' 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 CONTACT NAME Jackie Egerton Jacobs Insurance Inc. PHONE (561)967 8400 Fax N,; 561-967-9088 2135 S Congress Avenue 4b ADD IREESS: JEGERTON@)jacobsinsinc.com INSURER($)AFFORDING COVERAGE NAIC# West Palm Beach FL 33406 INSURER A: Capitol Specialty Ins co INSURED INSURER B: TITAN INS CO DONNIE BENNETT LIGHTING MAINTENANCE CO INSURER C: FLORIDA UNITED BUSINESS 4645 SOUTHERN BLVD STE J INSURER D: LICENSE NUMBER-ES12000358 INSURER E: WEST PALM BEACH FL 33415 INSURER F: 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 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 INSURANCE POLICY NUMBER POLICY EFF MPS Y EXP LTRLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,D00,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 A X BLANKET Al CS02348226-01 03/29/15 03/29/2016 PERSONAL&ADV INJURY $ 1,000,000 X PRIMARY AND NOWCONTRIBI GENERAL AGGREGATE $ 2,000,00_0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY F J Ci PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIM T Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED P Y BODILY INJURY 7719952 03/25/15 03/25/16 UR (Per accident AUTOS X AUTOS ) $ HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLALJAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION XWC STATS OTH- AND EMPLOYERS'LIABILITY YIN, ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDED? ❑N NIA 118696 09/21/2015 09/21/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addltlonai Remarks Schedule,B more space Is required) Electrical Contractor Lic.#ES12000358 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1005 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL AUTHORED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 0 Donnie Bennett Lighting Maintenance 4645 Southern Blvd Suite J West Palm Beach, F133415 561-688-1511 1p%3@eglile'r'ih r_iC1n1g_xur Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, F133138 Attention: Building Department Please allow Rick Becks and Gill Strelec JR.pull permits for Donnie Bennett Lighting Maintenance Company Please call me with any questions or concerns. Dly,Bennett President/Owner 561-685-2316 ES12000358 Detail by Entity Name Page 1 of 2 ' J Detail 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/CorporationSearch/SearchResultDetail?inqui"pe=Entity... 3/4/2016 Detail by Entity Name Page 2 of 2 •� , 8C 44 Kaliko Lane Wellington, FL 33414 Annual ReDorts Report Year Filed Date 2016 01/14/2016 Document Images 01/14/2016--ANNUAL REPORT View image in PDF format 01/09/2015-- Domestic Profit View image in PDF format Couvriaht V and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/4/2016 l e6 -- � AC ZODATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/20/2016 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 pollcy(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 CONTACT CT Jackie Egerton Jacobs Insurance Agency PHONE Ext): (561)967-8400 1 NAX No): (561)967-9088 2135 S Congress Avenue 46 ADDRESS: Jackie@jacobsfl.com INSURER(S)AFFORDING COVERAGE NAIC# West Palm Beach FL 33406 INSURER A: CAPITOL SPECIALTY INSURANCE CORP 10328 INSURED INSURER B: TITAN INSURANCE COMPANY 13242 DONNIE BENNETT LIGHTING MAINTENANCE CO INSURER c: FLORIDA CITRUS BUSINESS & 4645 SOUTHERN BLVD STE J INSURER D: INSURER E: WEST PALM BEACH FL 33415 INSURER F: 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 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 ADDTYPE OF INSURANCE INSD WVDSUBR POLICY NUMBER POLICY EFF POLICY EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE FXJ OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A X BLANKET Al CS02348226-03 03/29/2016 03/29/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JE� a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 7719952 03/25/2016 03/25/2017 BODILY INJURY(Per accident) $ AUTOS FSe] NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOSX AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDED? NI N/A 10655507 09/21/2015 09/21/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Electrical Contractor Lic.#ESI2000358 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 1005 NE 2nd Ave AUTHORIZED REPRESENTATIVE .� Miami Shores FL 33132 E0 � ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Miami Shores Village ` F'irtlf � 5� 10050 N.E.2nd Avenue NE Cta ,.ttttcn i11+�aKf Miami Shores,FL 33138-0000 Phone: (305)795-2204 ~ Ex (ration: 113/2016 Issue 3/17'/ 16 P� 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 Pompano Beach FL 33060- 1308 E Atlantic Boulevard Pompano Beach FL 33060- Contractor(s) Phone Cell Phone Valuation: $ 20,000.00 DONNIE BENNETT LIGHTING MAINTE (561)688-2511 __._.. .._._ttx.... Total Sq Feet: 0 Type of Sign:Wall Sign Available Inspections: Electrical Sign:Yes Inspection Type: Height: Final Width: Review Structural Color: Elevation: Review Planning Plans Submitted:Yes Additional Info: Review Electrical Classification:Commercial Scanning:3 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $12.00 Invoice# SGN-3-16-58923 CO/CC Fee $50.00 DBPR Fee $9.00 03/04/2016 Check#: 13309 $50.00 $779.00 DCA Fee $9.00 03/17/2016 Check#:13330 $779.00 $0.00 Education Surcharge $4.00 Permit Fee $600.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $16.00 Total: $829.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,P ECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDA : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an oning. Futhe au on bove-named contractor to do the work stated. March 17, 2016 Aut prized ' natu er / cant / Contractor / Agent Date Building Department Copy March 17,2016 1 Q LOT C BLOCK 30 I I b SCALE:1"=30' I I 4¢�� (No LD.) 130.00' P&M F.I.P. 1 -� ( , LD.))(No I I i II II I •CONE . ,GONG °. I � I ASi KALI ARKIINNG)AREA P N I I LOT f I I 16 er LOT BLOCK 30 11 I BLOCK 30 I I 9 — — — — — ASPHALT — �� '' I IN I " W1 �• i2 ., D BLOCK 30 L —mov ! 15'ALLEY • \ A BP/IALT qlARKlNG*A I � ( �PACES)I i - - - - a� / o �C N I v — - �� •2aO v g � i .. N oLa I Z I �� ` Ia L40' o 04 OT! 0 r •'• 13. ONE STORY C.B.S. CO \ BLOCK 3a tt� lll' �n MMERCIAL 7 I Q° 1e5 BUSING Lor 3 15 N I BLOCK 30 F"r - - - -_ - - _ 'I I aSPHALT 1.30' v o. nm' v� 37.50' tam' 4 . coNG> I LOT to W 14 I BLOC(30 I L I SIGN I I. I / I ,6=89"57'40* F.NA/ F.NdA. . . . — —L- - — —— R=25.00' • F.D�L� 130:00 P&M H� fo''cbNC SIDEWALK -` A=39.25' I 1.5' CONC.GUTTP'R Woo, 54'ASPHALT PAVEMENT � 70' TOTAL RIGHT-CF-WAYN.E. 96th STREET +� r—S CD ' 171 ill I J c� > 1 Cp . . . . . . . . 7 Sim tp 0.0 • •• • • • • • "' r gam. • Y iii�a'. ... Gee r ••• �• ••• •• • • 000 • • • • • • • • • • ELECTRICAL NOTES - L.E.D. CHANNEL LETTERS sews M 1 M1 Plastic returns with aluminum backs M3 M8 M2 Jewelite White trim caps �O [� olaocl F W zz M3 3116°white and Orange plex faces w/vinyl overlay for other colorssssxua �, e� ur © a;r� �g zo'e M4 M 7 M4 White L.E.D.Strips(5 p/f)41/2°on center&no less than 21/2°from returns with 3M V.H.B.tape I I W d M F M5 Interconnect cables between L.E.D.Modules a c M 5 M6 114°Weep Holes as required(if sign is used exterior location,no weep holes for interior locations) o M7 UL Approved 120 volt in Low Voltage(12v)out LED Power Supply and Enclosure G/LLQ 8 M8 Existing metal canopy fascade structure " �M =J M M9 Low Voltage Wiring and Sleeve as regulated by local codes a M M10 #12x 1-1/2'Sheetmetal Fasteners(Minimnum 4 per letter) Z • 1 •• Sm M 9 M11 10 Amp.(120 volt)Disconnect Switch in J-Box and primary electrical power to sign to be by others ALL SIGNS SHALL BE BONDED TO BUILDING EQUIPMENT BONDING CONDUCTOR-Per NEC Section 600 Client All fasteners and other metals in Chevron toMobil Cori�'Non .... contact with Aluminum shall be: 9601 NE 2nttAV1E'nue.• •• Stainless Steel or Hot Di Galvanized. •" •••• • 1 p Miami Shor%a M2 •....• ..i •• •• •.:• . • rN° is ... . w M6 • : 00,12 09 4L • . . .. E V � C 52' N 84" Ln h Ea 36„ o�/' 24„ M 4� Y 'I .c Y m o � c rn L2 26 'noII N� O U N m O v� � o ELECTRICAL REVIEW C LnAPPROVE DATE North Elevation 1 a � Z 3 General O Design is in accordance with the requirements of the Fla Bldg Code 5th Ed (2014) for use within & outside the High Velocity Hurrica ie Zone (HVHZ). A This engineering certifies only the structural integrity of chose systems, components, and/or other construction explicitly specified herein. Notes: 0 Electrical notes, details, & specifications are provided by and are the sole responsibility of the electrical contractor. No electrical review has been performed and no certification of such is intended. O Aluminum extrusions shall be 6063 T6 or stronger, unless noted otherwise. ELECTRICAL NOTES - L.E.D. CHANNEL LETTERS eats M 1 M1 Plastic returns with aluminum backs / M3 Mg M2 Jewelite White trim capsughgdug Mao[ 4c 1 c7[�Q@ FE W zz M3 3/16°white and Orange plexfaces w/vinyl overlay for other colors mMkAd 2016 0@9 NMW41� M4M4 White L.E.D.Strips(5 p/f)4112°on center&no less than 21/2°from returns with 3M V.H.B.tape M7 �m M5 Interconnect cables between L.E.D.Modules a A �a M 5 M6 1/4"Weep Holes as required(if sign is used exterior location,no weep holes for interior locations) o C w G/LLQ g V M7 LIL Approved 120 volt in Low Voltage(12v)out LED Power Supply and Enclosure N N M8 Existing metal canopy fascade structure i =J M M9 Low Voltage Wiring and Sleeve as regulated by local codes o m z • • p M10 #12x 1-1/2°Sheetmetal Fasteners(Minimnum 4 per letter) Z U • 1 • Sm M 9 M11 10 Amp.(120 volt)Disconnect Switch in J-Box and primary electrical power to sign to be by others ALL SIGNS SHALL BE BONDED TO BUILDING EQUIPMENT BONDING CONDUCTOR-Per NEC Section 600 Client All fasteners and other metals in Chevron to.Mobil ConYbWon .:* contact Wth Aluminum shall be: 9601 NE 26d•Qvenue•• , ; .' .. Stainless Steel or Hot Dip Galvanized. Miami Shoi .: e ift .. a 1 .... .... '•'o M2 ....• .. •• •• ••i• p�1 :00:0: O ' M6 • : caa . �(I *000 . . •. . E -iF uw c = o 52' Egli E 24" 2D Vinyl Nue 36 $ Oq o mLM L-C pY = O to 26 vi II N� O U v� m o V-� C Q ELECTRICAL REVIEW l'�/�, � L U ^ a` DATE -- E APPROVE & > Lb South Elevation aZ Z General O Design is in accordance with the requirements of the Fla Bldg Code 5th Ed (2014) for use within & outside the High Velocity Hurricane Zone (HVHZ). O This engineering certifies only the structural integrity of those systems, components, and/or other construction explicitly specified herein. Notes: O Electrical notes, details, & specifications are provided by and are the sole responsibility of the electrical contractor. No electrical review has been performed and no certification of such is intended. 0 Aluminum extrusions shall be 6063-T6 or stronger, unless noted otherwise. a zOM ��Ls • • F • 22 342183 201 A:101.5"x 89° B:23"x 89° C:101.5"x 89' FACE CHANGE ONILYT EXISTING is .. *. sot_ r LL W v v 8 ME all M 130 i Zovoi Chevron _ ! Client �s Mobil Chevron to Mobil Comsion • ••• 9601 NE 2p('Atrenue.• ; • . . . Miami Shpt*S.FE a �1. 3 +.... .••• Qj 4P 0 � •• 1 _ r :1 • 1 • • • E �r a: OU = Ln AV M / � O M �V) II � • I' � C O i 20 v, II O U v ' m �j J CL I �Q _ t E • ^ N AMID PLACARDS AND FONTS oQ � a u T 77 41 General O Design is in accordance with the requirements of the Fla Bldg Code 5th Ed (2014) for use wi,:hin & outside the High Velocity Hurricane Zone (HVHZ). O This engineering certifies only the structural integrity of those systems, components, and/or other construction ex licit s ecified herein. Motes: 8 Electrical notes, details, & specifications are provided by and are the sole responsibility of the electrical contractor. No electrical review has been performed and no certification of such is intended. 0 Aluminum extrusions shall be 6063T6 or stronger, unless�noed otherwise. ELECTRICAL NOTES - L.E.D. CHANNEL LETTERS Seats M1 ` M1 Plastic returns with aluminum backs M2 Jewelite White trim caps FE M3 M8 22 M3 3116"white and Orange plex faces w/vinyl overlay for other colors 201 M4 M M4 White L.E.D.Strips(5 pif)41/2'on center&no less than 21/2"from returns with 3M V.H.B.tape d o o+ M M5 Interconnect cables between L.E.D.Modules J Ws A oQ M 5 M6 1/4"Weep Holes as required(if sign is used exterior location,no weep holes for interior locations) M7 UL Approved 120 volt in Low Voltage(12v)out LED Power Supply and Enclosure /LLL Cv 0 r4 rN M8 Existing metal canopy fascade structure i TM 3 M.— =J M M9 Low Voltage Wiring and Sleeve as regulated by local codes y O M �4 M10 #12x 1-1/2"Sheetmetal Fasteners(Minimnum 4 per letter) z=00 • 1 '•• 00 M 9 M11 10 Amp.(120 volt)Disconnect Switch in J-Box and primary electrical power to sign to be by others ALL SIGNS SHALL BE BONDED TO BUILDING EQUIPMENT BONDING CONDUCTOR-Per NEC Section 600 CSI@I1t All fasteners and other metals in Chevron t9 Mgbil CoMetsion contact with Aluminum shall be: 9601 NE AA Venue,• • • Stainless Steel or Hot Dip Galvanized. MIai11 ShQ � •• �• •� 1 o 2 11 •••• • • • +I ..�..� ••.• ge 0990 ..:. M6 N • • • E •• • o v c X Oqa E o .. l7 CD v M o0 / L Y 2 N 'U T o O O V r� v 0 —� ELECTRICAL EVIEW C� Q APPROVEDvri DATF .1. --RTI i - p w R� 0 W UO 4 N Q - a 3 General 0 Design is in do-ordance with the requirements of the Fla Bldg Code 5th Ed (2014) for use wi.hin & outside the High Velocity Hurricane Zone (HVHZ). 0 This engineering certifies only the structural integrity of those systems, components, and/or other construction explicitly specified herein. Notes: 0 Electrical notes, details, & specifications are provided by and are the sole responsibility of the electrical contractor. No electrical review has been performed and no certification of such is intended. 0 Aluminum extrusions shall be 6063-T6 or stronger, unless noted otherwise.