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EL-15-2037Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Perr»lt
grit T. e. `Elect
Parcel Number
7
i an: AdditionlAiteration
PermitStatus: APPROVED
12015 Expiration: 05/02/2016
Applicant
952 NE 91 Terrace
Miami Shores, FL
Owner Information
MICHAEL MOLINA
1132060030130
Block: Lot:
Address
952 NE 91 Terrace
MIAMI SHORES FL 33138-
952 NE 91 Terrace
MIAMI SHORES FL 33138-
Contractor(s)
LEWDI ELECTRIC
Phone
954/782-0006
Cell Phone
MICHAEL MOLINA
Phone
(305)672-7131
Valuation:
Total Sq Feet:
Cell
(786)554-6017
$ 1,100.00
{
0
Type of Work: INSTALL NEW RECESSED LIGHT, INSTALL
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.25
$2.25
$0.40
$150.00
$3.00
$1.60
$160.70
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -8-15-56695
11/04/2015 Credit Card $ 160.70 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W. W.
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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I ce i , that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
nAV/
construction a
rmore, I authorize the above-named contractor to do the work stated.
Aut • rized ature: Owner
Building Departmen opy
Contractor / Agent
November 04, 2015
Date
November 04, 2015
1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL f
Phone: (305)795-2204 Fax: (305)756-8972 C
0 1 5 - I q
Inspection Number: INSP-241290 Permit Number: EL -8-15-2037
Scheduled Inspection Date: August 18, 2016 Permit Type: Electrical - Residential
Inspection Type: Final
Owner: MOLINA, MICHAEL Work Classification: Addition/Alteration
Job Address: 952 NE 91 Terrace
Inspector: Devaney, Michael
Miami Shores, FL
Project: <NONE>
Contractor: LEWD' ELECTRIC
Phone Number (305)672-7131
Parcel Number 1132060030130
Phone: 954/782-0006
Building Department Comments
INSTALL NEW RECESSED LIGHT, INSTALL NEW VANITY
LIGHT, INSTALL NEW EXHAUST FAN, INSTALL NEW
SWITCHES
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments. --
/69 /g -a7:6'
August 17, 2016
For Inspections please call: (305)762-4949
Page 3 of 33
PERMIT APPLICATION
❑ BUILDING ELECTRIC
❑ PLUMBING ❑ MECHANICAL
mi Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Master Permit No.
❑ ROOFING ❑ REVISION
NOV 20 2015
Art In. CLC,--
FBC 20 v0
cg—
Sub Permit No. e L-8 - / S- of o3 ?
❑ EXTENSION ❑RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: q52_ 1.1E -1 IItszvta
City: Miami Shores County:
Folio/Parcel#: ,13200 00 2)0 IO
Occupancy Type:
❑ CANCELLATION ❑ SHOP
DRAWINGS
Miami Dade
zip:
Load: Construction Type:
Is the Building Historically Designated: Yes NO
OWNER: Name (Fee Simple Titleholder): t)t 1 4 L‘11OUvPc
Address: 95.2- 0.e qt TavkAte
City: H tP f 15iko2Eei
Flood Zone: BFE:
FFE:
Phone#: SCLF ip01'j
State: C i.
Zip: -S3`'30D
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: [...Et, ID I . Tl2-1C. C_
Address: g®1�
Phone#: l'Stt q 2- bOb6
City: f L ' e ?- P f State:
Qualifier Name: Laki 15 .7-r�%-�--5Ji° A � Phone#:
State Certification or Registration #: LrC_ ( 7500 19)?) Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1 Square/Linear Footage of Work: /On sc
0
ft_
zip: 3s oci
Type of Work: ❑ Addition [V Alteration ❑ New
Description of Work: Mewl An- ,,iiZ 1 � J
❑ Repair/Replace
Lei. nc ) Amari
❑ Demolition
A0.1 /AA. 4
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ )"S me>'
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ -18 _oz)
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 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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve ' and a reinspection fee will be charged.
Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
c20 I'Q` day of "re -4-1,1k-) , 2013— , by ok day of 07,e , -"-Ace---) , 20/ S , by
,M k'h A(1611..,14 , who is personally known to , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print: iGno ?. /224. 20
Seal:
*
LINDA D. MAURO
Notary Public - State of Florida 4,
F.E. My Comm. Expires May 14, 2017
*' Commission # FF 001078 ;q
,,,1,,,„ ***Boum ihrrou'gn Natiorf i 16ia' itit'1ht"
APPROVED BY
(Revised02/24/2014)
identification and who did take an oath.
NOTARY PUBLIC:
Sig Gv 773a)
Print: ,Z-tN') e9 -
Seal:
*****************
;47 1-'420" rs Plans Examiner
!,,,p,., LINDA D. MAURO
1. Notary Public - State of Florida
My Comm. Expires May 14, 2017
Commission # FF 001078
*44444*** etittestclfgoisiptfletivel4NoteAlisi *
Zoning
Structural Review Clerk
• ••
• • • • •
• ••• • • ••
• • • • •
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• • • • •
• • • • •
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• •
••••
• •
••••
•• ••
• •
•• • ••••
• • • •
•
• • • •• ••••
• • •
•
•
•
• • • •
•• •
• •
"e0 -19
Miami Shores Village
APPROVED
'tel._.
21444+63 -DEPT
BLDG DEPT
UE3 11 C'T TO
BY
DATE
S
COMPI IANCF WITH AIL FEDFEIAL
STATE ANI) COUN IY Rt 1.FS AND REGI 11 ATIONS
4-1.4e./2/C._
® NEM VAi i 1...\ GNAT
(Z NEW GF.oyt ca
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12-1 Locm-c f cecr
Doan_
PERMIT APPLICATION
mi Shores Village
ding Department NOV 20 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 /4'i rl
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2010
Master Permit No. 0 - IJP 1 -1Q
Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 2_ I `tE `II I C'i“2-r<ci
City: Miami Shores County: Miami Dade Zip: 33'k t)
Folio/Parcel#: '10 32.060030 l •0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): \--4 tit-( I -1 L v4 01.4 NA Phone#: 1 %(O 564 loO f
Address: 'I S52.t�C 1 T.a. v c
City: \I IIkI W3Q- State: .L— Zip: 'j3`7.°0
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: VA I el -'i4 L tOLIN A- 6-10IMEcxul•}02.- Phone#: 7g CSLI (4)0 L
cissa. l SZ 'I h Tef2404..6
City: U 4'tti 0+R—ES State: 0.. Zip: ��«'60
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:State: Zip:
Value of Work for this Permit: $ ® Square/Linear Footage of Work: / CIO sy
Type of Work: ❑ Addition /:r Alteation ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: P I LI> .awn y. Yc›z.J�� e Av-A it./ elo ,u-vvri 1 ",k) ) %Q
c
YALVITt WekI,1
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE$ 8y ,��
(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 ELECERIC, 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 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 occurs 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
OWNER or AGENT
The foregoing instrum nt was acknowledged before me this The foregoing instrument was acknowledged before me this
ae, day of , 20/5 , by C�O(-' day of0."-Qir► , 20)S , by
/4((r,p 4.,, who is personally known to /14(Mame , who ispersonall ky nown to
oz
me or who has produced as me or who has produced as
Signa ure
CONTRACTOR
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
Seal:
*******
co/a,,,//„D
�P� �• in4WLD
`,,,!!,••,, LINDA D. MAURO
`.,, =: Notary Public - State of Florida
• ; v : • My Comm. Expires May 14, 2017
Bonded Through N.ional Notary Assn.
•,11111
APPROV
(Revised02/24/2014)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 41 i1)s9-lam- /441,M2D
Seal:
****************
Plans Examiner
Structural Review
s,1 -"P,',,, LINDA D. MAURO
;r•„ Notary Public - State of Florida
• E My Comm. Expires May 14, 2017
a" Commission # FF 001078
"*tend` t*Til tltilitttibiii`Melt?ifNIL
Zoning
Clerk
•
BUILDING
PERMIT APPLI ATION
❑BUILDING ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: 152. 1v6 I xv—
AUG 1 2 2015 I
FBC 20 14
Master Permit No. J D 1Cf
Sub Permit No. E L - IS -2039
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County:
Folio/Parcel#: 11 3010C, (DC:)- C) 13 C)
Occupancy Type: Load: Construction Type:
Miami Dade
Zip: / 31
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):�%'�I 141,- til. 0 1.4.164_.Phone#: 0(66) 554 60/
Address: 152_ NE %i s4- 7.�ry
City: J ` i rota. J kariS State: Zip: 331 3$
Tenant/LesseeLName: j Phone#:
Email: tko 11/4-1,1;144— C../�•� C.J &L tJtav .0-61,k
CONTRACTOR: Company Name: LE --1.0.0 i E C 12 /x. 2—/u(
Address: ,C/ A/W S-2' 3'r
Phone#:
City: T 1.•44d/ lJ,ttk
Qualifier Name:
State:
L510L5 SPASTA�r�
State Certification or Registration #: EC/3CX)/3Sig
DESIGNER: Architect/Engineer:
Address:
Zip: 33 3d?
Phone#:
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work: L{5 s�
❑ Demolition
Value of Work for this Permit: $ (,106
Type of Work: TrAddition ❑ Alteration
❑ New ❑ Repair/Replace
Description of Work:. _ INS (,(; 2iciSss tom} L, ,15 1 i iJS T as Airtk1 (' ar it 44144T; Ake%J
V 4 1— CA4 ricfriSs
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ /...4-0/A9 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ -
TOTAL FEE NOW DUE $ q-
(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 $2500, 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 occurs 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.
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged
I �A day of , 20 15 , by A47dayof jAl J
,'tom I , who is personally known to L 4-z-` S Pd -J '60""`Q , who is per
we- r who has produced as me or who has produced "A>Ob Bei
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
P�u/C1z
ANDRE J. DEPAGNi`.ER
0 MY COMMISSION # FF24555,2
EXPIRES June 30, 2019 I
FIendallowelor ee cCa:
140/) 3914153
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
before me this
20 ) ,by
Tonally known to
as
Print:
Sea:
*****************************-****-***********************
A/l�J/A ,fro% 1 P� _
APPROVED BY
Zoning
(Revised02/24/2014)
ROBERT CALDWELL
Notary Public - State of Florida
Commission # FF 231075
Mi4pwiw, c My Comm. irei *IZ .:.#:.
'1'(h ough National Notary Assn,
Structural Review
Clerk
RICK SCOTT, GOVERNOR
STATE OF FLORIDA
ND PROFESSIONALL, REGULATION
KEN LAWSON, SECRETARY
LICENSE NUMBER
SC13001388
The ELECTRICAL CONTRACTOR
Named !Mow IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
SPASIANO, LEWIS
LEWDI ELECTRIC INC
1680 NELSON TER
THE VILLAGES FL 32162
ISSUED: 08/11/2014 DISPLAY AS REQUIRED BY LAW
SEQ # L1408110001619
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100. Ft. Leuderdsde, FL33301-1895 _
954-831
VAUD OCTOBER 1,2014 THROUGN SEPTEMBER 34 MS
Business Name: LE9DI ELECTRIC INC
Owner Name: LEWIS SPASM/SAL
Locallograusiness 2585 SE 6 ST
1 memo BEACH
• SurlinessPhone: 954-782-0006
A
Rooms Seats
entgorces
10
Ret#18 1- 3401
Bis Types c
�
Business Ope10/d1/1988
Stet :BC13d01388
Number of
Truer Fee 1
io 0.00
•
For VendingRogness Only
NSF Fee
0.00
0.00
Polar Yews iClonsoffon Cost
0.00
THIS RECEIPT MUST DE POSTED CONSMUOUSLY D1 YOUR PLACE OF
TRW B $.ATAX RECEPT
VALh DATED.
•
6144 Address:
SPABIANOrtL NW ST
/Qum•
•'. FORT LAUDERDALE , FL 33309
0.00
"Ms tax is Levied for the privilege of doki business wade
Swam
in rhe. You must meet all County andkr
and zonbuir requkemente This Business Tax Receipt must be
the bis s sold, name has changed gr
business location. TthIs receipt does not t e
sZer
t is in comprrance Will State or loam laws and
2014 - 2015
Lewdi Electric
801 NW 57 St
Fort Lauderdale, FI. 33309
954-895-5308
Date:
State of J,14 -'l_
County of
Before me this day personally appeared &i.01.6.4who, being
duly sworn, deposes and says:
That he or she will be the only person working on the project located
at: 9S- N ,1. 9/rtie,, ca-ge / ,, z
Sworn to (or affirmed) and subscribed before me this /0 day of
. 20 , by
Low
Personally know
OR Produced Identification
Type of Identification Produced
41 -1 -e -L9
Print, Type or Stamp Name of Notary
LI IV p . 4. /quart)
"",,, LINDA D. MAURO
r , Notary Public - State of Florida
• My Comm. Expires May 14, 2017
ir9. t,
Commission # FF 001078
, ,,,, '" Bonded Through National Notary Assn.
Notice to Owner — Workers' Com
p
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
State of Florida
County of Miami -Dade
The fore ing was acknowle ge before me this I I day of 4jug / , 2015.
iG 4 //II/o. who iserso anally kno t� iii iSap oduced
�•.1% J�1y18-2o,,,off:.
Notary - W i N0IARY �y; m
PUBLIC
SEAL:
•
,, Aire .f.0 -•S•
By
as identification.
ifs on silt
08/05/2015 15: 40 5619959677
•
ACCORD
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.
VAN AMERINGENS PAGE 01/01
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD1YYYY)
8/5/2015
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must ba endorsed. If SUBROGATION IS WANED, subject to
the teens 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 Phone: (561)995-9577
Fax: (5661)995.9677
Van Ameringen s lnau anee and Financial Services
902 Clint Moore Rd
Suite 132
Boca Raton, Florida 33487
CONTACT Renee Small
NAME:
Neaxa'I�s°�'�' (561)995-9577
FAX
o X ANo); 561)995-9677
t
ADDRESS-
renes@vaaameringEals.cont
INSURERS) AFFORDING COVERAGE
INSURER A : Scottsdale Insurance Company
NAIC O
INSURED
LEWDI ELECTRIC, INC.
2149 NE 63RD CT.
FORT LAUDERDALE, FL 33308
INSURER 8:
41297
IN$TIRER C :
INSURER D :
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 125
L
THIS le TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS
OR POUCY EFF FOUCYExe
71t TYPE Of INSURANCE D WVD _ppUCY NUMBER tolINDOLYYYYI memoir -ern
I COMMERCIAL GENERAL LIABILITY
A
CLAIMS -MADE I I OCCUR
GEN'L, AGGREGATE LIMIT APPLIES PER:
POLICY jRG LOC
Il QYH R:
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
— AAUTOS LED
_, A VJWED
AVMs
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CP82105E88 1/3/2015 1/3/2016
UMURELLAUA8
axcess LIAR
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CLAIMS -MADE
DED i J RETENTION S
WORKERS COMPENSATION
AND EMPLOYERS' UASILIY Y IN
ANY PROPRIETORJPARTNELE(ECU11VE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
DESCRIPTION OP OPERATIONS /LOCATIONS I VEHICLES (ACORD 1101. Additlenai Remarks SdreduJe, may ba efach ad K mora OneIs raga
REFERENCING LICENSE 8 EC13001388
ELECTRICAL cONTRA.CTXNG
CERTIFICATE HOLDER
CANCELLATION
EVISION NUMBER:
ED NAMED ABOVE FOR THE POLICY PERIOD
DOCUMENT WITH RESPECT TO WHICH THIS
ED HEREIN IS SUBJECT TO ALL THE TERMS,
kad)
Mrs
EACH OCCURRENCE
$ 1,000,000
TENTED
PREMIISIESEStEaO 4lTEnete
$ 10!),000
MED EXP (Any one person)
5 5,000
PERSONAL $ ADV INJURY
$ 1,000,000
+ENERAL AGGREGATE
$ 2,000,000
PRODUCTS • coMPlOP AGO
S 2,000,000
$
r
COMSiNEDSINGLE LIMIT
$LIMI
$
(Par person)
BODILY INJURY (Par person)
$
$INJURY
BODILY INJURY (Per aooklant)
5
IrROPERTY 9AC1AGE
(Per segos
$
S _
EACH OCCURRENCE
$
AGGREGATE
5
$
on
STATUTE SR-i.,
EL EACH ACCIDENT
$
EL. DISEASE - EA EMPLOYE$
$
E.L DISEASE. POLICY LIMIT
$
1-roldet'a Nature of Interest = Certificate Holder
VILLAGE OF MIAMI SHORES
10050 NE 2ND AVE
MAIMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WrrH THE POLICY PROVISIONS.
AUTHORDED REPRESENTATIVE
0198&2014 ACORD CORPORATION. All right$ reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
2016 details - Business Tax Account LEWDI ELECTRIC INC - TaxSys - Broward Count... Page 1 of 1
dECORD TAXES A EAS
Records, Taxes & Treasury Div. Home Search Reports Shopping Cart
ATTENTION TAXPAYERS: Please be advised of the NON-REFUNDABLE processing fees for credit and debit
card transactions. Credit cards are charged 2.55% of the amount charged ($2.00 minimum fee). Domestic Visa
Consumer Check cards will be assessed a fee of $3.95 per transaction if you select 'Debit Card'. Thank you.
2015 Annual Tax Bills will be mailed prior to November 1, 2015, and will also become available on this
website November 1st for viewing, printing or online payment. Tax bills are mailed to the current mailing
address of the property, as listed on the Property Appraiser website www.bcpa.net . We recommend that
everyone verify their current mailing address listed for their property at www.bcpa.net — and immediately
report any mailing address change by using the link at the bottom of your property record for reporting
errors.
T Accou LEWD E ECTR1C
Business Tax Account #5425
Account details Account history
2016
2015 2014 2013
900
2009
PAID PAID PAID PAID PAID
Account number: 5425
Business start date: 10/01/1988
Business address: LEWDI ELECTRIC INC
2585 SE 6 ST
POMPANO BEACH, FL 33062
Physical business location: POMPANO BEACH
Owner(s): LEWIS SPASIANO/QUAL
801 NW 57 ST
FORT LAUDERDALE, FL 33309
Mailing address: LEWIS SPASIANO/QUAL
801 NW 57 ST
FORT LAUDERDALE, FL 33309
Cr Print account application
(PDF)
©' Print exemption application
(PDF)
CONTRACTORS
ELECTRICAUALARMS/CONTRACTOR
Additional documentation required: EC13001388 State Certification OR Broward Cert. of Comp. (each year)
10/01/2015-09/30/2016
PAID 2015-09-29 $27.00
Units: 10 Receipt #13B-14-00011116
https://www.broward.county-taxes.com/public/business tax/accounts/5425 11/2/2015