DS-12-1082Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 174792 Permit Number: DS -6 -12 -1082
Scheduled Inspection Date: June 27, 2012
Inspector: Bruhn, Norman
Owner:
Job Address: 429 NE 102 Street
Miami Shores, FL 33138 -2452
Project: <NONE>
Contractor: LEVY FATHER & SON
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060170790
Phone: (305)458 -7134
Building Department Comments
DRIVEWAY APPROACH ONLY
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 26, 2012
For Inspections please call: (305)762 -4949
Page 17 of 36
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Typ BUILDING
129 ,UL tot s4 .
JOB ADDRESS:
RECElk
_.
JUN 13 2012
FBC 20
Permit No, 1) (2
Master Permit No.
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: 11 -•32 Cl, — 011 if) -lei Q
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): �{�.��_!` Phone#: 3 t15- �'�{•S� = 7/3'�'
Address: RI SO rd"i5C2I,A-. �,�rt. . a
City: 4�v,% (% State: Zip: S3 /3fl
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: Levy ct v a l ,c),-1 Phone #: 780- 2
8O^ l Z3 LJ
Address:3550 k vJ f S Sl-
aty: MOM i State: -rto r l rt a Zip:
1 25
Qualifier Name: E 11 G d- LQ V'/ Phone #: -1(o-
l, ' 53-2(121F
State Certification or Registration #: CC- 12.60 ®0 WI Certificate of Competency #: 12 Z-L1 v D - Q .
Contact Phone #: 1't X53 201' • Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 11 00 Square/Linear Footage of Work: S3O S(UO ft e4 •
Type of Work: ❑Addition ❑Alteration l�1 Tew ❑Repair/Replace ❑Demolition
Description of Work: DY \J x ( approach (YVL i
ac t o P
Color thru tile: tt#t 6'
**** ********** ******x:+ x*** ******** ****** Fees**+ x************** *** ********x:**** **+x**+x*** **
Submittal Fee $ Permit Fee $ 40 OD CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 FT RCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 issu „ In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing ins went was acknowledged before me this The foreg.' ins went was acknowledged before me this
day of 2 0 20 _, by , day of , 20 /2 , by
Signa
'7
441/—.
Contractor
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: / /
't°/v/1 e %Sf 0
ILENA CASTRO Commission Expires: NOTARY PUBLIC
My Commission ission
Ex P
*
/(9/ itS , ` ` Comm# EE093686 "r, STATE OF FLORIDA
e em s' x* ***ax*xaxxxxxxx *** x� iJ�x` xx* x *
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
/,P oV /zi e siz2p
APPROVED BY 'C/ 6:0)61--1-- Plans Examiner
ILENA CASTRO
NOTARY PUBLIC
STATE OF FLORIDA
COMO# EE093886
0**** **
( j2
/ Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
CTQB
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
1 2BS00047
LEVY FATHER & SON CORP
D.B.A.:
LE LIAS
3
riffled under the prouislons of Chapter 10 of Mlami -Di
:- c5ounty
09 -29 -2010
ALEX SINK STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual fisted below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 09129/2010 EXPIRATION DATE: 09/28/2012
PERSON:
FEIN:
LEVY ELIAS
273515982
BUSINESS NAME AND ADDRESS:
LEVY FATHER & SON CORP
3550 NW 15TH STREET
MIAMI FL 33125
SCOPES OF BUSINESS OR TRADE:
1- CONCRETE WORK
IMPORTANT: Pursuant to Chapter 440 . 05(141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certff(cute al election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05412}. F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, at any time after the fWag of the notice or the issuance of the certificate, the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section. QUESTIONS? (850) 4151609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 09/29/2010
PERSON: ELIAS LEVY
FEIN 273515982
BUSINESS NAME AND ADDRESS:
LEVY FATHER & SON CORP
3550 NW 15TH STREET
MIAMI, FL 33125
EXPIRATION DATE: 09/28/2012
SCOPE OF BUSINESS OR TRADE
1- CONCRETE WORK
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
exempt.. apply only within the scope of the business or trade Listed on
Rthe notice of election to be exempt
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? 1850} 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
MIST-MASS
U.S POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
6949 02- 9
sunfomprrideins 8 °50N CORP
3550 NW 15 ST
33125 MIAMI
LE%/Y FATHER & SON CORP
i4"STY BUILDING CONTRACTOR WORKER/3
TNIS IS tNALY A LOCAL
BUSINESS TAX RECEIPT. rr
�00pES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISflNp' OUULA Y OR
OAEXET NOR
IT E
�ER PRDORM UCCEN E
NOT A C CCATION Of
E. HOLDER'S OUALIPICA-
IS NOT A HILL' - DO NOT PAY NEW.
CC il0C'il 0047
PAYAAENI' ROOMED
AgIABAWDA 3E COUN?Y TAX
COLLECTOR: 02/23/2012
02280012001
000045.00
SEE OTHER SIDE
DO NOT FORWARD
LEVY FATHER 8 SON CORP
ELIAS LEVY PRES
3550 NW 15 ST
MIAMI FL 33125
11,i11ti II,1111T h ! A1i 1�A111t11 ,A1�Ii11,11�,LlISAtt1 ►IfIILAI
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
06/15/12
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
American Quality Assurance
10250 S.W. 56 Street Ste. D -102
Miami, FL 33165
Phone (305)273 -3377 Fax (305)273 -7339
CONTACT
NAME:
PHONE FAX
(A/C. No. Ext): (NC, No):
ADDRESS:
PRODUCER
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Levy Father & Son Corp
3550 NW 15 Street
Miami, FL 33125-
305
rnveowr_oO __
INSURER A : Granada Ins Company
0185FL00030917
INSURER B :
10/31/2012
INSURER C :
$ 1,000,000.
INSURER D :
$ 100,000.
INSURER E :
MED EXP (Any one person)
INSURER F
❑
•
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
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POUCY EFF
(MM/DD/YYYY)
POUCY EXP
(MM/DD/YYYY)
UMITS
A
GENERAL LIABILITY
n COMMERCIAL GENERAL LIABILITY
N
0185FL00030917
10/31/2011
10/31/2012
EACH OCCURRENCE
$ 1,000,000.
DAMAGE
PREMISES EaEccu RENTED
$ 100,000.
❑ ❑ CLAIMS -MADE d OCCUR
MED EXP (Any one person)
$ 5,000.
❑
PERSONAL BADVINJURY
$ 1,000,000.
❑
GENERAL AGGREGATE
$ 2,000,000.
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP /OP AGG
$ 2,000,000.
n POLICY ❑ JRCT ❑ LOC
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALL OWNED AUTOS
❑ SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON -OWNED AUTOS
❑
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
❑ UMBRELLA LIAR ❑ OCCUR
❑ EXCESS UAB ❑ CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
❑ DEDUCTIBLE
❑ RETENTION $
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
WC STATU- OTH-
❑ TORY LIMITS n ER
E.L. EACH ACCIDENT
$
(Mandatory In NH)
If yyeess describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addhlonal Remarks Schedule, If more space Is required)
e4,114.1l.IA Al Tr 11A1 wow
CANCELLATION
Miami Shores Village Building Department
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED! POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2009/09) QF
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
a.
MONEYORDERECEIPT --- -----
ORDER NON NEGOTI ----
�BLE
Try the new Western Union Payments service for all your bills
search over 10
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ACT 317100 LCC 000000 DT 061812 $18.7518DOLLAR8 Alet ?SCENTS
srAx
34,46 Norm maw BE wampum, Au. noun Remains. ft suie To Raw wormy
MIAMI - DADE COUNTY, FLORIDA
DATE: 06/18/2012 LOCAL BUSINESS TAX
ACCOUNT INQUIRY
TIME 11:4:37
FINANCE DEPARTMENT
TAX COLLECTION DIVISION
140 W.FLAGLER STREET
MIAMI, FLORIDA 33130
LBTR YEAR: 2012 OCLM0107
ACCOUNT : 694902-9 COMM—DATE: 02/2012 ENTRY—TYPE—DIE: W 02/23/201E
B U S I N E S S : DELETE—ST: INSP—ID—DTE:
NAME: LEVY FATHER & SON CORP
ADDR: 3550 NW 15 ST SUITE:
ZIP: 33125 MUN: 01 ZONE: 06 PHONE: ( 786 ) 853-2618
CORP / OWNER (MAILING) :
NAME: LEVY FATHER & SON CORP C/O: ELIAS LEVY PRES
ADDR: 3550 NW 15 ST CITY: MIAMI STATE: FL
ZIP: 33125 HOME OFFICE: Y
OTHER INFORMATION:
PP—FOLIO: 00 000000 SSN/EIN: E 27 3515982 BADCHK:
RE—FOLIO: 01 3133 014 4771 FICTNM: LAST—TRANS—DTE: 02/24/2012
^ 0000 ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^^^ ^
LBT RCPT SEC TYPE AMOUNT—DUE D/R PD LEGAL 1NSP—TD INSP—DATE HOLD—PCPT
722468-6 196 BLDGS .00
F1=MENU CLEAR=PREVSCR F4=MOREREC ENTER=REC F12=PRTAPPL F13=PTX F14=PI
IMPORTANT: THE INFORMATION HEREIN DOES NOT NECESSARILY CONTAIN ALL PERTINENT FACTS WITH REGARDS TO
REAL ESTATE CLOSINGS AND OTHER SIMILAR ACTIVITIES.
PG 1
1
f PAN
F.LP. 12°
( NOEL)
PIP. 112
( NO El.)
F.I.P. 112'
(NO ID.)
20' ASPHALT PAVEIONV
(7WT0TAI R1W)
N.E. 102nd (PERRAT)
NC ARCONINTICIMIGPAO = FOUND NALATMNL
P.C.P. = PERMANENT CCNTROLPONT U.E. = WILEY EASEINEW
E.T.P. m ELECTRIC TRANSPCSOIER PAD DE. = WORM EASEMENT
I.M.E.* LAKE MAINTENANCE EA TT FIR.= FOUND IRON BAR
CBS.=CONC.&.00IC STRUCTURE -x -mCHA NLDBTFENCE
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S.I.R. = SET 1RONeAR AIL =FINAL
PH = RAE NYCRA T CL =CLEAR
RES. _ RESIDENCE BfY. =STORY
C.B. = CATCH WON 8* =SIDEWALK
RN = RIGHT CPROW 1. =Ara MOW
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SN. =RETINAL
R =RADIUS
ENC. .ENCROACHMENT
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IZIMMES. WALT.
A =CENIRN.ANSLE
KARL F. KUHN
PROFESSIONAL LAW SURVEYOR NT, 5962
3940 N 56Th AVE SMITE 108
NILLYVOOD R. 33021
PH 1 786 -202 4039
7116-M 5348
FAX 305- 271 5977
TYPE OF PACT'
BOUNDARY SURVEY
SCALD
ARSONS
WOE
08 -16.10
PRRJECT U A77IBb
ENE 'UMW sn T
ORA1NNBT:
DRAWN NA
R. BEu.a
CITY, STATE 8 ZIP CD3'
MIAMI SHORES, FLORMMA 33138
PRTJECTNa
10-M-151.
1417E OF FIELD UDR*
08 -13-10
SHEET 2 OFD 2