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RC-15-115
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243109 Permit Number: RC-1-15-115 Scheduled Inspection Date: September 11, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: PUGLISI, MICHALE& SANIBRINA Work Classification: Alteration Job Address: 1020 NE 104 Street MIAMI SHORES, FL 33138- Phone Number Parcel Number 1122320290250 Project: <NONE> Contractor: ARKIN CONSTRUCTION CO., INC Phone: (305)785-7440 Building Department Comments BATHROOM AND CLOSET RENOVATION. 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. September 10, 2015 For Inspections please call: (305)762-4949 Page 18 of 31 Miami Shores Village RECEIVED BuildingDepartment p artment SAN o 2015 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 FBC 200 BUILDING Master Permit No. 15 PERMIT APPLICATION Sub Permit No. FE-]BUILDING ❑ ELECTRIC ROOFING ❑ REVISION r--j EXTENSION RENEWAL ❑PLUMBING F-� MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1020 NE 104 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-029-0250 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):MICHAEL AND SABRINA PUGLISI Phone#: Address: 1020 NE 104 STREET City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#:N/A Email: 330�- --)?S- 2,9S9.4 CONTRACTOR:Company Name: AlflCly 60//'(T7?a Ln o/V Phone#: 30f - 79Y-- 7 Y YO T Address: 975 fATHV R &ePPA6Y 1?D 0 1,01- City: 02City: /j' JAAJ/ l9"V N State: F�- zip: Y MI P Qualifier Name: RQ o cRr /1n�-/N Phone#: :305' 7$s-M q o State Certification or Registration#: (6- 016160 Certificate of Competency#: DESIGNER:Architect/Engineer: /:�baZ EZ tr0/EZ /1'(?Gf17TeC-n Phone#: 39,57- 373- 36-33 Address: Z$- f 1 2- /WF City: M/A-M 7 State: r2 zip: 3 3 Value of Work for this Permit:$ 0 Square/Linear Footage of Work: /2) JP Type of Work: ❑ Addition EO Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: BATHROOM AND CLOSET RENOVATION Specify color of color thru tile: -1 Submittal Fee$ ---t Permit Fee$ t J • `0 CCF$ CO/CC$ w Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ 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$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 reinspectionfe will be charged. 6:�,:��i Si natur Si nature g g OWNER or AGENT CONTR CTOR Thifgrfoing instrumen was acknowledgedleforelme this The foregoing instrument was acknowledged before me this `/—�I day of O 20 i"I by 7-0 day of 01--TbQV�1— 20 1J by 1 ItIC6el PVA who is personally known to �j ( L1 n.L who is personally known to N me or who has produced as me or who has produce—;4';(C.2,!r 77d' V as identification and who did take an oath. identification and wh did take an oath. NOTARY PUBL NOTARY PUBLIC: ,If Sign: � Sign: Print: �( -A Print: Seal: Seal: �''��`�"'''°�'••,, MARLIN66ARCIA MARL NG GMCIA Notary Public-State of Florida �?: .° Notary Public-Stah of Florida J• ;,=My Comm.Expires Sep 28.201! a My Comm.Exphes gep 20.2010 . :' Commission I FF 128456 ******* si# *s*�S�� s�s ss s**r:***«**+t**t**s* **#'�'#•s* as:•s**s*:* ss***s*ss *sa*****�• APPROVED BY , Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR • KEN LAVIISON,SECRETARY STATE OF FLORIDA DEPARTMENT OF SUSWESS AND PROFESSIONAL REGULATION GtWs EtUCT-X*.!NWaIRY LW.EN31NO SOMM -Wow, hil IS.CEF IFIED Utidct>ae r489 FS. Expill on dam. AUG 31oil - �.. ARIGN;_ROBERT TODp� d\ ` �;'� • yARKI(�C N AAL ISSUED. 06/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406290001248 i 99�3 900/tood L99-1 89609OZ98L Moilo[11i1 smoo C i%,V-6oi3 :0Z K'_93-TT CITY OF MIAMI BEACH CERTIFICATE OF USE, ANNUAL FIRE FEE,AND BUSINESS TAX RECEIPT 1700 Convention Center Drive Miami Beach,Florida 33139-1819 TRADE NAME..ARKIN CONSTRUCTION CO.,INC RECEIPT NUMBER: RL-10000372 IN CARE OF: 'KOBERT ARKIN SWinnl ng: 10/01/2014 ADDRESS: 975 W 41ST ST,STE 202 Expires: 09/3012015 MMf4M1 BEACH,FL 33140--W Parcel No: A p y'if:-iiitposed for failure to imp this Ihmt em Tax Fawn" TRADE ADDRM. 975 W 41ST$T,SM 202 waft d coropicuously at ymw pbm of nosiness. Code CWIAcabe of UvwD=upation A Of Use/Business tax Receipt issued under this artiCie 004603 CONSTRUCTION CONSULTANT does not waim or supwsade other City laws,does not consft"City approval of a particular business acth*a19d does not excise th6 6oensae from all other laws applicable-to the Awnsee s ausmess. This Receipt may be tr err®d: A.Within 30 days of a bonafkle sale,otherwise a ego miete annual payment is due. &To another tom whin the CRY if proper qVM9Is and the Receipt we obtained prior to the opening of the now looation, AdWaml In brmation CERTIFICATE OF USE 400 CLU 9 05 UMTS sm Consult FF y Skwage Locadons FROM: CITY OF MIAMI BEACH _ PRESORTED 1700 CONVENTION CENTER DWE FIRST CLASS MIAMI BEACH, FL 33139-1819 U.S.POSTAGE PLAID ML41Yq BEACH,FL PERMIT No i 525 ARKIN CONSTRUC11ON CO., INC 975 W 41ST ST,STE 202 MIAMI BEACH,FL 33140-3341 �,Il„�Il,udirlif,lilumlr,fdlul�tl�n[llohl 59fii-d 900/,€00d �5i;-�. 896090Z98L �t0I�fld�Sl�iO� C�I�€i�'-ted i��0Z b�,-9�-ZZ 10 OP ID: PW ,4coRa► CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDI`15 • �,,.,-� 0110812015 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(ies) 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). CONTPRODUCER NAME: Dorothy Leavitt Rlemer Insurance Group PHONE 954 454-3145 FAX No 954-454-9552 Hallandale Branch LAIC No,g),t)-_ _ -14 - (-_ ) 4 - PO Box 250 E-MAIL dlvitt riemerinsuracom Hallandale,FL 33008-0250 ADDRESS:- ea -__� nce. __ --- PRODUC CUSTOMER PENTC01 Stephen L Rlemer ID#: -- INSURER(S)AFFORDING COVERAGE __._ NAIC# INSURED Arkin Construction Co. Inc. INSURER A:Colony Insurance Company 975 Arthur Godfrey Rd,#202 - - Miami Beach, FL 33140 INSURER B -- - - INSURER C: INSURER 0: INSURER E:- INSURER :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 --_- -- - _ ---- ADDL SUBR!- ---- --____. ---_-- 1 POLICY EFF ' POLICY EXP LIMITS LTR TYPE OF INSURANCE 'INSR W POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED — A XCOMMERCIAL AL LIABILITY ! 12/0912014 12/09/2015 PREMISES(Ea occurrence) 300,0 00 CLAIMS-MADE DE X.I OCCUR 1103GL0007531-04 : MED EXP(Any one person) S 5,00 I PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: : PRODU TS-COM P/OP AGG $ .2,000,000 -----_' POLICY r PRO- --- LOC; $ X 'T AUTOMOBILE LIABILITY !COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS il _._--i _ ,BODILY INJURY'Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ H{RED AUTOS PER AC(',IDENT) S NON-Ob'VNED AUTOS $ UMBRELLA LIAROCCUR '. EACH OCCURRENCE $ EXCESS LIARCLAfM - A AGGREGATE $ _ DEDUCTIBLE RETENTION $ S WORKERS COMPENSATION ', li WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS 1 ANY PROPRIETOWPARTNER/EXECUTIVE [:] E EACH ACCIDENT OFFICER/MEMBER EXCLUDED9 ''N/A -.. (Mandatory in NH) :.._E L DISEASE EA EMPLOYEE $ !f yes,describe under w E L DISEASE DESCRIPTION OF OPERATIONS beloPOLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) The license number is CG 038280 CERTIFICATE HOLDER CANCELLATION Miami Shores Village MIAMSHI g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bldg Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD PENTC01 PAGE 2 NOTEPAD INSURED'SNAME Arkin Construction Co. Inc OP ID: PW Date 01/08/2015 Certificate Holders: Bal Harbour North South Condominium Association, Inc. Bal Harbour Resort Master Association, Inc. 19701 Collins Avenue, LLC Bal Harbour Hotel, LLC, a Delaware limited liability company ("BHH") Starwood Hotels & Resorts Worldwide, Inc. ("Starwood") I I ' ® DATE(MM/DDIYYYY) ACOOR o CERTIFICATE OF LIABILITY INSURANCE 1/13/2015 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(ies)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). CONTACT PRODUCER SUNZ Insurance Solutions, LLC ID(Essential) NAME: Jennifer Hauger c/o Essential HR, Inc. dba First Star HR PHONE FAx ----- 251 O'Connor Ridge Blvd Suite 370 E-MAIL Y� } —- 214 492-1986 (Arc, _ _ Irving, TX 75038 ADDRESS: iennifer.hauger—CEDfirststarhr.com _ _ _INSURER(S)AFFORDING COVERAGE _ INSURER A: SUNZ Insurance Company _ 34762_ INSURED INSURER B: Aspen Re-London-Best Rating"a" Essential HR Inc., Essential HR II Inc, dba First Star HR INsuRER_c: Catlin Syndicate-Lloyds-Best Rating°a" —-- ----- ------ 251 O'Connor Ridge Blvd INSURER D: Brit Syndicate-Lloyds-Best Rating"A" Suite 370 INSURER E Irving TX 75038 - -- INSURER F COVERAGES CERTIFICATE NUMBER: 23049697 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�— ---_— ADDLUBR MI --- POLICY EFF OMITS LTR TYPE OF INSURANCE POLICY NUMBER MDD M COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ CLAIMS-MADE1:1 OCCUR -FREMISES- a occurrence) MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT — OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ — _--ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS — ------ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) $ UMBRELLA LIAB —�OCCUR EACH OCCURRENCE EXCESSLIAB 1CLAIMS-MADE AGGREGATE $____________. DED- l RETENTION$ $ A WORKERS COMPENSATION WCPE0000018402 10/1/2014 10/1/2015 ' STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L._DISEASE-EAEMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of:ARKIN CONSTRUCTION COMPANY INC Effective date: 10/1/2013 License Number:CGC038280 CERTIFICATE HOLDER CANCELLATION 68400005 Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 9 P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax: 305-756-8972 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23049697 Todd Trowbridge 1/13/2015 3:47:54 PM (CST) Page 1 of 1