RC-13-415 t Miami Shores Village FEB 2 8 2013
Building Department
90050 N.E.2nd Avenue,Mmmi Shores,Florida 33138 =- _
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
C
BUILDING Permit
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: ®Za 5'_ AI,—"
City: Miami Shores County. Miami Dade
Folio/Parcel#: //- 0a??-0-3 00
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): ,�,�c��� s7W rZ C-e V1 c Phone#:
Address: /,I v2 Al —
City: Wi'lA 1, 5'�04es State: r/®.za`C/'1 Zip: 23 13 R
Tenant(I.essee Name: Phone#: jk? 961
Email:
CONTRACTOR.Company Name: ��� ciJa�S/.Ulf//�s/ �a � Phone#:
Address: 19,26-3 _ w /o 3 r47`j
City: M,4-al' State: Zip: _33 157
Qualifier Name: ke is i l L..91 L® Phone#.
State Certification or Registration#: '6C. I tea D 5� Fa- Certificate of Competency#:
Contact Phone#: � '� -�� Email Address:
DESIGNER:Architect/Engineen.. KEF;rift af/C-0 Phone#
Value of Work for this Permit:$ A), �` e9 SquarelLinear Footage of Work: Sp
Type of Work: OAddition ®Alteration ONew,, s i7Repair/Replace ODemolition
Description of Work: L n! 0 /'q C o P T lds el
d 3 a -I 7/0 aA.c Via/
Color thru tile:
Submittal Fee$ Permit Fee$. CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ �c�
Bonding Company's Name(if applicable)4
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 ELECTRICAL 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
ENAPROVEMENTS 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 certif ed 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 A646 Signature-4i/ ea
Owner or Agent Contractor
The foregoing instrument was ac kr vl f re me tt 6 foregoing g
j / t' The fo oin instrument was acknowledged before me this
day of.. ,20-9 by day of {�® 20 A by
who is personally known to me or who has produced who' rsonally known me or who has produced
As identification and who did take an oath as identification and who did take an oath.
NOTARY LIC: NOTARY PUBLIC:
Sign Sign:
print '1j PrintS
My Commission :;c�Aar°�s��y� MABEL FUENTES My Commission Expires: Doty PO�V EUeM LOPEZ
Notary Public-State of Florida MY COMMISSION#EE031796
My Comm.Expires Mar 30,2014 * * EXPIRES:October 30,2014
Commission#DD 976991 �j1 Sao Sa6l Tin BadgdNateySwim
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012xRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15109)
DATE(MMIDD►YYYY)
CERTIFICATE OF LIABILITY INSURANCE E
,�. 02/18/13 i
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: V the certificate holder Is an ADDITIONAL INSURED,the cy(les)must be endorsed. if SU TION IS WANED,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 ilea of such endorsement(s).
CONTACT
PRODUCER E.'
Best Rate Insurance Agency,Ina. Ew (8W)61SOM (3135)403 1
8800 NW 17 St.Suite 170 jawpRESS, amorenar irate-Insurane&com
Doral,FL 33128 AFFORDSNte CObfiRA6E riAtCR
Phone (866)618-0065 FaX 40UM IMSURERA: Preferred CentractorsAssociaffa#
INSURED INSURER 0:
FCL Contsruction Group INSURER C:
18253 SW 109 Path INS IRER D:
Miami,FL 33157 (78M 5921083 INSURER E:
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 POUCYPERIOD
INDICATED.NOTWITHSTANDING ANY RECAAREMENf.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
T TOALL THE TERMS.
E.ICIES DESCRIBED HEREIN iS SUBJEC
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE PO
EXCLUS)ONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED 8Y PAIDCLAIMS.
TTSRI
POLE EUEP
TYPE OP IN6URANCE POLICY NUMBER LIMITS
GENERAL LIAORM EAC H OC CURRENCE 5 1,000 000.00
® COMMEURCIAL GENERAL UABIJTY' PR �j�OMM1ee - 60.0w.00
A ❑ ❑ '�� R1 Ott PCI( PCA975W 10130/2012 101 13 MEDEw(n+�ronaperson S 51000.00
PERSONAL&A[ArlftJlW s 1,000,0w-00
❑ GENERAL AGGREGAIE $ 1,000,000.00
GEWL AGGREGATE UWr APPLIES PER PR CS-COMMOPAGG S 1,00D.000.00
❑PCa.Iv 13-M ❑ L= BY PD s 1000,tM10.00
AUTOMOBILE LIABILrry a D��NOLE FT 5
❑ ANYMM 6ODILYINJ M(p pemon) 5
QALLOWNED SCHEDULED SODLYINJ wIperaew"q S
AUIOS
HIREDAUTOS O J�gOWNEt) S
S
❑ UMBRELL L" �OCCIN EACHOCCURRENCE $
E7CCCESS Luis OApge;.pAA 3E AGGREGATE $
DID 0 R6T8N—$ 5
vfORKERSCOMMPBNSATEOII WCSFATU 0113
AND EMPLOYERS•LIABILITY YIN
ANY EXCLUDED? NIA EL EACHACCIDENT 8
y�nd�Y la wl) EL DISEASE-EA EMPLOYE S
IDESCRIPTIOI+tOF�ERATfONSr�eka� EL DISEASE-P�1rE1MET $
DESCRIPTION OF OPERA'flON8/LOCATIONS(YEttttl.E6(Attach ACORD tOt.AddEelgi Remartea Schodula.U r�space is�
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED 811FORE
MIAMI SHORES VILLAGE BLDG DEPT THE EXPMTiON DATE THEREOF,NOT)CE INILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
10050 NE 2ND AVE
MIAMI SHORES,FL 33138 AUTHORIZED RFittESE?NTAME
�iM4�QiOACM�DC R ghts resatved.
ACORD 26(2010106)t1F The ACORD name and logo are registered marks otACORD
` FIRST-CLASS
n. U.S.POSTAGE
PAID
MIAMI,FL
PERMIT NO.231
705565-0 THIS IS NOT A BILL—DO NOT PAY NEW
733315-6
13U Sft%§WWT?bN GROUP CORP STATMCMM%20972
18253 SW 109 PATH
33157 UNIN DADE COUNTY
OWVR CONSTRUCTION GROUP CORP
WORKERlS
S"'clW ORM BUILDING CONTRACTOR 1
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT.IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
ZOONING LAAWS OF THE DO NOT FORWARD
COUNTY OR CITIES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE FCL CONSTRUCTION GROUP CORP
REQUIRED BLAW,THIS IS
NOT A CERTIFICATION OF
FELIX CASTRO PRES
THE HOLDER'S QUALIFICA-
TIONS.
18253 SW 109 PATH
PAYMENT RECEIVED MIAMI FL 33157
MIANI•DADE COUNTY TAX
":10/22/2012
02240002001 I .# . ; {A # }I tI.i It i #.# !. I# I HSI
000075.00 IF►i ttt t1iF)ItTIF1tI1F�t#hlttiSIF►1} *.,IF {;t}1}}it?►►P►I►t
SEE OTHER SIDE
t .
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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 listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 10/30/2012 EXPIRATION DATE: 10/3012014
PERSON: CASTRO KEFFLER
FEIN: 460993169
BUSINESS NAME AND ADDRESS:
FCL CONSTRUCTION GROUP CORP
7350 SW 89 STREET, UNIT 821
MIAMI FL 33156
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL
CONTRACTOR
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 under this section may
not recover benefits or compensation under this chapter.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 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 stall 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.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609
r• • r• rs °• r °r•°
i
AC 1 s��►T OF F�oR�n�
DEPARTMENT Bt?SINES3 AND: PROFR'SSION�L REGULATION
CONS UC ' .ON INDUSTRY LICENS.IN.. BOARt3 $Eta#ta121o� 00397
DATE BATCH NUMBER LICEN
The: Gf�NEta ar. CNTRACT R
O
O k} �
NamO& bei.ow IS CERTIFIXD
tinder the p ov siono of? Chapt�
Expiration date: ADG 31, 2014 F ��� ' �� �� 4
1
F LT OiSTRUCT Ot+l GROUP. COKE?,
7350 SW 89 'STRFET UNIT. 821 _
MIAMI FL. 33156
RICK SCOTT KEN LAWSON
GOVERNOR SECRETARYil
DISPLAY AS REQUIRED BY LAW
I
s I
i
t I61
CFN 2013RO194851 ,
NOTICE OF COMMENCEMENT INSPECTIO�,J" 28528 Ps 2080; (W)
A RECORDED COPY MUST BEPOSTED ON THE JOB SITE AT TIME OF FIRST ECORDED 03/13/2013 12059122
HARVEY RUVINP CLERK OF COURT ,.
MIMI-BADE COUNTYP FLORIDA
PERMIT NO. L- 1-13 -L[/&— TAX FOLIO NO. 11-D-OL-0,21 -0520UST PACE
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal description of_Trope rty and street/ dre 2�
_ r:0.4 +kLLj 50tee 19, gfogj( .2. � Sdjjyye
lal LK, ips e. Fos 4 7-s- V _I 0
ac.covI,a *o At JU4 Avreok VLg,�,Jed In'I"I" hacK 15cl Am-Ql! b,5
Aja ircss 17 7 WC
j; N(C-- qZ 5+ M�Q, 4$15F
2. Description of I proverne t Im, 4d- 5 f3wel j
V\Q_,-,N ko- ot Wa. 4_41i-e-s ok,06 (n LAS, conyty4i 54 W
'c
UARn mqs)ky_ 6&+h b c.� wsw I K gpi -laseA �reza lrder'24 -&A a42
3. Owner(s) name ain�44dr : I
01 1111re- IM 5
it c9m,C
M e CA 3 313 9
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and addr iss.
Fr_..
7:
19153 5w 109 1& Kfam? R. 35_151�
5. Surety: (Payment bond required by owner from contractor, if any)
Name and Address:
Amount of bond$
6. Lender'sAame a d address: A *(?36
ke RVWT 7
SLID lave Ern-Nd Vk0aj is+ Im
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes.
Name and Address: STATE OF FLORIDA.CC DT"
INSjoy UNTY OF
cEqnFYth&y-gq,,k.a-0.,
8. In addition to himself, Owners designates the followingnpF40 a Lienor'
in Section 713.13(1)(b), Florida Statutes. NESS my hand and OrflOal 8*01.
MAR -
h pry-
Name and Address: Ic
Syr (0, cw*co ft,
9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a
different date is specified)
Signature of Owner
Print Owners Name Prepared by
Sworn to and subscr ad be me this day of WW'.61 20 13
7>
Address:
Notary Public:
Print Notary's Name: WABEL
My commission expires:
P, sc's I utdly MPH; lor
• * .-My Comm.Expires r 2 14
Commission#D Big
oil:
M0 Bonded Through National Notary Assn.
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-186568 Permit Number: RC-2-13-415
Scheduled Inspection Date:April 29,2013 Permit Type: Residential Construction
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: PREDRAG STARCEVIC, KAREN BLAIR Work Classification: Addition/Alteration
Job Address: 1225 NE 92 Street
Miami Shores, FL Phone Number (305)751-9333
Parcel Number 1132050270300
Project: <NONE>
Contractor: FCL CONSTRUCTION GROUP Phone: (305)542-7866
Building Department Comments
CONVERT A BEDROOM INTO A WALK-IN CLOSET, Infractio Passed comments
CONVERT BATHTUBS INTO SHOWERS AND RENOVATE INSPECTOR COMMENTS False
MASTER BATH AND BATHROOM#2 BY REPLACING
FIXTURES
ON HOLD FOR NOC
NOC RECEIVED ON 3/13/13
Inspector Comments
Passed q F�7e 2
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
April 26,2013 For Inspections please call: (305)762-4949 Page 18 of 50