BPP-15-771 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: P-2 1 53 Permit Number: BPP-4-15-771
pe INS 3 6
Scheduled Inspection Date: March 22,2016 Permit Type: Pools/Whirlpools/Hot Tubs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner. JACKSON, LANCE AND PAULA Work Classification: New
Job Address:391 NE 103 Street
Miami Shores, FL 33138-2432 Phone Number
Parcel Number 1121360130290
Project: <NONE>
Contractor: PARKWOOD POOLS INC Phone: (954)583-3355
Building Department Comments
POOL AND DECK CONSTRUCTION. POOL GALLONS Infractio Passed Comments
6,828. PAVER DECK SET IN SAND. INSPECTOR COMMENTS False
QUALIFIER NEEDS TO MEET WITH BUILDING OFFICIAL
JF 10/6/15
Inspector Comments
Passed �'r/.�/ cit✓.�L ®dam
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 21,2016 For Inspections please call: (305)762-4949 Page 2 of 36
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-253786 Permit Number: BPP-4-15-771
Inspection Date: March 15,2016 Permit Type: Pools/Whirlpools/Hot Tubs
Inspector: Dacquisto, David
Inspection Type: Survey Final
Owner: JACKSON, LANCE AND PAULA Work Classification: New
Job Address:391 NE 103 Street
Miami Shores, FL 33138-2432 Phone Number
Parcel Number 1121360130290
Project: <NONE>
Contractor: PARKWOOD POOLS INC Phone: (954)583-3355
Building Department Comments
POOL AND DECK CONSTRUCTION. POOL GALLONS Infractio Passed Comments
6,828. PAVER DECK SET IN SAND. INSPECTOR COMMENTS False
QUALIFIER NEEDS TO MEET WITH BUILDING OFFICIAL
JF 10/6/15
Inspector Comments
Passe �, t CREATED AS REINSPECTION FOR INSP-253750. IDENTIFY LOCATION
OF POOL EQUIPMENT ON THE PLAN.
DIMENSION POOL SETBACKS FROM REAR AND SIDE PROPERTY LINE
Failed a TO POOL DECK AND WATERS EDGE.
Correction - PCX%
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
For Inspections please call: (305)762-4949
March 15,2016 Page 1 of 1
�- BOUNDARY AND TOPOGRAPHIC SURVEYW= 01
I I PROPERTY ADDRESS: 391 NE. 103rd STREET, MIAMI SHORES, FLORIDA 33138 3_"-OWE.-E
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— --- — I LEGAL DESCRIPTION p a p a a�a a
F.R.01/2" 15' ALLEYg' PAVEMENT F.R.01/2" , THE EAST 25 FEET OF LOT 23 AND ALL OF LOT 24, IN BLOCK 118, OF a�
NO ID. NO ID. AMENDED PLAT OF SECTION No. 5 OF MIAMI SHORES, ACCORDING TO
THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, AT PAGE 47, OF o 6
x,—x—� N o°rp ' .'� ?. I THE PUBLIC RECORDS OF MIAMI—DADE COUNTY, FLORIDA. z F
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aM I c A (5J-17 FAC), IS "RESIDENTIAL". THE MINIMUM RELATIVE DISTANCE ACCURACY FOR THIS TYPE ?
OF BOUNDARY SURVEY IS 1 FOOT IN 7,500 FEET THE ACCURACY OBTAINED BY MEASUREMENT ci
"i I N > AND CALCULATION of A CLOSED GEOMETRIC FIGURE WAS FOUND TO EXCEED THIS REQUIREMENT. a a
IV -WELL IDENTIFIED FEATURES AS DEPICTED ON THIS SKETCH WERE MEASURED TO AND ESTIMATED
F.N. A I ' HORIZONTAL POSITIONAL ACCURACY OF 0.1 FEET. m}zy5
NO ID. -LANDS SHOWN HEREON WERE NOT ABSTRACTED, THEREFORE THIS SURVEY IS SUBJECT TO o: S-_0 R 1$3
F__ EASEMENTS, RIGHT OF WAYS, AND OTHERS MATTERS WHICH MIGHT BE REFLECTED IN A FLOOD ELEVATION INFORMATION: a v Z3
-—— 9' ': :' ' ire• i F RaO� /Zs. A: D' SEARCH OF TITLE TO THE SUBJECT LANDS. DATE OF FIRM: 09-11-09 a a ° a It a a a a
-NO ATTEMPT WAS MADE TO LOCATE UNDERGROUND FOOTINGS OF ANY STRUCTURE.
-THIS SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITY (ENTITIES) COMMUNITY No: 120652 m m
——'♦ "'+ NAMED HEREON IN THE CERTIFICATION AND DOES NOT EXTEND TO ANY UNNAMED PARTY. << ci c3 c3 c3
@ 5' SWK. U.P. U.P. -ELEVATIONS ARE REFERRED TO NATIONAL GEODETIC VERTICAL DATUM (1929) PANEL 0302 SUFFIX L
��Q1v I MIAMI-DADE COUNTY BENCHMARK No.N-397-R; LOCATOR N0.3100; ELEVATION=10.12' ZONE: X BASE FLOOD ELEVATION: N/A
O I s �'°`�'��TSS��
h �Village ANTONIO FIORE,FI OREPSM
WILL BEAR THE EME:OSm SEAL
,7 I OF THE ATTESTING LAND SURVEYOR
BY ATF_ LAND SURVEY'C)R LAND PLANNER
g1 / 1842 SW. 124th Place, Miami, Florida 33175
IG DEPT Phone: (305) 221-3040 Fax: (305) 221-9040
10 6
NE 103rd S 1 R 10 8$ I HERIMY CERTIFY THAT THIS=INDARY AIS TOPOGRAPHIC SURVEY OF THE PROPERTY
—- - - - -- - - rTr-�"P- - - - -
RECENTLYURVEYED AND DRA CORRECT�MYY SUPERVISION.THE�
24' PAVEMENT `'F
---- W111i THE STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA BOARD OF PROfE350lIAL ANTONIO ORE
C� C;O"v1PL-I�,NC1_Vb'ITI 1 ALL FLDLRAL LAND SURVEYORS IN CHAPTER 5J-17 FLORIDA ADMINISTRATIVE CODE,PURSUANT 7O PROFESSIONAL SURVEYOR AND MAPPER No 5184
SECTION 427027 FLORIDA STATUTES. STATE OF FLORIDA
�'''� A''nr'� SCALE: 1"=20' DRAWN BY: F.A.L. REFERENCE: 02-03-15 FIELD BOOK: 16-0126 DATE 02-16-16
V 9— .911ft
Inspection Worksheet
Y Cu Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-253750 Permit Number: BPP-4-15-771
Inspection Date: March 01,2016 Permit Type: Pools/Whirlpools/Hot Tubs
Inspector: Dacquisto, David Inspection Type: Survey Final
Owner: JACKSON, LANCE AND PAULA Work Classification: New
Job Address:391 NE 103 Street
Miami Shores, FL 33138-2432 Phone Number
Parcel Number 1121360130290
Project: <NONE>
Contractor: PARKWOOD POOLS INC Phone: (954)583-3355
Bullding Department Comments
POOL AND DECK CONSTRUCTION. POOL GALLONS Infractio Passed Comments
6,828. PAVER DECK SET IN SAND. INSPECTOR COMMENTS False
QUALIFIER NEEDS TO MEET WITH BUILDING OFFICIAL
j rI
JF 10/6/15 l.!&A
965-
Inspector Comments
Passed El
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
For Inspections please call: (305)762-4949
March 01,2016 Page 1 of 1
BOUNDARY AND TOPOGRAPHIC SURVE ; ' •�, '•' •�• z=
' A04ERTY ADDRESS: 391 NE. 103rd STREET, MIAMI SHORES, FLORIDA 33138
U.P. ---- 102M .1 =mea
--- ----- - •• LEGAL DESCRIPTION
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F.R.01/2" 15' ALLEY 9' PAVEMENT F.R.01/2" 'i• ••' '•' •% .:. :,:THE EAST 25 FEET OF LOT 23 AND ALL OF LOT 24, IN BLOCK 118, OF > a� C\
NO ID. NO ID. 30 AMENDED PLAT OF SECTION No. 5 OF MIAMI SHORES, ACCORDING TO
THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, AT PAGE 47, OF o
10 •• •" •• THE PUBLIC RECORDS OF MIAMI–DADE COUNTY, FLORIDA.
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F.E.=11.31' x " I 9 N 9
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m E'
-mom _ f NOTES:
' a
o , I -THE EXPECTED USE OF THE LAND, AS CLASSIFIED IN THE STANDARDS OF PRACTICE w
A=39.14 (5J-17 FAC), IS "RESIDENTIAL". THE MINIMUM RELATIVE DISTANCE ACCURACY FOR THIS TYPE z
a d , „ OF BOUNDARY SURVEY IS 1 FOOT IN 7,500 FEET. THE ACCURACY OBTAINED BY MEASUREMENT o v
'S� I N 89 41 51 I AND CALCULATION OF A CLOSED GEOMETRIC FIGURE WAS FOUND TO EXCEED THIS REQUIREMENT. F m
. . Apl
4WAO%N..# pry -WELL IDENTIFIED FEATURES AS DEPICTED ON THIS SKETCH WERE MEASURED TO AND ESTIMATED
F.N. o, I HORIZONTAL POSITIONAL ACCURACY OF 0.1 FEET. c? o m
NO ID. I -LANDS SHOWN HEREON WERE NOT ABSTRACTED, THEREFORE THIS SURVEY IS SUBJECT TO
— —— I EASEMENTS, RIGHT OF WAYS, AND OTHERS MATTERS WHICH MIGHT BE REFLECTED IN A FLOOD ELEVATION INFORMATION: U$U U U
"•.. .99*,.4:•::•,.:;..•:. q,;.••••;••••' SEARCH OF TITLE TO THE SUBJECT LANDS. a a a
i•q •': 3 :.:, ..,. " -NO ATTEMPT WAS MADE TO LOCATE UNDERGROUND FOOTINGS OF ANY STRUCTURE DATE OF FIRM: 09-11-09 a
1110:ID: •, °•. -THIS SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITY (ENTITIES) COMMUNITY No: 120652 m m c�=z vi
C——— < - I NAMED HEREON IN THE CERTIFICATION AND DOES NOT EXTEND TO ANY UNNAMED PARTY. a<m ci Cj ci U Pi d
5' SWK. U.P. U.P. I -ELEVATIONS ARE REFERRED TO NATIONAL GEODETIC VERTICAL DATUM (1929) PANEL: 0302 SUFFIX L
MIAMI-DADE COUNTY BENCHMARK No.N-397-R; LOCATOR No.3100; ELEVATION=10.12' ZONE: X BASE FLOOD ELEVATION: N/A
0 I VAUD COPIES OF THIS SURVEY
M M I ANTONIO FIORE, PSM OF THE ATTESTINEAR THEG LAND SURSEAL
VEYOR
LAND SURVEYOR LAND PLANNER
1842 SW. 124th Place, Miami, Florida 33175
Phone: (305) 221-3040 Fax: (305) 221-9040
6� NE. 103rd STREET -
1 HEREBY CERTIFY THAT THIS BOUNDARY AND TOPOGRAPHIC SURVEY OF THE PROPERTY �
24' PAVEMENT DESCRIBED HERON IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF
AS RECENTLY SURVEYED AND DRAWN UNDER MY SUPERVISION.THIS SURVEY COMPLIES ANT NIO FIORE
WITH THE STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL PROFESSIONAL SURVEYOR AND MAPPER No.5184
LAND SURVEYORS IN CHAPTER 5J-17 FLORIDA ADMINISTRATIVE CODE, PURSUANT TO
SECTION 427.027 FLORIDA STATUTES STATE OF FLORIDA
SCALE: 1"=20' DRAWN BY: F.A.L. REFERENCE: 02-03-15 FIELD BOOK: 16-0126 DATE: 02-16-16
sg, Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204 `
Expiration: 1112 2015
Project Address Parcel Number Applicant
391 NE 103 Street 1121360130290
LANCE AND PAULA JACKSON
Miami Shores, FL 33138-2432 Block: Lot:
Owner Information Address Phone Cell
LANCE AND PAULA JACKSON 391 NE 103 Street
MIAMI SHORES FL 33138-
391 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone $ 10,000.00
Valuation:
PARKWOOD POOLS INC (954)583-3355
Total Sq Feet: 286
Approved:In Review Available Inspections:
Comments:
Inspection Type:
Date Approved::In Review
Fence
Date Denied: Final
Type of Work:Swimming Pool Occupancy:Private Pool Deck
Additional Info: Bond Retum: Wall Steel
Classification:Residential Scanning:3 Review Electrical
Review Electrical
Review Plumbing
Review Plumbing
Review Planning
Review Planning
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building
Bond Type-Contractors Bond $500.00 Review Structural
CCF $8.00 Invoice# BPP-4-15-55074 Review Structural
CO/CC Fee $50.00 05/26/2015 Check#:1641 $994.00 $50.00
DBPR Fee $4.50 04/06/2015 Check#:777 $50.00 $0.00
DCA Fee $4.50 Bond#:2724
Education Surcharge $2.00
Permit Fee $300.00
Plan Review Fee(Engineer) $80.00
Plan Review Fee(Engineer) $80.00
Scanning Fee $9.00
Technology Fee $8.00
Total: $1,044.00
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,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: Ice at aII ;Fye1 regoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. F rm re,I /,+r�( a the above-named contractor to do the work stated.
May 26,2015
Authorized Signa r�Im
ner / Applicant / Contractor / Agent Date
Building Del aent Copy
May 26,2015 1
s
Miami Shores Village REcE
Building Department APR s zo�5
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY
Tel:(305)795-2204 Rai»(305)756-8972
wspwTioN UNE PHONE NUMBER:(305)762-4949
FBC 20 16
BUILDING alii�ter Permtt No. p
BUI i3� lam_
PERMIT APPLICATION Sub Permit No.
ZUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
[-]PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [-]CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRES& 391 NE 103 5"t
City Miami Shores County Miami Die zip: 33138
Fo#o/ParceNk 11-2134-013-029O is the BWhft Histwically fid:res NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 44thAZI-0 Phone#: $bs-3a3-55 w
Address: All !3E IC9 S h' f
City: miarAi State: `11 Zip: 33438
Tenant/Lessee Name: 41 A Phone#:
Email:
CONTRACTOR:Company Name: %ALwonol ruts J Z, Phvone#: 3355
Address: (0101 W. &&4lhioe 364-
City: 91A4&AL;V16 State•. Ft.. Zip: 33313
Qualifier Name: David AJ&mc_ Phone#: 9N-?01-L8101
State Certification or Registration#: CPC 146#711q Certificate of Competency M
DESIGNER:Architect/Engineer. nt rYWW &MA Pho nr#: 9564 w-28:15
Address: Aw s, Fawa 14 tcA —aty: &"gLLA&iocLState• fL Zip: M"J,
Value of Work For this Pwndt:$ .000. — �' S4� ge Rootaof W� 2416fiixio -K l s 4"kr
Type of World ❑ Addition ❑ Alteration E: New d Repair/Replace ❑ Demolition
Description of Worla 17..1 + DOdA, (oncjr� 171.1 G lo-a L.In 6 ?000.-
Raust dello, d.1 w�, e---Q
Specify color of color thm We: �
Submittal Ree$ � Permit Fee$ - CCF$ Co/CC$ s `/~Z)
Scanning Fee$ Radon Fee$ DSMt s Notary$
Technofty Fee$ TrainhWEdueation Fee$ Double Fee$
Structural Reviews$ Bond$ +�\
TOTAL FEE NOW DUE$
(Rev /24/2014) � .00
y
Bonding Company's Name(if applicable) 114 iA
Bonding Company's Address
City State ZIP
Mortgage Lender's Name(if applicable)_ aIA
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.....
OWNEWS 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."
Nouse to Appilcont: As a aondit/on to the issuance of a bOdng permit with an estimated vahw exceeding$2SCQ the applicant must
promise in good Cdr that a copy of the notice of cormnence►rwnt and construcdon lien law brochure arta be dethrered to the person
whose property Is subject to attachnwit Also,a certified copy of the recorded notice of commencement must be posted at the M site
for the first insecuon which occurs seven (7)dogs after the bufidbrg permit is issuedin the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature Signature^
OWMER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
.30 day bf rnGAe&-, .20 1115 by ao day of 20 115 by
_'arl,44m who is personally known to IwW AJt &-& .who Is personally known to
me or who h roduced &MA 1iceetL as me or who has produced as
Identification and who did take an oath. Identification mind who did take an oath.
NOTARY PUWC: NOTARY PUBLIC:
Sign: Sigm
Print• Print: rn0
Seal: it `... CHERYL MORGAN seal: ...... CHERYL
MORGAN
'`a;'
F'Jy QE MY COMMISSION#FF008874 MY COMMISSION#FF008874
.,'�;,, off.•'' EXPIRES June 28,2017 of q" EXPIRES June 28,2017
m�iiiir �!!! !i!!!ilit!!it! lii � �E�Ni
� f
APPROVED BY 72;L")
lJ Plans Examiner J 2� Zoning
b 1} Structural Review Clerk
( /24/Z014I
Eggs gguE Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. ✓ COPY OF QUALIFIER'S STATE LICENCES
B.. COPY OF LOCAL BUSINESS TAX RECEIPT
C. J COPY OF LIABILITY INSURANCE*
D. ✓ COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER 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 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
Xpertificate must specify the description of operations or contractor license number. 140
BUSINESS NAME: BiU Lwood ?bo is _ ac-.
BUSINESS ADDRESS: fo76 l W. �ur�n�.e. �13F CITY ? , STATE - ZIP 33313
BUSINESS PHONE: 9( 57 1 5'53-3355 FAX NUMBER(aS4 1 5-93-3oogi
CELL PHONE91 6- ) 787- L90-7—QUALIFIER'S NAME: lawm Adams
QUALIFIER'S LIC NUMBER: CPC 145'l4?4
410STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
ADAMS, DAVID WILLIAM
PARKWOOD POOLS INC
6761 W SUNRISE BLVD#16
PLANTATION FL 33313-6000
Congratulationsi With this license you become one of the nearly
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, DEPART W-BUSINESS AND
and they keep Florida's economy strong. PROFS �ULATION
Every day we work to improve the way we do business in order to CPC1457879• l ''=•06/16/2014 ;a
serve you better. For information about our services,please log onto
www.Myfloridalicense.com. There you can find more information CERT COMM I!OQt *lTR
about our divisions and the regulations that impact you,subscribeADqMS,pAVtll�
to department newsletters and learn more about the Department's
initiatives.
PARKWOOD
Our mission at the Department is:License Efficiently,Regulate Fairly. ' K � ;
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida, 18,CERTIFtEI)-undet the-tttovisions Of Eh.489 FS.
and congratulations on your new licensel Eipb>5lfW-&J&-.-AUG 31,2018•- L14061WWIOM
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE ff FLORIRA
DEPARTMENT OF RUSPIM AND PROFESSIONAL REGULATIONI
CONSTRUCTIdN INDUSTRY LICENSING WARD. {
s
I
CPC1457879 r. '
Tbo CIAL POOLISPA CONITRAt—RNaftd below 15 f
r
Undue�te pr'ovlakmof CIt�+RW 489 FS.
Expfra date: AUG-31,2016 -,
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t
s d '� _VIS' .-�f�l�t��E��i'7`P�-t``°` i'�Y. �� > 'O� ���� '������ �,• 0�q 'y,V� Y e . .
••..°.>< ...:.'��. .�. ...<''-' �.,a..sZ .1�....`..a..�....'.ta.«..y,'.._1k«.-.mow.«,.-._• .,..'.._..� _..a.
115 S. Andrews Ave.,q�Rm.. A-1 00,
Ft. Lauderdale, FL 33x33®01-1395®9Q54�-331-4000
VALID OCTOBER O®ER 1 g 201 THROUGH SEPTEMBER 3%2015
DBA: Receipt 'POOL�MARINE CONTRACTOR
Rusin Name:PARKWOOD POOLS INC Business Type: (COMMERCIAL POOL/SPA
CONTRACTOR)
Owner Name:DAVID W ADAMS/QUAL Business Opened:03/12/2009
'1
Business Location:6761 W SUNRISE BLVD 16 State1County1C9rUR9g:CPC1457879
PLANTATION Exemption Code:
Business Phone:
Rooms sents Employees Machines Professionals
2
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee MSF Fee Penalty PnorYears Collection Cost Total Paid
27.00 0.00 0.00 0.00 0.00 0.00 27.00
THIS RECEIPT MUST BE POSTE® CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory in nature.You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location.This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
DAVID W ADAMS/QUAL Receipt #OIA-13-00005953
6761 W SUNRISE BLVD STE 16 Paid 08/12/2014 27.00
PLANTATION, FL 33313
2 1
PARKPOO-01 MARTIND
CERTIFICATE 4F LIABILITY INSURANCE °A'E`" "
711012014
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 polkies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in Ileu of such endorsement(s).
PRODUCER NAME
S.S.Nesbitt&Company PHONE (251)344.5530 , 251 343-0653
860 Downtowner Blvd
M410-
Mobile,AL 36609 A
AFFORDING COVERAGE MAIC 0
INSURERA:Scottsdale lndemnfty Company 15580
INSURED INSURER B
Parkwood Pools Inc INsuRERC
6761 W Sunrise Blvd Ste 16 INSUReRO:
Plantation,FL 33313 INSURERE:
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 PERF
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 DOL Sum POLICY MCP POMMLTR TYPE OF INSURANCE POLICY NUMBER LIMITS
A X COMMERCIAL,GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C
SMS." a OCCUR APPCPS1836273 0710/2014 071IW2015 $ 100,0001
NEDEXP WV one perew $— 5,0
PERSONAL&ADN INJURY $ 1,000,00
GENA AWREGAT E LIMIT APPLIES PER: GENERAL AGATE $ 2►000r
POLICY LOC PRODUCTS•COMPIOPAM $ 2,000,00
OTHERLIMIT $
AUTOMOBILE LIABILITY IMINSFUM $
ANY AUTO
BODILY MIJURY OW POW* $
ALL
O
AUTD AUT SOMY INJ�Y IPw a S
HIREDAUTOS AUTOS
O $
$
UNBRELI A LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR I ICLAIMSSAABE AGGREGATE $� —
DED I I RETEW ON $
WORI(ERS COMPENSATION A
AIRS GMPLOYOW LIABIL TY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN M 1 A E.L.EACH ACCIDENT $ _
OFFICERII
E L DISEASE-EA EMnEng$
SRI S urder
OF OPERATIONS ter E.L.DISEASE-POLICY umtr I$
A Pool Pop Up Coverage PCPS1836273 07/10/2014 07/10/2015 $50,000 per occurren 100,000
may be aUached If more ae is
DESCRIPTION OF OPERATXXVS l LOCATIONS/VEHXx.ES tACORO fef,Addidonai Remarks Schedule, p spa required)
Pool Contractor(Waterfalls&Spas)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE Miami Shores Village ACCORDANCE THE POLICY PROPIRATION DATE VISIONS.NOTICE WILT. BE DELIVERED IN
10050 N E 2nd Avenue
Miami Shores,FL 33138
AUTHORIZED REPRESEWATIVE
./ Al—..-4,
I 019988"t 2014 ACORD CORPORATION. AN rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
co�Rv® CERTIFICATE OF LIABILITY INSURANCE 9/25/2014°"m"
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 pol(cy(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 endomemen s.
PRODUCER WMIRcT Andrea Lopez Ext 314
BB Insurance Marketing Inc PHONE I FAX
10167 W Sunrise Blvd,3rd Floor (M.NO,EW-954-452-4900 No)-954-452-0450
E-MAL
Plantation FL 33322
INSURER(S)AFFORDING COVERAGE NAIL 0
INSURER A Associated Ini:1ustries Ins Co 23140
INSURED PARKW-4 INSURER B:
Parkwood Pools,Inc. INSURER C:
6761 W Sunrise Blvd#11 &12 INSURER D:
Plantation FL 33313
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:154296448 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.
LTR TYPE OF INSURANCE POLICY NUMBER MADDLISUER PoiJCY EFF Mtl POLICY
EXP YM LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
P—M
MERCIAL GENERAL LIABILITY YDAMAGE TO RENTED- —
renc $
CLAIMS-MADE �OCCUR MED EXP one $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $
POLICY PRO- LOC $
AUTOMOBILE LIABILITY Ea e t
ANY AUTO BODILY INJURY(Per persM) $
ALL OVIAUTOS ED AUTOS SCHEDULED BODILY INJURY(Per accident) $
NON-0NMED DAIMAGE $
HIREDAUTOS AUTOS
UMBRELLA LIABOCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMSAADE AGGREGATE $
DED I I RETENTION $
A WORKERS COMPENSATION 3371881 9=014 /23/2015 X YtlC ATU OTH
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETORIPARTNERMXECUTIVEEL EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED? F N J A
(Mandatory in NN) E.L.DISEASE-EA EMKOYEE $1,000,00D
It yyes describe under
DESG�RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Addidonai Remarks Schedule,N more apace is required)
Pool Construction(Waterfalls&Spas)
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.
10050 NE 2nd Avenue
Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE
y
M
0188&2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD
1
Miami hores Village
Building Department loan NMI"
10050 N.E.2nd Avenue
Miami Shone,Florida 33138
Tel:(305)795.2204 R ►
Fax: (305)756.8972
COPY
Permit No: Pi P PIS Page 1 of 1
Structural Critique Sheet
4 C-
SP
STOPPED REVIEW
Plan review Is not complete,when all Items above are corrected,we will do a complete plan review.
If any sheets are voided,remove them from the plans and replace with new revised sheets and Include one
set of voided sheets In the re-submittal drawings.
Mehdi Asraf