POOL1306-0105-ApplicationCity of Parkland
Building Permit Application
www.cityofoarkland.org _
Contact Person:Wj ' Phone 10) ar� )-1 : 4� E-mail: f '(,tt,' ` � 1 {�'l( +
ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 CO)
Company NameQ� ' E�,e%% w�j�/ e1 _ '' Master Permit Number 300-00S
Business Address LLC F Ij'� " bleat,// Date 1 7 I "
City, `K� �f %state f( zip3 q ern Gam- e #9 4 ; g� Construction Value
/ /l
engineer's Name
r
Property Owner's Name fr1 j iVebei Engineer's License #
treet Address P "` �" • ` s�" Phone #
Owner's S
r i
City
Stage—/ Zip
one #C , `% � ( IJ . / Crichitect's Name
Job Site Address rC,0 (S1 Z / 1P Block
Work Description: c -7-00e)/ (.fa /et? tw ) /rk (3 n (j P r on�fr CA -Or -
Architect's
ar
Architect's License #
Phone #
Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit
and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be
secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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
Contractor y Property Owner
Notification E -m il: re
Print Nam of Qua iffier/Buil
License,nger:__
. itL#4&-Y i "q'%i!Not f cation E-mail:
Print Name of Property Owner:
fillyotirc
)4-beij /fir lnur'Af1 ` lod CLII-Trq
Owner's Address: `�/'��"^rte
Property Owner:
hn this day of r, 20.38 'before me, the undersigned
Notary Pubf of the State -FierlY personal y appeared
and whose name is subscribed to and within the
instryzqent, 51d he/she accknoowle es that he/sheeeex�eccuutted it.
! NOTARY PUBI`IC, STATE OF FLORIDA
Signature Of Qualifier: °t
On this day of D
Notary Pub 1c of the State
the instrument, and h
'NOTARY PUBLIC, STATE OF FLORIDA
V v < < a--L—
efore me, the undersigned
only appeared
w ose name is subscribed to and within
owledges that he/she executed it.
PRINTED E OF NOTARY PUBLIC
❑ Personally known to me
❑ Oath taken
NOTARY PUBLIC SEAL OF
OFFICE:
Application Approved By:
Permit Officer
❑ Produced identification
❑ Oath not taken
��:•:;;�� LAURIE POLLOCK
* MY COMMISSION # FF 130330
EXPIRES: June 15, 2018
Banded TM Budget Notary Services
Aidocc %aj.-I-II^ki Qn
PRINTED NAME OFJIOTARY PUBLIC
❑ Personally known to me 4L Produced identification
❑ Oath taken
NOTARY PUBLIC SEAL
OF OFFICE:
Date:
❑ Oath not taken
NANCYCG,-L,,ibiANO
MY COMMISSION # EE 159417
EXPIRES:January 12,2016
reblic Underwriters
7.1
IElectrica�
Business Ad
License #:
Phone #:
Qualifier Signatur :
Estimated Construction Value:
1 Notification E-mail: f 9 (L'
Print Name:
e me thus Arr day of
The foregoing instrument was ac .nowle
who is personally n to me or who pr.
Notary Public:
PiumbinE Contractor:
Business Address:
License It:
Phone #:
Qualifier $ignature:
The foregoing instrument was acknowledged before me thus 31
who is personally known to me or who produced
Notary PUblic: My Commission Expires:
Commission Expires:
he above named person
1 as identificaWOTI I'h°o did/did not take an oath
461:44.4k, LAURIE POLLOCK
• * i y COMMISSION it FF 130330
EXPIRES: June 15, 2018
Estimated Construction Value:
Notification E-mail:
Print Name:
day of December
Mechanical Contractor:
Business Address:
License #:
Phone #: Notification E-mail:
Qualifier Signature: Print Name:
The foregoing instrument was acknowledged before me thus 31 day of December
who is personally known to me or who produced
Notary Public: My Commission Expires:
,20 30 ,by the above named person
as identification who did/did not take an oath
Estimated Construction Value:
Landscaping Contractor:
Business Address:
License #:
,20 30 ,by the above named person
as identification who did/did not take an oath
Estimated Construction Value:
Phone #: Notification E-mail:
Qualifier Signature: Print Name:
The foregoing instrument was acknowledged before me thus 31 day of December
who is personally known to me or who produced
Notary Public: My Commission Expires:
Other Contractor:
Business Address:
License #:
,20 30 ,by the above named person
as identification who did/did not take an oath
Estimated Construction Value:
Phone #: Notification E-mail:
Qualifier Signature: Print Name:
The foregoing instrument was acknowledged before me thus 31 day of December
,20 30 ,by the above named person
who is personally known to me or who produced as identification who did/did not take an oath
Notary Public: My Commission Expires:
ELECTRfCAL U1 ORKS IN
954-495-7043
7-7-2014
Electrical Works Inc,
31 SW 16th Street
Pompano Beach FL
33060
Parkland Building Department,
EWI is requesting to withdraw itself from the project located at:
Muhammad Farooq 6035 NW 80`" Terrace Parkland FL 33067
We are currently a sub contractor of Right Choice Pools
Please use this letter as means to do so.
o ue Ben avazosl
EC1'*041
THIS CARD MUST BE POSTED IN FRONT AT ALL TIMES
City of Parkland
6600 University Drive
Parkland, FL 33067
(954) 753-5447
BUILDING\ENGINEERING PERMIT
PERMIT NUMBER: POOL1306-0105
PERMIT TYPE:
POOLS/SPA/REMODEL/WF
SITE ADDRESS: 6035 NW 80 TER
TYPE OF IMPROVEMENT: NONE
Applicant Information
Contractor Information
RIGHT CHOICE POOLS & SPAS, INC
ISSUED DATE: 11/21/2013
FOLIO NO: 484102000327
CODE YEAR:
Owner Information
HAMEED,MUHAMMAD FAROOQ
3855 NW 124 AVENUE 6035 NW 80 TER
CORAL SPRINGS, FL 33065- PARKLAND, FL 33067-1130
(954) 345-7277
DESCRIPTION: POOL/DECK/ALARMS/FENCE & DEMO EXISTING POOL
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. (F.S. 713.135).
Notice: In addtion to the requirements of this permit there may be additional restrictions applicable to this property that may be
found in Public Records of the County, and there may be additiona permits required from other governmental entities such as
water management districts, state agencies or federal agencies.
PERMIT EXPIRES 180 DAYS FROM EITHER THE ISSUE DATE OR 90 DAYS FROM THE LAST APPROVED INSPECTION
For Inspections please call (954) 753-5447. Inspections are scheduled for same-day inspections up until 6:00 AM.
SEQ INSPECTION TYPE
ID
12 ELECTRIC FINAL
SEQ INSPECTION TYPE
ID
12 LANDSCAPING
Building Official or Authorized Signature Date
ELECTRICAL
INSPECTIONS
INSPECTOR DATE
PLUMBING
SEQ INSPECTION TYPE INSPECTOR DATE
ID
7 PLUMBING POOL FINAL
LANDSCAPING STRUCTURAL
INSPECTOR DATE
No Inspection Group
SEQ INSPECTION TYPE
ID
2 ELEC POOL STEEL BOND
4 DECK BOND
5 FENCE BOND
INSPECTOR DATE
SEQ INSPECTION TYPE INSPECTOR DATE
ID
1 NOC
2 POOL STEEL
4 DECK STEEL/PAVERS
5 FENCE
5 SAFETY ACT 515
12 FINAL SURVEY
14 FINAL**
SEQ INSPECTION TYPE
ID
2 MAIN DRAIN
3 PERIMETER PIPING
THIS CARD MUST BE POSTED IN FRONT AT ALL TIMES
City of Parkland
6600 University Drive
Parkland, FL 33067
(954) 753-5447
BUILDING\ENGINEERING PERMIT
PLUMBING
INSPECTOR DATE
PERMIT TREE
City of Parkland
PERMIT NO
SUB -PERMIT
SUB -PERMIT
SUB -PERMIT
OL .306-0105)
PERMT" SPE
STATUS
FEES CHARGED
7,r141 4
OBVALUE
DESCRIPTION
APPLIED �QF ISSUED
FEES PAID BA ANCE DUE
POOLS/SPA/REMODEL/WF POOL/DECK/ALARMS/FENCE
APPROVED
$1,813.49
$40,152.00
FEES CHARGE[) FEES PAID
1
$1,813.49
06/20/2013
$90.00
$1,723.49
HAMEED,MUHAMMAD FAROOQ
$90.00 $1,723.49 $40,152.00
12is(d_ ie.A. Poo1s
Drintnrl• AAnnrinv !lf Alnvnn,hcr 1(111
1 of'I
#•9 11I
Contact Person:
Company Name
Business Address
CityC \ Spr4iqSState (� Zip 330((5 -Phone# %
Property Owner's Name (\ f -
Owner's Street Address 6Q))5 kAl Te,(-
CityPWO State �L Zip 3300 Phone# qsqJW %J 10)5--
00-"%-e-4-1
5)S
0me-„1 cisit . S5'7, 0(I --f
City of Parkland
Building Permit Application
www.cityofparkland.org
Phone#Cq'4 k—`'loll
E mail:l f l(,I,,4i � f'ttt n'11fPPoL stao
ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135
Job Site Pf ddress
Work Description:
Master Permit Numbe j 13 db -c oS
Date � (f) I ?f
Construction Value --Ac)
0
1�1 0
Engineer's Name Mark" `,) heootllt
Engineer's License #
Phone #
Architect's Name
Architect's License #
(d ?'h�� \k\ r 7,r Lot �1 Block Phone # {�
2)\If�\I ;Uv 0.`�1�t n%i'�,, J c_7(.uimrtflw -?rc CL )PC
Lk -1 � i 1\ l7 PO3L t— Dec K
Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit
and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be
secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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
Contractor
Notification E-mail: MrtArt.0 q1Cirm, f p
Print Name of Qualifier/Builder:
ITT IC Y bar`as S
License number:
Sigur of Qualifi
Came
O IQ dayAf b'f e , 20 1 , before me, the undersigned
Notary Public of the State of Florida, personally appeared
Cour % S l3 Ll r qc i and whose name is subscribed to and within
the instyent, all he/she acknowledges that he/she executed it.
NOTAR}7 PUBLIC, SfATEOf FLORIDA�
1
\16(Af i Cithib' 1 t r
PRINTED DIME OF NOTARY PUBLIC
l"f Personally known to me
C) Oath taken
NOTARY PUBLIC SEAL OF
OFFICE:
Application Approved By:
Permit Officer
❑ Produced identification
❑ Oath not taken
r)(11
~ ' atr NANCY MY COMMISSION k EE159417
: EXPIRES: January 12, 2016
Bonded Thru Notary Public Underwriters
Property Owner
Notification E-mail:
Print Name of Property Owner:
N1Pert. -Fn `runt.
Owner's Address:
1,2 t`7 2, U .'J) . fl Ttcri Pack ii r�1�
Signature of Property Owner:
On this ""t of -5- ..76—E 20 \.3 , before me, the undersigned
Notary Public of the State of Florida, personally appeared
1.-t-aM/ o c-, r rii: r4_ and whose name is subscribed to and within the
Y, and the she acknowledges that he/she executed it.
NOOT(ARYpUBLI ,STATE OF FLORIDA�
nr
PRINTED NQ�11E OF NOTARY PUBLIC ' ` fi'.:s- °. 0 C^
❑ Personally known to me Produced identification
❑ Oath taken
NOTARY PUBLIC SEAL
OF OFFICE:
C7 54 ,3.45. 72-7' f
Date:
❑ Oath not taken
s7,97.1%.1,,,\ NANCY CALTABIANO
MYCOMMISSION bEEE 159417
EXPIRES: January 12, 2016
'Cita .^r.P Bonded Thru Notary Public Underwriters
Electrical Contractor: (% W 1
Business Address: -42 a,i (z-nL /WJE r✓?y.4P e4..g
License #: 't'CJ fO6,, Estimated Construction Value: l jr'j ®0 , 00
Phone #: Notification E-mail:
Qualifier Signature ,
The foregoing instrument as acknowledged befofe me thus
who is perso �-1, Y--..�„ YcALrti No
Notary Public fr..` MY COMMISSION# 159417 My Commission Expires:1
s . - , e�= EXPIRES: January12, 2016 ` a ac.). 1 W
-4%•••• d`:.' Bonded Thru Notary Public Underwriters
Print Name:,� OF C .,\ C JA7�e—
(o day of ,20 1,, ,by the above named person
as identification who did/did not take an oath
Plumbtnit Contractor: 'R . NANce. els ts__,SplAs Trac
Business Address:Iv vii 1 tk-kii -A 0.e
License #: r p(' I Li.,
Phone#: 513Y
Qualifier Signature( tt
nt was*knowledged before me thus
The foregoi instr
who is
Notary
Estimated Construction Value:
1) SCXR,Oc
Notification E-mail: RW-Vt- p i f iv-(' brt c Pry i , C
Print N me: CIA( Qgs r( (Ls s
to day of SI) ,20 t3 ,by the above named person
as identification who did/did not take an oath
Ic�pwntoQEjad ucer
' t, MY COMMISSION # EE 159417
tenMustybUearTNolarJanuary12,
te.4
/ ({'Lb Y X1-7
Mechanical Contractor: /
Business Address:
License #: Estimated Construction Value:
Phone #: Notification E-mail:
Qualifier Signature:
The foregoing instrument was acknowledged before me thus ,20 ,by the above named person
who is personally known to me or who produced as identification who did/did not take an oath
Notary Public: My Commission Expires:
My Commission Expires:
Print Name:
day of
tandscapr ng Contractor:
Business Address:
License #: Estimated Construction Value:
Phone #: Notification E-mail:
Qualifier Signature: Print Name:
The foregoing instrument was acknowledged before me thus day of ,20 ,by the above named persor
who is personally known to me or who produced as identification who did/did not take an oath
Notary Public: My Commission Expires:
Other Contractor:
Business Address:
License #:
Phone #:
Qualifier Signature:
The foregoing instrument was acknowledged before me thus
who is personally known to me or who produced
Notary Public:
Estimated Construction Value:
Notification E-mail:
Print Name:
day of
My Commission Expires:
,20 ,by the above named person
as identification who did/did not take an oath
City of Parkland, Florida
BUILDING PERMIT APPLICATION
� rr^^ee www.cityofparklan org
Contact Person: <�C.1��Y' Phone #: ��r�G E-mail:,
ALL OF THE FOLLOWING MUST BE FILLED IN BY A PLICANT, ACCORD! TO F
WC44A-Cci(cr
41.1
� r
13.13
r- 641
31..P 6 4 '5c) . 01051
LOT-,:
-2-00.�.. W £e-✓tX Sj t-PA `tom.; y„.
Application is hereby made to obtain a permit to do the work and installation as indicated. 1
certify that no work or installation has commenced prior to the issuance of permit and that all
work will: be performed to meet the standards of all laws regulating construction in the City of
Parkland, Florida. I understand that a separate permit must be secured for ELECTRICAL
WORK, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS,
ROOFING, SHUTTERS, ETC.
(
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPORTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT
j J
/Ytl,C�2C�rd0Rtt9'ktAY�liC�i'YtiXF:#61CG,'!"Ii)'. a' _.. a-s•:17`1ua.wHC..lbta.'A#Nh3iWY.'Yt.�w.'iMer�tS
x !�
On this 1
JQ.rrtes 61'05
t S!
ay of fj �"Scam
e-110
NO AIRY PUBLIC, STATE OF FLORIDA
PRINTED NAME OF NOTARY PUBLIC
• Personally known to me, or Produced identification ❑ Oath taken ❑ Oath not taken
x
20 13, before me, the undersigned Notary Public of the State of Florida, personally appeared
and whose name is subscribed to and within the instrument, and he/she acknowledges that he/she executed it.
Witness my hand
•�°"'r'g% Debra Ann Grosse
and official seal. '.ot�PY?U�,
.:; ,:. : COMMISSION # FF 005952
ciPS EXPIRES: APR. 07,2017
'# WwW.AARONNOTARY.com
�i4n�N
NOTARY PUBLIC
SEAL OF OFFICE:
• 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.
On this \ day of h�CV
MoNtNavrrrol
NOTARY PWBLI,C, S1�TE OF FLORIDA
PRINTED NAME OF NOTARY PUBLIC
❑ Personally known to me, or
Application Approved By
, 20 \i fore me, the undersigned Notary Public of the State of Florida, personally appeared
and whose name is subscribed to and within the instrument, and he/she acknowledges that he/she executed it.
JOANNE SICA
Witness my hand
and official seal.
NOTARY PUBLIC
SEAL OF OFFICE:
roduced identification ❑ Oath taken ❑ Oath not taken
Permit Officer
Date
MY COMMISSION t EE 176329
EXPIRES: April 3, 2016
Bonded Thru Notar; Public Underwriters
REV 07/07
INSTR # 111589280, OR BK 49870 PG 84, Page 1 of 1, Recorded 06/10/2013 at 08:13
AM, B'oward County Commission, Deputy Clerk ERECORD
Permit 1
Fobo 1 541 U� DO 03 Yl
NOTICE OF COMMENCEMENT
The undersigned hereby gives notice that improvement will be made to certain real
property and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of C . .. , . . t :
1. Legal Description of Property:
Street Address if available:
2. General description of Improvement
3. a. Owner name and address:
b. Interest in property.
c, Name and address of fee simple
titleholder Mother than Owner):
4. a. Contractor none and address:
b. Contractor's phone number:
S. a. Surety name and address:
b. Surety's phone number:
c. Amount of bond:
6. a. Lender name and address:
b. Lender's phone number:
:nus r}wcareswaed for recorder
Lot.5.a. BlockBIdg0 QLengthyiegel attached
Subdivision / Condominium: 'Cli('Q� t E+i#c, •mac,
(p1�35 N J r ( merits cf
_KA u,' 1 1C1c tt t ri t 3 ANIV1 t nr� .Pe -Y11
rn r -r- 4 r -f rr c
A 61•
7. a. Persons within the State of Florida designated by Owner upon whom notices or other doctanents may be served as provided
by Section 713.13(1Xa)7., Florida Statutes:
Name:
Address:
b. Phone number:
8. a. In addition to himself or herself, the Owner designates
b. Phone number of person or entity designated by owner
8. Expiration date of notice at aeraraancemera
to recede a copy of liana's Notice per Section 713.13(1Xb), Florida
(the expreoon date* 1 year from the date d recordng unks a ddferers date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Sfgn.twat') of s) or Own er(sy nzed rectoriPartnerIManager
ay :� �G By
P.D01 Mame /-AR e107/110'.04/9X-19 mot Name
Title/Office Q,gjq/d/L Title/Office
STATE OF FLORIDA
COUNTY OF BROWARD -�(" OCA
1' _
The foregoing instrument was acknowledged before reef this .1 day of ,1 ( jA.'
byfNt 1,�r1'1 t(
DIndiviepoually,or as �y1sa�ssdtlrsyeY.,�e t for
oPe�f "01IlGTti +7¢11tWSVwsafiol I.dwt: r rz5 i.e.(cS ni.D
MY COMMISSION i EE 159417
EXPIRES: January 2018 %) -
Bonded Thou Notary RtoYc ? liPRgfA Pf Notary Pubic: .f / ' i 1 _r k /}
Print Name: i * i � yr. F.J� . ...,N, -n-, ' ; " iZ
(SEAL)
VERIFICATION PURSUANT TO SECTION 82.626. FLORIDA STATUTES
Under penalties of perjury, I declare that I have read am foregoing and
that the facts slated in it are true, to the best of my knowledge and belief.
Signatur
By
) of Oasner(s) or Owners)' Authorized
0Diractw/PartnarAAanager who signed above:
7f
0.7 WevATIA
ay
g Wcudnaysm*oc • mice Of cmmwament revised 1.307 da
Easement Agreement
To the City of Parkland:
I propose to apply for a City permit to erect a Fr -n 4. -
property located at Ca O 3 S' tN ISO
No. Block No. Subdivision
A brief description of dimensions and location from property lines:
PUBLIC WORKS DEPARTMENT
CITY OF PARKLAND
6600 University Drive
Parkland, FL 33067
954-753-5040 * Fax 954-346-2160
in the utility easement on my
, the legal description of this property being Lot
T
Owner Name: b t u ha.-wthe.- c c4 14-tvw..e...e_s4 Contractor Name: ., _ YIX..ktikLA1�
(Please print) j
Street Address: 4 0 3 S~ lJ u1' O'1""^ l Street Addres! KSS ) 124
City/State: ?okdl_ t. civ. c4 , Ft.., s'%4:::) (0.-7 City/State: (Q _()A/1 C et 6
The following utilities have the right to enter easement area noted below for construction, improvements and maintenance of
their facilities:
City of Parkland City of Coconut Creek
Florida Power & Light Teco People's Gas
BellSouth Comcast
North Springs Improvement District Parkland Utilities
The City of Parkland recommends the owner/contractor contact the above agencies prior to construction.
If your company does have underground facilities within the easement, then I, fV%„-J, AMA/' 11A /46 b t2 (owner) will
notify your company through the Utilities Notification Center for Location before Excavation (U.N.C.L.E.) by calling:
(800) 432-4770, so that your facilities can be accurately located.
I understand that your company will not be responsible in any way for repairs to, or replacement of, any portion of
this (description of work to be done) and that removal or replacement of this construction
necessary for your use of this easement will be done at my expense. Also, all expenses for repairs or damages incurred during
or as a result of construction of this (description of work to be done) will be my responsibility.
This agreement is in effect for present owners, renters and future successors and assigns. The City of Parkland will not be
responsible for any damages or expenses, which may occur during or as a result of any construction.
Print names �1
k/4 i,MAP ate 0c2 /`/Atrere-0
Owner's signatur _ ,g—trdi„ Gf
State of \ \OC \A,Ok-� }}
County ofC O�N��C"a►-
Witn ss my hand and official seal at C t ;1y ( c - this \�day of,
20 \ .
Notary Public
My commission ex sires:
Seal
JOANNE SICA
MY COMMISS!ON r EE 176329
EXPIRES: April 3, 2016
Bonded Thru Notar.- Public Underwriters
HOMEOWNER SURVEY AFFIDAVIT
Property Owner: A survey which is submitted to obtain a
Building Permit must show all structures, easements, and rights-of-
way on your property. If your existing survey is older than one (1)
year old, you may submit this affidavit along with the older survey to attest to the fact
that there are no existing elements other than those shown on the survey.
I / We, to .i INc-t w` w.eci , do hereby attest that the survey
included in this building permit application shows an accurate representation of all
current structures, easements and rights-of-way that are located on my/our property
located at c KN../ #2,04- `Le✓ , Parkland, Florida. I / we
understand that providing incorrect, misleading, or false information on the survey may
result in the building permit application or building permit being revoked or denied or
initiation of a possible code enforcement action being taken against me/us. In addition,
I / We hold the City of Parkland harmless for any costs or damages incurred by me / us
e to the information contained or rn'ssing on the attached survey.
-7640
ignature of affiant]
-'� MingAHHAP //J�o Q
[printed or typed name of affiant]
e5. 31- N41 g 6/47bic
,[address of affiant, line 1]
PAO( LAND, FL 3 3 0 (r)
,[address of affiant, line 2]
State of Florida
County of Broward
Sworn to (or affirmed) and subscribed before me this day of
! (year), by '\(1 r xx\o t0(1)
(Signature fdf Igtary Public - State of Florida)
name of person making statement).
ICA
MY COMMISSION' EE 176329
EXPIRES: April 3, 2016
Bonded Thru Notary Public Underwriters
(Print, Type, or Stamp Commissioned Name of Notary Public) /
Personally Known OR Produced Identification 1.
Type of Identification Produced (GAJ, �'O/
112ev. Nov 2008
U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
unr»ud Flood Insurance Program
Al. Building Owner's Name FAROOO
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
6035 N.W. 80TH TERRACE
City PARKLAND
State FL ZIP Code 33067
OMB No. 1660-0008
Expiration Date: July 31, 2015
FOR INSURANCE COMPANY USE
Policy Number.
Company NAIC Number:
A3, Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description. etc.)
LOT 5-3. PINE TREE ESTATES (UNRECORDED)
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 26.305 Long. 80.234 Horizontal Datum: 0 NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1 -AA
A8. For a building with a crawlspace or enclosure(s):
a)
b)
c)
d)
Square footage of crawlspace or enclosure(s) 0
Number of permanent flood openings in the crawlspace
or enclosure(s) within 1.0 foot above adjacent grade 0
Total net area of flood openings in AB.b
Engineered flood openings? 0 Yes ❑ No
sq ft
sq in
A9. For a building with an attached garage:
a)
b)
c)
d)
Square footage of attached garage 625 sq ft
Number of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade
Total net area of flood openings in A9.b Q sq in
Engineered flood openings? 0 Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
PARKLAND -120051
B4. Map/Panel Number
12011C0105
B5. Suffix
F
132. County Name
BROWARD
B6. FIRM Index Date B7. FIRM Panel
10/2/97 Effective/Revised Date
8/18/92
88. Flood
Zone(s) (
B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item 89.
❑ FIS Profile 0 FIRM 0 Community Determined 0 Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 0 NAVD 1988 0 Other/Source:
1312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date. 0 CBRS 0 OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1 -A30. AE, AH, A (with BFE). VE, V1 -V30. V (with BFE). AR. AR/A. AR/AE. AR/A1-A30. AR/AH AR/A0 Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only. enter meters.
Benchmark Utilized: BROWARD COUNTY B.M . Vertical Datum: NGVD-29
Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 NAVD 1988 0 Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
83. State
FLORIDA
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
N/A
❑ Yes ®No
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 17.51
b) Top of the next higher floor 17.94
c) Bottom of the lowest horizontal structural member (V Zones only) N/A
d) Attached garage (top of slab) 17.31
e) Lowest elevation of machinery or equipment servicing the building 17.13
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 16.7
g) Highest adjacent (finished) grade next to building (HAG) 17.0
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Check the measurement used.
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
0 feet 0 meters
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information, I certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? 0 Yes 0 No
0 Check here if attachments.
Certifier's Name DANIEL L. CARNAHAN License Number 3002
Title REF. LAND SURVEYOR Company Name DENI CARNAHAN. INC
Address PO BOX 938858 City MARGATE State FL
Signature
FEMA Forrrl 086-0-33 (7/12)
ZIP Code 33093
Date 9/16/13 Telephone (954)971-0540
Q
)
See reverse side for continuation. Replaces all previous editions.
_._..,.. .......-,
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite. and/or Bldg. No-) or P.O. Route and Box No. Policy Number:
6035 N.W. $0TH TERRACE
City PARKLAND State FL ZIP Code 33067 Company NAIC Number:
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments Note: lowest elevation of machinery servicing the building is on the A/C slab
Signature
Date 9/16/13
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request. complete Sections A. 8,
and C. For Items E1—E4, use natural grade, if available Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (NAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet CI meters 0 above or 0 below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 meters 0 above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see ages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is 0 feet 0 meters 0 above or 0�below the HAG.
E3. Attached garage (top of slab) is 0 feet 0 meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 below the HAG.
ES. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this information in Section G.
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA -issued or community -issued BFE)
or Zone AO must sign here. The statements in Sections A, B. and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
0 Check here if attachments.
The local officinal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E), and G
of this Elevation Certificate Complete the applicable item(s) and sign below. Check the measurement used in Items 08—G10. In Puerto Rico only. enter meters.
01 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO
G3. 0 The following information (Items 04—G10) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters Datum
09 BFE or (in Zone AO) depth of flooding at the building site:. 0 feet 0 meters Datum
G10. Community's design flood elevation: 0 feet 0 meters Datum
Local Official's Name
Community Name
Signature
Comments
FEMA Form 086-0-33 (7/12)
Title
Telephone
Date
I1 Check here if attachments.
Replaces all previous editions.
City of Parkland
Plan Log Out
This form must be completed before plans can be logged out
()Zoning Structural ( ) Electrical () Plumbing () Mechanical () Fire () Engineering
Notified Date(s): /a// n t / o(LA113
Permit #: �Q0i. - Oi O Permit Type: ?CX)
2i, � IJ IContractor / Owner Name: Q [l b; c E
Site Address:
Owner Name:
Date Logged Out:
By:
Print nameetS
Company / Title:
10/05
cJ o O I O S�
roward County POOLS/SPA/WF/REMODEL
PBC 107.7.A.13 / R4101.17.1.9.. INDICATE LOCATION OF OPENINGS TO RECEIVE
ALARMS ON POOL PLAN..
FENCE
FBC 105.3.2 / 107.2.1.. PERMIT APPLICATION INDICATES 4' HIGH ALUMINUM FENCE.. SURVEY INDICATES 5'
HIGH ALUMINUM FENCE..
107.7.2.. INDICATE WIDTH OF DDG.. SHOP DRAWING REQD FOR LEAVES > 48"..
44- Ifoto 0 10S--
,lean Panebianco ENGINEERING
1306-0105
NEED TO APPLY FOR ENGINEERING RIGHT OF WAY PERMIT FOR FENCE INSIDE 5'
EASEMENT
$25 FEE FOR RIGHT OF WAY PERMIT REQUIRED
FENCE IN REAR HAS TO BE OUTSIDE THE 17.5 EASEMENT (SHOW ON PLANS)— (� .vim c}r) lc -�
yvovL
-Q4-v1 a_.1 -12A- J 1° 1 2.s-' i�
In accordance with
Permit Number
Owner Name
Jobsite Address
Name of Original General
OR Sub -Contractor
Name of New General
OR Sub -Contractor
Reason for Change
City of Parkland Building Department
CHANGE OF CONTRACTOR
Florida Building Code, Broward County Administrative Provisions, Section 105.13.4
'PO 6- Li 3 4.1)(c-01
ective Date
CC/
!"C- , Parkland
cuff- Qetl, `' tArariliDerpri.,jax)i-110(e-,
9 (c'i C_- le& License Number °L)C � 3 3 I
O-- , -r trx) ;L1 Z pae
��r
The undersigned agrees to indemnify, hold harmless, and defend the City of Parkland, its agents and employees, from and against
any cause arising out of this change of contractor through the act, error, omission or negligent act of the undersigned, or his agents
or employees, or through any act, error, omission or negligent act for which the City of Parkland or its agents or employees are
alleged to be liable.
Chanae of General Contractor OR Chanae of Sub -Contractor
Signature of Owner required Signature of both Owner & Qualifier required
Property Owner
Print Name
Signature
Property Owner \ C 000 CI vvA.0,.P c\
Print Narrre
Signature
General Contract
Signature
The foregoing instrument was acknowledged before me this 1 day of
by Owner:
or who has produced
Notary Public Signature:
My Commission Expires:
The foregoing in trument was ac
by Contractof: MS
or who has produced
Notary Public Signature:
My Commission Expires:
Rev. 3/12
(Name of Person Acknowledging) who is personally known to me,
(type of ID) as identification and who did / did not take an oath.
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