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HomeMy WebLinkAbout405 Celery Ave 12-270 Garbage Enclosure77,:,2011 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: %� Documented Construction Value: $ f oo –col, Address: �� S `� Historic District: Yes ❑ No ❑ Parcel ID: Zoning: D.eseXiption of Work: Q -� �l C �o �S cP v (� e cS�� l o "e q GJ Plan Review Contact Person: Title: r LW oo d' Phone: Fax: E -mail: ,-Property Owner Information Name �l/1711H4-1z,1 e c X41041 rPG4� ,/� C— Phone: 3d 3,;7? ' g 5;�' 5 Street: �� 5 e° Resident of property? City, State Zip: S��/� o��, %rte �Z ?7 I Contractor Information Name Street: City, State Zip: Name: Street: City, St, Zip: Bonding Company: Address: Building Permi4 Square Footage: No. of Dwelling Units: Electrical ❑ New Service – No. of AMPS: Ffone: Fax: State License No.: Architect/Engineer Information Fnone: Fax: E-mail: Mortgage Lender: Address: PERMIT INFO A, f �,,,���•; , .:,::f� l ;� •��'� y `a�;G;i `ci�t� �i341iE)� ••'JJI��••��;• Construction TVDe: o. of Stories: Flood Zone: Mechanical ❑ (Duct layout required for new systems) Plumbing ❑ New Construction - No. of Fixtures: Fire Sprinkler /Alarm ❑ No. of heads: Pq. ©0 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 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 of 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. 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 RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the permit is rel d. 6Za6VL%r#-dr(O wn gent Date Signature of Contractor /Agent Date Print Owner /Agent's Name Signature of Notary - tate of Florio; & d — mate, _ ',�OtPR� PVeC'� DEBBIE BLANTON . Notary Public - State of Florida ;� : • My Comm. Expires Feb-25, 201; Commission # EE 60182 ��''� " "•, Bonded Through Nation Notary Assn. Owner /Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZO It t t UTILITIES: 1� COMMENTS: Rev 11.08 Print Contractor /Agent's Name Signature of Notary-State of Florida Date Contractor /Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: // Property Address: I � and capable of performing the requested conditions speci d above. ofRfwner- Builder Form of Identificati (Must be Photo ID) 9 U do hereby state that I am qualified with the permit application filed and agree to the Date A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local permitting jurisdiction shall withhold fmal approval, revoke the permit, or pursue any action or remedy for unlicensed activity against the owner and any person performing work that requires licensure under the permit issued. Rev. 9.14.2009 I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern owner- builders as well as employers. I also !� understand that the construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. I am of aware of construction practices and I have access to the Florida Building Codes. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, the Florida Department of Financial Services, and the Florida Department of Revenue. I also understand that I may contact the Florida Construction Industry Licensing Board at 1- 850 -487 -1395 or at www.myflorida.com/dbpr /pro /cilb/ for more information about licensed contractors. I am aware of, and consent to, an owner- builder building permit applied for in my name and understand that I am the party legally and financially responsible for the proposed construction activity at the address listed below. I agree to notify the building department immediately of any additions, deletions, or changes to any of the �JV(� j information that I have provided on this disclosure or in the permit application package. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Construction Industry Licensing Board, the Department of Business and Professional Regulation and the building department may be unable to assist you with any financial loss n that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is property licensed and the status of the contractor's workers' compensation coverage. Property Address: I � and capable of performing the requested conditions speci d above. ofRfwner- Builder Form of Identificati (Must be Photo ID) 9 U do hereby state that I am qualified with the permit application filed and agree to the Date A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local permitting jurisdiction shall withhold fmal approval, revoke the permit, or pursue any action or remedy for unlicensed activity against the owner and any person performing work that requires licensure under the permit issued. Rev. 9.14.2009