HomeMy WebLinkAbout1805 Palm Way (3)MAY 2 Building & Fire Prevention Division
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PERMIT APPLICATION
Application No: 119 " a 4 04
Documented Construction Value: $ —
Job Address: \N Historic District: Yes[]No
Parcel ID:
Type of Work: New[] Addition❑ Alteration
I I I I A I
Description of Work:
Plan Review Contact Person: Y r 11
,"20
Phone: Fax:
Name
Street:
City, S
Residential Commercial
Repair Demo Change of Use❑ Move❑
P" NO - 33�
Title:
Email: L'_ CIOVI„
nformation 1
Phone: L2 (P]S 6
Resident of property? : S
Contractor Information
Name Phone:
Street: Fax:
City, State Zip: State License No.:
Arch itectlEnginee r Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: Address:
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.
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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 61' Edition (2017) Florida Building Code
Revised: January 1, 2018 Permit Application
i
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
AM 0
Vjk -i,4 18
Signature o Owner/Agent Date
N I CIA 9;FAA/::WA1
Print Owner/Agent's Name 1%
4"'1" VVL
of Notary -State i
-9•214•IS
Date
%y' • JOMN M. JOHNSON
"q % MY COMMISSION # FF 956284
EXPIRES: March 23, 2020
Bonded Thru Notary Public Underwriters
ar„n•°
Owner/Agent is Personally Known lo Me or
Produced ID Type of ID L
Signature of Contractor/Agent Date
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
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING: - y UTILITIES:
ENGINEERING:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
COMMENTS: Off' .ie �s�I�c./� G,c/�rdx 3a /,He.�� �a/- aL Li'0
C-A4;A/.114 ANIc as t'/bw..► nh 1J440'
Revised: January 1, 2018 Permit Application
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own name. I also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in I year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
w� y� i
I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
persons working on my building or residence. It is my responsibility to ensure that the persons whom I
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is
not licensed to perform the work being done. Any person working on my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
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.
Y �J
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
V
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
fVA�—
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
V7Kinformation
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
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.
Pr(
an
conditions specified above.
0 irl 0 Pal&k�_P_A
Signature of Owner -Builder Date
Form of Identification
(Must be Photo ID)
qualified
Tee to the
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 final 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
BOUNDARY SURVEY
PROPERTY DESCRIPTION: LOT
3, BEL—AIR REPLAT, ACCORDING TO .THE. PLAT .4HEREOF�ALjj ,ES RDED IN PLAT
BOOK 9, PAGE(S)
83-84,
OF
THE PUBLIC RECORDS OF SEMINOLE
COUNTYlv�Ow
' '4
FOUND
CRESCENT STREET
1/
1P
NO LD.
Ok to install a pprox. -V linear feet
�a
of t foot high C` ' /,#C fence and
o
gate(s) as shown on plan. Fence
2
shall be constructed with finished side
o
o --
facing outward.
O_
00
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LOT 2
LOT 7
END OF FENCE 5.0
�w11L of R/w N90"00'00"E (P)
O
125.00 (P) L_
0.3'_—� S FOUND
I.R. 2< CAP
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nzo
N89'56'30"E, (M)
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p]020 END OF FENCE 20
ON —IfFOUND
EAST OFR7W N89`56'38"W (P) 125.00 (P) s7e'.a_
V O NO I.O.
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LOT 4 LOT 9
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FOUND 112'
I.R. & CAP
CAP ILLEGIBLE COURT STREET
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LEGEND: w E
A/C -AIR CONDITIONER, BB=BEARING BASIS, BLDG-BUILDING, C=CALCULATED, CB -CONCRETE BLOCK, CH -CHORD, CHBRG=CHORD BEARING, CM=CONCRETE MONUMENT,
CNA=CORNER NOT ACCESSIBLE, CONC=CONCRETE, COV=COVERED, CPP=CONCRETE POWER POLE, D=DESCRIBED, D/B/A=DOING BUSINESS AS, DE=DRAINAGE S
EASEMENT, DUE=DRAINAGE AND UTILITY EASEMENT, FOP -EDGE OF PAVEMENT, EOW=EDGE OF WATER, F=FIELD, FF ELEV=FINISHED FLOOD ELEVATION, ID
=IDENTIFICATION, IR=IRON REBAR, IP=IRON PIPE, L=ARC LENGTH, LS=LAND SURVEYOR, LB=LAND SURVEYING BUSINESS, M=MEASURED, NR=NOT RADIAL, OR -OFFICIAL I = 30
RECORDS, P=PLAT, PC=POINT OF CURVATURE, PCP -PERMANENT CONTROL POINT, PI=POINT OF INTERSECTION, POB=POINT OF BEGINNING, POC=POINT OF GRAPHIC SCALE
COMMENCEMENT, PRM=PERMANENT REFERENCE MONUMENI PT=POINT OF TANGENT, R=RADIUS, RAD-RADIAL RES-RESIDENCE, R/W=RIGHT OF WAY, S/W=SIDEWALK,
TOB=TOP OF BANK, TX -ELECTRIC TRANSFORMER BOX, UR=UTILITY ROOM. UE=U11L11Y EASEMENT, WF=WOOD FRAME, WPP=WOOD POWER POLE 0 15 30
,Q, = UIILIEY POLE C = GAS METER ',Cr = FIRE HYDRANT
BRICK � = SET 1/2" I.R. & CAP PSM # 7020 ® NOTES:
FOUND SURVEY MONUMENT } = GUYWIRE 1: .THIS SURVEY IS BASED ON THE LEGAL DESCRIPTION AS
= CENTERLINE PROVIDED BY THE CLIENT.
= CONCRETE WATER METER 2: THIS SURVEYOR HAS NOT ABSTRACTED THE LAND
0' BSL = BUILDING SETBACK LINE
FLOOIN
ZONE INFORMATION SHOWN HEREON FOR EASEMENTS, RIGHTS OF WAY OR
MAP NUMBER, 1217C 0070 F-x—x—x—x x- = ViNYL FENCE RESTRICTIONS OF RECORD WHICH MAY AFFECT THE TITLE
DATE: 09 28 07 —❑—❑—❑ ❑ ❑— = WOOD FENCE OR USE OF THE LAND.
ZONE X. —0-0-0-0-0— = CHAIN LINK FENCE 3: DO NOT RECONSTRUCT PROPERTY LINES FROM INTERIOR
.(FOR INFORMATIONAL PURPOSES ONLY AND IS NOT CERTIFIED.) HU — UHU OVERHEAD UTILITY LINES IMPROVEMENTS. (BUILDINGS, FENCES ECT... )
CERTIFIED TO: 4: NO FOOTINGS OR OVERHANGS HAVE BEEN LOCATED
ALEXANDER C. TWEED AND MICHELLE TWEED EXCEPT h,S SHCS"v'iJ.
SOUTHERN FINANCIAL TITLE SERVICES, INC. 5: NO UNDERGROUND IMPROVEMENTS OR UTILITIES HAVE
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK BEEN LOCATED EXCEPT AS SHOWN.
CITY FIRST MORTGAGE SERVICES, LLC., ISAOA ATIMA 6. NO WETLANDS AND/OR OTHER NATURAL FEATURES
Bradley Cox & Associates
1J Land Surveying
CVA 405 W. 25th Street
Sanford, Florida 32771
Phone (407) 323-9202
Fax (407) 324-9661
HAVE BEEN LOCATED EXCEPT AS SHOWN,
7. THIS SURVEY SHALL NOT BE USED FOR DESIGN OR
JOB # BCA15610 CONSTRUCTION WITH OUT PRIOR WRITTEN AUTHORIZATION
DRAWN BY: DFY-MP FROM THE SIGNING SURVEYOR.
8: THIS SURVEY IS NOT VALID WITHOUT THE SIGNATURE
CHECKED BY: BC AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED
SURVEYOR AND MAPPER.
FIELD BY: CC I HEREBY CERTIFY THAT THE SURVEY OF THE HEREON DESCRIBED
(FIELD DATE:) 05/17/10 PROPERTY WAS PREPARED UNDER MY DIRECT SUPERVISION AND
MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY THE
REVISIONS: FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN
CHAPTER 5J-17, FLORIDA ADMINISTRATIVE CODE, PURSUANT TO
CHAPTER 472, FLORIDA STATUTES.
05/18/10
�BRAKEYA COX, PSM #5567 (DATE)
CERTIFICATE OF AUTHORIZATION # LB7020
Bradley Cox & Associates
1J Land Surveying
CVA 405 W. 25th Street
Sanford, Florida 32771
Phone (407) 323-9202
Fax (407) 324-9661
HAVE BEEN LOCATED EXCEPT AS SHOWN,
7. THIS SURVEY SHALL NOT BE USED FOR DESIGN OR
JOB # BCA15610 CONSTRUCTION WITH OUT PRIOR WRITTEN AUTHORIZATION
DRAWN BY: DFY-MP FROM THE SIGNING SURVEYOR.
8: THIS SURVEY IS NOT VALID WITHOUT THE SIGNATURE
CHECKED BY: BC AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED
SURVEYOR AND MAPPER.
FIELD BY: CC I HEREBY CERTIFY THAT THE SURVEY OF THE HEREON DESCRIBED
(FIELD DATE:) 05/17/10 PROPERTY WAS PREPARED UNDER MY DIRECT SUPERVISION AND
MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY THE
REVISIONS: FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN
CHAPTER 5J-17, FLORIDA ADMINISTRATIVE CODE, PURSUANT TO
CHAPTER 472, FLORIDA STATUTES.
05/18/10
�BRAKEYA COX, PSM #5567 (DATE)
CERTIFICATE OF AUTHORIZATION # LB7020
41-1 CITY OF
Building & Fire Prevention Division
RESIDENTIAL FENCE AFFIDAVIT
(6 FEET OR LESS IN HEIGHT
PERMIT #: It -ag c)q ADDRESS: PCY I RA
�SG�-L
HEREBY AFFIRM THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AND ACCURATE. THE FENCE WILL BE INSTALLED IN THE APPROVED LOCATION AS SHOWN ON THE APPROVED SITE
PLAN. THE FENCE WILL BE NO HIGHER THAN 6 FEET, MEASURED FROM GRADE. THE FINISHED SIDE OF THE FENCE IS REQUIRED TO FACE
OUT. IT IS THE HOMEOWNER'S RESPONSIBILITY TO VERIFY THE FENCE IS PLACED WITHIN THE PROPERTY LINES AND ANY DISPUTES
BETWEEN ADJACENT HOMEOWNERS WILL BE A CIVIL MATTER. I UNDERSTAND THAT FAILURE TO PROPERLY FOLLOW THESE GUIDELINES
AND ADHERE TO ALL CITY CODES (SANFORD LAND DEVELOPMENT REGULATIONS, SCHEDULE F) COULD RESULT IN THE FENCE HAVING
TO BE REPLACED, RELOCATED OR REMOVED AT THE OWNER'S EXPENSE.
El FENCE CONTRACTOR
BY SIGNING THIS AFFIDAVIT, YOU ARE ACKNOWLEDGING YOU HAVE MADE THE HOMEOWNER AWARE OF THE FENCE AFFIDAVIT
STIPULATIONS AS STATED ON THIS DOCUMENT.
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
DATE:
9, HOMEOWNER (OWNER/BUILDER)
OWNER/BUILDER NAME: 0 lo'�
OWNER / BUILDER SIGNATU DATE:
/ Lq/
*PLEASE NOTE"
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON RESIDENTIAL FENCES. THIS
AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND WILL
SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE FENCE.
STATE OF FLORIDA COUNTY OF L
Sworn to and Subscribed before me this Q `� day of 201$ by:
Q
WJZ Who is ❑ Personally Known to me or h>s-4roduced (type of
identification) 17UDc- as identification.
ignature of Notary.P blic JDANNM.JOHNSON
State of Florida '__ MY COMMISSION i FF.M84
Print/Type/Stamp Name
of Notary Public
EXPIRES; March 23; 2020
?,'qf,n Bonded Thru Notary Public Underwriters
Effective: August 1, 2017