121 Drew Ave; 17-2007; REPLACE METER BOXjug: 0 5 20V
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: [_-T 30v-
Value: $ 0
Job Address: 2 ( D kl) 4r
Parcel ID:
Type of Work: New
Description of Work:
Plan Review Contact Person:
Documented Construction
Historic District: Yes No
N
Residential Commercial
ition ElAlteration Repair [A Demo Change of Use Move
Title:
Phone: Fax: Email:
Property Owner Information
Name Phone:
Street: //Yvv Resi
City, State Zip:
Contractor Information;,,
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Pho
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
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: 5" Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
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 FFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done i,q,,Zompliance with all applicable laws regulating construction and zoning.
I/
SKnature of
Alre
Print Owner/Agent's Name
M
AIOIIiT1E; -
a. Nobly u111e • 8tN.d,ii0lNt
Cbnanh Fon 16R Oi01l -
rr My Comm. ERpm J" Is. "I$
Ow 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
Construction Type:
Total Sq Ft of Bldg:
Electrical Mechanical
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Plumbing[] Gas[] Roof
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
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.
Ll
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
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
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
and capable of performing the requested constr
con ' io s spe l above. /
R
do hereby state that I am qualified
involved with the permit application filed and agree to the
U "
12,
ature of Owner -Build r Date
Form of Identification
Must be Photo ID)
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
I
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 1 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.
4LI 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
SCPA Parcel View: 31-19-31-525-OJ00-0060 Page 1 of 2
Property Record Card
oP00a 'cfA
Parcel: 31-19-31-525-OJ00-0060
Ai R Owner: ELBERY ANDREA J MIMI
x.l rirX^ I Y, F4C>ROA I Property
Address: 121 DREW AVE SANFORD, FL 32771 Parcel
Information Value Summary Parcel
31-19-31-525-OJ00-0060 Owner
ELBERY ANDREA J Property
Address 121 DREW AVE SANFORD, FL 32771 Mailing
121 DREW AVE SANFORD, FL 32771-3958 Subdivision
Name WASHINGTON OAKS SEC 2 v
Tax
District S1-SANFORD DOR
Use Code 01-SINGLE FAMILY Exemptions
00-HOMESTEAD(1996) 20
d
y
C flo
A
a
Plp
II1QIP C()„In I GS 12017
Working 2016 Certified Values
Values Valuation
Method Cost/Market Cost/Market I
NumberofBuildings11 Depreciated
Bldg Value $ 04 49,816 Depreciated
EXFT Value Land
Value (Market) $15 000 13,500 Land
Value Ag Just/
Market Value " $68,904 63,316 Portability
Adj Save
Our Homes Adj $12,618 j $8 188 Amendment
1 Ad/ P&
G Adj $0 0 Assessed
Value $56,286 55,128 Tax
Amount without SOH: $602.00 2016
Tax Bill Amount $540.00 Tax
Estimator Save
Our Homes Savings: $62.00 Does
NOT INCLUDE Non Ad Valorem Assessments Legal
Description LOT
6 BLK J WASHINGTON
OAKS SEC 2 PB
16 PG 87 Taxes
Taxing
Authority Assessment Value Exempt Values Taxable Value County
General Fund 56,286 1 31,286 ; 25,000 Schools
J
56,
286 25 000 31,286 City
Sanford 56,286 31 286 3 j
25,
000 SJWM(
Samt Johns Water Management) 56,286 , 31,286 25,000 County
Bonds 56,286 31,286 i 25,000 Sales
Description
Date Book Page Amount Qualified Vac/Imp WARRANTY
DEED 12/1/1995 03012 [ 1496 45,300 Yes Improved WARRANTY
DEED t - __
2/
1/1982 01377 1800....)._,... 23 800 = No 1 Improved WARRANTY
DEED( 3/1/1981 01334 0279 3 $100 E. No Improved Find
C.mparable S®1es Land
Method
Frontage Depth Units Units Price Land Value LOT
1 $15,000.00 s $15,000 Building
Information k
Description Year Built Fixtures Bed Bath Base Area Total SF living SF Ext Wall Adj Value Repl Value Appendages Actual/Effective 1
1SINGLE 1973 5 2 1.5 = 1,042 1,354 t 1,042 i CB/STUCCO $53,904 3 $70,926 jy ( Descnption Area FAMILY
FINISH I 12.
00 http://
parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=3119315250J000060 7/5/2017