HomeMy WebLinkAbout9 Oak Ave�> CITY' OF SANFORD
IE BUILDING. PERMIT APPLICATION PERMIT No.
0 SITE DEVELOPMENT PERMIT APPLICATION IE
r nnr T k M Mn nn r I
BUILDING:.VALUATION
1. OWNER
i
2. OF++.. JOB ,n.
SITE DEV 'VALUATION
�A)DDRESS
a�K . V a
o �(
t `
3b. •
4. SEV TWP RGE
5. SUBD-TRACT-PARCEL
6. BLK •,
7.
LOT
9. USE OF BU LDI-NG
10. RESIDENTI C: - '"
11. FLOOD PRONE
es rn o,;_
COMMERCIAL Cv .INDUSTRI'AL
1=
_Pa'SS� (NO)
12. DESCRIBE WORK
13. CHANGE OF USE FROM:
14. CHANGE OF USE TO:
L V_e, �f e Bd edoak-
15.. UTILITIES CITY WATER
L] k4TY SEWER 1:3 SEPTIC TANK O'SOIL TEST (IF APPLICABLE)
16. TYPE OF CONSTRUCTION
17. OCCUPANCY GROUP
18'. TOTAL LAND AREA
19. ZONING
C 6C-
Isl
20. NO. OF STORIES
21. NO. OF DWELLINGS
22. TOTAL SQ." FT.
23.�,NO. OF STRUCTURES
24. CONTRACTORo { MAILING kliDR�(SS
Je ri4es:Cl d
CI /ZIP PHONE
Soh"T��^� 33c) S6v
1-1owari Of
.SCIVIV, V.O,�d��;7
�
25. ARCHITECT/ENG NFER MAILING ADDR S
CITY/ZIP
PHONE
t
C1-}11
&,y JT7
San u►- 330-S67Cl
FEES:
SITE DEV.
BUILDING
RADON GAS.
OPEN SPACE
UTILITY
POLICE
FIRE
FEES•
DRIVEWAY
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, MECHANICAL, REMOVAL OR RELOCATION OF
TREES AND ADVERTISING SIGNS.,"
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN
180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A.PERIOD OF 180 DAYS AT
ANYTIME AFTER THE WORK IS COMMENCED.
ALL PLANS FOR THE BUILDING WHICH ARE.REQUIRED TO BE,SIGNED.AND SEALED BY THE ARCHITECT OR
ENGINEER OF RECORD SHALL CONTAIN A STATEMENT THAT, TO THE BEST OF THE ARCHITECT'S..OR
ENGINEER'S KNOWLEDGE, THE PLANS AND SPEC'S COMPLY WITH THE APPLICABLE MINIMUM BLDG. CODES.
The named Contractor/Owner Builder to whom the permit is issued shall have the resnonsi-
bility for supervision, direction, management, and control of the -construction activities
on the project for which the building permit was issued.' F:S'•. 553-85.
SIGNATURE_OF CONTRACT R DATE STATE CERTIFICATION NUMBER OR
STATE REGISTRATION NUMBER AND COMP CARD NUMBER
"W-A'
SIGNATURE OF OWNE DATE
APPLICATION ACCEPTED BY:
PLANS CHECKED BY:
APPROVED FOR ISSUANCE BY:
PERMIT VALIDATION: CHECK CASHDATE BY
FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING
TWICE FOR BUILDING IMPROVEMENTS.
COMMENTS
ORIGINAL (BUILDING) YELLOW 4CUSTOMER) PINK (COUNTY -TAX OFFICE) GOLD (CO. ADMIN. OFFICE)
'INSTRUCTIONS FOR COMPLETING'THIS PERMIT APPLICATION
COMPLETE ALL ITEMS NUMBERED ONE (1) THROUGH -TWENTY-FIVE (25)..
LEAVE ALL OTHER ITEMS BLANK.
ITEM #1: OWNER: The owner of the property.
ITEM_#2: ADDRESS: Where the work is being performed.
ITEM #3a. BUILDING VALUATION: Enter the value of construction
for the project. Do not include the land value. Do not include
the value of the electrical, plumbing, mechanical or well
drilling. Do include all other costs.
ITEM #3b. SITE VALUATION: Improvement to land other than
building.
ITEM #4. SEC TWP RGE: Enter the section, township and range
where the property is located. This can be obtained from your
annual tax statement or from the Tax Assessor's Office at the
Seminole County Services Building located at 1101 E. 1st Street
in Sanford.
ITEM #5. SUBD-TRACT-PARCEL: Enter the parcel number assigned
by the Seminole County Tax Assessor. This number may be found on
your annual tax statement. The Building Department does not have
a record of these numbers.
ITEM #6. BLOCK: Enter the block number (if applicable) from
your legal description.
ITEM #7. LOT: Enter the lot number (if applicable) from your
legal -description.
ITEM #8. PB/PG: Enter the plat book and page number(s) on
which your property is recorded in the records of Seminole
County.
ITEM #9. USE OF BUILDING: Enter a description of the primary
use of the building. Example: Single Family Residence, Retail
Sales, etc.
ITEM #10. RESIDENTIAL, COMMERCIAL, INDUSTRIAL: Check which one
applies.
ITEM #11. FLOOD PRONE: Check if it is or is not a flood prone
area.
ITEM #12. DESCRIBE WORK: Enter a description of the work you
wish to accomplish under the permit for which you are applying.
ITEM #13. CHANGE OF USE FROM: Enter for what the building is or
was used. Enter n/a for all new construction.
ITEM #14. CHANGE OF USE TO: Enter what you wish to use the;
building or structure for once it is completed.
ITEM #15. UTILITIES: This item has several places that need to
be checked. Check which one that applies to you.
ITEM #16. TYPE OF CONSTRUCTION: Enter what the construction type
is (materials used).
ITEM #17. OCCUPANCY GROUP: Enter one of the following:
A -Assembly, B-Business, E-Educational, F-Factory/Industrial,
H-Hazardous, I -Industrial, M-Mercantile, R-Residential, S-Storage
ITEM #18. TOTAL LAND AREA: Enter total area of land in acreage
or square footage.
ITEM #19. ZONING: Enter the zoning of the property.
ITEM #20. NUMBER OF STORIES: Enter the number of stories the
building has.
ITEM #21. NUMBER OF DWELLINGS: Enter the number of dwelling
units in structure.
ITEM #22• TOTAL SQUARE FOOTAGE: Enter total square feet of the
building or the square footage of the area being remodeled,
repaired, altered, etc.
ITEM #23. NUMBER OF STRUCTURES: Enter the number of buildings
involved.
ITEM #24. CONTRACTOR: Enter the name, address, city/zip and the
telephone number of the contractor.
ITEM #25. ARCHITECT/ENGINEER: Enter the name, address, city/zip
and the telephone number of either the Architect or Engineer.
Note: The Building Official may require the signatureand/or
seal of an Architect or Engineer on all building construction
plans. Normally _ these signatures are not required on
residential single family homes, additions, alteration, repairs,
etc.
NOTE: This application shall be completed and legible otherwise
it will not be accepted. If a contractor is pulling the permit,
he must sign the application at the Building Department Office.
If you have further questions, call (407) 322-3161, ext. 270.
FLOOD PRONE: In addition to standard requirements, if the
property is located in the Flood Plain, the procedures for
construction in the Flood Plain shall be followed. If your
property is FLOOD PRONE please obtain separate forms from the
Building Department.
CITY OF. SANFORD
+. 0BUILDING PERMIT APPLICAT:.ION PERMIT NO 1'
O. SITE.DEVELOPMENT PERMIT APPLICATION
APPLTCANT TO rnMPI.FTP.. N1.1.MRRRRn CDarPC nMTM nT0 r"TTnMC nu mare
BUILDING VALUATION`',
CTt1 .. s-,,
3a . / 0 0
1. OWNER
2.. ADDRESS OF JOB ! n
SITE DEV. VALUATION `
C f"f C� .n T a r
f Q �4 �► �1 o r c
3 b.
r`''4. SEW TWP. RGE
5.. SUBD-TRACT-PARCEL.
6. BLK
7., LOT
8. PB/PG
9. USE OF BU
Res
LDING
�ro � PL) 01 � " �
10'.. RESIDENT•I� L C -T
L
11. FLOOD PRONE
o�.,
COMMERCIAL;" .INDUSTRIAL 1=
(NO)
12., DESCRIBE WORK
13. CHANGE OF USE PROM;
14. CHANGE OF USE TO:
Ve
ed
15. UTILITIES yr
CITY WATER L] JTY . SEWER 0 SEPTIC TANK O SOIL TEST (IF APPLICABLE)
AA/.
16. TYPE OF CONSTRUCTION
I7. QCCUPANCY GROUP :.
1-8._ TOTAL LAND AREA
19. ZONING
I + yr ock
� 1
20. NO. OF
21.' NO: OF DWELLINGS
22. TOTAL SQ.
23. N0..OF.STRUCTURES
)STORIES
,�T.•
.l'+
7 T
7 o
r
24. CONTRACTOR%1 p� MAILING XDDREjSS CI /ZIP ( PHONE
�Ower je-tf r�F.S ci 33� Sc/� 0
0- 0n.;,&r 0,60 9 QhTvrG
25. ARCHITECT/ENG NFER MAILING ADDR S CITY/ZIP PHONE
FEES:
SITE DEV.
BUILDINNG
RADON GAS
OPEN'SPAC,E
UTILITY
POLICE
FIRE
0
FEES:
DRIVEWAY-�A
y NOTICE
SEPARATE:'PERMI,TS, ARE REQUIRED FOR ELECTR1ICAL, PLUMBING, MECHANICAL,, REMOVAL OR RELOCATION OF
-TREES AND ADVERTISING SIGNS.
f'
THIS PERMIT BECOMES�ALL AND VOID JF`dW RK OR''CONS,TRUCTION AUTHORIZED IS NOT COMMENCED WITHIN
180 DAYS OR IP;CON,STRUCTION OR WORK IS SUSPENDED OR,'ABANDANED FOR A PERIOD OF 180 DAYS AT
"AN•YTIME AFTER THE-4ORK IS COMMENCED.
ALh PLANS FOR• -am BUILDING WHICH ARE REQUIRED TO BE SIGNED AND'SEALED BY THE ARCHITECT OR
ENGINEER OF RECORD SHALL�CONTAhN A STATEMENT"THAT „TO.THE,B'EST OF THE ARCHITECT'S.OR
_.. ENGINEER'S KNOWLEDGE::, 1THE1 PLANS ANDISPEC' S COMPLY ,,WITH1- HE APPLICABLE MINIMUM BLDG, ,.. CODES.
r '
The named Contractor/Owner Builder to whom the permit is issued shall have the resnonsi-
bility for supervision, direction, management;;) and control of the construction activities
on the pr0,ect for which the building'.permi.t'was issued.. F.S. 553-85.
SIGNATURE OF CONTRACT R DATE STATE CERTIFICATION NUMBER OR
.. STATE REGISTRATION'NUMBER AND. COMP CARD NUMBER
SIGNATURE OF OWNE DATE
>>
APPLICATION ACCEPTED BY:
PLANS CHECKED BY:
APPROVED FOR ;ISSUANCE BY:
i
PERMIT_VALIDATION: CHECK_: CASH DATE BY
FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING
TWICE FOR BUILDING IMPROVEMENTS.
COMMENTS:
ORIGINAL (BUILDING) YELLOW CUSTOMER)PINK (COUNTY TAX OFFICE)
GOLD (CO. ADMIN.,OFFICE)
It
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION
J
COMPLETE ALL ITEMS NUMBERED ONE (1) THROUGH TWENTY-FIVE (25).
LEAVE ALL OTHER ITEMS BLANK.
ITEM #1: OWNER: The owner of the property.
ITEM #2: ADDRESS: Where the work is being performed.
ITEM.03a. BUILDING VALUATION: Enter the value of construction
for the project. Do not include the land value. Do not include
the value of the electrical, plumbing, mechanical or well
drilling. Do include all other costs.
ITEM #3b. SITE VALUATION: Improvement to land other than
building.
ITEM #4. SEC TWP RGE: Enter the section, township and range
where the property is located. This can be obtained from your
annual`tax statement or from the Tax Assessor's Office at the
Seminole County Services Building located at 1101 E. ,1st Street
iri Sanford.
ITEM #5. SUBD-TRACT-PARCEL: Enter the parcel number assigned
by the Seminole County Tax Assessor. This number may be found on
your annual tax statement. The Building Department does not have
a record of these numbers-.
ITEM #6. BLOCK: Enter the block number (if applicable) from
your legal description.
ITEM#7. LOT: Enter the.lot number (if applicable) from your
legal description.
ITEM #8. PB/PG: Enter the plat book and page number(s) on
which your property is recorded in the records of Seminole
County.
ITEM #9• USE OF BUILDING: Enter a description of the primary
use of the building. Example: Single Family Residence, Retail
Sales, etc.
ITEM #10. RESIDENTIAL, COMMERCIAL, INDUSTRIAL: Check which one
applies.
ITEM #11. FLOOD PRONE: Check if it is or is not a flood prone
area.
ITEM #12. DESCRIBE WORK: Enter a description of the work you
wish to accomplish under the permit for which you are applying.
ITEM #13. CHANGE OF USE FROM: Enter for what the building is or
was used. Enter n/a for all new construction.
ITEM #14. CHANGE OF USE TO: Enter what you wish to use the*
building or structure for once it is completed.
ITEM #15. UTILITIES: This item has several places that need..to
be checked. Check which one that applies to you.
ITEM #16. TYPE OF CONSTRUCTION: Enter what the construction type
is (materials used).
ITEM #17. OCCUPANCY GROUP: Enter one of the following:
A -Assembly, B-Business, E-Educational, F-Factory/Industrial,
H-Hazardous, I -Industrial, M-Mercantile, R-Residential, S-Storage
ITEM #18. TOTAL LAND AREA: Enter total area of land in acreage
or square footage.
ITEM #19. ZONING: Enter the zoning of the property.
ITEM #20. NUMBER OF STORIES: Enter the number of stories the
building has.
ITEM #21. NUMBER OF DWELLINGS: Enter the number'of dwelling
units in structure.
ITEM #22• TOTAL SQUARE FOOTAGE: Enter total square feet of the:
building or the square footage of the area being remodeled,.
repaired, altered, etc.
ITEM #23. NUMBER OF STRUCTURES: Enter the number of buildings
involved.
ITEM#24. CONTRACTOR: Enter the name, address, city/zip and the
telephone number of the contractor.
ITEM #25. ARCHITECT/ENGINEER: Enter the name, address, city/zip
and the telephone number of either the Architect or Engineer.
Note: The Building Official may,require the signature and/or
seal of an Architect or Engineer on all building construction
plans. Normally these signatures are not required on
residential single family homes, additions, alteration, repairs,
etc.
NOTE: This application shall be completed and legible otherwise
it will not be accepted. If a contractor is pulling the permit,
he must sign the application at the Building Department Office.
If you have further questions, call (407) 322-3161, ext. 270.
FLOOD PRONE: In addition to standard requirements, if the
property is located in the Flood Plain, the procedures for
construction in the Flood Plain shall be followed. If your
property is FLOOD PRONE please obtain separate forms from the
Building Department.
✓'"4 f t I TY OF. SANFORD "
U BUILDING PERMIT APPLICAT-ION
CT SITE DEVELOPMENT PERMIT APPLICATION
rnnr TllrA1T Mn r-nunr nmc. .niurc.nnn n��w..n
PERMIT N.O.
BUILDING VALUATION
On 1
3 a. /� 00 U
1. OWNER g� (`
"2. ADDRESS OF+' JOB �y {
"i
SITE DEV. VALUATION
0 G I� Q "� y r t
3 b.
4. SEV TWP RGE
5. SUBD-TRACT-PARCEL.
6. BLK
7.
LOT
8. PB/PG
9. USE OF BUILDING
t
�U
10. RESIDENTIAL ❑
11. E`LOOD PRONE
R,G
rQ U++.;
COMMERCIAL L . NDUSTRIAL C
_J.*eg*r- (NO)
12. DESCRIBE WORK
13. CHANGE OF USE' -FROM:
14. CHANGE OF USE TO:
15. UTILITIES
U� CITY WATER L7
ITY SEWER ❑ SEPTIC TANK ❑ SOIL TEST (IF APPLICABLE)
16. TYPE OF CONSTRUCTION
OCCUPANCY GROUP.,
}8. TOTAL LAND AREA
19. ZONING
117.
C is
! T � 13
20. NO. OF
21. NO.
OF
22. TOTAL SQ. FT.
23. NO. OF STRUCTURES
STORIES
)DWELLINGS
1�
* ,
24. CONTRACTOR MAILING %DDRESS CI /ZIP
PHONE
33
25. ARCHITECT/ENGfNEER MAILING ADDRE&e^� CITY/ZIP
PHONE
/r
33 0-5 L/
FEES:
SITE DEV.
BUILDING
RADON GAS
OPEN-SPAGEUTILITY
POLICE M
FIRE
tls o o
I
FEES:
DRIVEWAY
\
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, MECHANICAL, REMOVAL OR RELOCATION OF
TREES AND ADVERTISING SIGNS.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN
180 DAYS OR I'F CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT
"-ANYTIME AFTER THE--�#ORK IS COMMENCED.
`' ALL PLANS:F'0R-T,E BUILDING WHICH ARE REQUIRED TO BE SIGNED AND SEALED BY THE ARCHITECT OR
ENGINEER OF RECORD SHALL CONTAIN A STATEMENT THAT, TO THE BEST OF THE ARCHITECT'S OR
ENGINEER'S KNOWLEDGE, THE PLANS AND SPEC'S COMPLY WITH THE APPLICABLE MINIMUM BLDG.,,CODES.
The named Cont-ractor/Owner Builder to whom the permit is issued shall have the resnonsi-
j bility for supervision, direction, management, and control of the construction activities
on the project for.which the building permit was issued. F.S. 553-85.
SIGNATURE OF ,CONTRACTOR DATE STATE CERTIFICATION NUMBER OR
STATE REGISTRATION NUMBER AND COMP CARD NUMBER
SIGNATURE OF OWNER('DATE
APPLICATION ACCEPTED BY:
PLANS CHECKED BY:.
r
APPROVED FOR ISSUANCE BY:
PERMIT.VALIDATION: CHECK, CASH DATE
BY
FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING
TWICE FOR BUILDING IMPROVEMENTS. �-
COMMENTS:
ORIGINAL (BUILDING) YELLOW 4CUSTOMER)r PINK (COUNTY TAX OFFICE) GOLD (CO ADMIN. OFFICE)
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION .
COMPLETE ALL ITEMS NUMBERED ONE (1) THROUGH TWENTY-FIVE (25).
LEAVE ALL OTHER ITEMS BLANK.
ITEM #1: OWNER: The owner of the property.
ITEM #2: ADDRESS: Where the work is being performed.
ITEM #3a. BUILDING VALUATION: Enter the value of construction
for the project. Do not include the land value. Do not include
the value of the electrical, plumbing, mechanical or well
drilling. Do include all other costs.
ITEM #3b. SITE VALUATION: Improvement to land other than
building.
ITEM #4. SEC TWP RGE: Enter the section, township and range
where the property is located. This can be obtained from your
annual tax statement or from the Tax Assessor's Office at the
Seminole County Services Building located at 1101 E. 1st Street
in Sanford.
ITEM #5. SUBD-TRACT-PARCEL: Enter the parcel number assigned
by the Seminole County Tax Assessor. This number may be found on
your annual tax statement. The Building Department does not have
a record of these numbers.
ITEM #6. BLOCK: Enter the block number (if applicable) from
your legal description.
ITEM #7. LOT: Enter the lot number (if applicable) from your
legal description.
ITEM #8. PB/PG: Enter the plat book and page number(s) on
which your property is recorded in the records of Seminole
County.
ITEM #9. USE OF BUILDING: Enter a description of the primary
use of the building. Example: Single Family Residence, Retail
Sales, etc.
ITEM #10. RESIDENTIAL, COMMERCIAL, INDUSTRIAL: Check which one
applies.
ITEM #11. FLOOD PRONE: Check if it is or is not a flood prone
area.
ITEM #12. DESCRIBE WORK: Enter a description of the work you
wish to accomplish under the permit for which you are applying.
ITEM #13. CHANGE OF USE FROM: Enter for what the building is or
was used. Enter n/a for all new construction.
ITEM #14. CHANGE OF USE TO: Enter what you wish to use the
building or structure for once it is completed. .
ITEM #15. UTILITIES: This item has several places that need to
be checked. Check which one that applies to you.
ITEM #16. TYPE OF CONSTRUCTION: Enter what the construction type
is (materials used).
ITEM #17. OCCUPANCY GROUP: Enter one of the following:
A -Assembly, B-Business, E-Educational, F-Factory/Industrial,
H-Hazardous, I -Industrial, M-Mercantile, R-Residential, S-Storage
ITEM #18. TOTAL LAND AREA: Enter total area of land in acreage
or square footage.
ITEM #19. ZONING: Enter the zoning of the property.
ITEM #20. NUMBER OF STORIES: Enter the number of stories the
building has.
ITEM #21. NUMBER OF DWELLINGS: Enter the number of dwelling
units in structure.
ITEM #22• TOTAL SQUARE FOOTAGE: Enter total square feet of the
building or the square footage of the area being remodeled,
repaired, altered, etc.
ITEM #23. NUMBER OF STRUCTURES: Enter the number of buildings
involved.
ITEM #24. CONTRACTOR: Enter the name, address, city/zip and the
telephone number of the contractor.
ITEM #25. ARCHITECT/ENGINEER: Enter the name, address, city/zip
and the telephone number of either the Architect or Engineer.
Note: The Building Official may require the signature and/or
seal of an Architect or Engineer on all building construction
plans. Normally these signatures are not required on
residential single family homes, additions, alteration, repairs,
etc.
NOTE: This application shall be completed and legible otherwise
it will not be accepted. If a contractor is pulling the permit,
he must sign the application at the Building Department Office.
If you have further questions, call (407) 322-3161, ext. 270.
FLOOD PRONE: In addition to standard requirements, if the
property is located in the Flood Plain, the procedures for
construction in the Flood Plain shall be followed. If your
property is FLOOD PRONE please obtain separate forms from the
Building Department.
CITY OF; SANF`OR D
0BUILDING PERMIT APPLICATION
O SITE DEVELOPMENT PERMIT APPLICATION
Amor TrSAIT mr) room v'*v M11U0Voon Qnft/ Vl- f%L r V _ f1TrfBn.,,tn►fn n.t n./.v
PERMIT NO.'
�r�.
BUILDING VALUATION
C,
/ S7 000
t"1 t
3a .
1. OWNER
2. ADDRESS OF JOB
x
SITE DEV. VALUATION
M) a� a Y
'4.
3b.
4. ;SEV TWP RGE
5. SUBD-TRACT-PARCEL- 16.
BLK
7. LOT
S. PB/PG
9. USE OF BUILDING t J •
`�'ro
10. RESIDENTIAL Ct
11.
I
FLOOD PRONE
IR Q S Vim- (- ( to}
COMMERCIAL ik•.ZNDUSTRIAL
t7�
(,APE'S r_ (NO)
12p DESCRIBE WORK
13. CHANGE OF USE -FROM:
TO:
14. CHANGE O'^^+F�
- S , :Nw
%USE
15. UTILITIES L CITY WATER LlAITY SEWER ❑ SEPTIC TANK
❑ SOIL TEST
(IF APPLICABLE)
t`
16. TYPE OF CONSTRUCTION
17. OCCUPANCY GROUP
,_118- TOTAL LAND AREA
19. ZONING)
20. NO. OF STORIES
21. NO. OF DWELLINGS
22. TOTAL SQ. FT.
23.
NO. OF STRUCTURES
24. CONTRACTO_Rf, MAILING ADDRESS
CIS'/ZIP
PHONE
', �kM1
ked @" a (� t ''a V, 0 '.* •'�
�
+"''`y !, '� �,'
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I I f�s� �� r -!
ti.'. ;r. �/
'v+(,
fi
25. ARCHITECT/ENGI'NFER MAILING ADDRESS
CITY/ZIP
PHONE
C .� tip. J 1 6o 2 2
- z,
3 0 - Scl
ii 0.1 n k- r x
e,-
.
FEES:
SITE DEV.
BUILDING
RADON GAS
OPEN' SPACE
UTILITY
POLICE
FIRE,
I I
EES:
DRIVEWAY
- NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, MECHANICAL, REMOVAL OR RELOCATION OF
-_TREES AND ADVERTISING SIGNS.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN
180 DAYS OR 'I'P CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT
"AN.YTIME AFTER THEtXORK IS COMMENCED.
4',.
ALL PLANS-FORHE BUILDING WHICH ARE REQUIRED -TO BE SIGNED AND SEALED BY THE ARCHITECT OR
ENGINEER OF RECORD SHALL CONTAIN A STATEMENT THAT, TO THE BEST OF THE ARCHITECT'S OR
ENGINEER'S KNOWLEDGE, THE PLANS AND SPEC'S COMPLY WITH THE APPLICABLE MINIMUM BLDG.,,CODES.
The named Contractor/Owner Builder to whom the permit is issued shall have the resnonsi-
bility for supervision, direction, management, and control of the construction activities
on the project for which the building permit was issued. E.S. 553-85.
SIGNATURE OF CONTRACTOR, DATE STATE CERTIFICATION NUMBER OR
}^; r
LI_"n
STATE REGISTRATION NUMBER AND COMP CARD NUMBER
f
t F
SIGNATURE OF OWNERKI( j DATE
APPLICATION ACCEPTED BY:��.�✓
PLANS CHECKED BY:
APPROVED FOR ISSUANCE BY: �.�e✓t...,
PERMIT VALIDATION: CHECKCASH DATE BY
FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING
TWICE FOR BUILDING IMPROVEMENTS.
COMMENTS.:
f .x -,y,•
ORIGINAL�`(BUILDING) YELLOW i,4CUSTOMER) PINK (COUNTY'TAX OFFICE)
GOLD (CO.'AdMIN. OFFICE)
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION
COMPLETE ALL ITEMS NUMBERED ONE (1) THROUGH TWENTY-FIVE (25).
LEAVE ALL OTHER ITEMS BLANK.
ITEM #1: OWNER: The owner of the property.
ITEM #2: ADDRESS: Where the work is being performed.
ITEM #3a. BUILDING VALUATION: Enter the value of construction
for the project. Do not include the land value. Do not include
the value of the electrical, plumbing, mechanical or well
drilling. Do include all other costs.
ITEM #3b. SITE VALUATION: Improvement to land other than
building.
ITEM #4. SEC TWP RGE: Enter the section, township and range
where the property is located. This can be obtained from your
annual tax statement or from the Tax Assessor's Office at the
Seminole County Services Building located at 1101 E. 1st Street
in Sanford. '
ITEM #5. SUBD-TRACT-PARCEL: Enter the parcel number assigned
by the Seminole County Tax Assessor. This number may be found on
your annual tax statement. The Building Department does not have
a record of these numbers.
ITEM #6. BLOCK: Enter the block number (if applicable) from
your legal description.
ITEM #7. LOT: Enter the lot number (if applicable) from your
legal description.
ITEM #8. PB/PG: Enter the plat book and page number(s) on
which your property is recorded in the records of Seminole
County.
ITEM #9• USE OF BUILDING: Enter a description of the primary
use of the building. Example: Single Family Residence, Retail
Sales, etc.
ITEM #10. RESIDENTIAL, COMMERCIAL, INDUSTRIAL: Check which one
applies.
ITEM #11. FLOOD PRONE: Check if it is or is not a flood prone
area.
ITEM #12. DESCRIBE WORK: Enter a description of the work you
wish to accomplish under the permit for which you are applying.
ITEM #13. CHANGE OF USE FROM: Enter for what the building is or
was used. Enter n/a for all new construction.
ITEM #14. CHANGE OF USE TO: Enter what you wish to use the
building or structure for once it is completed.
ITEM #15. UTILITIES: This item has several places that need to
be checked. Check which one that applies to you.
ITEM #16. TYPE OF CONSTRUCTION: Enter what the construction type
is (materials used).
ITEM #17. OCCUPANCY GROUP: Enter one of the following:
A -Assembly, B-Business, E-Educational, F-Factory/Industrial,
H-Hazardous, I -Industrial, M-Mercantile, R-Residential, S-Storage
ITEM #18. TOTAL LAND AREA: Enter total area of land in acreage
or square footage.
ITEM #19. ZONING: Enter the zoning of the property.
ITEM #20. NUMBER OF STORIES: Enter the number of stories the
building has.
ITEM #21. NUMBER OF DWELLINGS: Enter the number of dwelling
units in structure.
ITEM #22• TOTAL SQUARE FOOTAGE: Enter total square feet of the
building or the square footage of the area being remodeled,
repaired, altered, etc.
ITEM #23. NUMBER OF STRUCTURES: Enter the number of buildings
involved.
ITEM #24. CONTRACTOR: Enter the name, address, city/zip and the
telephone number of the contractor.
ITEM #25. ARCHITECT/ENGINEER: Enter the name, address, city/zip
and the telephone number of either the Architect or Engineer.
Note: The Building Official may require the signature and/or
seal of an Architect or Engineer on all building construction
plans. Normally these signatures are not required on
residential single family homes, additions, alteration, repairs,
etc.
NOTE: This application shall be completed and legible otherwise
it will not be accepted. If a contractor is pulling the permit,
he must sign the application at the Building Department Office.
If you have further questions, call (407) 322-3161, ext. 270.
FLOOD PRONE: In addition to standard requirements, if the
property is located in the Flood Plain, the procedures for
construction in the Flood Plain shall be followed. If your
property is FLOOD PRONE please obtain separate forms from the
Building Department.
-
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CITY OF SANFORD BUILDING DEPARTMENT
OWNER/BUILDER AFFIDAVIT
Disclosure Statement 489.103 (7) as amended by P.C.O. 88-38
State law requires construction to be done by licensed contractors. You
have applied for a permit under an exemption to that law. The exemption
allows you; as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction
yourself. You may build or improve a one -family or two-family residence,
or a farm outbuilding. You may also build or improve a commercial
building at a cost of $25,000 or less*. The Building must be for
you own use and occupancy. It may not be built for sale or lease. If you
sell or lease more than one building you have built yourself within 1
year after the construction is completed, the law will presume that you
built it for sale or lease, which is a violation of this exemption. You
may not hire an unlicensed person as your contractor. Your construction
must be done according to building codes and zoning regulations. It is
your responsibility to make sure that people employed by you have
licenses required by state law and by county or municipality licensing
ordinances.
For your information, the Owner/Builder becomes liable and responsible for
the employees he/she hires to assist in the construction project. This
responsibility may include the following where required by law:
- i
A. Worker's compensation (for workers injured on the job)
B. Social Security Tax (must be deducted from the employee's
wages and matched with the owner's funds)
C. Unemployment Compensation (may or may not be required)
D. Liability Coverage
E. Federal Withholding Tax
I acknowledge that as an Owner/Builder, I Na-►ard J eT�tr am
obligated to actually., physically, build`\the structure or do the work
which I have permitted.
I understand that if I am not physically doing the work or physically
supervising free labor from friends or relatives, that I must hire
licensed contractors,i a electrician, plumber, mechanical (heating and
air conditioning, etc.). I further understand that the violation of not
physically doing the work, and the use of unlicensed contractors at the
construction site, will cause the project to be shut down by the Inspector
Staff of the City of Sanford Building Department. Additional State statues
allows for penalties up to $1,000 and up to 1 year in jail. I also
understand that if this violation does occur, that in order for job to
proceed, I will have a licensed contractor come in and sign on the permit
as taking the job over. I understand that if I hire subcontractors under a
contract price, that they must be licensed to work in the City of Sanford,
i.e. masonry, drywall, carpentry, etc. All contractors licensed by City of
Sanford Licensing Board have worker's compensation and liability coverage
and are registered with the State of Florida.
I will assume full responsibility as an Owner/Builder Contractor, and will
personally supervise or do all work allowed by law on the permitted
structure.
Property Owner
Permit Address
Telephone (yo-7
Other Identifi
Address
cation
0, �OX % % .S c, h T , Ci ,
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I hereby acknowledge th t I have read and understood the above
affidavit on this %9, day of P% A.
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Owner/Bui Signature
*489-Part II only exempts from licensing and owner doing or supervising
any electrical work on a one or two family residence. Commercial work
requires a licensed electrician.