HomeMy WebLinkAbout1919 S Palmetto Ave - E18-004518 - NEW AMP OUTDOOR PANELoS
1r•nb,
o •
MORK
r FS1,71a 1'
PERMIT APPLICATION
Application No: I Ste' L 0
Documented Construction Value: $ CEO
G c j
Job Address: _ { r t 1 L, e % Historic District: Yes No
Parcel ID: Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: 1 e c tr
Plan Review Contact Person:
Phone: Fax: Email:
Title:
Property Owner Information
Name e r ; L /% o t CYn Phone• 7 - SDI y _ ' ?2
Street: / c. j r" I %/ o V(f Resident of ro ePPrtY? .
City, State Zip:
c Contractor Information
Name h S G( - Phone:
Street: Fax:
City, State Zip: State License No.:
Architect/Engineer 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 apermit to do the workand 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:6°i Edition (2017) Florida Building Code
NOTICE: In addition to the requirements ofthis permit, there may be additional restrictions applicable to this property that maybe 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 offthe 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.
S- I/ /e
Signature ofOwner/Agent Date
Sh,1• lNo,m
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Signature ofContractor/Agent Date
Print Contractor/Agent's Name
Signature ofNotary -State of Florida Date
i''•. DEBBIEBLANTON
MY COMMISSION # FF 178648
a EXPIRES: February 25, 2019
Owner/Agent is ` ` erwdters Contractor/Agent is Personally Known to Me or
Produced ID Type of ID L - Produced ID Type of ID
9-
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Fire Alarm Permit: Yes No
WASTEWATER:
BUILDING:
p1
0
k
n
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
v 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
for the isU,) responsible construction and 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.
I understand that, as the owner -builder, I must provide direct, onsite supervision ofthe 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
I 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
W
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
I abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
J 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 ad4ess
listed below.
1 I agree to notify the building department immediately of any additions, deletions, or changes to any of the
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
JJ 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: ' 0 l h , l / T V (f
I, _ s l D W ojlcl , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
Signature of Owner -Builder
Form of
Must be Photo ID)
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 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
Prepared' By and Return To:
HEATHER SALVTORIELLO
Quality Title & Escrow, LLC
1801 Lee Rd., Ste. 205
Winter Park, FL 32789
File No. QTE09124432
Property Appraiser's Parcel I.D. (folio) Number(s)
36-19-30-511-0 K00-0090
WARRANTY DEED
I hereby certify this to be
a true copy o t e original
Quality Titl Escrow, LLC
THIS WARRANTY DEED dated October 4, 2018, by Marion F. Culpepper an unremarried woman,
whose post office address is 4424 Woodland Hills Dr, Tuscaloosa, AL 35405, hereinafter called the
grantor, to Sheri D. Workman a single woman, whose post office address is 1919 S PALMETTO AVE,
SANFORD, FL 32771, hereinafter called the grantee:
Wherever used herein the terms "grantor" and "grantee" include all the parties to this
instrument and the heirs, legal representatives and assigns of individuals, and the
successors and assigns of corporations)
WITNESSETH: That the grantor, for and in consideration of the sum of $10.00 and other valuable
consideration, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens,
remises, releases, conveys, and confirms unto the grantee, all the certain land situated in Seminole
County, Florida, to wit. -
Lot 9, and the South 1/2 of Vacated Alley on the North, Block K, N.H. Garners Addition to
Markham Park Heights, according to the map or plat thereof, as recorded in Plat Book 1,
Page(s) 81, of the Public Records of Seminole County, Florida.
Subject to easements, restrictions, reservations and limitations of record, if any.
TO HAVE AND TO HOLD the same in Fee Simple forever.
AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in
fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the
grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of
all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing
subsequent to: December 31, 2017.
Warranty Deed (Individual to Individual)
iiupenorSo dr
September 25, 2018
Job _Address
Sheri DWorkman ~~'---
19195Palmetto Ave Fil
JV61313.
Previous
Awards2015,2014,2013, A+ Job
Details Replace:.
New 2 amp main breaker ne[ und system, r old fuse panel
tothenevvoutdoor paneiinstaUingfiveGFC|receptodes and removing cloth wire inpanel box. lies 2ODAmp CHflush
indoor/
outdoor main electrical panel SGF[|receptacles new connectors new
Work tobe
compl i-
6d--
noja er than October20, 2018 by electrician John Sparky Contractor signature Homeowner signatui 925Sunshine
Lane, Suite
101O Altamonte
Springs, FL32714 407'331-9077* 407-331-0305F/
QX UC.#CVC5693l