HomeMy WebLinkAbout1108 S Myrtle Ave - E08-001593 (NEW WALL OUTLETS) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION
pplication u q +) + , Submittal Date: b'
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Call of Work: S ! ddress: I
Parcel IUD: ` 1,
Zoning:
Historic District: esD
criptionof'Work: D lY4(t-x .E.[lpWl., t,xL(.V-i i' Square Footage: , I......................................................................................... '.....................
Permit '
l)pe: Building Electrical* Mechanical Plumbing Fire Sprinkler/Alarm Pool Si w Electrical :
Ne+k Service - tz of AMPS Addition/AIteration Change of Service Temporary Pole Mechanical
Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/
NeNs Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/
Ness Residential: # of Water Closets Plumbing Repair- Residential Commercial Occupanc.
T. pe: Residential Commercial Industrial Occupancy Use Group(s): Construction
T. pe: <?Nl # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required ) I...... ..................................................................
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ro pert 0`, Contractor: dL
dr.;;? /' Address: d
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AXPhoil
C. 777 D E-mail: Phone: State License Number: Bonding Company:
Mortgage Lender: Address: rchltect,'
E:
ngineer. ddress Address:
Phone:
Fax:
Plan
ReN
ieN+ Contact Person: Phone: Fax: E-mail: ppll.auon
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 !hr ssuancc oi-
a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separa!e perlil must
be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and SIR CONDITIONERS,
etc. 0\\ NE:
R'S .-',FFID:',VIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable la++s regU;i! :_ onstru,nuun
and zoning. RNING TO -
OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOIL IN'IPRO\
EN11_NIS TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BFfroRl': itli I IRi!
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YUt,:x 0! 10:
OF CO:M.N1ENCEMENT. e-> Ill
i_ In a+idiuon to the requirements of this permit, there maybe additional restrictions applicable to this property that maybe found in the public rccurds of ount+, and !
here maybe additional permits required from other governmental entities such as water management districts, state agencies, or federal agenc:cs cceptance,pf
perr Stet aimc—
off 0++ner/Agent Print f
ner APertt' Name verification at
1 will notify thq owrytr of the property of the requirements of Florida Lien Law, FS 713, e Signature
of Contractor/Agent Date W, i
Print
Contractor/
Agent's Name,. Signa[urroiNutat '
i-N nlf//Th ,_ Date O+rner :
cen . Peison,allyaKno toM*o_ RO\\I_
S: ZONING: ry i UTI`6:\\ FD: JnJItI )IIis
J/ !; __F _
4•
Signature of
Notary -State of Florida Date Contractor/Agent
is _ Personally Known to Me or Produced ID
ENG: BLDG:
VD
OWNER BUIL®ER,STATEMENTIAMDAVIT
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
FSS 489.103 Disclosure Statement
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 with certain
restrictions even though you do not have a license. You must provide direct, onsite supervision of 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, provided your costs do not exceed $75,000. The building or residence must be for
your own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a
buildingyouhave built or substantially improved yourself within 1 year after the construction is complete, the law will. presume
that you built or substantially improved it for sale or lease, which is a violation of this exemption. You may not hire
an unlicensed person to act as your contractor or to supervise people working on your building. It is your responsibility
to make sure that people employed by you have licenses required by state law and by county or municipal
Licensing ordinances. You may not delegate the responsibility for supervision work to a licensed contractor who
is not licensed to perform the work being done. Any person working on your building who is not licensed must
work under your direct supervision and must be employed by you, which means that you must deduct F.
I.C.A and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your
construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. SIGNING
THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement) 1
UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103 5
AS LISTED ABOVE. 0'
5 1 HAVE ACCESS TO THE ADOPTED CODES. 1
AM FAMILIAR WITH THE CODE PROVISIONS. I
HAVE ADEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY SUPERVISE
THE WORK. THIS
PROPERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY. 7
THIS STRUCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE. 5
I
UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN OWNER
BUILDER STRUCTURE WITHOUT BEING INVESTIGATED. I
UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A., WITHHOLDING
TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE. Qroperty
Add s: I 0 ing
the requested construction involved Form
of Identificafol, A
violation oft 3
exceeding 1 jurisdiction
shall activity
against the Rev.
4/20/07) 77/
do
hereby state that I am qualified and capable of the
permit application filed. 5/
7 /0 Date
tv
I t
be Photo ID) hieanor
of the first degree punishable`by a term p ofimrnisoment note in
addition to any civil penalties. In addition, the local per miffing Woval, revoke
the permit, or pursue any action or remedy for unlicensed y person
performing work that requires.licensure under the permit issued. y