HomeMy WebLinkAbout502 E 24 PlCITY OF SANFORD PERMIT APPLICATION
Permit #:
Job Address: �� oZ C• �t 7' �!
Description of Work:
Historic District:
Date: S--
IA C -
Zoning: Value of Work: $
ODU
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential ✓ Commercial Industrial Total Square Footage: / �L
Construction Type: # of Stories: L # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
3�7 71 Phone: '- O
State License Number:
Contact Person: Phone:
Phone:
Fax:
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 -
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. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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 t is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signatur of Owner/A eni j Date Signature of Contractor/Agent Date
liR 0—r
t Owner/Agent's Name Print Contractor/Agent's Name
Signature of1—tary- to of Florida" " Signature of Notary -State of Florida Date
DEBBIE BLANTONMy COMMISSION # DD 188491EXPIRES: February 25, 2007Owner/Ageneoo-sI'eCsonally Kngw>l toce r o� o Contractor/Agent is _ Personally Known to Me or
Produced ID`� -+.. J Produced ID
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APPLICATION APPROVED BY: Bldg: Jj�a J0�oning: Utilities: FD:
(Ini ial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
CITY OF SANFORD BUILDING DIVISION
OWNER/BUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, onsite supervision
themselves of all work not performed by licensed contractors, when building or improving farm
outbuildings or one -family or two-family residences on such property for the occupancy or, use of such
owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to
exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under. this part, proof of sale or lease, or offering for sale or lease, of any such
structure by the owner -builder within 1 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other person
unless that person is registered or certified under this part and the work being performed is within the
scope of that person's license. For the purposes of this subsection, the term "owners of property"
includes the owner of a mobile home situated on a leased lot. To qualify for exemption under this
subsection, an owner must personally appear and sign the building permit application.
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 $25,000. 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 building you have 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 supervising
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.
I, N I l I e LJu d r VI , do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
i
- C� --05
Own rBuilder Signature Date
Print Owner/Builder Name
Signature
Owner is
Produced
(Inalq'10"
DEBBIE BLANTON
MY COMMISSION # DD 188491
bris y 5, 2007
to e� %
1 -800 -3 -NOTARY FL Plotwy Discount � W
r -
THIS INSTRUMENT PREPAWICE OF NMENCEMEN'T
NAME
Permit No. ,yam , Tax Folio No.
State of Florida
County of Seminole 7
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
O" sr-
-i. Desc�ption of property: (legal de cription of the rope and street address if available)
S E. - 1A Q s ��
--1-
--72: General description of
0
5.
Own -- r
a.
,C
b. Interest in property
c. Name and address of fee simple titleholder (if other than Owner)
- iil�i��11�3�>�Ilf��1>ll��l}ill�<�iH�910�!
Contractor
a. Name and address
b. Phone number Fax 2MW,7 Twp PS 4:-�1 12'
Surety CL E RK IIS 0 200.50814 21
a. Name and address k-WIIRM OWWaM WtWa221 An
REW0I1% fUS I&
b. Phone number Fax 19990@ BY D Thomas
c. Amount of bond
Lender
a. Name and address
N
! b. Phone number
Fax number
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number Fax number
8. In addition to himself or herself, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
a. Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified)
E� LA A AJ -
Si ture of Owner
s r�lC l (c�e3c� �-K
Sworn to (or affirmed) and subscribed before me this 33 day of F�a,�., , 20 C7�j , by
Personally Known OR Produced Identification
i Type of Identification Produced I
Signature of Notary Public, State of Florida
Commission Expires:
DEBBIE BLANTON i
my COMMISSION # DD 1884 11
EXPIRES: February25, 2007
I-800 3 NOT1Hy FL Notary Discount Assoc. Co.
- i
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company:
Owner:name
phone phone
License #:
Project Information
Permit #: 05- _ J, to �� 1
Subdivision:
Lot #:
I, (le- Lc L,rej, affiant, hereby affirm that I am the duly licensed
contractor of record for the abo e referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
\'(6WA'J_ 0 �.� Aea
signature
�(kc err
Punted name
STATE OF FLORID
COUNTY OF
l
This instrument was acknowledged b fore me tpi day of `7) el , 2�, y the
above referenced individual, ho acknowledg d that he/she is a
duly licensed contractor with
and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced _E�� l— as valid identification.
WITNESS my hand and seal this day of A-1 , 200
otary Public
DEBBIE BLANTON
MY COMMK'SION # DD 188491
^' �n EXPiI ELt: February 25, 2007
1 -800 -3 -NOTARY FL Notary Discount Assoc. Co.
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