HomeMy WebLinkAbout1114 10 St WRECEIVED
DEC 14 2010 CITY OF SANFORD,
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: J / o T Documented Construction Value:
Job Address: 111 V 16 -fA 5f 14) ban tro4, Historic District: Yes No
r
Parcel ID: oZ "/ y 3 0 `" 50, " / l / q - 0 0 ,,0 // Zoning:
Description of Work: -r S,d/% lVe6j? K d D T 4SA41
Plan Review Contact Person:L L Title:
Phone: 707 G%Yp 7 0/ 7 Fax: V01 6 D 7 7L E-mail:
Property Owner Information
Name G /u c r/ S Phone: /X/i % 3o2, 3 76 3
Street: r,'sso JI I/ Resident of property?
City, State Zip: C 3d _7 71
Name
Contractor Information
Phone:
Street: Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit 0
Square Footage: / S
No. of Dwelling Units:
Electrical
New Service — No. of AMPS:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction.;Type: , 6Oo No. of Stories:
Flood Zone: 7-17,e
Mechanical (Duct layout required for new systems)
Plumbing
New Construction - No. of Fixtures:
l
Fire Sprinkler/Alarm No. of heads:
J
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. 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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will .be applied to your permit fees when the
permit is released.
2 -llJ
ignature of Owner/Age Date
5_111L_S
Print Owner/Agent's Naiie
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
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
WASTE WATER:
BUILDING:
Rev .1.1_.Og_.w
US DepaMnent of Housing and Urban Deve111on-ni
OMB No. 2502-0265A. Settlement Statement
B. Type of Loan
t _ FHA 2. _ FmHA 3. _ Conv. Unins. PAGE i OF 3
Z#t:nt# r 8. Mortgage Insurance Case Number4. VA 5. Gonv. Ins.
fumished to give you a statement settlement costs. Amounts paid to and by the settlement agent are shown. Items marked %p_o.c.)" were pa doutsideofdosing: they are shown here for information purposes and are rat mcluded in the totals. WARNING: it is a crime to knowi IUnitedStatesonthisoranyotherform. Penalties upon conviction can include a fine i
n9h false dents to the
1010. nWdsonmernt. For details see: TiBe 18 U S. Code Section 1001 and Section
A NAME OF BORROWER EMORY GREEN, GLADYS GREENAnnn....
u, "nv. JH !`VKL1,. I-L 31f II
E NAME OF SELLER: DEUTSCHE BANK NATIONAL TRUST COMPANY, AS TRUSTEE IN TTRUST FOR THE BENEFIT OF THE CERTIFICATEADDRESS: HOLDER
46- REGENT BLVD, SUITE ZCO, IRVING, TX 75063
F. NAMtOF ENDER: CASH
ADDXXXX000-0000 G.
PROADDRESS: 1"A W tOTHST, SANFORD, FL 32771-2344H. SETNTAGENT: POWERLINK, AN AGENT OF CHICAGO TITLE INSURANCE COMPANY-345 ROUSER RD. CORAOPOLIS, PA15108PLAETTLEMENT: 2181BRISSONAVE, SANFORD, FL 32771-8466 . I.
SETTLEMENT DATE: 12/10/2010 J.
SUMMARY OF BORROWER'S TRANSACTION: DISBURSEMENT DATE: 12I70l2010 100.
GROSS AMOUNT DUE FROM BORROWER K. SUMMARY OF SELLER'S TRANSACTION: 101.
CONTRACT SALES PRICE $25,600.00 400GROSS
AMOUNT DUE TO SELLER 401. CONTRACT
SALES PRICE 102. PERSONALPROPERTY25,600.00 402. PERSONAL
PROPERTY 103. SETTLEMENTCHARGESTOBORROWER (LINE 1400) $554.00 403. 104: 404. 105.
405.
ADJUSTMENTS
FOR
ITEM$ PAID BY SELLER IN ADVANCE 106. CITY/
TOWN TAXES ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE 107. COUNTY
TAXES 12/10/2010 TO 01/01/2011 $67.57 406. CITY/
TOWN TAXES 407. COUNTY
TAXES 12/10/2010 TO 01101/2011 10. SCHOOL TAXES 109. 67.57 408. SCHOOL
TAXES
409. 410.
ill. 11. 41
L
112.
412. 120.
GROSS AMOUNT
DUE
FROM
BORROWER $26 221.57 200. AMOUNTS PAID BY OR
ON BEHALF OF BORROWER 42D. GROSS AMOUNT DUE TO SELLER $25,667,57 j 201. DEPOSIT OR EARNEST MONEY
500. REDUCTIONS IN AMOUNT DUE TO SELLER 2.50b-.O-0 203.
PRINCIPAL AMOUNT OF NEW
LOANS 1501. EXCESS DEPOSIT SEE INSTRUCTIONS
20EXISTING LOANS TAKEN SUBJECT TO
5. SETTLEMENT CHARGES TO SELLER (UNE
1400) $5 030 13 204. 50023. EXISTING LOANS TAKEN SUBJECT
TO 504. 205. 50. 206. 506. 207,
208.
508.
209.
509.
ADJUSTMENTS
FOR
ITEMS
UNPAID
BY
SELLER
210. CITY/TOWN TAXES ADJUSTMENTS FOR
ITEMS UNPAID BY SELLER 211. COUNTY TAXES 510. CITY/TOWN
TAXES 511. COUNTY TAXES 212. SCHOOL TAXES
512. SCHOOL TAXES
213. 513. 214. 514. 215. 515.
216.
516.
217'
517.
218.
518 .
219.
51.
220.
TOTAL
PAID
BY/
FOR
BORROWER $
2,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER $5,030,13 300. CASH AT SETTLEMENT FROM ORTOBORROWER800. CASH AT SETTLEMENT FROM OR TO SELLER 301. GROSS AMOUNT DUE FROM BORROWER (LINE 120) $26,221.57 601. GROSS AMOUNT DUE TO SELLER LINE 420 $25 667.57 ` 302, LESS AMOUNTS PAID BY/FORBORROWER (LINE 220) $2,500.00 602. LESS REDUCTION AMOUNT DUE SELLER (LINE 520) $5 030.13 303. CASH FROM BORROWER Sl lPtgT1T1rMP-A $23,
721.57 ltwo cc, ,.emu
c.T. r.-....'_ ...
603. CASH TO SELLER $$5 637
44 Revenue Service. If
you
are required
to file a return, anegligencepenaltyorothersanctionwillbeimposedonyouifthisitemisrequiredtobe -reported and the IRS determines that it has not been reported. The Contract Sales Price described on line401aboveconstitutestheGrossProceedsofthistransaction. ' SELLERS INSTRUCTIONS: If this real estate
was your principal residence, file Form 2119, Sales or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions, complete the applicable PartsofForth4797, Form 6252 andfor Schedule D (Form 1040). You are required by law to
provide the settlement agent (Fed. Tax ID No: 1 with your current taxpayer id antification number. If you do not provide your correct taxpayer identification number, you maybesubjecttocivilorcriminalpenaltiesimposedbylaw. Under penalties of perjury, 1 certify that the number shown on this statement is my correct taxpayer identification number, TIN: / SELLER(S) SIGNATURES: I SELLER(
S) NEW MAILING ADDRESS: SELLER(
S) PHONE NUMBERS: (H) PowerUnk
Printed 12/09/2010 at
09:15 AM by mboWn REV. HUD-1(3/86)
C11
T16
A
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, lyUinter 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.
I 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 afrequent 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 in 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
I agree that, as the party legally and financially responsible for this proposed construction activity, I willa
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.
I 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 Address
ti
A
do hereby state that I am qualified
and capable of perform rig the requested construction involved with the permit application filed and agree to the
conditions specified above.
ature of Owher-Bu
Form of Identification
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