HomeMy WebLinkAbout1325 Summerlin AveJUL 0 6 2011 '
CITY IOF SANFORD
JaUILDING & FIRE ; PREVENTION
PERMIT APPLICATION
Application No: I I IT 51 Documented Construction Value: $ .2 S _ (C"
Job Address: 3_,s <Su a-\ m i? (- ( (1"\( Historic District: Yes No
Parcel ID: ,i Zonhig:
Description of Work: leC_k 1kJ00& e_
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
Property Owner Information
Name _C_\ O, S6 n Phone:
Street: SUl QY\`(Y-\ P 1 \ t 2 Resident of property?
City, State Zip: nQ OLc C N—
Contractor Information
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address: ` `
PERMIT INFORMATION
Building Permit
Square Footage: Construction Type: No. of Stories:
77,
No. of Dwelling Units: Flood Zone: _
Electrical Plumbing K C '
New Service — No. of AMPS: New Construction"• No. of Fixtures: _
Mechanical (Duct layout required for new systems) Fire Sprinkler/Alarm No. of heads:
Q b
o
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.
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Signature of Owner/Agent Date
Print Owner/Agent's Name
Sign ture of Notary -State of Florida Date
oti0i4i±lltcl;ytidd.. *;;.-,
Owner/Agent is Personals . to MZ 0&
Produced ID Type o -
n per:
o R. z"
APPROVALS: ZONING=
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:
Rev 11.08
I agree that, as the party legally and financially responsible for this proposed construction activity; I will
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.
1
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: Sum Y) e_( ('(r\- P\y e -
I, - C)aA . \ c _ a ` e -u S o n , 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 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
e. . a
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
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
nin 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 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
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
1 risk.
Rev. 9.14.2009
LEGEND'.
CONC. - CONCRETE
R/W - RIGHT OF WAY
P.0.L. ° POIW 01,1 LINE
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CITY OF S ORD - BUILDING PLAN REVIEW
PLANNIN AND ENT SERVICES
APPROVE
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CERTIFIED TO:
STEWART TITLE OF
ORANGE COUMTV, INC.
D15COUNT FIniANCIAL
CORPORATION
INLAND MORTGAGE
CORPORA'TIoN
905E.9 ' A. ANO
PATRICIA A. PETER50N
89 ° 5 5 `40" W 150.00
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50LIWPARY 5tJRvEy
LOT5 9 A1JD 10, BLOCK D, BUEUA V15TA
E5TATE5, A5 RECORDED IN PLAT BOOK -5,
PAGES I AND 2, PUBLIC RECORDS OF SEMINOLF-
COOK f Y, FLOP,IDA.
NOTE5.
I. BEARINGS BASED ON THE eAST R/w L.(KIE,
0 OF 5UMME:RL.IN AVENUE A5 BEING NORTH.
O 2. UNDERGROUND IMPROVEMENTS NOT IACATED.
S. 5UF3JECT TO EAS•EMEWM AND RESTRICTION'S
OF RECORD.
4. SUBJECT PROPERTY L1E5 IM ZOtAE'C', PER
FLOOD INSURANCE RATE MAP PANEL KL2
1202940010 8, DATED: 5EPT. 17, 19$0•
a DATE OF FIELD SURVEY: AUG. I-7, 1993.
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HEREBY CERTIFY: DATE: AUG.17, 1993
That this survey meets the
minimum technical standards SCALE:
set forth by the Florida Board
I'' = 30'
of Land Surveyors in Chapter JOB NO. 95-111,820
21 H H - 6, F. A. C.
BIGLEY LAND SURVEYING
Thomas J. 6lgley 124 Robin Road
Fla. Reg. Land Surveyor #4887
Suite
e S9yAltamonteSprings, F1.
407) 767-0166
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LEGEND:
CONIC. - coNCRETE
R/W - RIGHT OF WAY
P.o.L. t POINT 01.1 LINE
O ' P01NT NOT ZK-T
CITY OF S. W ORD - BUILDING FLAN REVIEW
PLANININ t;Ii,0 EDIT SERVICES
APPROVE
DATE
CITY OF SANFORD • BUILDINR PLAN REVIEW
PLANNING
J
DEVELOPMENT SERVICESOFFICEAPPROVE
DATE,__ _ G • ,(/' ii'1
LOB
N 89055'40"E 150,00`
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CERTIFIED TO:
STEWART TITLE OF
ORANGE COUNTY, INC.
DISCOUNT FINIANCIAL-
cos PoRATIoN
INLAND MORTGAGE
COR PORATI O N
ROBERT A. AND
PATRICIA A. PETER50N1
89 0 5 5 '40" W
L.OT
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LOT
10
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e,887 P.O.I.:
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130UWPARY 5U9VEY
LOTS 9 AQD 10, BLOCK D, E3UEE 4A VISTA '
65TATE5, A5 RECORDED IN PLAT BOOK 3,
PAGES I AND 2, PUBLIC RECORDS OF SEMIMOC.E
COUNT, FLORIDA,
I. F EARIMG5 BASED ON THE eA5T Filvi LINE
OF 5UMMERLIN AVENUE AS BEING NORTH.
2. UNDERGROUND IMPROVEMENT5 NOT LOCATED.
S. SUBJECT'rO EA5F-Mr=KT'5 AND RESTRICTIONS
OF RECORD.
d 4. SUBJECT PROPERTY L E5 IN ZONE'c', PER
5 FLOOD INSURANCE RATE MAP PANIEL, t-lS
1202940010 8, DATED- 5EPT. 1"7, 19BO.
5. DATE of FIELD 5URVEY: AUG. 1-7, 1993.
HEREBY CERTIFY: DATE: AUG.17, 1993
Thal, this survey meets the
minimum technical standards SCALE: 1` 30
set forth by the Florida Board
of Land Surveyors in Chapter
JOB NO. 93-i 1 1.620
21 H H - 6, F. A. C.
i BIGLEY LAND SURVEYING
Thomas J. Bigley 124 Robin Road
11Fla. Reg. Land Surveyor 114887 Altamontesuite me Springs, F1.
407)-767-0166