HomeMy WebLinkAbout1215 S Palmetto Avef
714F'EB 042016
T..
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 401 `
Documented Construction Value: $ Zl 1U .
Job Address: Historic District: Yes E No
Parcel ID: Residential 0--commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
r . — . I I._ t r, (I , — r . I — eJ I
Description of Work:
Plan Review Contact Person: `1 Title: <:CW Ili i --h
Phone: Fax: Email: f .L
Name VD- f
Street: C
City, State Zip:
T
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Property Owner Information
Phone: (- [Vll i+ qQ1/ q
Resident ,ofdp roperty?
to 9iW2 - aildjp VIGivo
Contractor Information
Phone:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
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 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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51h Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
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 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 off the 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.
a al q 1 16
S' a ure o wner Agent Date Signature of Contractor/Agent Date
Signature of ,"
ti Y p ,,ti ANNETTE SCO
e ; Notary Public - State of Florida
My Comm. Expires Jan 16, 2018
Commission I FF 071760
Ato Bonded ThmugA thftonal Notary Assn Owner/
Aersonal y nown to Me or Produced ID
Type of ID L t_ 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 BELOW IS
FOR OFFICE USE ONLY Permits Required:
Building Electrical Mechanical Plumbing Gas Roof Construction Type:
Total Sq
Ft of Bldg: Occupancy Use:
Min. Occupancy
Load: New Construction:
Electric - # of Amps Fire Sprinkler
Permit: Yes No # of Heads APPROVALS: ZONING:
Y V4 2- y- UTILITIES: ENGINEERING: COMMENTS: _
tI
kin C-
e— 1 e C of
FIRE: Flood
Zone:
of Stories:
Plumbing - # of
Fixtures Fire Alarm
Permit: Yes No WASTE WATER:
BUILDING: 6GO-
d
G E Revised: June
30, 2015 Permit Application
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APPLICATION #
FOR A CERTIFICATE OF APPOPRIATENES'BV-- =J
Answer all the questions on this form and submit all required attachments. Incomplete applications will not
be reviewed. If you have questions about application requirements contact the Historic Preservation Officer
at 407.688.6146 to ensure your application is complete.
General Information
Downtown Commercial Historic District Residential Historic District Is this a retroactive request? Ye No
Is this application filed in response to a Notice of Violation from the C e Enforcement Departmemk' Yes No
Proposed improvements will affect the following elevatio : orth South East West
Property Address:
Property Owner IInnfor'ma ttiion,
Print Name:`
Mailing Address:
Phone:..1,61 • * I-
u1111 IQEmail: Applicant/
Agent Information Print
Name: Mailing
Address: Phone:
Email: Signature: BY
SIGNING BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE SCOPE
OF WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO DETERMINE
IF A BUILDING PERMIT IS REQUIRED. FAILURE TO OBTAIN A BUILDING PERMIT WILL RESULT
IN A STOP WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING BELOW,
YOU ALSO ACKNOWLEDGE THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE
AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE. E T
4 Signature:
Date: , Would
you like to receive emails regarding Historic Preservation and Community Planning within your community? Description
of proposed work Completely
describe the entire scope of work, including changes in material and color, and methods that will be used to accomplish
the proposed work. For large projects an itemized list is required. Use the reverse side if necessary. 0, ) - —,-
IN c, HISTORIC
PRESERVATION BOARD • 300 S. Park Avenue • Sanford, Florida 32771 9407.688.5145 • www.sanfordfl.gov/HP
Figure 1.43,17ood privacy fence to be installed in locations noted on survey.
Double drive gate to •- installed, as well as walk gate. Finished •- of fence must face outward.
1215 S. • Avenue
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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, 1 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 asmy-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. t 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 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 n> -
notlicensedtoperformtheworkbeingdone. Any persoworking 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 1 '
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.
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 J r
I, \D L\Q gl , 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 Date Form
of Identification Must
be Photo ID) 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