HomeMy WebLinkAbout1617 Magnoliaa
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BY:
CEI
JAN 13 20%
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: p- g.(.,o
Documented Construction Value: $ '' /Cr 0)(2
Job Address: Historic District: Yes No EV
Parcel ID• Residential [v"Commercial
Type of Work: New 9 Addition Alteration Repair Demo Change of Use Move
Description of Work: _Chain Gz K k &)o o lX d -217 c Q
Plan Review Contact Person:
Phone: qo 7 ` 9 Z Q - 3 r; 3OFax:
F Title:
Email:_ 9 4Z 0 eart Z rK , h 2 t
Property Owner Information
Name jp,//ape/' Y
Street: //7 l /-In ha, U,0-
City, State Zip: 7 7 /
Phone:
Resident of property? .
Contractor Information
Namee
Street: /.?Z,l Jf
City, State Zip: Lo h c Wp 0lj 1,
1 5L _T 2 7 ,5 0
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
State License No.-
Architect/Engineer Information
Phone:
Fax:
E-mail: —
Mortgage Lender:
Address:
4
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 constructioninthisjurisdiction. 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: 511 Edition (2014) Florida Building Code
Revised: June 30, 2015
Pennit 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 ofthis 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.
401ml /-- 4 L—Avl
ore of 6wne gent Date
Print Owner/Agent's Name
PI 0-/3./(0
Signature of Notary -State of Florida D
mr+e
DEBBIEBLANTON
MY OOMMISSION II FF 17864E
EXPIRES: February 25, 2019
Bonded Thor Notary PubRc underm v,
Owner/Agent ersonally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent
Print Contractor/Agent's Name
Date
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: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
cN (&—
APPROVALS: ZONING: 6"444'UTILITIES:
ENGINEERING:
COMIVIFNTc-
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Ok to install approximately 200 linear feet of 5 foot high chain link fence, 59.5 linear feet of 5 to 6 high
foot wood fence and 82 linear feet of 4 foot high picket fence as shown on plan. Fence shall be =
constructed with finished side facing outward.
Revised: June 30, 2015 Permit Application
4 OWNER BUILDER STATEMENTIAFFIDAVIT
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.
p 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 toThe 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 Q
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 IJandmaterials. 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 q
not licensed to perform the work being done. Any person working on my building who Is not licensed A
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 will
abide by all applicable laws and requirements that govem 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
pp Revenue Service, the United States Small Business Administration, the Florida Department of Financial
h 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.
QQ I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
J!- 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 E o
I, . , do hereby state that I am qualified
and capable of p orming the requested construction involved with the permit application filed and agree to the
conditions sne ffied above. '
Sig
Form of Identification
Must be Photo ID)
Date
I %Y-16
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
Boundary Survey
Legal Description:
All of Block B, Revised Plat of Markham Park Heights, according to
the Plat thereof as recorded in Plat Book 1, Page(s) 78, Public
Records of Seminole County, Florida.
Flood Zone: X Panel: 0317F
Community Number: 12071 C Date: 8/28/2008
CERTIFIED TO:
Betty D. Siebert
Fnd 'W
No I enl
Date:
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Scale:1"=20'
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Lot 1
Lot 2
Block "B"
Block "B"
APPROVED FJLApgS
ENG. DEPT.
Q} NAVD 88 Datum , Ok to install approximately 200 linear feet of 5
site Benchmark Information- foot high chain link fence, 59.5 linear feet of 5
Q#1 Top of Well Box Elevation=37_13Y
to 6 high foot wood fence and 82 linear feet of
2 Set 60D Nall In 30' Oak Tree Fiavation=3e 4 foot high picket fence as shown on plan.
Fence shall be constructed with finished sideeComleted:10-27-15F Surve Is Based u the I ovs oaa°m°d P'°ponyts y P tagofasroconUyySurveyodAbutUngPropeNesDeedsfacingoutward. rrennRoanfumfahedloMerNumber. IS-23837 Point
of Curvature Overlaps
and/or Hiatus. Subject
to any Easements and/or Restrictions of Record. actleo
for Lend Survoyin h
ft Sisto or r 0O W1 n0 ChoppTe_r -,7.052 Florida Adminlstrauve
Codes, Pursuant t Uon 472 27 Florida Statutes. P_ P -
Polnnt of Bearing
Basis shown hereon, Is Assumed and Based upon the Una Denotedwitha'BB'. P.
O.B.- Point of Beginning BeginningP.
O.L- Point on Una PP
Power Buildin
Ties are NOT to be used to reconstruct 9Property tines. Fence
Ownership Is NOT determined. Q
ai'F•QL A ; "
Qa I(, i FOR PolePRM -
Permanent Reference Monument
Roof
Overhangs. Underground UUIIUes and/or Footers have NOT been
located UNLESS otherwise noted. s
i $TAT , / - THE FrRnPT -
Point of Tangency Radius
Septic
Tanks and/or Draingeld locations are approximate and MUST be
verified by eppropdato UUIIry Location Companies. Patrick
K. Irelan tL`•.,Ftonr u 637 LB 7623 Thls
Surveyy Is intend ' 'Y' p use of Said Certified Parties. R&
CR - Reb1N $ C Use of This Survey for Purposes other than Intended, Without This Surve l TVAUD U and FJIIbOSSedtYltil Sunre S S821. or
ap Written Verifleto the or. be at the User's Sole l be and tMUrout Ireland & Associates Surd ying/ Inc. Rea - Recovered Lloblllry to the Survoyyo0r. Nothing Hereon shall be Constnred to glvo Rid. _ RoaIedp",,,. A ANY Rights or BoneC to Anyone Other than those Cer1J1 Book
UE Y. WM -
e - 1301
S. International Parkway Suite 2001 Lake
Mary, Florida 32746 www.
irelandsurveying.com 407.
678.3366 Fax-407.320.8165