HomeMy WebLinkAbout125 Holloway CtJob Address:
Parcel ID:
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
20 1S Application No: S
Documented Construction Value: $ p 0 4 . 0 C
s or f—D rZ/ Historic District: Yes No
Type of Work: New Addition Alteration
Description of Work: Yk— rur)
LL1
Plan Review Contact Person:
Phone:
Residential [r Commercial
Repair IR Demo Change of Use Move
Fax: Email:
Pro e O I
Title:
p riY caner nformatlon
Name _ O l 61c, Phone: 467 3 / '/ i
Street: 1 °Z5 go /laved y Resident of property?
City, State Zip: d Yd % -3 Z 77 /
Contractor Information
Name
Street:
City, State Zip: _
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
State License No.:
Arch itectlEng ineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFCOMMENCEMENT. .
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: 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. r
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 Iocal 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.
4
Signs u =510 n
E,
Date
Print
jOw
er/Agent's Name
Signature of Notary -State of Florida
DEBBIE BLANTO- N
pjy COMMISSION # FF 178648
e' EXPIRES: Fobruary 25, 2019
ponded Thru Notary Publlc Underwriters
Signature of Contractor/Agent
Print Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Kpovym to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID ) L- 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:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 - Permit Application
OWNER BUILDER STATEMENT/AMDAVIT
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 saleor- 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 I
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 r
comply with laws requiring the withholding of federal income tax and social security contributions f
I 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 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
I
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
1p 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: ' 77 J
I, Zy y ,qG S " 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.
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
City of Sanford
Roof Permit Application Checklist
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
Building Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
applicant).
A site specific notarized power of attorney shall be required from the licensed contractor if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
Certificate of insurance indicating worker's compensation insurance coverage and naming the City of
Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of
Florida (must be submitted with each application if contractor is the applicant).
Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
These guidelines were compiled to assist the applicant in preparing a roof permit application and may not be
complete. The applicant is required to meet all City of Sanford, state, and federal code requirements.
112321191 111h,21 11211a1111 HIM 11911 1991 illtil JTHISINSTMl: P EPAf BY: Name:
cv H cx Address:
0 NOTICE
OF COMMENCEMENT State
of Florida County
of Seminole Permit
Number: Parcel ID Number: HNE
1'l0RSEP SEPt:(HOLE (i1UINTY L.
i::1tP; iJr 111:'I CL
ER.IV S ; 201_61151117 3; 1I:
I ,UL` 1=-l;lt, ;; 1,.;] i-'(" l_lill' .1`
il: 'i'C'i..`=i `•..iti 1111 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. DESCRIPTION OF PROPERTY: (
Legal eTE scription of thepropertyandstreet address if available) C1 In OF
01 Fee
Simple
Title
Holder (if other than owner) Name: Address: R: I ,
C -
P
4 (c/, Address: i?.S
140 //O --)Q `' Persons within the
State of Florida Designated by Owner upon whom notice or other documents may be served as provided by
Section 713.13(1)(b), Florida Statutes. Name: Address: In
addition
to
himself, Owner Designates of To receive a
copy of the Lienor's Notice as Provided in Section 713.13(
1)(b), Florida Statutes. Expiration Date of
Notice of Commencement (The expiration date is 1 year from date of recording unless a different date is
specified) WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND
CAN 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•COMMENCINCt-WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under pe les-
6f perk declare that i have read the foregoing and that the facts stated in it are true to the t
f my knowl OPa Ord belief. owners Si nature
Owner's Printed Name Fiodda Statu _ ign
the notice of commencement and no one else may be permitted to sign in his or her stead: State of County
of `}k t!o `C The foregoing instrument
was acknowledged before me this day ofy 20 `c - by,
TA Lr 7 }
l_Who is personally known,to me 0 „j Name of person
making
slatem y a of identification
produced: n ;,, OR who has producedidentificgstiPPCtiPY-MARYANNE MORSE ? `1* "
9rr i : ; tii•• •t r-' CLERK Or THE
CIRITCOURTANDCOmp , LLER EMIN LEG , Fl
RIDA dS '•.
ti Notary SignatureBy b ..••'' O \,. .
DEPU4YCLE
2o sHEAT , E
DeEPUTY CLFRR
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: /&`2-C/ is
I, P S " -' /k5 hereby acknowledge that I personally inspected
Z Roof deck nailing and/or iZ( Secondary water barrier work
at I'-L6 kh I IO cam) cA 3 2-7ZIhave determined that the work
Job Site Address)
was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
ASectio7
F.S.
gue o tractor Date
Printed Name of Contractor License #
License Type: General Building Residential SeRoofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF & M I OJ L
Sworn o (or armed) and subscribed before me this / day of , 20 / , by
t-f
1/r/26 , who is Personally Known to me or has 5 Produced (type of
ideptUicat on) rl- OL1 A 4X `7,2l' 94. 6 as identification.
v1 /u 9-'— (SEAL)
Signature otary Public
State of FloYrida
nJD y IZ f6av5 6nl
Print/Type/Stamp Name
of Notary Public
00 "Le Notary Public State of Florida
Wendy R Benson
w < a oa My Commission FF 035664
Expires 07/14/2017
3