HomeMy WebLinkAbout2505 Georgia Ave (2)b CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ -1 0
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Job Address: v 0( 1 6L (L 0 istoric District: Yes NoEf2
Parcel ID • -' ` ' v Residential Commercial
Type of Work: New Additio Alteration Repair Demo Change of Use Move
Description of Work:
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Plan R view1Contact Person:
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Title:
Phone:. Tq I gg'0 4 C--'F xx: 'A Q q A) Email: eai o tear a 1 t o r ,
Property Owner Information
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Name r- c l Y Phone: 4 0,33 g`
i r) 6-,;b yr- L,k r' Resident. of propert P. n a r)+ Street: P P -p ty, ..
City, State Zip: Cl 3
Contractor Information
Name
Street:
City, State Zip: —
Name:
Street:
City, St, Zip:
Bonding Company:
Address: -
Phone:
Fax:
State License No.:
Architect/Eiigineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE,TO RECORD A NOTiE a
NOTICE NCEMXNT
Y RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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: 5th 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.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
E_.Jdlu
Print Owner/Ag 's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
p BLANTON
Y " " `: iS10N # FF 178G0
February 25, 2019
gotary Public Underwfiler_
Owner/Agent is Personally K wn to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID 1-1J L Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas[ Roof [
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
1N0f3'__
APPROVALS: ZONING: • 0- 1-116 4"'1 UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
Ok to install 4 foot high wood picket fence in front yard and 8 foot high wood fence as shown on plan.
No more than 4 foot high shall be between the front building line and the front property line. Fencing
and gates within front yards shall be decorative and semi -transparent and shall not be solid or shadow-
boxed. All fencing shall be made out of attractive long-lasting materials. Fence shall be constructed with
finished side facing outward.
Revised: June 30, 2015 reninApplication
J
OWNER BUILDER STATEMENT/AFFID"IT
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)
Rev. 9.14.2009
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 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
risk.
Rev. 9.14.2009
Property
I, L dl U O 11 L-\
and capable of performing
conditions specified above.
Signature of
3 v-J
CL `( , do hereby state- that I am qualified
the requested construction involved with the permit application filed and agree to the
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
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
Olx
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.
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
v 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
I, L dl U O 11 L-\
and capable of performing
conditions specified above.
Signature of
3 v-J
CL `( , do hereby state- that I am qualified
the requested construction involved with the permit application filed and agree to the
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
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4
5 370 Waymont Court • Lake Mary, FL 32746 • Voice 407.688.7631 • Fux 407.688.
7691 Lot 27, Block 35. 4TH SECTION DREAMWOLD, according to
the plat thereof, as recorded in Plat Book 4, Page(s) 99, of the
Public Records of Seminole County;
FL. Community number: 120294 Panel:
0045 Sufftr: E F.I.R.Al. Date: 411711995 Flood Zone
X Date vffield work: 121W2005 Completion Date:
1212012005 Certified
lo: Rafael Marie; Eddollu Santiago: Southeast Professional Title,
LLC Commonwealth Laud Title Insurance Company; Chapel
Mortgage Corporation, its'successors a» dlor
assigns. ffl'F „ •<>. p . p• -
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1s¢ k. APPROVED PLANS _
GEORG
ENG. Ok to install 4 foot high wood picket fence
in front yard and 8 foot high wood fence as
shown on plan. No more than 4 foot high shall
be between the front building line and the
front property line. Fencing and gates within
front yards shall be decorative and semi -
transparent and shall not be solid or shadow-boxed.
All fencing shall be made out of attractive
long- lasting materials. Fence shall be
constructed with finished side facing
outward.
City of Sanford
Fence 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:
Fences must be compliant with the City Land Development Regulations, Schedule F
Fence Permit Application completed and signed. Application must include correct address and complete
parcel I.D. number.
lbrCopy of a contract, signed by the contractor and the property owner, indicating the documented
construction value
Copy of the Business Tax Receipt (if the contractor is the applicant).
I Eertificate 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).
Indicate the number of linear feet, height, number of gates, and type of material on application.
Two (2) copies of site plan indicating where the fence will be located on the property.
Repairs
No Permit is required for Fence Repairs. A Fence Repair is qualified by one or more of the following:
Replacing individual slats; no more than 10% of the entire fence
Replacing a section; no more than 3 sections of the entire fence. A section is defined by the fencing
material between 2 posts.
Replacing a post; no more than 4 posts total. Posts must be placed in or directly around the removed
post without encroaching on neighbor's property.
Replacing a gate
Please contact the Building Division if you have any questions on Fence Repairs"
These guidelines were compiled to assist the applicant in preparing a fence permit application and may not be
complete. The applicant is required to meet all City of Sanford codes and requirements.
Revised: September 2016
3455 SOUTH U.S. HNY 17-92
E"".. " ="' `°"''^^^-=°'
0262 0002'3 38333 0/3016 03:38 PM
CASHIER NICOLE
ORDER ID: H0262'17267
RECALL AMOUNT 642.75
764666528543 PTN3S5 -A> 27.48
10 X 3" PG10 EXT SCREW 5 LB
MAX REFUND VALUE $26.46
670.23 $25 Off Credit Offer 25.0d
MUST RETURN ALL. ITEMS FOR A FULL REFUND
SUBTOTAL 645.19
SALES TAX 45.18
T0 690.37
XXXXXXXXXXXX9071 HOME T 690.37
AUTH CODE 030746/5230877 TA
0262 23 38333 10/30/2016 2692
RETURN POLICY DEFINITIONS
POLICY ID DAYS POLICY EXPIRES ON
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CUSTOMER INVOICE P=s'
Plmne:(407)332-9500
Sekslaerson: t:%N6606gMoredoing.' Reviewer.
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cement by iHom Depot register validation.
aoT 847-3176
3455 SOUTH U,S. HVY 17-92
CAS:, LBERRY, FL W.707 (407)332-950
0262 OOU73 3833:1 10/30/16 03:38 PH
CASHIER NICOLE
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OMER 70: H0262-17267
RECALL AHOIINT 641.75
764666528543 PIMS5 4- 27.48
0583 oie LAFAYETTE I QUY
10X 3' PGIO EXT SCREW 5 LB
HAX VALUE $26.46RsEFUND
Gi0:P3 32255 Off Credit OfferCr "-25.04- ERCHANDISE AND SERVICE SUMMARY s'd
MII6I,RE, N41 U,. ITEMS FOR AFIYI. N:1U41_
EFa W04 SKU i 0000315664 Customer Pldrue/Will Call
SUBTOIAL 645.19
SALES TAX 45,18 DESCRIPTION
TOTAL $690.37 X4 -BFT R2 PT GCXNXNXNXNXXXX9071IX4EIIFINII690.37
AUTH CODE03074G/52.VC77 TA
XB' PT PINE 4' DOG EAR FENCE PANEL
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0262 23 300 1 ' 2016 2692
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Store 0282 CASSELBERRY Phone: (407) 332.9500
3456 5 US HWv 17-92 Salesperson: N%N6606
CASSELSERRY, FL 32707 Reviewer:
is only a QUOTE for the momhandhte and eerAces fainted below. This beeomM an
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RAFAEL
Page 1 of 3 No. H0262-17267
16
OP.DER ID: H?2t2-1'26'
RECALL AMOUNT 642.75
CUSTOMER AGREEMENT DISCOUNT O2
ADDL M05E SUBTOTAL 26.41
SUE•TOTAL L45.19
SALES TAX
TOTAL S.lII7690.'
XXXXXXXXXXXX9D71 HOME DEPOT 690..'
110GENESMRD I AUTH CODE 030744:5220577 TA
SCOTT 1e0eiT"'" Fenco
LA 70683 """ LAFAYETTE QUOTE Is valid for this date: 1M130MI6
CUSTOMER PICKUP #1 MERCHANDISE AND SERVICE SUMMARYem
REF p W04 SKU#922"10LM, Fustonms Pickup Will Call
STOCK MERCHANDISE TO BE PICKED UP:
REF.p SKU OTY Lim DESCRIPTION PI CE EAC EXTENSI
R01 0002.256276 14.00 EA 4X4-8FT p2 PT GC
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D 88.87 596.18
R02 0000-696.603 11.00 EA 8'X8' PT FINE 4' DOG EAR FENCE PANEL A Y 638.97 3408.67
A03 0000.556238 5.00 EA 1X4 42XB PT FRENCH GOTHIC SPCD PANEL A Y 827.98 8139.90
SCHEDULED PICK DATE: 11 16
END OF USTOMER PICKUP - REf sW04
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Page 1 of3 No. H0262-17267 Customer Copy
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3455-SOUTH U.S. HMY 17-92 !?
C,ASSELBERRY, Ft. 32707 (407)732-95 n
026200023 38333 10!30/16 113:38 PM
CASHIER NICILE
M)ER ID: -HW62-17267
RECALL AMOUNT 642-75 ( 0'
764666528593 PTN;IS5 -A'- - 27.98.,,;, -
010 X 3" %10 EXI SCREW 5 LB
MAX REFLW VALE $26.46
5S25 Otf Nen Accant Q'dit---:---'. 670.21 525 Ott C,.Jt O) fer -25.114:,,. E '
MIST RETLRN,ALL ITEMS FOR A F(U- REF(A4O-
SUBTOTAL 695.19"t
SALES TAX 95-1fl;.iTOTAL $690.37 -;X
XXXXXXXXXXXX9071 IDE IEPO1 fi9O-37*t
AUTH CODE. n30746/52"77 Ike
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2692
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POLICY ID DAYS POLIf.Y EKPIRES OW
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