HomeMy WebLinkAbout174 Kelly Cir (2)ft
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
1 (. 30 3s'
Documented Construction Value: $ 7f 3 a 500
Job Address: 4o 1 -7 y e ! �/ ('. i Y. Historic District: Yes ❑ No [°3'
Parcel ID:
Residential [Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work:
Plan Review Contact Person:
Phone:
Fax: Email:
Property Owner Information
Title:
Name —0%1-q c ca --CCL L a Phone: y07- 3 22 7 rJ Z
Street: 17 y Ke- ( l u (' i or Resident of property?
City, State Zip: '�S An� L� -� G+ L . r3 •Z 77 3
Contractor Information
Name
Street:
City, State Zip:
Phone:
Fax:
State License No.:
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
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: 5'" 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 o"rdinance. 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.
rgnature I
wner/Agent Date
Print Owner/Agent's Name
omotary-state
Owner/Agent is
Produced ID
8. / `/ /b
DEBBIE &.AIMId
MY COMMISSION U FF 17e848
EXPIRES: February 25, 2019
Boded Tbiu Flolery Public Un4erw6ten
Personally- to Me or
Type of ID r 1 � 1.
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
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 ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised: lune 30, 2015 Permit Application
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)
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 1, as the owner of
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the property listed, may act as my own contractor with certain restrictions even though I do not have a
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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
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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.
_1 mnderstand_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 1 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
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and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
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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
operty Address:
1, �la naca (Tl • �S7fDLc:t(� , do hereby state that 1 am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified abpve.
Of
Form of Identification
(Must be Photo ID)
Date
) ®- / -/- ZD/t'l.
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
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 am of aware of construction practices and I have access to the Florida Building Codes.
1 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. 1 also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850487-1395 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
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information that 1 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
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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.
operty Address:
1, �la naca (Tl • �S7fDLc:t(� , do hereby state that 1 am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified abpve.
Of
Form of Identification
(Must be Photo ID)
Date
) ®- / -/- ZD/t'l.
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
)� THIS I T UMENT PRARE ! I1�I�I Il1911169! I1181 III! 88111 ILII 161
Name: MARYANNE NORSE? SEMINOLE COUNTY
Address:2773 CLERK OF CIRCUIT COURT & COMPTROLLER
GK 8804 P9 1638 QP3s)
CLERK'S 4 2016118103
NOTICE OF COMMENCEMENT RECORDED 11/14/2! 16 10:44:42 AN
RECORDING FEES `610.00
State of Florida RECORDED BY hdevore
County of Seminole
Permit Number: �i0 — 3 O 3S Parcel ID Number:
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 F PRO�ERTY: (Legal des ption f th roperty and street address if available)
17c/ _Ke U� 4 Lz-,' s6t—,�o7d PZ. 7�2721--
yiGENERAL DESCRIPTION OF IMPROVEMENT:
.1—
OWNE ORMATION: 7
Name: 6 N a ea LZ
Address: 17 K e a,, :v — 2 Z
Fee Simple Title Holder (if other than owner) Name:
Address:
CbNTRACTOR:
•, I I ,
Address:
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: / / / ✓ice
Address
In addition to himself, Owner Designates of
To receive a copy of the Lienors 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 1, 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of pery'u , I declare that I have read the foregoing and that the facts stated in it are true
e
to
to tfreJesy ,,g-', and belief.
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O
t Printed Name
'r� 01- eir
Owners Signature Owner's
' '
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FI Statute 773.13(1)(9): The owner must sign the notice of commencement and no one else may be permitted to sign In his or her stead.*
Yj J • S4d
State of County of
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The foregoing Instrument was acknowledged before me this14 day of / r �'w'�M 20
it
by OlQnn C, 1L eS aa Who Is known to me ❑
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W
personally
Name of person making statement
OR who has produced identificationXtype of identification produced: E L
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t
m.v•
DEBBIEWNTON
MY COMMISSION I FF 178648
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EXPIRES: February 25, 2o1g Notary Signature
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OwdedThruI tarypubrcUidenrriters
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V U m
CITY OF SANFORD BUILDING SERVICES
- Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: lb ✓ 3o 3
1, /e�,Qov hereby acknowledge that I personally inspected
l/Roof deck nailing and/or P/econdary water barrier work
at 7 V/CP_IIV L i eG / � rO Q
� /lit KGC �i4.37--7 and have determined that the work
(Job Site Addr&s)
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
Sectio 7.06Y.
Signature of Contractor Date
�a2�oS 4M #Aj r
Printed Name of Contractor License #
License Type: 0 General 0 Building 0 Residential 0 Roofing Contractor
0 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF 5 F_ M j U OLE
Sworn to (or affirmed) and subscribed before me this ----'5 day of N 6veA,,,1 b,,r , 20 , by
who is 0 Personally Known to me or has 0 Produced (type of
identification) 1:1.SD* -c of -v as identification.
cu (SEAL)
Sign ure f Notary PiRbIfic
State of Florida
" kua-N U �-e��►s
Print/Type/Stamp Name
of Notary Public
MAURA VARGA8
....... �, ' NOTARY PUBW - STATE OF FLORIDA
Z, SG ':. COMM18810N OFF 021M
.. ;:) EIWGM A" P, 2017
;, : > BONDED THRU Ho" Punic und0+wWvs