HomeMy WebLinkAbout406 S Sanford Ave (2)MAR 10 2011
CITY OF SANFORD
BY: & FIRE PREVENTION!
PERMIT APPLICATION,
4
Application No: ( Documented Construction Value: $ pax ,
Job Address: ® So, ` u X N\3L Historic District: Yes No
Par6el ID: Zoning: .G
Description of Work;
Plan Review Contact Person:
Al
Title:
Phone: Fax: &mail: .
Property Owner Information
Name A`t 5 vU .,s .,N c` Phone: ,al c1 4
Street: Fhb v+ \)F, Resident of property?
City, State Zip: Sr1f-S . 3a
Contractor Information
Name O a. ( v din` Phone: LAn GIS% <Ao\
A n o
Street: Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name: \,>, \ , t c cg. ' Phone:3 ` at ` , 7 0 4 .
Street: Fax:
City, St, Zip: ,e,t FL 3 3 E-mail:
Bonding Company:
Address:
Mortgage Lender:
Address:,
PERMIT INFORMATION
Building Permit
Square Footage: Construction Type: N6 ;of Stories:
No. of Dwelling Units: Flood Zone: o
Electrical Plumbing -, 0
New Service — No. of AMPS: New Construction - No. of .Fixtures:
Mechanical (Duct layout required for new systems) Fire Sprinkler/Alarm 11 No. of heads:
F__
e
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, beaters, tanks, and
air conditioners, etc.
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.
WARNING TO OWNER: YOUR FAILURE VO'RRECORD 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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed ;the documented
constructio va'l u when the executed contract is submitted, credit will be applied to your permit fees when the
permit isele d. \
Signature f Owner/Agent
tS'•J i.... N i
Print r/Age NamV,
Date Signature of Contractor/Agent
V. t
Signature of Notary -State of Florida T Date
COMMENTS:
Rev 11.08
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
WASTE WATER:
BUILDING:
i iC it„ r1t1114
Owner/Agent is. Persona ii to-
Produced IIID. s` Type
USW cV .::
i.
APPROVALS: ZONING :TILITIES: _
L •. ''del• .'
ENGINEGr:•,a..°°°r''; FIRE:
COMMENTS:
Rev 11.08
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
WASTE WATER:
BUILDING:
OWNER BUILDER STAVE ENT/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 appitea ror
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 requiredto 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
is leasedlease. If a building or residence that I have built or substantially improved myself sold or 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
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
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 Address: O& t \ 0 Sx,:ur- f'wc
do hereby state that I am qualified
and capable o erforming the requested construction involved with the permit application filed and agree to the
conditions"'sp cified
Signature
Form of Identificatian
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
MIS 19SI UMEN't PREPARED 1 111111111111 loll
NAME NNEr4UkyE, CLERK OF CIRCUIT COURT
Permit No.
Tax Folio No. 11 O S G- `
ASR J•E C CUN7Y
SK 0I562 Pg 0357; (lpg)
NOTICE OF CdMMENCEMENT ' S # 2011044.032
REt;l RI)EU 04/ 7/2011 11:36:47 PX
State of Florida REWRI)INI FEES 1040
County of Seminole REWNDEli BY T Van Nuys
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.
1. pp- escItion Of pr erty: (legal description of the property, and street address if available)
2. Gen description of improvement:
3. Owner information: Name:
Address:
b. Interest in property: &Ldeyz
c. Name and address of fee simple
Address:
Contractor Name:
c./Address: #012
5. Surety Name
Address:
if other than Owner)
Phone number:
7/
b. Amount of bond: $
6. Lender: Name:
Address:
b. Lender's phone number:
7.a. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes: Name:
Address:
8.a. In addition to himself or herself, Owner designates of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement (the expiration date is 1 year from the 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 PROP T_Y. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE TN PECTIO Ili-YOU.INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER 0 N ATTO ORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMEN E T.
Signature of O ner or Ownerts Aut ori ed O fcer irector/Partner/Manager Signatory's Title/O ice 7,-
The-foregoinginstrument as ac 'novel ed be ore me thio ' da of AV ef
g f , by name of person) as (type of
authority, .. e. . officer, tr tee; tt ey in/f t) for (name of part Up a I d) .
oy
PRY P`
YT's ,KATHY J. WOODWARD
Notary Public - State of Florida
j2RZ=-j Al (SEAL) ,91 oeMy Comm. Expires Jul 5, 2013
Sign toe of Notary Public OF Foo-' Commission # DD 904812
Pei -so Kn wn OR Produced Identification
nnp
Verification p ant to Sc i 2 rida.Statutes: Under penalties of perjury, I declare that I have re,a T m an That
the facts stat it are true d,. the es f my knowledge and belief.
V"
i 'MORSE
CLERK OF' :CIRCUIT CORT
ZSEOE 0 NTY LOR10ASignaturefNaturalPeronS' inj; Above
Rev. date /2008 J
DFpI try ct_Fa
r
APR 2'7 2011