HomeMy WebLinkAbout1714 Park Ave (2)t
CITY OF SANFORD PERMIT APPLICATION r /
Permit # :05—
v5— Z \ (-)( Date:
Job Address: 1 � 1 "/ d' '-C'C'
Description of Work: �`� G tee— G' 1/1d T(n ') , �1 C Ct'q
Historic District: Zoning: Value of Work: $ 611(/Wy
Permit Type: Building Electrical
Mechanical --L— Plumbing
Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
Addition/Alteration
Change of Service Temporary Pole
Mechanical: Residential — 6,_ Non -Residential
Replacement ,� New
(Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures
# of Water & Sewer Lines
# of Gas Lines
Plumbing/New Residential: # of Water Closets
Plumbing Repair — Residential or Commercial
Occupancy Type: Residential ')( Commercial
Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: (^ C'4— ` e .S
Phone:
Contractor NName &
S l L
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
Contact Person:
l �- C r,
ate License
Phone:
Fax:
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.
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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 TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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.
Acceptan*ererification t at [ will r tify the owner of th property of the requirem nts Florida Lien L w, FS 71
wne t to r n ture of Contractor/Agent Date
e L,� K tA) (
n t w r/A n Name Print Contractor/Agent's Name
/a 3 L)\",-- n to • 2-:S �S
Date a e, X,Notary S i FMo.
DatergnatureofNotay Stateof JTSN
MY COMMI;SION # DD 188491
' • • ' * MY COMMISSION # DD 285822
Ekpl; IF: February 25.2007 * EXPIRES: March 23, 2008
wner� e Persona 4ktt2Sw�tr4 Re Co
ent is9ondsd Tper�t9fi Y wn to—Me or
ducedID
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APPLICATION APPROVED BY: Bldg: Zoning:
(Initial & Date)
Special Conditions:
Utilities:
FD:
(Initial & Date) (Initial & Date)
=MIf1me Ut,Jt,6+tt
BK 05779 Ftp, Ott it 1t
NOTICE OF COMMENCE K' S ## 200510
494
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DED 0623/-2
Permit No.E 10.00
State of Florida R�- ��alikka
County of Seminole
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. Description of property: (legal description of the property and street address if available)
Q Crs� 0,-w«✓jam 17;y powk e-
2. General description of improvement: 0 / , C- fiy co "D J, -F/ o rlJ
3
Owner information
a. Name and address
/1 Lr /� � l 7 / Z -f 4vz---
b. Interest in property Q e-l"J/1-G-2
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
a. Name and address
b. Phone number t ¢ o -7 2 _ o ?S Fax number
5. Surety
a. Name and address r _qr rIr nov
A n\/ n wiwir ww..
b. '"Phone number Fax number ,. r_ „r
c. Amount of bond
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6. Lender �€7 M.
a. Name and address C / ne
b. Phone number Fax number O-AUA 0 2,QA..
7. Persons within the State of Florida designated by Owner upon whom notices or othe od&h6 t0U5 be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number Fax number
8. In addition to himself or herself, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section
713. 3(1)(b), Florida Statutes.
a.` Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year fro e date of recor ; g e a different
date is specified)
Signature of Owner
Sworn to (or affirmed) and subscribed before me this 3�_ day of ,20 0 , by
Personally Known OR Produced Identification
Type of Identification Producedj L P_►G� , 10 -J c)
} l5 IN `fi�� MEI PREPARED BY;
r ^ >° DEBBIE BLANTON n
MY COMMISSION # DD 188491 NAME 3 ( °
Signature of Notary Public, State of Florida EXPIRES: February 25, 2007 l � �� y k
Commission Expires: 1 -800 -3 -NOTARY F� Ncta3iscount Assoo. Co ADDR.
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CITY OF SANFORD PERMIT APPLICATION
Permit #: Date:
Job Address:
Description of Work: ) JQQ /VL -w C( ILC u/'� f Camel %� U6✓l ^/L
Historic District:
Zoning: Value of Work: S �z 0-u , (/y
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair – Residential or Commercial _
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: i� (Attach Proof of Ownership & Legal Description)
Owners Name & Address: / '//] L)Q " / U( L'—� 1 7��
Contractor Name & Address
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person:
Phone:
State License Number:
Phone:
Fax:
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
pemvt must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, 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 TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 p i verification that I tify the wrier of the property of the requirements of Florida Lien Law, FS 713.
�-2 7 6 r-
Signat&e of Owner/Agent Date Signature of Contractor/Agent Date
Z/44 'a
Prin O er/ gen 's 14ark Print Contractor/Agent's Name
�(a31cs
Signature of No Date of Fla Date Signature of Notary -State of Florida Date
FL Mbg rk IDE GRAVE
MY COMMISSION # DD 164280
r EXPIRES. November 12,200t
Owner/Agent,ic.. o�`° Pft"a�l� a' t2trv4e�ece:r , "� Contractor/Agent is _ Personally Known to Me or
Produced ID .)olQ d ' _Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
CITY OF SANFORD BUILDING DIVISION
OWNERIBUILDER AFFIDAVIT
ELECTRICAL & FIRE ALARM SYSTEMS
An owner of property making application for permit, supervising, and doing the work in connection with
the construction, maintenance, repair, and alteration of and addition to a single-family or duplex residence
for his or her own use and occupancy and not intended for sale or an owner of property when acting as his
or her own electrical contractor and providing all material supervision himself or herself, when building
or improving a farm outbuilding or a single-family or duplex residence on such property for the
occupancy or use of such owner and not offered for sale or lease, or building or improving a commercial
building with aggregate construction costs of under $25,000 on such property for the occupancy or use of
such owner and not offered for sale or lease. In an action brought under this subsection, proof of the sale
or lease, or offering for sale or lease, of more than one such structure by the o«rner-builder within 1 vear
after completion of same is prima facie evidence that the construction was undertaken for purposes of sale
or lease. This subsection does not exempt any person who is employed by such owner and who acts in
the capacity of a contractor. For the purpose of this subsection, the term "owner of property" includes the
owner of a mobile home situated on a leased lot. To qualify for exemption under this subsection, an
owner shall personally appear and sign the building permit application.
State lav requires electrical contracting to be done by licensed electrical contractors. You have applied
for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to
act as vour own electrical contractor even though you do not have a license. You may install electrical
wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical wiring in
a commercial building the aggregate construction costs of which are under $2,000. The home or
building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or
lease more than one building you have wired yourself within 1 year after the construction is complete, the
law will presume that you built it for sale or lease, which is a violation of this exemption. You may not
hire an unlicensed person as your electrical contractor. Your construction shall be done according to
building codes and zoning regulations. It is your responsibility to make sure that people employed by you
have licenses required by state law and by county or municipal licensing ordinances.
I, L O
/214 L t' C4!�4';f do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
I will assume full responsibility as an 0-wrier/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure-
Owner/
Builder Signature Date
�t-,2
Print Owner/Builder Name
�a", - (��_ K aA Q �0 I P
Signature of Notary—State of Florida Date
Owner is Personally Known to Me or has
Produced ID w�
RORENCE A. DE GRAVE
4v COMMISSION # DO 164280
XPIRES- November 12,200,
' " �' 3 nded?hri Budget Notary Bervice: