HomeMy WebLinkAbout1217 W 2 StCITY OF SANFORD PERNIIT APPLICATION
Permit No.
S
7 10 a Job Address: -
Date:
Permit Type: _Building"- Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: l ti/doN fCdA-C G- f 'L
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration _Change of Service Temporary Pole New AMP Service (# of AMPS )
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: _Residential Commercial _ l tJIndustrialTotalSqFtg: Value of Work: S y Type
of Construction: W 00a- Flood Zone: Number of Stories: Number of Dwelling Units: Parcel
No.: Owner/
Address/Phone: Contractor/
Address/Phone: Contact
Person: Title
Holder (If other than Owner): Address:
Bonding
Company: Address:
Mortgage
Lender: Address:
Architect/
Engineer Address:
Phone &
Fax Number: Attach
Proof of Ownership & Legal Description) State
License Number: Phone
No.: Fax
No.: 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. 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 permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. gnature
of Owner/Agent Date Print
Owner/Agent's Name 2tS
Q 2 Signature
of Notary -State of Florida E>Ste o"
r'p•, Melissa Cameron ram,
SCommission # DD079918 t
42 Expires Dec 20, 2005 lCCOf
F\vp` Bonded Tbrll Atlantic
Bonding co., Inc, Owner/
Agent is Personally Known to Me or PC
Produced ID W 3 2 3 q?-53 34S O APPLICATION
APPROVED BY: 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 Date:
Special
Conditions:
TE
Mo,
LADESC—RJIPJU
IONS
PLUMMG
MONO WQRARY•P0LE- ROU R.I. UNDERGROUND
FQUNIfj N v fROUND' R.I. CEIELL R ir117 Air ir o OR yq e-ig-Z" n
SLAB.'
PR
HOOD SYST-EM.' TUB SET
00F]tW4L SHEATMNO.: G WERSPRINKLERSYST
GAS ALPIPE JGA&APEALINEL 'GROUND'-
HANGt. C OFSE9 C FINAL FINAL
INSULAT ALARM' OTHER OTHER
FIREWAIL ; :, —.-POPOVVER
FINAL AL
j
FIRE-AlISCELLANN:` TIIER
DRIVEWAY
OTHER
THIS !Aft IS TO DISPLAYED ON STREET SIDE OF THE LOT AND
SRAILIjYMT BE REMOVED UNTIL WORK IS COMPLETED.
Yl,S'ANITARY FACELITILES REQUIRED ON SITE
WARNING TO : OWNER XQUR 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 OF COMMt F;i YESTREQUIRED: N
D G- OFF
CITY OF SANFORD BUILDING DIVISION
OWNER/BVH DER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, onsite supervision
themselves of all work not performed by licensed contractors, when building or improving farm
outbuildings or one -family or two-family residences on such property for the occupancy or use of such
owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to
exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease, of any such
structure by the owner -builder within 1 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other person
unless that person is registered or certified under this part and the work being performed is within the
scope of that person's license. For the purposes of this subsection, the term "owners of property"
includes the owner of a mobile home situated on a leased lot. To qualify for exemption under this
subsection, an owner must personally appear and sign the building permit application.
State law requires construction to be done by licensed 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 your own
contractor with certain restrictions even though you do not have a license. You must provide direct,
onsite supervision of the construction yourself. You may build or improve a one -family or two-family
residence.or a farm outbuilding. You may also build or improve a commercial building, provided your
costs do not exceed $25,000. The building or residence must be for your own use or occupancy. It may
not be built or substantially improved for sale or lease. If you sell or lease a building you have built or
substantially improved yourself within I year after the construction is complete, the law will presume that
you built or substantially improved it for sale or lease, which is a violation of this exemption. You may
not hire an unlicensed person to act as your contractor or to supervise people working on your building. 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. You 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 your building who is not licensed must work under your direct supervision and must be employed by
you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation
for that employee, all as prescribed by law. Your construction must comphr with all applicable laws:
ordinances, building codes, and zoning regulations.
I ex do hereby state that I am qualified and capable of performing the
quested construction involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor; and will personally supervise all work
allowed by law on the permitted structure.
Owner/Builder Signature Date
c
G7' ,,' itoo %,`,
Print Owner/Builder Name
WWI.
Signature of Notary —State of Florida Date
o
23 8 8
0
Owner is Personally Known to Me or has
Produced 1D L4)