HomeMy WebLinkAbout2453 Palmetto AveCITY OF SANFORD PERAUT APPLICATION
Permit No.: (/ v _1 3:1. Date: dot -,IZ4` 0 Z
Job Address: ,.-Z*s-3 V4,1&Z 770
Permit Type: _f, Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: vSX- -
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: V Residential Commercial _ Industrial
Type of Construction: ler' A&C Flood Zone:
Parcel No.:
00
Total Sq Ftg: 15-6D Value of Work: S a? 00, 5y
Number of Stories: Number of Dwelling Units:
Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: /y /L 41 0-, csOy%je/'L
4 .i'3 P,}G r v A s-N AW YqG( 32 77/ - 3.3o7- ,--7 7 Z-
y.
Contractor/Address/Phone:
Contact Person:
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender;
Address:
Architect/Engineer
Address:
Phone & Fax Number:
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 FINANCINY, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT. A
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 1 will notify the owner of theproperty of the requirements of Florida Lien Law, FS 713.
Gl,c ZC 0
Signature of Owner/Agent Date
Print Owner/Agent's Name
tea 2 ,o, 6 2
Signature of Notary -State of Florida Date
o., i
Melissa Cameron
G
Commission # DD079918
a Expires Dec 20, 2005
Bonded ltuu
Atlantic Bonding co., lac.
Owner/Agent is Personally KnIno4wtn.t1oS9Me,tdor
ProducedID --,' 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: & (Olm
If Jq
Special Conditions:
CITY OF SANFORD BUILDING DIVISION
t?' OWNER/BUILDER 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
f 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 owna.>.
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
i substantially improved yourself within 1 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
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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 constniction must comply with all applicable laws,
ordinances, building codes; and zoning regulations.
I,Wl<1<F do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
1 will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
4X 6 Z-,Z -o 7—
Owner/Builder Signature Date
CU/6Lll fitCSO cJ IyiC/'Git7r%O b c
Print
Owner/Builder Name 'a,o•;:0`' Signature
of Notary— tate of Florida Date Its % gig
Owner
is Personally Known to Me or has Produced
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