HomeMy WebLinkAbout519 Palmetto Ave (3)CITY OF SANFORD PERAUT APPLICATION
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Permit
Job Address:
Permit Type: B uild*nng Electrical Mechanical
Description of Work: %i4 re Ke6eif &E2 .SI.c.4
Date: % oo 3 V Z
Plumbing Fire Alarm/Sprinkler
Additional Information for Electrical & Plumbing Permits
Electrical: _Addition/Alteration _Change of Service Temporary Pole New AND 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 _ Industrial Total Sq Ftg: Value of Work: $ v00.
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.: %(Attach Proo of Ownership & Legal Description)
Owner/Address/Phone: % 1'9a%-fi S C. si g /J4/__ - 7a ke - , /
Cf /Ro Z
Contractor/Address/Phone:
State License Number: J"e. Ir,, .if! CCC'cr 6 y/
Contact Person: /[,hi,9c / S'.e Phone &Fax Number: 5/O 7 - 9.2 y q 7 S
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
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.
of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
017OWnWAgEt Date
e4gV1 w l/iJ( d vR fiAO'A/
co Print Owner/Agent's Name QF/`
Signature of Notary -State of Florida Date
Melissa Cameron11jiYPU 'ii
lk t,f Expires Dec. 4 20M
of F,rs Bonded1bm 7
fnnw, Atlantic Boadin8co..Im
1
Owner/Agent is Personally Known to Me or
Produced ID //2503994/Z410/O
Signature of Contractor/Agent
Print Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: I ' 1r— 0Date:
t1 " ,-w _f
Special Conditions: H y gqy rc5 jl y U bS . b<- rD l5 `f'1 tN n Orl'i d' rtr? e, t,
A,) ttW t r'n rte,dc+ (p r eA0 nt 18
CITY OF SANFORD,BUILDING DIVISION
OWNER%BUiLDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct. onsite supervision
themselves of all Nvork 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 otTered 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 I year after completion of same creates a presumption that the
construction Nyas undertaken for purposes of sale or lease. This subsection does not exempt am 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 owners 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 lacy. The exemption alloys you, as the owner of \-our property, to act as your own
contractor with certain restrictions even though \-oil do not have a license. You must provide direct,
onsite supervision of the construction yourself. You may build or improve a one -family or t-wo-family
residence or a farni 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 \our contractor or to supervise people working on \,our building. It
is your responsibilit. to make sure that people employed by you have licenses required by state lacy 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 lacy. l-'our constniction must comply \yith all applicable lays.
ordinances. building codes, and zoning regulations.
I. {.J (/(Ci/ . do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
will assume hill responsibility as an Owner/Builder Contractor. and will personally supervise all work
allowed by law on the i)ermittcd structure.
Y
Signature of Notar.\--State of Florida Date
O\\ ner is Pcrsonalh Known to Me or has
Produced ID--F L DG',/2503 9y2/d
I
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PURCHASER'S NAME Ik- I JL ( Rz 5 . 1 • HOME PHONE OFFICE NUMBER
ADDRESS CITY STATE ZIP
fj ICI 14 CZ1>T C 1 rQeY 32Y)ca`
NEAREST CROSS STREET INSTALLATION ADDRESS, IF DIFFERENT CITY
r
STATE ZIP
SALESPERSON TO CHECK ITEMS TO BE CHAIN LINK FENCE O WOOD FENCE OTHER:
BID AND SPECIFY ON PROPOSAL q ALUMINUM ORNAMENTAL VINYL FENCE.„
TYPE FENCE: ;t T t Cfr 1 !rih (-, S SPECIFICATION:
Overall Length: IOverall Height: Fence to follow slope of ground
Walk Gate: 1 Drive Gate: top rail to be straight (customer .
CHAIN LINK may fill in low spots later)
Wire Gauge: knuckle. Up ElBarb Up kFence to follow contour ofDiameterTopRail: DiameterTermirial Post: ound (bottom of fence to be in
Diameter Line Post: Line Post Spacing: contact with ground),
Fence to be level with highest"
Special Instructions:
pal , I •
grade (customer may fill, low I,
spots later)
El Fence to be level with lowest 11
9 grade (trenching in high spots)
He I C'- 7- t - Fence to, be level and split the
Z ^ t `A;, Iz , grade (trenching in high spots
customer .may fill in low spots."
latertt
FENCE DIAGRAM
KEY:
FENCE LINE TO BE
ERECTED:®
TIE-ONS: X
Get Permission)
TERMINAL POST: O
EXISTING
FENCE:**
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BUILDINGS: I I
L----- J
WALK GATE: d O
DOUBLE 1
GATE: U
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RESPONSIBILITY OF BUYER: I agree to locate and identify the property line, easements and all underground cables and pipes.I agree that I am
solely responsible for the location of the. fence described in this proposal. I will also defend Home Depot and reimburse them for all costs In connection ,
with any claims made by. anyone about the location of the fence. I am responsible for any special Workdescribed in this proposal. Initials
UNUSUAL CONDITIONS, ADDITIONAL CHARGES: I agree that Home Depot has the right ,to make additional `charges if unusual ground conditions
hinder the installation. Such unusual ground conditions may, be rock formations;. tree roots; and other similar obstacles. Any charges necessary to
satisfactorily complete the installation will be based on additional labor;equipment and material`costs,.: Initials..•
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CASH PRICE: $ Approximate Monthly Payment: $ (may vary or not be applicable based upon credit approval)
METHOD OF PAYMENT: (The credit terms and conditions are provided on a separate document.) Price valid for thirty (30) days.
Cash: payments, as foll
If payment by check: BANK REFERENQE: CONTACT NAME: PHONE #.
XC ireditCard: Circle One: HD MC VISA MEX DISCOVE Card# 3 I Q i 4
Authorized. Cardholder's Signature: Exp. Date:
777
Home Depot Extended. Credit !
SUBMITTED BY APPROVED BY
z . ` REPRESENTATIVE + MANAGER
I/We, the owners) of the premises described above (hereinafter referred to .as "Purchaser(s)") offer to contract with The Home Depot to furnish,
deliver and arrange for installation of all materials necessary according to the above specifications. THE TERMS AND CONDITIONS OF THIS
AGREEMENT ARE CONTAINED ON BOTH SIDE FT IS F7M: .
I(C4. PURCHASER'S SIGNATURE:"SPOUSE'S SIGNATURE: DATE: 2y
YOU, THE BUYER, MAY CAN EL -THIS 'RANSAC ION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE.,.
OF THE TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION.OF THIS RIGHT.
H D I F001-0501-S. FL