HomeMy WebLinkAbout804 Magnolia Ave (2)Permit No. b2 -1 315
CITY OF SANFORD PERMIT APPLICATION
Date:- I
Job Address:
Permit Type: Building Electrical Mechanical (Plumbing Fire Alarm/Sprinkler
Description of Work: G t
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 _ Industrial Total Sq Ftg:
Type of Construction: _
Parcel No.:
Own er/Address/Ph on e:
Contractor/Address/Ph one:
Contact Person:
Title Holder (If other than Owner):
Address:
Bonding Cmmnanv-
Address:
Mortgage
Address:
Architect/Engineer
Flood Zone: Number of Stories:
Value of Work: S 5M
Number of Dwelling Units:
7/ ^ ^ (
Attach Proof of Ownership & Legal Description)
Phone & Fax Number:
State License Number:
Phone No.:
Address: 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 o er of the property of the requirements of Florida Lien Law, FS 713.
S'` ature &of Owner/Agent Date Signature of Contractor/Agent Date
int OAwne-/Agent's Name
RklA-41-
Wature of Notary -State o lorida Date
1N Mi JOHNSON
CC 921808
is x d 2604
is.+fm'tMnipb s'^eNotnrYServices
O t`,Agen is- Personally Known to Me or
Produced ID Cc- 7 t- k- (e W ' ' (n 75(e -7
CAPPLICATIONAPPROVEDBY:N,*,A Q!Z
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID
Date: Li
Special Conditions:
CITY OF SANFORD BUILDING DIVISION
OWNER/BUILDER AFFIDAVIT
CONSTROCTION 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 comn:ereial 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 I year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt an\ 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 constriction to be done by licensed contractors. Yob 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 $2,000. 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 voii sell or tease a building you have built or
substantially improved y'Ourself within I year after the constriction 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 countN. 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 supenAsion and: must be employed by
you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation
fort at employee, all as prescribed by law. Your constriction must comply with all applicable laws,
ordi anc s, building co es, and zoning regulations.
I, do hereby state that I am qualified and capable of performing the
req ested constru. " volved with the permit application filed.
I will assume full responsibility as an Ow»er/Builder Contractor, and will personally supervise all work
allowed by law- on the ennitted structure.
Owi er/Builder Signature Date. t
Print Owner/Builder Name
s [-nature of Notary —Star f Florida Date r
fixF` F JOgNNM:JOHNSON
e kly COMMISSION # CC 921808
f XPIAB. Marth 42004
O\vner is Personall -Knovn to Me or has Ht; ` 051 I a r!irU U ge14otaryS[ivicoe
Produced KD FFLJ- )— L (o'S StV%, "1:-
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Property Line
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4' Picket — — — — — — — — — 4_Picket - _ —
Sidewalk
804 S Magnolia Ave
Sanford, FL 32771