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HomeMy WebLinkAbout2009 Adams Ave (3)Application #: b /— / Job Address•_ U C? CITY OF SANFORD PERMIT APPLICATION Submittal Date: F'r'_6 Value of Work: $ (_PCD, Parcel ID: Zoning: Historic District: Description of Work: �� P ( P�� Square Footage: ...................................................................................................................... Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbingl� Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑ Mechanical: Residential ❑ Non -Residential Q 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,O Commercial ❑ Occupancy Type: Residential Commercial ❑ Industrial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) ................................ ................... ............ ....................................................... Property Owner: Contractor: Address: _ �1©Oq AlA� A/' -R-) Address g .► Fbfe F1yQ i bA Phone: V7 302- //�� ��E-mail: Phone: State License Number. Bonding Company: C2U1,4i1I aw C,J I b';�_ Mortgage Lender: Address: Address: Architect/Engineer: —A-46 tl�_ Phone: Address: Fag: Plan Review Contact Person: I)� ( GO Phone: 4117-321-27521 Fag: - t1/i+ — E-mail: Application is hereby made to obtain a permit to do the work and installatigns ac -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 OMMENCEMENT-NOTICE:In addition to the requirements of this pennit, 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 verif ' n that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. ' Z - /-5-, P " Signature of Owner/A#cnt Date Signature of Contractor/Agent Date er/Agents Name Signature of Notary -State of Florida Date �' "" DEMtoMe T0J1 MY D629096 �o EX5, 2011 1400-3-NOTARY0"/ Assoc. Co. Owner/Agent is oral yor Produced. ID P APPROVALS: ZONING: Special Conditions: _ Rev 02/2007 UTIL: FD: Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/Agent is _ Personally Known to Me or Produced ID ENG: BLDG: FA Cy �T 2©o 7� To W D vy-N t+ w\ o., (�-O c e- C -*.4 Y- e,� a r S �� Vti�e �o e�� 'oca eA a -� 1,2 © ct av lM-O rO Rte' A 7 . w, cue c' e iso+ ""AIngelo Notary f'ui+;+� :y'tate of New York No. OIt�aS00'-.878 A / Qualified in Bronx Count�� ham) ,p�GO Commission Expires, March 30, 20� City of Sanford Owner/Builder Affidavit Construction Contracting 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 $75,000. 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 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 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 comply with all applicable laws, ordinances, building codes, and zoning regulations. 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 Owner/Builder Contractor, and will personally supervise all work allowed by law o Lhe permitted structure. Owner/Builder Sign re Date Owner is Personally Known to Me or has Produced ID ignature of Notary—State of Florida DaDEN1- My Commission Expires: MY COMMISSION # DD629096 EXPIRES: February 25, 2011 OF F`° FI. Notary Discount Assoc Co. 1$00-3-14 0TARY