HomeMy WebLinkAbout218 S Elm Ave (5)Y �r
CITY OF SANFORD
JAN232012 BUILDING & FIRE PREVENTION
B PERMIT APPLICATION
Application No: Docum rated Construction Value:
Job Address: Historic District: Yes ❑ No ❑
Parcel ID: Zoning:
Description of Work: i C �e e-�� �� `7 0-A
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
Property Owner Information
Name N l.tJ Phone: y 0 -7
Street: Z CI a es S fJ Resident of property?
City, State Zip: EL 2�2 (o J
Contractor Information
Name 5e ( __Q Phone:
Street:
City, State Zip:
Fax:
State License No.:
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit O
Square Footage:
No. of Dwelling Units:
Electrical 0
New Service — No. of AMPS:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION,,�i:
Construction Type:
Flood Zone:
No. of Stories:
Plumbing 0
New Construction - No. of Fixtures:
Mechanical 13 (Duct layout required for new systems) Fire Sprinkler/Alarm O No. of heads:
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, beaters, 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. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signature of Owner/Agent Date
Print Owner/Agent's Name
DEBBIE 80N ION
Notary Public State of Florida
• ; • c My Comm. Expires Feb 25.2015
Commission #
•�,�%•.,,�•� e.
E
60162
Bonded Through National y Assn.
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
Rev 11.08
10 l:I
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 Type of ID
WASTE WATER:
I
C
WE
•
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
I am of aware of construction practices and I have access to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure or in the permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Property Add
2(g S. E 144 "4�-_
I, A `A�- U D O" (D ' do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
Signature of Owner -Builder
Form of Identification 4D L
(Must be Photo ID)
Date
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
14
OWNER BUILDER STATEMENT/AFFIDAVITi.
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
Rev. 9.14.2009
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
Old
responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own name. I also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. 'The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in 1 year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
/1
I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
persons working on my building or residence. It is my responsibility to ensure that the persons whom I
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I 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 my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
i�
Application For a Certificate of Appropriateness
RX� City of Sanford Historic Preservation Board
—1877= P.O. BOX 17ea
Swft4 Fb fta 32772-1788
PAom: 407.688.5145 Fa:: 407.688.5141 Emwd: www.aW*".9W
Answer all the questions on this form and submit all required attachments. Incomplete applications will not be reviewed.
If you have questions about application requirements contact the Historic Preservation Officer atAO7.688.5145 to ensure
your application is complete. A building permit may be required for the activity detailed below. Please contact the Building
Department at 407.688.5150 for more Information. Failure to obtain a building permit may result In fines and/or double permit
fees.
1. General Information
Downtown Commercial Historic District 0 Residential Historic District 0 Is this a retroactive request? 0 Yes 0 No
Is this application filed in esponse to a Notice of Violation from the Code Enforcement Department? 0 Yes 0 No
Property Address: -
Property OwnIrtfoormation n
Print Name: // 'V 04
Mailine Address: Za y C1 J eS SJP CU v 2
Phone: Ya�l ZZ l 4f? V Fax:
Signature:Q-� t�
Email:
Applicant/Agent Information
Print Name: S4W AS AGO Vr
Mailing Address:
Phone: Fax: Email:
Signature:
I certify that all information contained in this application is true and accurate to the best of my knowledge.
Applicant/Owner Signature:
0 Would you like to receive emails regarding Historic Preservation and Community Planning within your community?
2. Application Category (check all that apply)
Proposed improvements will affect the following elevations: 0 North
0 Site Improvements/Driveway/Walkway 0 Storage Shed
0 Replacement Windows or Doors 0 Underskirting
0 New Construction/Additions 0 Paint
0 Roofs/Gutters/Downspouts 0 AC/Mechanical
0 South 0 East 0 West
0 Replacement Siding/Floor/Porch
0 Signs/Awnings
0 Fences/Gates/Pergolas
0 Other
3. Description of proposed work
Completely describe the entire scope of work, including changes in material and color, and methods that will be used to
accomplish the proposed work. For large projects an itemized list is required. Use the reverse side,jf necessary.
**** This certificate must be prominently displayed on the site when work isin progress. ****
'Boundary Survey
Legal Description:
Lot 5, Block 4, Tract 7, Town of Sanford, according to the Plat thereof
as recorded in Plat Book 1, Page 61, Public Records of Seminole
County, Florida.
Flood Zone: X Panel: 0070F
Community Number: 12117C Date: 09/28/07
CERTIFIED TO:
Robert J. Bennett
Lot 4 l
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Block 4 l 1
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Fnd. h� Rebar I l 117.23'(M) I 4'
a cap -vKs-li _ -- Rebar
117.00(P) a cap -yxs-
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is 17.1 off
--------- -.;---------------- --
N 89°42'40" W(M) 117.10'(M) EdgeofAspheit `s79�4�1
'BB_ — 117.00'(P)
— — — — — sN)cc�,�
(Platted Third Street) p I CeP.I. located In
:.. nterline
Known As: West 3rd Street 'n b o Fnd.4*x4•C.M.
(50' Platted Right -of -Way) t.6 c6 M In wellll bboxox l (No cation)
(Asphalt Road) ca (° o
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Lot 1, Block 5
Fnd.'A* Rebar
6 Cap WKS"
Note:
All Bearings Shown
hereon are ASSUMED
W E
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•Suhlect Prnnertv has Puhlle Watnr R Sawar ServlrAs-
Graphic Scale
,722�215' 3 ' 60'