HomeMy WebLinkAbout712 S Palmetto Ave (2)RECEI ..'..r -
DEC 01 2011 i CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Z \ Documented Construction Value: $
Job Address: �7/Z �'� �Q�l ffo A --e Historic District: Yes Nmp No ❑
Parcel ID:
Description of Work:
Zoning:
Plan Review Contact Person: ��a �n �' �/1%�S axe v Title: 1�av� •e r
Phone: 11 CT? — -7141f — fe Fax: E-mail: %r
/ Property Owner Information '!
Name �Phone: �lo�— 7yy'3�2 ,�-
Street:—7t a Resident of property?
City, State Zip: .Bait4�
Contractor Information
Nameet 0^e— r— er S Phone:
Street:
City, State Zip:
Fax:
State License No.:
Architect/Engineer Information
Name: AY, A Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
3uilding Permit O
)quare Footage: Construction Type: No. of Stories:
Jo. of Dwelling Units: Flood Zone:
:lectrical O
Tew Service — No. of AMPS:
lechanical E3 (Duct layout required for new systems)
Plumbing 13
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 0 No. of heads:
Application is hereby made to obtain a pennit to do the work and installations as indicated. I certify that ng
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. 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.
n42 -(--ll
Signaturrtj
g Date
Print Owner/Agent's Name
I -. , —.It. L�� Z- I - ((
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
APPROVALS:
COMMENTS:
Rev 11.08
ENGINEERING:
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
UTILITIES: WASTE WATER:
FIRE: BUILDING:
C
44
OWNER BUILDER STATEMENT/AFFIDAVIT
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
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 1
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.
/
I understand that, as the owner -builder, I must provide direct, onsite supervision of the-constru tion.
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
Property Address: 11-2-
1,
2
I, 1 ga( g>
and capable of performing the
conditions specified above.
Signature of
Form of
a�
, do hereby state that I am qualified
involved with the permit application filed and agree to the
_ ! �
Date
A violation of this exemption fs!a'iriiStie'meanor 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
V
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 1-850-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
A,
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
Othat
I am the party legally and financially responsible for the proposed construction activity at the address
listed below.
agree to notify the building department immediately of any additions, deletions, or changes to any of the
qpI
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 Address: 11-2-
1,
2
I, 1 ga( g>
and capable of performing the
conditions specified above.
Signature of
Form of
a�
, do hereby state that I am qualified
involved with the permit application filed and agree to the
_ ! �
Date
A violation of this exemption fs!a'iriiStie'meanor 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
V
n
all CITY OF SANFORD HISTORIC PRESERVATION BOARD
I
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
—187— ..._ ..... — I- _ r____ inn ees r • I
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 at
407.688.5145 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'tkjs this a retroactive request? Des 0 No
Is this application filed in response to a Notice of Violation from the Cod Enforcement Department? 0 Yes /4
Property Address: 7 / Z 5 i24 hwe 6i, ih:&�
Property Owner Information
Print Name: '.fuc-o�> L
Mailing Address:
Phone: 6�0_-2
Signature:
Applicant/Agent
Print Name:
Fax:
se*1
Mailing Address:
Phone: Fax: Email:
Signature:
I certify that all information contained i
Applicant/Owner Signature:
application is true and accurate to the best of my knowledge.
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: b North
South East 0 West
0 Site Improvements/Ddveway/Walkway 0 Storage Shed Rep acement Siding/Floor/Porch
0 Replacement Windows or Doors 0 Underskirting 0 Signs/Awnings
0 New Construction/Additions 0 Paint �ences/Gates/Pergolas
0 Roofs/Gutters/Downspouts 0 AC/Mechanical 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 prZo
s an itemized list is required. Use the reverse side if/necessary.
ir ;trice— %ice
OFFICIAL USE ONLY APplieatlon Received On:
Historic Preservation Board Meeting Date: &VA
WApproved O Denied (Conditions Noted Below).
d y '?'
' H DEC - J Zhll
` r
Signature: Date: /d ��/ r''► ' err f
(APPROVAL IS VALID FOR SIX MONTHS UNLESS OTHERWISE NOTED.) PAGE�F ;-
"'• THIS CERTIFICATE MUST BE PROMINENTLY DISPLAYED ON THE SITE WHEN WORK IS IN PROGRESS. "�•
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