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Home My WebLink About109 Centennial DrApplication # Jo Address:l Parcel ID: CITY OF SANFORD PERMIT APPLICATION IDri'leS, > �a,u - )77c u��f 9 Zoning: Submittal Date: -77 Value of Work: $ 7400 Historic District: Description of Work: Square Footage: ........................................................................................................................ Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service -4 of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑ Mechanical: Residential ❑ Non -Residential ❑ 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 ❑ Commercial ❑ Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required .................^....................................................................................................... 'Pr-oper� -t O r: hnne Mur7e. McC0L✓4'1 Contractor: Addresse 109 �'�ertt+rnniQl A� Address: San-( ord F -L 33--)13 Phone: �(o?-,3/Y A9I14 E-mail: Phone: State License Number: Bonding Company: Mortgage Lender: Address: Architect/ Engineer: Address: Plan Review Contact Person: Address: Phone: Fax: Phone: Fax: E-mail: 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. 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 -11-6-7 Signature of Owner/Agent Date Signature of Contractor/Agent Date Marie "Cccrf'k /4nne Print Owner/Agent's Name Print Contractor/Agent's Name n n Signature of Notary -State of Florida Date Signafure of Notary -State of Florida „ BLANTO1' DEBBIE # DD62299096 MY COMMISSION $ EXPIRES: February 111 OF FL Fl. NotaryDiSCAUnt Asaoc. C+. 1.800 -3 -NOTARY Owner/Agent is Personally Known to Me or Contractor/Agent is _ Personally Known to Me or _ Produced ID F1 1, e `�` - `i Ict `� Produced ID APPROVALS: ZONING: UTIL: FD: ENG: BLDG: Special Conditions: Rev 07.07 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 FSS 489.103 Disclosure Statement 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 supervision 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. BY SIGNING THIS STATEMENT, 1 ATTEST THAT: (Initial to the left of each statement) ,,t peftyAddress: 109 �'�Qn'�Qnr� q Dri,)c SaA'Fo,(d PL 3-x-77.3 ne Marc w Co r 4 � y do hereby state that I am qualified and capable of performing the requested construction involved with the permit application filed. Signature ,?-//- a 7 Date MY COMMISSION # DD629046 `� � EXPIRES: February 25, 20l I C, OFF\. 1-ACb-J-NOTARY FI. Notary Diswunt Psoa Cc Form of Identification \,4,t— CfA_� �, (Must be Photo ID) 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. 4/20/07) 1 UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103 AS LISTED ABOVE. 1 HAVE ACCESS TO THE ADOPTED CODES. Win 1 AM FAMILIAR WITH THE CODE PROVISIONS. I HAVE ADEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY SUPERVISE THE WORK. THIS PROPERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY. AAA THIS STRUCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE. I UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED. ( I UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A., \ WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE. ,,t peftyAddress: 109 �'�Qn'�Qnr� q Dri,)c SaA'Fo,(d PL 3-x-77.3 ne Marc w Co r 4 � y do hereby state that I am qualified and capable of performing the requested construction involved with the permit application filed. Signature ,?-//- a 7 Date MY COMMISSION # DD629046 `� � EXPIRES: February 25, 20l I C, OFF\. 1-ACb-J-NOTARY FI. Notary Diswunt Psoa Cc Form of Identification \,4,t— CfA_� �, (Must be Photo ID) 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. 4/20/07) NOTICE OF COMMENCEMENT Permit No. Parcel ID:0000– /976 3—Lo-S s Sf=T— State of Florida County of Seminole The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.. "1 'Description of property: (legal descZg&n ionof the pro erty and street`a'�ddiess if available) L 6- LOT /07 L �IPN Z Urif �i, W n i a- IIN111110 11111 9i1 11 11111111111 a III I III If 1110 11111111 MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY BK 06815 Rq 08381 t 1 pq ) CLERK" S 41 _`e:07132+:137 RECORDED 09/11/W 12:3210 M RECORDING FEES 10.0 `DOPY RECORDED AY T Isith �ERTIFIDD MORSE , 'r � A�tY ANN �' UIT GDURS,-� RK OF CIRC ORIDA CLE _ L ,DUNTY; FL. - SEMIN� K (,' General description of improvement: 1)e -co r- -r 3' Owner Information THIS INSTRUMENT PREPARED BY: r Sa-.Name and address: hne h'lQ �fe MC C4 ✓f�ky l09 �PNfiPn trial Dri �E �N7 0/� '32--7 �? (`� J b. Interest in property: c. Name and address of fee simple titleholder (if other than owner) 4. Contractor a. Name and address b. Phone Number: Surety a. Name and address: b. Amount of bond $_ c. Phone Number: Lender a. Name and address: b. Phone Number: . 50 -)Id 0-S 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.130)(a)T, Florida Statutes: a. Name and address: b. Phone Number: – 8. In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes: a. Name and address: b. Phone Number: 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTINCE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. v` Signature of Owner or Owner's Authorized Officer/Director/Partner/Manager The foregoing instrument was acknowledged before me this (name of person) as fact) for Signature of Notary Public, State of Florida Commission Expires: Signatory's Title/0 day of , 2001 by4r,,–M A v i — (type of authority ...e.g. officer, trustee, attorney in J _ (name of party on behalf of whom instrument was executed). y�/1I/fui±�,MIV'DEBBIE H�L YpIYgb7Ag..�`MTq� PN gJEAD 171 dJLANTOIV MY COMMISSION # DD629096 a ExPIRFS: February 25.2011 of W FI. Notary Discount Assoc. Co. 1-BW-7-110TARY A1n �g�y� yp