HomeMy WebLinkAbout112 Winterglen DrCITY OF SANFORD PERMIT APPLICATION
Application # : �� � a3 �J 3 3 Submittal Date:
0J
Job Address: 1� W �v`te ���y. Or 5ati�oc�i �.�a?�1 ValueofWork:S
Parcel ID: Zoning: Historic District:
Description of Work: �h 5�C>\� 4' X -7 c y s� v� C Square Footage: �%
........................................................................................................................
Permit Type: Building IM Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # 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: woo C� # of Stories: I # of Dwelling Units: '1 Flood Zone: (FEMA form required)
.........................................................................................•.............................•
Property Owner: A\1uS lk.16\aGk Contractor: V,Sb'14 -r_—
Address: Address:
Sa��ot`d� �\ori a �27i1
Phone: 1.107 32-07312, E-mail: Phone: State License Number:
Bonding Company: - -
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
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. 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.
WolSighature of Owner/Agent Date Signature of Contractor/Agent
Owner/Agent is Personally KnoyYst�Jl,�g># 0507298
Produced ID
APPROVALS: ZONING: UTIL�//
Special Conditions:
Rev 02/2007
Print Contractor/Agent's Name
Signature of Notary -State of Florida
Date
Date
Contractor/Agent is _ Personally Known to
Produced ID
ENG: BLDG:
Boundary Survey
for
Julius A. & Carolyn
Lot 50,
MAYFAIR MEADOWS
Plat Book 29, Pages 31-33,
Seminole County, Florida
Lot 43
fence 0.5' off
fence 4.6' Insl
Lot 50
e/c
House 0.96' Inside 21.3'
N
UD N
O
^7
w
6 g- wood deck g, p•
Lot 51 T�QhG� N
0 6. 9' o
0
—o—o— 1 Story
Residence 2.6'
•112 �,
Covered
C. Black
Lot 44 /
lLot 45
7' fence �.6' off
{ _�
fence ■2.4' orr
o \
I \
I
I
11.3' =1a1.I{
House 0.84' Inside 19.0'
N
Q
CS
House 12.1 off
lig
cci
w Lot 49
v Residence
N
0
0
W
lit�f;�ifl
NTERGLEN DRIVE_ _
Curve • Radius Delta Length
0i 232.65' 6' 06' 17' 32. 94
C2 248.09' i' 48' 36' 7.84
NLegend
❑ = Recovered 4'x4''Concrete Monument.
■ = Set 4'x4' Concrete Monument •L86300 This Survey Certified To:
• Recovered Nail 6 Disk LB2108 Kampf Title S Guaranty Corporation
• Recovered X Cut In concrete Contemporary Mortgage
nos
• Recovered i/2' Iron Rod nos o Recovered t/2' Iron Rod Commonwealth Land Title Insurance Co.
= Julius A. Black
CERTIFICATION -0- - Light Pole as shown Julius
n C. Back This survey map is not valid
—o— =4'Wood Fence —X—=4'Chain link fence y without the signature s original
This is to Certify that I have performed —"— -Fence as shown
a field survey of the above described A -Central Angle L -Arc R -Radius R/W-Right of Way raised seal of the Florida
property, for the purposes hereon El =Concrete Slab A/C -Air Conditioner (R) -Radial (NR) -Non -Radial licensed Surveyor and Mapper
represented, and, that this drawing Is a (P) -Plat (M) -Measured (C) -Calculated (D) -Deed Bearings are based on the
representation of that survey, and meets SCALE: t'= 30' Ppb -Point of Beginning POC -Point of Commencement North line of Lot 50
the Minimum fechnical Standards pursuant as being NBO'40'23'W, per plat
to Section 472.027, Florida Statutes REVIEWED BY: MWS This Survey Is certified to and prepared for the Legal Description furnished by
(Chapter 61017, F,A.C.). sole and exclusive benefit of the entitles and/ client (unless otherwise noted)
/// DRAWN BY: SAW or individuals listed and shall not be relied on
by any other entity or Individual whomsoever. This Is to certify that I
/ DATE: July 12, 1996 have reviewed the Flood
Underground foundations and/or Improvements were Insurance Rating Nap (FIRM),
JOB No.: 967436 not located as a part of this survey. Panal Number 120294 0040 E,
Michael W. Solltro, Dated 4/17/95 and determined
Certificate •4458 Lands shown hereon were not abstracted for rights that the lands shown hereon
Revised:
Not valid unless signed and sealed of ways and/or easements of public records. lies In Flood Zone 'x'.
AO -U 9191TE NUIEdIET 0 ®M Vim® Lmr1@UU 0 ®M, DUE.
375 Douglas Avenue, Suite 2001
Phone (407) 862-7555 Altamonte Springs, Florida 32714 Fax (407) 862-6229
OFFICE
Pr o P o s QA n e %4j %j &C,
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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, I ATTEST THAT: (Initial to the left of each statement)
Property
do hereby state that I am qualified and capable of
performing the requested construction involved with the permit application filed.
� I �� o
Date
Form of Identification - V -::,A Z 0— A 2 1- 4 b— OA S - 6
(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)
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I UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
AS LISTED ABOVE.
I HAVE ACCESS TO THE ADOPTED CODES.
I 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.
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.
Property
do hereby state that I am qualified and capable of
performing the requested construction involved with the permit application filed.
� I �� o
Date
Form of Identification - V -::,A Z 0— A 2 1- 4 b— OA S - 6
(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)
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