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Home My WebLink About174 Brushcreek Dr (2)CITY OF SANFORD PERMIT APPLICATION Application # : ^ �l 3-1 a Q 7Submittal Date: dobl Address: d,W t (/�r/�7 fJ� J 1v , foes u Work: Parcel ID: \ Zoning: Historic District: Des ription of Work: I J 161a Square Footage: .................................................................................................................... Permit Type: Building [li� • •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: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) ........................................................................................................................ ,. Por perry Owner: tractor. Add re s%`4Address: Pt%:` O �2� Sc _ E-mail: _ � ee�f •t✓.Or-\ 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" 1 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 v0ficatjetfdf 1 will notify the okner 9T the property of the requirements of Florida Lien Law, FS 713" r of Notary -State of Florida Date Gp (o /o,) Date Owner/Agent is _ Pe�Sona11 Knojvq to Jva9 or I Produced ID %" �� L-, !�J APPROVALS: ZONING: Special Conditions: Rev 02/2007 UTIL: FD: 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 ENG: BLDG: `F Li Is 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. Y SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement) ,—Propertdss: fZY%/hcYc —� �,7%� LaA ► i performing the requested , do hereby state that I am qualified and capable of involved with the permit application filed. Date tification (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) 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. 1 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. ,—Propertdss: fZY%/hcYc —� �,7%� LaA ► i performing the requested , do hereby state that I am qualified and capable of involved with the permit application filed. Date tification (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 $1,000.00 fine in addition to any civil penalties. In addition, the local permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy for unlicensed activity against the owner and any person performing work that requires licensure under the permit issued. (Rev. 4/20/07) 'COUNTRY -CLUB PARK HOMEOWNERS ASSOCIATION E, 3 9073MITM-1 -9-900 This. request forai is'. tG.be completed by the. homewwmer and. submitted. to the Architectural. Review Committee borm any work commences. Plftse refer to Your Declaration for a desc0ption of the Committee and its purpose, Please allow 30 days fromthe time we receive your submission for the review results. Please send the completed request to Country Club Park HQA, c/o Caldwell Banker Commercial NRT, "I N.. Lake Destiny, Suite 110, Maltlaud; FL 32-751, telephone (407) 539400ik fax number 007) 539--032& Late of Request: OFWftft / property hatmatip ft, Owner Name: Mlohe#�-,N(i7d/ Alqltl Lot # / Unit # / Phase MV Property Address: 7`7 CaL L& Mailing Address: Phone Numbers: go -7- 9a -5-31e, Description of Proposed Changes 1 Additions: (please check one) OFencing. ., 0 Swimming fool- 0 Addition 0 Landscaping 0 Other (describe below) . n - Attl0a OR of a plot plan or sorvq ladicaft Where tke addition, fence, parch, etc. is to he located. AD Materials, dimalwas and finithcs must be described in detail and color samples must he attached for any paint: *Fother finishes. All requests must conform to -the local zoning and building regulations And you must OMAIV all htMitty perifilt$ if yotW request h -to be aj)#f6*e0 by the ArthitWue,41 RM#W COAWflttee. .... ......... ..his section to be completed by AmItheelmral Review Commidee 0. ,--Senied (see notes below) Ir " Appravned as. Submitted 0 Approved with Required Changes (see notes below or an attached plans, drawing& or survey) Rev" Notes l,Comments: Alt itppeovals are . sub*t "to , the following: A. Properly owner must obtain at(y necessary permits. R, Property owner must accept liability far damage to common areas or otherprqper(y. G. Property owner mustaccept liability . �nfojj 0 easements: , WryforLancroachim 'damage to Lot 31, COUNTRY CLUB PARK (PHASE 1), according to the plat thereof, as recorded in Plat Book 50, Page(s) 63 through 66, of the Public Records of Seminole County, FL. Community number: 110194 Panel. 0040 Suffix: E F.LR.M. Date: 411711995 Flood Zone: X Date of field work: 912912005 Completion Date: 913012005 Certified lo: Brian Sturgill; Michelle Slurgill; Equitable Title Agency, Inc.; Lawyers Title Insurance Corporation; First Magnus Financial Corporation, its' successors andVor assigns. SCALE: 1 " = 30' CURVE TABLE NO. RA0N5 DELTA .IRC TAMIL CHORD CHORD BEARING 1 125.00• 11'28'59' 15.05• 12.57' 25.01' N48'421097 -� Wood Fence W.M. Water Meter N.T.S. Not to Scale --0— Wire Fence TEL. Telephone Facilities O.R. Official Records F.N. Found Nail ®Covered Area O.R.B. Official Records Book • Property Corner B.R. Bearing Reference RCA Permanent Control Point R. Record CH Chord P.R.M. Permanent Reference Monument M Field Measured RAD Radial PG. Page CL Clear N.R. Non Radial PVMT. Pavement ENCR Encroachment A/C Air Conditioner P. B. Plat Book Centerline B.M. Bench Mark P.O.B. Point of Beginning Concrete C Calculated PO.C. Point of Commencement FL Property Line = Block Wall POI. Point on Line C . Concrete Monument D Central Angle/Delta PC. Point of Curvature FLR. Found Von Rod D.B. Deed Book PR.C. Point of Reverse Curvature F.LP Found Iron Pipe D. Description or Deed PT. Point of Tangency RM Right of Way D.H. Drill Hole R. Radius (Radial) N&D Nail & Disk D/W Driveway R.O.E. Roof Overhang Easement D.E. Drainage Easement ESMT Easement S.I.R. Set Iron Rod & Cap U.E. Utility Easement EL Elevation SNV Sidewalk FD. Found FF. Finished Floor T.O.B. Top of Bank P Plat F.C.M. Found Concrete Monument TYR Typical O.H.U. Overhead Utilities F.PK. Found Parker.Kalon Nail W.C. Witness Corner P. P. Power Pole L Length 10.05 Existing Elevation T% Transformer L.A.E. Limited Access Easement E.O.W. Edge of Water CAN Cable Riser M.H. Manhole aur 4 r( Pr T" 3ORMT-IR r"'11Z or 36' E ' aPS_A_L I_ LB. 1. P.I. 6 f, 1t.7 EK TIVE + » t 1 1 b BIXRs,a4Ry N. 00' 16'30 E 51.15' nR 112 - TRACT 3 DPIDV Si"i ununEs FIR 1/2' Property Address: 174 Brushcreek Drive Sanford, FL 32771 Survey number: SL 61315 I. Legal description provided by others. 2. The lands shown hereon were not abstracted for easements or other recorded encumbrances not shown on the plat. 3. Underground portions of footings, foundations or other Improvements were not located. 4. Wall ties are to the face of the wall. 5. Only visible encroachments located. 6. No identification found on property corners unless noted. 7. Dimensions shown are plat and measured unless o rwise noted. B. Elevations if shown are based upon N.G.VD. 192 u le otherwise noted 9. Adjoining lots are within the same bloc less th s s noted. lo. This is an AS.BUILT SURVEY unless c e ise to . 1 I. Not valid unless sealed with the sign,, su ey s e 12. Flood zone deterrriinanons are pro, ed s co r s on a ar derived from the best sources available to the surveyor This of rma no e r ied upon for flood Insurance purposes. and may differ h - or at, n r id y her 13. L.B. 7132 I4. Septic tank and/or drainfield locations a c ox, a d ST erified by appropriate utility location companies. a s Sf P wO� d rut i,ue aM care: i r<Presen rarron of1—, Ralph Swerdloff ReglsRred land Su v , rut 3a1I