HomeMy WebLinkAbout211 Bradshaw Dr (3)N CITY OF SANFORD PERMIT APPLICATION
Ar- p-TAtion # : V 2
Job: Address: l Q �c�c� ShCS) PC Je
Parcel ID:
Zoning:
Submittal Date:
Value of Work: $
Historic District:
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Permit Type: Building ❑AF:IectrTical ❑ 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
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
................. Q ............... .............................................................................
F -Proper ty70w—neer • •!Rla� (' I G I1(� Qf e> • ICc�' v' Z Contractor:
Address: Lo Address:
3Z-7 I
L101--4D2,-248d `�''
p�: E-mail• (c��l_,r��M7r� ;„rari?Ct' Phone: State License Number:
Bonding Company: Mortgage Lender:
Address: I
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.
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�SgtwcofOwner/Agent Date Signature of Contractor/Agent Date
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Prmt Owner Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
Personally Known to Me or
Date Signature of Notary -State of Florida Date
UTIL: FD:
Contractor/Agent is
Produced ID
ENG:
Personally Known to Me or
BLDG:
OWNER BUILDER STATEMENT/AFFID"IT
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. 1t 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)
iTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
D ABOVE.
[;CESS TO THE ADOPTED CODES.
ILIAR WITH THE CODE PROVISIONS.
DEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY
SE THE WORK.
$PERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY.
UCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE.
>TAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN
WILDER STRUCTURE WITHOUT BEING INVESTIGATED.
>TAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A.,
.DING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE.
21 Qcadsha� ���ve Scar 'Cd , �_ 3 z-7-
�a (n Cod Q) � & m � cc Z , do hereby state that I am qualified and capable of
performing the requested construction involved with the permit application filed.
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Signa` ure Dates
Form of Identification
(Must be Photo ID)
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment not
exceeding I. 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)