HomeMy WebLinkAbout901 E 2 Str
o ud y ey e gray clnd' orrnf lo. cow
CITY OF SANFORD PERMITAPPLICATION
Application # : L7� I
Submittal Date:
i_
Job Address: 90 1 E� 2- n d S 1 Y C� f
Value of Work: $ 1 t UfS U U
Parcel ID: Zoning:
Historic District:
V
Description of Work Cha F'1 n f, frbn Gc
Square Footage:
........................................................................................................................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing
❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS :Addition/Alteration
❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non-Residetitial ❑ Replacement ❑
New ❑ (Duct L,ayout,& 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 ►
........................................................................................................................
ner: &ro-j � GCS r -Ci' -fl(D PI'D9Crt'1CS
PropertyOwner:
Contractor:
Address: -I0 1 E . 2n d Sfir_Q_z--t
Address:
SG► n 'Fy r d, F I_ 324-17 I
q0_1 - 324E -mail: E-mail:
Phone: State License Number:
Bonding Company:
Mortgage Lender:
Address:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
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 t the require^�s.o.f this_p` t, there may be additional restrictions applidi ble to this property that -may: _oand�in the public records of
this county, and there may be �ddittonal permits requtred`rom other governmental entities such as w�ate m nagement distri state agenctes�yor federal agencies.
Acceptance of permit is verification that II wit notify the owner of the property d the requiremen of Florida Lien Law, FS 713'.
8 taj�
Signature of Owner/Ag t Date Signature ofContr/ K/Agent Date
Agent's
ignature of Notary -State of Florida /% Date Signature f Notary -State of flo%da /�' Date
lNY COMMISSION # DD629096
�"or�d EXPIRES: February 25, 2011
14003 -NOTARY FI. Not D•
Owner/Agent is Ce. Contractor/Agent is _ Personally Known to Me or
Produced ID L Produced ID
APPROVALS: ZONING:1 UTIL: FD: ENG: BLDG:_
Special Conditions:
Rev 07.07
Limited Power of Attorney
Date: September 12, 2007
Re: 901 E. 2nd Street, Sanford, Florida 32771
Clifton Gorenflo, as one of the managing members of the corporation known as Gray &
Gorenflo Properties, LLC hereby gives Audrey Black, authority to sign for and pick up
the permit from the City of Sanford, said permit to erect a fence on the property owned
by the said co oration, locatedt 901 E. 2nd Street, Sanford, Florida 32771.
Signe
onIf renflo, Esq.
Date: September 13, 2007
STATE OF FLORIDA
COUNTY OF SEMINOLE
BEFORE M the undersigned authority, personally appeared, CLIFTON H.
GORENFLO,
_personally known to me
who presented
as identification;
and who being by me first duly sworn, swears and affirms acknowledges that has
read and executed the foregoing for the purposes set forth therein and the contents thereof
are true and accurate.
SWORN TO and SUBSCRIBED before me in the County and State aforesaid on
this 12th day of September, 2007.
allota�ry)Public�'Staieof Florida
My Commission Expires:
Robyn L. Malone
R Commission # DD484185
Expires December 2, 2009
j of F 9. "n troy Fan .ins
.., urancs. Inc9o9:t919
'•1 • .�, p,, i r� �, t � .� t tl1 �.
3
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.
�_TSSIGNING THIS STATEMENT, I ATTEST THAT
(Initial to the left of each statement)
(�OJ2
UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
LISTED ABOVE.
1 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.
C,,b
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.
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 Address:'' q Q I t Ind Str,-Q-4A Soon fo rd , FL_ 32-7--71
IX A U cLy, 9-u 131 CLcK , do hereby state that I am qualified and capable of
performing the reques d construction involved with the permit application filed.
Form of Identification
(Must be Photo ID)
Date
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)
P
s�
rJr