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CITY OF SANFORD PERMIT APPLICATION
Permit #: I "
Date:
Job Address: 161 CH O O (<G9 Pzly &: J)A , SRA//oK f, /--L ,?2'7 7-?
Description of Work: Z/U E7wCA_T/DN f)/= 4%6W f9'NC - AW,4C D p 6E/ICi; AW J%F.%TiAOYE%iHistoric
District: Zoning: r
value
of Work: $ /0 O O r ffy Q/Q C yE Permit
Type: Building;,_ Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool 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 or Commercial Occupancy
Type: Residential Commercial Industrial Total Square Footage: Construction
Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #:
Owners
Name & Address: / E 7_ AL A 141"
A7-690 W, Ft 317%9 Contractor
Name & Address: Phone &
Fax: Boadiog
Company: Address:
Mortgage
Lender: Address:
Architect/
Engineer: Address:
Attach
Proof of Ownership & Legal Description) Phone:
State
License Number: Contact
Person: Phone: Phone:
Fax:
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 WrM YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. N
TI : 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 mts required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance
of pennil4 verlicaton harlwill notify the owner of the property of the requirements of Florida Lien Law, FS 713. 11
Date Signature of Contractor/Agent Date Date
MY
COMMISSION # DD 188491 EXPIRES:
February 25, 2007 r
Produced
ID APPLICATION
APPROVED BY: Bldg: /21d(tin Special
Conditions: Print
Contractor/Agent's Name Signature
of Notary -State of Florida Date Contractor/
Agent is, Produced
ID _ Utilities:
tia &
Date) (Initial & Date) Personally
Known to Me or FD:
Initial &
Date) (Initial & Date) 4$ "'
q "'o
CITY OF SANFORD BUILDING DIVISION
OWNERBUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, onsite supervision
themselves of all work not performed by licensed contractors, when building or improving farm
outbuildings or one -family or two-family residences on such property for the occupancy or use of such
owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to
exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease, of any such
structure by the owner -builder within 1 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other person
unless that person is registered or certified under this part and the work being performed is within the
scope of that person's license. For the purposes of this subsection, the term "owners of property"
includes the owner of a mobile home situated on a leased lot. To qualify for exemption under this
subsection, an owner must personally appear and sign the building permit application.
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 $25,000. 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. I1
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 supervising
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.
I / 0071C- , 1yA (-Y/L Qdo hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the itted structure.
I A 'n
Owner/guilder Signature r-- y ' Date
Y w csc6-Y MALAya- 4pe66
Print Owner/Builder Name
Eqac, 3 / co /o
ignature of Notary— e
DE8131E gLANTON
MY Cot.; '.»ION S DD IN491
Owner is PersFnowIvle`ia` ms
Produced ID ARY FLNotery xW
PLAT OF BOUNDARY SURVEY
DESCRIPTION (As Furnished)
LOT 47, HIDDEN LAKE PHASE III, UNIT ll, according to the plat thereof as recorded
in Plot Book 27, Pages 48-49 of the Public Records of Seminole County, Florida.
FOUND 1/2-IRON ROD
No identification)
FOUND 1/2" IRON ROD
CAP Stamped "LB/68"
SCALE: 1' 6 30'
LOT 48
Hence Corn. 161- l
0.4' NW.
a6
a m
Off -
e
PC
tit
I
J
PTFOUND 5/8- IRON ROD
No identification)
P
a
FOUND 1/2' IRON ROD
No identification)
Fence Corner is
0.4' W. AND 0.4' N
iC
i
aL.01.
LOT 46
A G O 0v
o A C PLA
0 1d
FOUND 1/2' IRON
No identification)
Fence Corner
is 0.9' W.
A/C Fence Cornis3.8' NW. Car — is
l
5 AZ'
J"
0
413O
I
S OP •N Jp1Q°4°
Pd
PC
FOUND 5/8' IRON ROD- FOUND 1/2- IRON ROD
No identification)
No identification)
b= 0612'34"(P)
R=344.80'(P)
L=37.37'(P)
CB=S33'21'45"E
Ch=37.35'
N33'13'26"W 37.40'(M)
Gi E: NO EASEMENTS OF RECORD HAVE BEEN PROVIDED TO THIS FIRM
0
A= 84'49'52"(P)
R=25.00'(P)
L=37.01'(P)
CB=S78'52'58"E
Ch=33.73'
N78'52'08"W 33.69'(M)
NO 11TLL OPINION OR ABSTRACT OF MATTERS AFFECTING TITLE OR
80 14DARY TO THE SUBJECT PROPERTY OR THOSE OF ADJOINING LANDSAV, BEEN PROVIDED. THERE MAY BE OR OF RECORD, UNRECORDED
U-:r:OS OR OTHER INSTRUMENTS WHICH COULD AFFECT THE BOUNDARIES
OR USE OF THE SUBJECT PROPERTY.
Hosea on the FEDERAL EMERGENCY MANAGEMENT AGENCY, NATIONAL
1_300 INSURANC' E PROGRAM, FLOOD INSURANCE RATE MAP. se -mole County. Florida, Community Panel Number 120294112117C 0045 E.
dated April 17, 1995 it appears from a scolinq of void map
ul the land described hereon Is shown to be within "ZONE %
Asses determined to be outside 500-yeor 0oodplain). Said map is not
u s,.rvey and no responsibility is taken for the information contained in
or :nil accuracy of the above referenced map.
tri. Plat represents o Boundary Survey of the dasaripdon oil furnished
n Surwyng and Mopping, Inc Par client's instruction and makes
rnraa ens regarding ornr•hip w rktht. of powaseian.
2 flearhgs M hereon we eased an the Narlheoelaly the of Lol 47. n00EN CARE PHASE III, UNIT TWO. Plot Book 27. Page 49 as S 2B'3e'17" E (Per plot).
y , has not child the Public r wds -abstracted the land Mown
ante, right of rays, Coven onto and rsetrictions or Other PertinentHanr• rhiM may ee found in the public r wda of lhla county. ThiseaeareYtrtIndudedInthescopeofailofthisIkm.
e rtlolivn tliatance y tar boundary dimenelans Morn hereon
5 n Hsu of 1 Fool h 7.500 Feel.
g--d improwmenls and utilities hate not been located.
99uufeyPwfwmedbyHoolsanSurveyhgandMappingla,%s. f M1rean hl/iil thdraring
Inauclient• nomad her— for the eapreca stated purpose legally
binding withauI my signature and riglna raised embossed seal. a —lhka party is ulharixetl la a this dr—inq in anY way, and this rwyor shall uFeldliableafardamagesr•aulling ham the unau lhorixeJ ar Illagd asecutione emo
is of ckcumvenlhg prescrWed lams ar proleesiand lee Payments. or
plpiR
reports, moles, Plana. epecifieatians• computer Nes. fleld mates or tlolo. rdocumentsandInstrumentspreparedbythisHimailhslrumentsofaadl
remain the prOor'Y al this frm. TM1is firm Mal retain all Comm l.,
lary and olhr reserved rights. intludinq the copy l thereto. The wlgha log
r a the Praparty of Har i on 5urveyng d M.p,mg, Inc.. HARRISON
SURVEYING AND MAPPING ONALSURVEYORSoINC, APPE>z5 Certificate
of Authorization #LB 6948 HSMJNC
32529 Ok.i352)
oso
12
Sorrento.
Florida 32776-8990 Phone: (352)
735-1263 JOB NO.
04-1734T Sheet 1 of 1 A= 02'
41'37"(P) R=530.
00'(P) L=24.
92'(P) C8=S6O'
O2'54'W Ch=24.
91' S60'12'
10"W 24.61'(M) CERTIFIED TO:
MATAYIL GEORGE
AND AMY STEWART TITLE
TITLECORP OF
FLORIDA LEGEND: P.
C.
Point of Curwture P.R.
C. P.T. Pohl of
Revrse Curve Pohl of
Tangency D.E. = Drainage Easement P.8.
Plat Book S.E_ - Sidewalk, Easement P 1.
OHUL = Overhead Utility Lins(s) C-.L'F' C.LF. car— Chain LhkO.R.B. - l Recarde Book A/C
Condition Data (Intersection Mille) Den, R/y/
Ri -Ot-WG Right-Ol-WOY R Radl- R LengthM)
Flea
Oberwllan L _ Mc P) Plat
Ch Chord Ben n9 U) Cdcul°
led
D.U.E. - Oromoqe rt Utsity Easement FSMT. Dnariptan
Easement U.E. Utility Eosa enl Eft. Equipment
m nl Cenlrlins
U. sos = Utility eoa DRAWING: 04-
1734T.OWC; SURVEY DATE: 6/O3/U4 INTENDED DISP!
AY SCALF_: 1" 30' DRAWN: T.E.H. EYpf'CTED
USE t^.F THIS LAND: RESIDENTIAL PURPOSES IT M
CERTIFIED THAT THE SUN'lY REPRESENTED HE. MEETS M E% FDS
THE MINIMUM TECHNICAL ST-DARDS AS SET FORT/ R1 CHAPTER 6TG17-6
FICMaGA Al L10 STRATIVE CODE. PURSUANT TO SECTION E AND
THE ORIDINAt RA SURVEYOR AND
MAPPER 5680 (For
the