HomeMy WebLinkAbout203 Palm PlPermitType%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 #:
1__Ownerrs Name & Address: _1
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Descriptiou)
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 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 o/ rmit is verification that
notiifyy the owner of the property of the requirements of Florida Lien Law, FS 713.
of Owner/AgeAt ( ) d- I Date Signature of Contractor/Agent Date
US/
Print Contractor/Agent's Name
Siinature of Notary -State of Florida Date Signature of Notary -State of Florida Date
DEBBIE BLANTON
Own r/ e s Contractor/Agent is _ Personally Known to Me or
to EXPIRES: February25.2007 I IL ey- qk, Produced ID
1-WOFL Notary Discouol Assoc. Co. G)
APPLICATION
APPROVED BY: Bldg: Zoning: Utilities: FD: Initial &
Date) (initial & Date) (Initial & Date) (Initial & Date) Special
Conditions: 7
SI
vt tv. .X..1 S . a ^^`.
i CITY OF SANFORD BUILDING DIVISION
OWNER/BUILDER AFFIDAVIT
TCONSTRUCTIONCONTRACTING
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 perforated 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. 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 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,>-?? Dili ,rU Zvi- , do 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 wort:
allowed by law on the permitted structure.
Owner/Builder Signature D a ti
Print OwnerBtiilder Name
Signature of t crto DEBBIE
Bl kNTON MY
COMMISSION 8 DD 16"91 Own
r Pcmurvdl5eKwt;%A- Me has Prod
C¢ TA FL Notary Discount Assoc• Co.
IIIIJ II,V.I. v... ... ..._. •7, iv;i ";•` . `C' ar{tY ':,•t,1W`;r'.1S J.'::[.;!):: al\ i't1.
NAME
OTICE OF COMMENCEMENT
ADD 92LetNo. - nl fy'iw ( i 3 Z 7 7 3 Tax Folio No.
State of Flom"
County of Seminole
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of
2. General description of i
3. Owner information
a. Name and address e4
property and street address if available)
b. Interest in property
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
a. Name and address
5.
b. Phone number _
Surety
a. Name and address
b. Phone number _
c. Amount of bond _
Lender
a. Name and address e"-ky M-0 R
CERTIFIED, COPY
MARYA NE.
Fax number -S%EWt PFICIRCu&
to,E FL R
i
Fax num c
E--
b. Phone number Fax number
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number
8. In addition to himself or herself, Owner designates
Fax number
of
713.13(1)(b), Florida Statutes.
to receive a copy of the Lienor's Notice as provided in Section
a. Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified)
Signature of Own
Sworn to (or affirmed) and subscribed before me this /_ day of Ti — J , 20 6 J , by
imipa em>lalir o o aiuu l uu®®1118
Personally Known OR Produc d Identificatio
Type of Identification Produced_ f L- I 0
gnature of otary Public, State of Florida
Commission Expires:
DEBBIE BLANTONzMYCOMMISSION # DD 188491
EXPIRES: February 25, 20D7
1-8003•NOTARY FL Notary Dlscmnt Assoc Co.
MARYANNE HORSE, CLERK OF CIRCUIT COURT
SEMINOLE COWTY
BK 05579 PIG 0158
CLERK'S M 2005006567
RECORDED 01/12/2005 02:59:27 PN
RECORDING FEES 10.00
REODRDED BY t holden