HomeMy WebLinkAbout474 Hansom ParkwayCITY OF SANFORD PERMIT APPLICATION
Permit # • d -\off Date:
Job Address:. %-% Lr Hans ty C%-y r
Description of Work:
Historic District: Zoning: Value of Work: S R'on
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS AdditiorJAlteration 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:
Ld ,32 X> Phone:
Contractor Nana & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
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 mast be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: 1 certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatingconstructionandzoning. 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 permi venflea ' 1 t will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
r re of Own/Agent Date Signature of Contractor/Agent
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Print Owner/ r1r
Si
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MY COMMISSION I DD 164280
IPA
EXPIRES: November 12, 2006
Own'rfA;xW iris B0" b ' +ii {Sm
p Produced ID
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Print Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: ` Zoning: g Utilities: FD:
Initia te) rtial & Date) (Initial & Date)
Special Conditions:
Initial & Date)
lie CITY OF SANFORD BUILDING DIVISION
OWNER(BUILDER AFFIDAVIT
ELECTRICAL & FIRE ALARM SYSTEMS
An owner of property making application for permit, supervising, and doing the work in connection with
the construction, maintenance, repair, and alteration of and addition to a single-family or duplex residence
for his or her own use and occupancy and not intended for sale or an owner of property when acting as his
or her own electrical contractor and providing all material supervision himself or herself, when building
or improving a farm outbuilding or a single-family or duplex residence on such property for the
occupancy or use of such owner and not offered for sale or lease, or building or improving a commercial
building with aggregate construction costs of under $25,000 on such property for the occupancy or use of
such owner and not offered for sale or lease. In an action brought under this subsection, proof of the sale
or lease, or offering for sale or lease, of more than one such structure by the owner -builder within 1 year
after completion of same is prima facie evidence that the construction was undertaken for purposes of sale
or lease. This subsection does not exempt any person who is employed by such owner and who acts in
the capacity of a contractor. For the purpose of this subsection, the term "owner of property" includes the
owner of a mobile home situated on a ]eased lot. To qualify for exemption under this subsection, an
owner shall personally appear and sign the building permit application.
State la,%v requires electrical contracting to be done by licensed electrical 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 vour own electrical contractor even though you do not have a license. You may install electrical
wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical wiring in
a commercial building the aggregate construction costs of which are under $25,000. The home or
building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or
lease more than one building you have wired yourself within I year after the construction is complete, the
law will presume that you built it for sale or lease, which is a violation of this exemption. You may not
hire an unlicensed person as your electrical contractor. Your construction shall be done according to
building codes and zoning regulations. It is your responsibility to make sure that people employed by you
have licenses requ. ed by tate law and by county or municipal licensing ordinances.
do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
1 will assume full responsibility as an O,%%,ner/Builder Contractor, and will personally supervise all work
allowed by law on the ermitted structure.
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wyOwner/Buildcr Signature Dale, ,
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Print Owner/Builder Name 1-104
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a ure of Notary— tate of Florida Date z m g mc>
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Owner is Pcrsonally Known to Me or ha
Produced 1D
CARRIAGE COVE
REQUEST FOR IMPROVEMENT
TODAY' S DATE S
PROJECTED DATE WHEN IMPROVEMENT IS TO TAKE PLACE: bn:5)hf
TYPE OF IMPROVEMENT: nr p
MATERIALS TO BE USED FOR H PROVEMENT:-A I V fM e %— c Jock
PERSON/COMPANY INSTALLING .5t
SUBCONTRACTOR'S LICENSE NO.
PLEASE DRAW A DIAGRAM OF PROPOSED WORK: _
qo-7-zjoz.
c0 oad
NOTE: IT IS THE RESPONSIBILITY OF THE
UNDERGROUND UTILITY LOCATE% (1&00-432
ANY WORK. / /
SIGNATURE OF RESIDENT:
PRINT NAME OF RESIDENT: M c-kae \ Pa Y
LOT # r4 7 Q
APPROVAL OF MANAGEMENT:
DATE OF APPROVAL: f-
iU m; n v vtn
NOTIFY THE
IE START OF
NO WORK IS TO BEGIN UNTIL WRITTEN APPROVAL HAS BEEN RECEIVED.