HomeMy WebLinkAbout918 Celesey AveD-S aoo
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Zoning:
CITY OF SANFORD PERMIT APPLICATION
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical. Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Owne Name
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Eagineer:
Address:
Date:
S 4?-,
a
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
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Contact Person:
State License Number:
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 commnced 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 Tray 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 off p e rmit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713,
lg`nature /?. D3te Signature of Contractor/Agent Date
1_
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Name
MY COtth%ISSION * DD I8N91
EXPIRLS: February 25, 2007
180p nRy _ FL Notary D scount Asscc. Co.
Print Contractor/Agent's Name
Date Signature of Notary -State of Florida Date
Produced ID T-
APPLICATION APPROVED BY Bldg: Zoning:
Initial & Date) (Initial & Date)
Special Conditions:
Contractor/Agent is _ Personally Known to Me or
Produced ID
Utilities: 49
Initial & Date) (Initial & Date)
S0%
CITY OF SANFORD BUILDING DIVISION
OWNER/BUILDER 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 I 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, E f , 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 work
allowed by law on the permitted structure.
OwnerBuilder Si lure Dat
Print Owner/Builder Name 1
DEBBIE BLANTON
AY C(' QSION # DD 18M1
Owner isM,,LonWly_KAQvm4a&dwor
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CITY OF SANFORD
DEMOLITION
Building Division Acknowledgement
Permit Application
B. State Forms
C. State Statutes/Contractor Licensing
Public Works Acknowledgement
A. Sidewalk Closing
B. Street Use/Closing
1. Walkways — Protection — Width
2. Barricades — Protection — Width
3. Fencing — Protection — Width - Height
4. Curb Protection/Sidewalk Protection/Street
5. Storm Sewer Protection
C. Dust Control
Police Department Acknowledgement
A. Traffic Control
B. Crowd Control/Security
Utility Department Acknowledgement
A. Water, Sewer — Capped off, Sealed
B. Water for Dust Control (Meter)
Engineering & Planning Acknowledgement
A. Historic District
B. Zoning Issues
Address of Job: 9 1 X G e l er
Additional Comments:
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CITY OF SANFORD
DEMOLITION
Building Division+ AakboMcdgemcnt
A. Permit Application
B. State Forms .
C. State Statatcs/Contractor Licensing
PuNic Works Aeltnowledgement
A. Sidewalk Closing
B. Street Use!Closing
1, Walkways — Protection — Width
2. Bamicedes — Protection — W idtb
3. Fencing — protection — Width - Height
4. Curb ProtecttoWSidewalk Protaction/Street
S. Storm Sewer Protection
C. Dust Control
police Department Acknowledgement
A. Traffic Control
B. Crowd (:onttoVSeeurity
vtwty Department Acknowledgement
A. Water, Sewer — Capped off, Sealed
B. Water for Dust Control (Meter)
8nglawduS dt Planning Acknowledgement
A. Historic District
B. 7.oning Issues
Address of Job.
Additional Coilunents•
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All CITY OF SANFORD
DEMOLITION
Building Division Acknowledgement
A. Permit Application
B. State Forms
C. State Statutes/Contractor Licensing
Public Works Acknowledgement
A. Sidewalk Closing
B. Street Use/Closing
1. Walkways — Protection — Width
2. Barricades — Protection — Width
3. Fencing — Protection — Width - Height
4. Curb Protection/Sidewalk Protection/Street
5. Storm Sewer Protection
C. Dust Control
Police Department Acknowledgement
A Traffic Control
B. Crowd Control/Security
tUity Department Acknowledgement
A. Water, Sewer — Capped off, Sealed
B. Water for Dust Control (Meter)
Engineering & Planning Acknowledgement
A. Historic District
B. Zoning Issues
Address of Job: 9 / G l er
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CITY OF SANFORD
DEMOLITION
Building Division Acknowledgement
A. Permit Application
B. State Forms
C. State Statutes/Contractor Licensing
Public Works Acknowledgement
A. Sidewalk Closing
B. Street Use/Closing
1. Walkways — Protection — Width
2. Barricades — Protection — Width
3. Fencing — Protection — Width - Height
4. Curb Protection/Sidewalk Protection/Street
5. Storm Sewer Protection
C. Dust Control
Police Department Acknowledgement
A. Traffic Control
B. Crowd Control/Security
Utility Department Acknowledgement
A. Water, Sewer — Capped off, Sealed
B. Water for Dust Control (Meter)
YA neering & Planning Acknowledgement
Historic District
Zoning Issues
Address of Job: 7/ s C e l e r
Additional Comments:
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CITY OF SANFORD
DEMOLITIONQeV
Building Division Acknowledgement
A. Permit Application
B. State Forms
C. State Statutes/Contractor Licensing
Pub Wworks Acknowledgement a
Sidewalk Closing Al
Street Use/Closing /#
1. Walkways —Protection —Width A ll4
2. Barricades —Protection — Width /V/A-
3. Fencing— Protection —Width -Height A11A
4. Curb Protection/Sidewalk Protection/Street NIA
5. Storm Sewer Protection 11r1A
C. Dust Control m/lg,
Police Department Acknowledgement
A. Traffic Control
Crowd Control/Security
Utility Department Acknowledgement
A. Water, Sewer — Capped off, Sealed
B. Water for Dust Control (Meter)
Engineering & Planning Acknowledgement
A. Historic District
B. Zoning Issues
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