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Home My WebLink About115 E 21 St (5)�l 7n 2 CITY OF SANFORD PE*MIT APPLICATION / Permit #: V C�.cJn� • Date: Job Address: Description of Work: �Q_ p 1 0:C e. ro (u. m' �1 Pi O� -� 1.21 I %10 w 9 `2 l a 0 Mmo S e rV,l Historic District: Zoning: Value o ork: S Cl6Se- 0 i30a 51-Ct - o f o C1 a lZe J=or•stze Permit Type: Building Mechanical Plumbing C/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 #: 36-19- 3+D Q 6 y Ig -00 0 0 (Attach Proof of Ownership & Legal Description) � Owners Name & Address: G �t7 YP�� i V� IR IQ - Y 3 m E -tle 0S! to ri F,' Phone: �Z O Z— 32Z— Contractor 7Z—Contractor Name & Address: /✓�/9 State License Number: Phone & Fax: Contact Person: Phone: Bonding Company- ompanyAddress: ^, p Address: Mortgage Lender: Address: W WS y H,w Architect/Engineer: Phone: Address: Fax: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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 a4ditional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance tgnature of that I wi otify the owner of the property of the requirements of Florida Lien Law, FS 713. ��F Special Conditions: (Q(. n V% Tt ('r- Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/Agent is _ Personally Known to Me or Produced ID (Initial & Date) Utilities: FD: (Initial & Date) (Initial & Date) 10 Print go-OATMITNaMe X o b B �- W Bti nature of Notary -State of Flon a Date W WS y H,w cc v =Owner/Agent is _ Personally Known to Me or W I D � d ,-M.Ewduced o tC>i, k�oning: APPLICATION APPROVED BY: Bldg: nitial & Date) Special Conditions: (Q(. n V% Tt ('r- Signature of Contractor/Agent Date Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/Agent is _ Personally Known to Me or Produced ID (Initial & Date) Utilities: FD: (Initial & Date) (Initial & Date) M 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 I 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 leased lot. To qualify for exemption under this subsection, an owner shall personally appear and sign the building permit application. State law 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 your 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 copts 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 required by state law and by county or municipal licensing ordinances. I. G £O JP G E C t-AAR ►Q1 do hereby state that I am qualified and capable of performing the requested constriction involved with the permit application tiled. I will assume full responsibiliv as an O%%mer/Builder Contractor, and will personally supervise all work allowed by la n the permitted structure. ,/ �Q3 (5wner/l3uifder Signature Date (;6:,01f6 E c N )P el 5 Print O%vnerBuilder Name ,��;;�"'• (�_iignature of Notary—Sta a of Florida toCD � ppa� a rte.• f3i� Qi N y. Owner is Personally Known to Me or has Ift Produced ID L GOO !j 93w VOi w 'ri 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 f6r;n 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 otitbuilding. 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 presur„l�: that you built or substantially improved it for sale or lease, which is a violation of this exemption. You :-v;ay not hire an unlicensed person to act as your contractor or to supervise people working on your hui].Ci , irr:, Ji. is your responsibility to make sure that people employed by you have licenses required by state lav: -.ind 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, G EO YP G C C \n ►4 R_ 1 7—: , 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. Owner/Bui er Signature Date 94col'GG E�vc Print Owner/Builder Name v iaCo�•3 VD a s. `z sv — c of Notary—State of Florida Date o 2 o v C l woer is Personally Keown to :\1c or has Produced 11)-_G%6 3I -9 -ter f 3 40 --- v v It F f5 t,- - rz 1 G -- I -p� NU1 SANFORD BUILDING DEPT. -- 45:S ARE REVIEWED A' CON �NALLLY CE DFOR PERMIT. A PERMIT ISSUED I-TdSTRUEDII TO BE A LICENSE TO PROC ITH; E WORK ' ND NOT AS AurIAORITY TO VIOLATE. AN.CEl.-..A TER,. R..S•E_T...ASInF tyly,Y r`c THE; OVISIONS OF THE ECHNIC C ES. NOR SHA W. 1 SUANC�F A PE MI�PR THE OVILDIN(i Z EPT FR THER Flcc -,RlE 1 iTJL,ACORKED OF ERRORS Tj3E PLA to (. i i rO"ERYjCLAm - . QRTNE OFFICE COPY I o i tr 1 I --.. �... A 1 36 Aja OT - 'T t %J . } Sn i EX+sT?% j Nt'^l door (SCE Exk,O--S,� Q�U �i 8iA f/� DUG Y� G�oc b l� /14 39 fe goG 0 1 %ft -0 It -0,5 ?-. Ne"J'T w%,YN40W