HomeMy WebLinkAbout144 Country Club Dri
Permit #
-Job Address:
Of
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: IC! — t 93
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 —r— 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:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
of
Phone:
State License Number:
rte, 7-179 3
--2 !7f,,O'974
Contact Person: Phone:
Phone:
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. 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 requireme is of ' 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 additi I required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acce cc of permit is verificat, t I ill notify the owner of the property of the requirements of Florida Lien Law, FS 713.
o •6 3
Signature of Own r/Agent Date Signature of Contractor/Agent Date
r f/
Print Owner/Agent's Name Print Contractor/Agent's Name
nature'of INot�,ry-State.y JoridaJOHNSON ( Date Signature of Notary -State of Florida Date
IJI .
MY CONINMISSION N CC 921808
�N EXPIRES: March 25: ?tiG4 '
4i.,(J ng;.0, TF^ 3 oet
Owner/AgAt is. __Personal i�nown.t�-Mc-or g ^ Contractor/Agent is _ Personally Known to Me or
LProduced ID — — — T�Q 39 'V _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initi I Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
CITY OF SANFORD BUILDING DIVISION
OWNERIBUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, on:,ite. supervision
themselves of all work not performed by licensed contractors, when building or improving farin
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 presurne that
you built or substantially improved it for sale or lease, which is a violation of this exemption. You »ia.y
not hire an unlicensed person to act as your contractor or to supervise people working on your. bui.lci is yip-. it.
is your responsibility to make sure that people employed by you have licenses required by state lav; ;.trid
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 d uct F.I.C.A. and withholding tax and provide workers' compensation
for that employee, all as prescri y law. Your construction must comply with all applicable laws,
ordinances, buildingcodee+ and g regulations.
_, do hereby state that I am qualified and capable of performing the
the permit application filed.
I will assume full responsi i 'ty as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the perinifted structure.
d• 0�
uilder Signature 4tr Date
:: �kPrint Owner/Builder Name
ignauirc of Notary— to of i=lorida Datc
k 0 .,r"5
Owner isPe`rsy iall�, Known to Me` or has
_
1
1. - "�s•1�. V h'.,., ..::i(. .iw .77 ,
..e
„ .rl •;, r . 7" f. .(r. r,l...iT4-e�•.r r i
'
ENT _ = U.S. ' Depariment of
and Urban Development
4.
13, Twe of Loan
QMB No. 2-562-0266'
1. _ FHA !'L _ FmHA ' 3! a Conv. Unlns.
a. Foe Number .. . loan Number
--T-,Mor19a9e Inurance Cao Number.
a. VA 6. _ Conv. Ins.
TBrophy
�. , :,, .. • a •,• I r Y
_
5500.963
C. NOTE: This form Is furnished to give you a statement of actual
settlement costs. Amounts paid to and by the settlement agent are shown..
Items marked (P.O.C.) were paid outside the closing; they are shown here for information purposes and included
D. Name and Address of Borrower
are not In the totals.
E. Name and Address of Seller
DESMOND BROPHY
F. Name and Address of Lender
MICHAEL A. McKENNA 'HABITAT
TRUST I
2815 Park Avenue
685 Benitawood Court 1524 E. Livingston Street
Sanford, FL 32773
Winter Springs, FL 32708 Orlando, FL 32803
G. Property Location
H. Settlement Agent _.
Orange Title. Inc. �•_.
144 Country Club Drive
Sanford, FL 32771
_ Place of Settlement
Lot 12, Blk B. Country Club Manor
I. Settlement
_ .,_ _. 2002 E. Robinsen,Strget Date
Unit 2. PB 11, p 100, Seminole Co. FL
Orlando, FL 32803 1
05/22/03
SUMMA
5/22/03
SUMMAgyr
too. Grove Amount Due From Borrower
TRANSACTION:
400. Gross Amount QuLXSeller
101. Contract I a
�'1111 nA 00
X. 2Xj. 5dGntraCt 92199 Dries 30 000.00
102, Personal
103. Settlement charoes to bo
1,421.25 403,
104, [SIM 17. 404
405,
Aftatments for Items paid by seller In Ildvance11 I dvance
106, CRY/town x
7, County taxes4
108, Assessments
to
-4DB. Assessments
109.repair escrow000.00
t
4 ! I.
1
10,
t
411,
412,
120. GROSS AMOUNTR ," 39,421.251 y _ 30,000.00
200. Amounts Paidn Behalf of Sorrorer
201, Depos or earnest money
00.00 0AQ12
ns In Amounto pug Ig �2112[
00.00
9n9. PH -1-1 em —i ..r ..e... r..e..r... .. ,.,... ..___ _ I
,r
210. CRY/town x :4to
tas to
x O1/Ol 05/ 4 .0 01/01 to 05/22 345.02
212, Assessments to t 512, Assessments
�w
IiNll
03. AASH TO BORROWEp` - ! _
1 023 77 fiO3 CASH 7Q SFI I Fa 4 487 79
You an required by law to VVrovido ORANGE TITLE. INC with your correct ..payer Identification number. 11 you do not provide ORANGE TITLE. INC.
hh Yi'our correst Uxpayet tiles of
Pion number, you may be esbl ct 10 CIVk Or Criminal penalties Imposed by law.
DERTIFICATION: Under psnalllo, of perjury, I cetl y Iha1 iM numbTr shown on this statement Is my Correct laxpayet Identification number. I
•C as um er '•
'
SELLER INSTRUCTIONS. •• , ax Ym art
�II Ihb 'rest seine was your principal residence, file Form 2119, Salo or Exchange of Principal Residence, for any. gal,, or h your Income
lax return; for other transaction,, complete the a pllcablo parts of Form 4794, Form 6252 and/or Schedule D (Form 1040}
SUBSTITUTE 1099: The Intormnlon comslned In Blocks E. 0, H• 1 and on ane 401 (of, If Form 401 la asterlehad, knee 403 and 404) Is Important tax Inlormallon I 1
and le being Iumished to IM Internal Revenue service. If you see nqulred to filo a return a nepllpesce penally w elhar eseellon wit be Impesed on you II
thle Item It required to be reported and IM INS determines that 11 hes.not been reported. �„"_ „ _ •,,,,y •�••;,,,•�
...r RF.ti'PA •NR 4?nS 9 _ •. Inc,, vuur� r� n❑ I 1