HomeMy WebLinkAbout200 E 19 StPermit #: I I
Job Address: _
Description of Work:
Historic District:
"C7 Li
CITY OF SANFORD PERMIT APPLICATION
Date: ��Ju4 acU—_
Value of Work: S_ -1
Permit Type: Building S/ 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 V`0� 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:
(Attach Proof of Ownership & Legal Description)
Phone: -z22-
State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address: �^
Mortgage Lender: o $tiL "1 tt.Qfn
Address:
Architect/Engineer: Phone:
Address: 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 cern that all of the foregoing information is accurate and that all work will be donein compliance with all applicable laws regulating
construction and zoning. WAR ING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMI ROVEMENT TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEHORE RECOR ING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addi ' n to the r
this county, and tMe may be
is
s of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
I will notify the owger of the property of the requirements of Florida Lien Law, FS 713.
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)
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APPLICATION
APPROVED BY: Bldg: Zoning:
(Initial & ate)
Special Conditions:
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)
CITY OF SANFORD BUILDING DIVISION
OWNER/BUII:DER 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 1 year after the construction is complete, the law will presun,.e that
you built or substantially improved it for sale or lease, which is a violation of this exemption. You n-ja.y
not hire an unlicensed person to act as your contractor or to supervise people working on your bu .d3) i;. lt.
is your responsibility to make sure that people employed by you have licenses required by state lave -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,
or"ces, byAding codes, and zoning regulations.
I, � D n& a �� r Jsw.r� do hereby state that I am qualified and capable of performing the
regpested onstrt�ction involved with the permit application filed.
i' 11 assume ful ' responsibility as an Owner/Builder Contractor, and will personally supervise all work
allyv�d by law 4n the permitted structure.
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Signature of Notary—State of Florida D to
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A.SETTLEMENT STATEMENT
U.S.DEPARTMENT OF HOUSING
AND URBAN DEVELOPMENT
OMB No. 2502-0265
B. TYPE OF LOAN
1. OFHA 2.0 FmHA 3. D CONV.UNINS.
4. QVA 5.0 CONV.INS.
6. File Number:
870-0307707
7. Loan Number:
0029359833
8. Mortgage Insurance Case Number:
171761331315
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 informational purposes and are not inclluded in the totals.
D.NAME AND ADDRESS OF BORROWER:
Gary M Grissom
200 East 19th Street
Sanford, FL 32771
E. NAME AND ADDRESS OF SELLER/TAX I.D.No.:
Jimmy M Grissom
Ellen J,Grissom
2750 East Bay Apt. F-5
Largo, FL 33771
F. NAME AND ADDRESS OF LENDER:
Wells Fargo Home Mortgage, Inc
9600 Koger Blvd
Suite 120
St Petersburg, FL 33702
G.PROPERTY LOCATION:
200 E 19th St
Sanford, FL 32771
H.SETTLEMENT AGENT:
LANDAMERICA GULFATLANTIC TITLE
Lot 5 & 8 Block H, Markham Pk
Heights, Seminole Cty, Floridal
PLACE OF SETTLEMENT:
7682 Dr. Phillips Blvd., Suite C
Orlando, Florida , 32819
(.SETTLEMENT DATE:
07/18/03
J. SUMMARY OF BORROWER'S
TRANSACTION K. SLMv1ARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price
80 000.00 401. Contract Sales Price 80 000.00
102. Personal property
402. Personal property
103. Settlement charges to borrower (line 1400) 2,036.96 403.
104.
404.
105.
405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to
406. City/town taxes to
107. County taxes to
407. County taxes to
108. Assessments to
408. Assessments to
109.
409.
110.
410.
111.
411.
112.
412.
120. GROSS AMOUNT DUE
FROM BORROWER
420. GROSS AMOUNT DUE
82 036.96 TO SELLER 80 000.00
200. AMOUNTS PAID BY OR 1N BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money
501. Excess deposit (see instructions)
202. Principal amount of new loans)
81,600.00 502. Settlement charges to seller (line 1400) 6,426.61
203. Existing loans) taken subject to
503. Existing loans) taken subject to
204.
504. Payoffoffirstmortgage loan 38 649.11
205.
505. Payoff of second mortgageloan
206.
506.
207.
507.
208.
508.
209.
509.
Adjustments for items unpaid by seller
Adjustments for items unpaid by seller
210. City/town taxes to
510. City/town taxes to
211. County taxes 01/01/03 t007/18/03 436.96 511. County taxes 01/01/03 t007/18/03 436.96
212. Assessments to
512. Assessments to
213.
513.
214.
514.
215.
515.