HomeMy WebLinkAbout2569-67 2563-65 Elcapitan> ti,
CITY OF SAT
Permit # . 10-11(2111L
11 j. ` 11 L / .,• - :.
Job Address
Description of Work: -e DJ• r'
Historic District: Zoning: Value of
t4 A1t +:4� " ��rti�+'..G't. t rt.. 4, R.'Y+•jR. yv �iid,'
ci•.,o.. SJR IY+ u i t u
PLICATION,r,�''�5,,�1"� j;,
..`` �z 3/3
Date: ` '
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm PoQt .
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Tempor*y Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cali. 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 C/ Commercial Industrial Total Square Footage:
Construction Tyne: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name &
(Attach Proof of Ownership & Legal Descripti
Ci 10 a/ A4 1 1 Or is 5on �v -
`Z`7 rpt / r C41 5 e / / / Phone: `-f 0 fi 3 d J
Contractor Name &'Address: 4ti�
State License Number: 00
Phone & Fax: Contact Person: �! t :j rg::;APhone: eilO %
Bonding Company:
Address:
Mortgage Lender:
Address:
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 io the
issuance of a permit and that all work will be perfom►ed 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 regularing
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. . N , + ,
NOTICE: In addition to tate 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.
Accepta a of permit is ven ficatio that 1 wil y the o
of the pro y o the requirements of Florida Lien Law, FS 713.
23 03
ignature of Owner/Agent
Date Signature of Contractor/Agent
Print Ome
Print Contractor Agent's Name
Signature of Notary -State of Florida
Dal e Sienature of No::iry-State of Florida
Melissa Dunklin
Commission 11DD163723
Expires: ec 20 2( 05
Date
Date
Owner/ Aguu� i5.:• °: Person o e or Comractor/Ager.: is _ Personally Known to Me or
/�ProducCti�i t�' ��} Produces :D
APPLICATION APPROVED BY: Bid � Zoning: tii:::::ei: PD:
IM tlnitial &Dale (Initi_al tC DJatel (Initial K Date) (hrivaI & Datc
Spccij! Conditions: Ddub (R C>"L, f 1C�►O , � f"� ,�. —
OA'y 1\0P(0?1C,1q9 C00er\NtLultzi�kd -�Acp
CITY OF SANFORD BUILDING -DIVISION
O WNER/B UtLDEk 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 costnot 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 alter 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 presuin.e that
you built or substantially improved it for sale or lease, which is a violation of this exemption. You rruay
not hire an unlicensed person to act as your contractor or to supervise people working on your building. 1'.
is your responsibility to make sure that people employed by you have licenses required by state law arid.
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, \ / OLH.e�.D . 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.
��vner/B%Mder Signature Date
Print OwnerBuilder Name
a mn
x o
Q3
Signature of Notary—State of'Florida Date
o g y H y
age=sv
�•�NvG
Owner is Personally Known to Me or has
c 2 oGC
Produced ID S 3(6?, /73ZS
o w
28 4
4 274 6 5
5 5
23
6 J = 26 6
22 8
7 j Q 25 7 9
zi U7
8 0 20 24 8 10 0
n < D
a- C3
9 23 9 -T- 19 I I 01
1 0 0
1 0 L.JJ 22 1 812 tz
.30
2 1 1 1= 17 1 3
1 2 20 1 2 16 114-
1 3 19 13
14 1 8 1 4
115) 26
15 17
5
16 1 6 2 4 75
3�O 2
1723
ID
2
1 7 2 ID 21 3
1 6 20 4
?ID
1 0 1 5
D 130 -
0 1 5 4
%D
0
2
14 5 18 c-
3
1 3 6 .1.7 7
4
12 7 I6 8
8 15
6 C)
130 10-A 8-A- W 14 10
!A
0 L 10 0 1 3
130 13 Q 130
U E SU IU DR E 12
--T(5 0-
32
31
30
5
6
T-
7
< = 29
a- 28
8
27
F 26
9
1 0
Lli
25
24
23
22
.21
2 0
20
II
1 2
1 3
14
15
16
17
30
OD"
1 8
19
1 20
28 4
4 274 6 5
5 5
23
6 J = 26 6
22 8
7 j Q 25 7 9
zi U7
8 0 20 24 8 10 0
n < D
a- C3
9 23 9 -T- 19 I I 01
1 0 0
1 0 L.JJ 22 1 812 tz
.30
2 1 1 1= 17 1 3
1 2 20 1 2 16 114-
1 3 19 13
14 1 8 1 4
115) 26
15 17
5
16 1 6 2 4 75
3�O 2
1723
ID
2
1 7 2 ID 21 3
1 6 20 4
?ID
1 0 1 5
D 130 -
0 1 5 4
%D
0
2
14 5 18 c-
3
1 3 6 .1.7 7
4
12 7 I6 8
8 15
6 C)
130 10-A 8-A- W 14 10
!A
0 L 10 0 1 3
130 13 Q 130
U E SU IU DR E 12
--T(5 0-
r
A plot plan must be submitted along with any application
building permit, or application for special exception to the
Board of Adjustment.. This form may be 1_Itilized. for any single
family construction, either conventional or mobile home. The
following items must be indicated:
�. Dimensions of lot or parcel.
2. Name of abutting street or road.
3. Proposed location of home, accessory building, or
home; showing setbac}'s to all property lines.
4. Any existing structures on property.
Need Slab Elevations
6. If any trees are to be rem6ved, show location, =i. .e =,nd
type.
7. Any easements on property.
2. IndicateIt,e_o,� �c e, r o p e r t y .
ten° rN'
ESS OF PROPERTY
DATE
FAD]
APPLICANT