111 Golfside Cir 17-1130; FENCEEIE
APR 2 4 2012
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Y.-
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: -7- //Jy Documented
Construction Va•Iue: $ 60— o
dress: III Q FSW40, Ca C. PY. 3Z`-3 Historic District: Yes No Parcel
ID: Residential Commercial Type
of Work: New Addition Alteration Repair Demo Change of Use Move Description
of Work: Novi Rwk ipublA pm&,L (o%Vn, &a k e
lL r wt b ertix s, CQ 6 , SS Plan
Review Contact Person: Phone:
Fax: Email: Property-
Owner-_I:nformabon NameLlkO
n t
Street: III
C-, e I FS 6 l.P O City, State
Zip: Name Street:
City,
State
Zip: GI Title:
Phone: -
C
c L —,? SS=I -7s q Resident of
property? : Contractor Information
Phone: Fax:
State
License
No.: Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: E-mail: Bonding Company:
Address: Mortgage
Lender:
Address: WARNING
TO
OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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. FBC 105.
3 Shall be inscribed with the date of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code Revised: June
30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be add itional'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.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
Agent's
c
LISA ANTONINI
Notary Public - State of Florida
My Comm. Expires May 21, 2018
Commission # FF 125242
Produced ID Type of ID
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING-46 o-417UTILITIES:
ENGINEERING:
COMMENTS:
FIRE:
I \A1,
Oki. D61
Gas Roof
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
I A _ II_ 1 _
ti
Revised: June 30, 2015 Permit Application
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have a
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
J J responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
in his or her name instead of my own name. I also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
lease. If a building or residence that I have built or substantially improved myself is sold or leased within :
in 1 year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
U
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
1,
persons working on my building or residence. It is my responsibility to ensure that the persons whom I
have the licenses by law byemployrequiredand city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
J injuries sustained by an unlicensed person or his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I 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 my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern owner -builders as well as employers. I also
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
J I am of aware of construction practices and I have access to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
1
information that I have provided on this disclosure or in the permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
Lobtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Dreperty Address I.
i/1,f y a(o , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
re of Ownef,8uilder
Form of Identification
Must be Photo ID)
Date
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
BOUNDARY SURVEY OF:
Lot 32, MAYFAIR CLUB PHASE I.
according to the plat thereof as recorded in
Plat Book 53, Pages 7 and 8, of the
Public Records of Seminole County, Florida.
THIS SURVEY IS CERTIFIED TO:
Stephanie M. Blackwelder and Luke Vergara
Esquire Title Services, Inc
Old Republic National Title Insurance Company
National Bank of Commerce
FLOOD CERTIFICATION:
This is to certify that I have consulted the
National Flood Insurance Flood Hazard Boundary
Map and found the subject property is not within
a special flood hazard area, according to Map No,
121l7C 0065F, dated 9/28/2007. (ZONE X)
PROPERTY ADDRESS:
Ili GOLFSIDE CIR., SANFORD, FL 32771
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NOTES:
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Section" P.B. 9,
PGS 65-66 4/03/2017
A00 n__C=^.'_: ::''• _r_ 12/15/20-
6
FROM: NATIONAL BANK OF COMMERCE
1919 CAHABA ROAD
BIRMINGHAM, ALABAMA 35223
Phone: (866)313-1857
TO: ESQUIRE TITLE SERVICES, INC.
1019 TOWN CENTER DRIVE STE. 100
ORANGE CITY, FLORIDA 32763
386)851-0655
ATTN: LYNNE RICHARDSON
RE: Borrower(s): STEPHANIE M BLACKWELDER
Property Address: 111 GOLFSIDE CIR
SANFORD, FLORIDA 32773
LOAN DOCUMENTS:
Document Date: APRIL 7, 2017
Closing Date: APRIL 7, 2017
Disbursement: APRIL 7, 2017
Case No.:
LoanNo.: 2017020050 App.
No.: Order
No.: 17-699LR Escrow
No.: 17-6996LR SPECIFIC
CLOSING INSTRUCTIONS We
enclose the following documents necessary to complete the above referenced loan transaction: X) Note (X) Affidavit and Agrmnt. (X) Transfer of Servicing X) Mortgage (X) Privacy Policy (X) Compliance Agreement X) Planned Unit Dev. Rider (X) Allonge to Note (X) GFESD X) Payment Letter (X) Worksheets X)
Hazard Ins. Req. (X) Loan Application X)
Initial Escrow Acct. Disc. (X) Patriot Act Stmt. (X) Borrowers Cert. X) Impound Auth. (X) 4506T Deliver
one (1) copy of all loan documents to the Borrower(s); deliver one (1) copy of the Federal Truth -In -Lending Disclosure StatementorClosingDisclosure (as applicable) to each Borrower. LOAN
TERMS: Loan
Amount: 17 6, 0 0 0. 0 0 Initial
Advance: Sales
Price: 2 2 0, 0 0 0. 0 0 Term (
Months): 3 6 0 Interest
Rate: 4 . 3 7 5 Initial
Payment: 8 7 8. 7 4 First
Payment Date: 0 6 / 01 / 17 Last
Payment Date: 0 5/ 0 1/ 4 7 ARM
Loan: ( ) Yes (X) No Index:
Margin:
Periodic
Rate Cap: Lifetime
Rate Cap: Lifetime
Rate Floor: Interest
Change Date: Payment
Change Date: LoanPurpose:
PURCHASE PAYOFF REQUIREMENTS:
It is
a condition to the funding of this loan that the following payoffs be made through this closing. Indicate payoffs on the HUD-1SettlementStatementorClosingDisclosure.(as applicable) or provide other satisfactory evidence of payoff: CONDITIONS TO
BE SATISFIED PRIOR TO DISBURSEMENT OF LOAN PROCEEDS: 3.) VERIFYGIFTSOF $14,000 AND $14,000 FROM MOTHER AND FATHER ARE WITHDRAWN FROM DONOR ACCOUNTSANDTRANSFERRED/DEPOSITED TO BORROWER BANK ACCOUNT ,WITH PROPER PAPER TRAIL. VERIFYSUFFICIENTTOTALLIQUIDFUNDSTOCLOSE. Survey and termite waivers to be used ifnoneareprovided. Short Form Title Policy required for waiver. Signed and dated 1003 - Uniform Residential Loan Application **SEE ATTACHED ADDENDUM TO CLOSING INSTRUCTIONS** TITLEINSURANCE
REQUIREMENTS: You are
authorized to use funds for the account of the Borrowers and to record all instruments when you comply with the following: 1. THIS
LOAN MUST RECORD IN 1ST LIEN POSITION ON OR PRIOR TO THE DISBURSEMENT DATE NOTED ABOVE. PROVIDE DUPLICATE ORIGINALS OF THE AL.TA TITLE POLICY. 2. Vestingtoread:
STEPHANIE M BLACKWELDER AND LUKE VERGARA WIFE AND HUSBAND 3. 8T8i'
ttle1 Policy Tmuust contain the following endorsements (or their equivalents): FLORIDA FORM , ALLTA 4. AL1ATitlUDePolicymustbefreefromliens, encumbrances, easements, encroachments and other title matters except i) thelienofourloanintheamountofourloanonthepropertydescribedhereinshowingtheInstrumentorDocumentNumberandthedateofrecordingoftheSecurityInstrument; (ii) general, specific, state, county, city, school orothertaxesandassessmentsnotyetdueorpayable: iii) other
items as permitted by us; and (iv) the following items as shown on the preliminary title report, commitment, binderorequivalentdatedFEBRUARY1, 2017 SECONDARY FINANCING:
Secondary financing
in the amount of $ NONE has been approved. SPECIFIC CLOSING
INSTRUCTIONS SCLMSC 01113/
16 Page 1 of 2 Docuagccgpdoom