1801 E Airport Ave 03-2886 ElectricalPermit # : t /
Job Address: l
Description of Work:
Historic District:
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CITY OF SANFORD PERMIT APPLICATION
Date: _
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Zoning: Value of Work: $ of 5-0. 00
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 150 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 #: tJ l !X-
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone: q(9 7 — S'9- 9 WOO
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State License Number:
Contact Person::'L tNI—e(07 y/ry009 Phone: '/o7 7ya0
Phone:
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 certify that all ofthe 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 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.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
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a a d o Signature of Notary -State of Florida
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ate Signature of Notary -State of Florida Date
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o xErOwner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
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APPLICATION APPROVED BY: Bld :I `ZZ — Zoning:
Initial & Date)
Special Conditions:
Initial & Date)
Utilities: FD:
Initial & Date) (Initial & Date)
CITY OF SANFORD BUILDING DIVISION
OWNERIBUILDER 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 vour ovm electrical contractor even though you do not have a license. You may install electrical
wiring for a farnl outbuilding or a single-family or duplex residence. You may install electrical wiring in
a commercial building the aggregate construction costs 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 1 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 responsibilitv to make sure that people employed by you
have licenses required by state law and by county or municipal licensing ordinances.
I, , 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 Owmer/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
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O <ner/Builder Signature Date
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Print Owner/Builder Name d "•No;.
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Notary—Slate of on a at D N
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Owner is Personally Known to Me or has
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