4250 Sharps Settlement Ln 04-262 temporary poleCITY OF SANFORD PERMIT APPLICATION
Permit #
40 b Address:
escription of
Historic District:
Date: if — 3 — d 3
Zoning: Value of Work: $
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 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)
e 3a-7-73 Llo-)-3a3 ia75
State License Number:
Phone & Fax: Contact Person: Phone:
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. 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 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 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 ma dditional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit s v cation that I will notify a ow r of the property of the requirements of Florida Lien Law, FS 713.
zwkeI/
Sig f Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name n Print Contractor/Agent's Name
2 * MY COMMISSION # CC 9" -808
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EXPIRES: P,rlarch 23 -
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3.031 APPLICATION
APPROVED BY: Bldg: Zoning: Special
Conditions: Signature
of Notary -State of Florida Date Contractor/
Agent is Produced
ID _ Utilities:
Initial &
ate) (Initial & Date) Personally
Known to Me or FD:
Initial &
Date) (Initial & Date)
CITY OF SANFORD BUILDING DIVISION
OWNERBUILDER 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 1 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 your own electrical contractor even though you do not have a license. You may install electrical
wiring for a farm 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 responsibility to make sure that people employed by you
have licenses required by state law and by county or municipal licensing ordinances.
e- b(J (2 CCL_ 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
allowedly law on the permitted structure.
1/3
Signature Date
nt Owner/Builder Name
1 1 3'03
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0lvner. s__.- ---Per-sanal N-KnowiTW-Me or has
Produced ID MCI 20