175 Bristol Forest Tr - BR18-004263 - WINDOWSi t.0_ 1090
OCT 18 2018
PERMIT APPLICATION
Application No:
Documented Construction Value: $ 1
Job Address: 135 Brn' 6I Fdres Tr"" 1
4 San-W ( FL ' JJ_711 Historic District: Yes NoEf
Parcel ID: Residential z Commercial
Type of Work: New Addition [Alteration Repair Demo Change of Use Move
Description of Work: a r\J L.A t tkt'V-1,N t o - S
Z (o-cdQ0
Plan Review Contact Person: J e M `JTitle: Phone: -
1- 30 5- 3 3 (0 G Fax: Property
Owner Information Name
Jecenny AACI tr Phone: 3 a I - 3 6S ` 33 6OD Street: %
S gr)°5.41 drQi+ bra Resident of property? City,
State Zip: San -( r A FL 3 a77 f Contractor
Information W- Name
Phone: Street:
City,
State Zip: Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Fax:
State
License No.: Architect/
Engineer Information Phone:
Fax:
E-
mail: 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 herebymade 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: 6' Edition (2017) Florida Building Code
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 1 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.
nature Owner/Age Date Signature of Contractor/Agent Date
Prin Owner/Agent's Name Print Contractor/Agent's Name
L"-ffl
Signatuixe of Wo4a -State o F on a a e i Signature of Notary -State of Florida Date
R p a;% ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My CopmEx it J 16 2018 Ownr/t ertt is ersoWa noWn t e or Contractor/Agent is Personally Known to Me or Produced
ID Type of I Produced ID Type of ID BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type: Occupancy Use: Flood Zone: Total
Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New
Construction: Electric - # of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire
Alarm Permit: Yes No WASTE
WATER: BUILDING:
am
c
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.
n I understand that building permits are not required to be signed by a property owner unless he or she is
Jl 1 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
A 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 withinI \ 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.
1 „ n
I V 1
I understand that, as the owner -builder, 1 must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
n /1 persons working on my building or residence. It is my responsibility to ensure that the persons whom I
employ have the licenses required by law and by 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 anyJ 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
n
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
I
V \ understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
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
JAN` 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
Jn that I am the party legally and financially responsible for the proposed construction activity at the address
V 1 listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
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
J 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
obtain 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.
Property Address: 175 3(
and capable of performing the requested
conditions specified above.
Own
f,-d . rr& 3 a 7 7/
do hereby state that I am qualified
construction involved with the permit application filed and agree to the
Form of Identification DF) ir2T5 L_tr` q_ASe
Must be Photo ID)
b I6 k
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
rullil IILLF.1I W W W•JLYYlIl I.VIII.II..'IVV-OF'J.V..... "IllklhlI . -.. Weathermaster
Building Products Inc. INVOICE WEATIIERMASTER
112
Central Park Place 2016-08-1211:04:26 \ NVIN
OWS 6 I)OORs Sanford, FL 32771 kayla
i
91winys. 407)
324-2080 CusCode
Invoice# Order# Invoice Date Ship VIA PO? Sales Tax Terms 0086
105417 305837 2016-08-12 Purchase TAX USEN15 Sold
To: Job Info: CASH
FLORIDA
ENGINEERING SOLUTIONS
JEREMY
MEYER RES. 175
BRISTOL FOREST TR. SANFORD,
FL Cust
Phone# Cust Fax# Sales Person Job Contact Job Phone DG
PO
Num Project
Subdivision Lot Model 175
BILL
TO: 12620
CURLEY ST. SUITE 105 SAN
ANTONIO FL 33576 Line
Room Qty Full Description for Item 10
1 WINDOWS INSTALLED INCLUDES DEMO/REMOVAL AND REINSTALLATION 30
1 MATERIALS Materials
Installation Grand Total 70.
62 $ 367.65 $ 438.27 33
of 112 8/12/2016 2:50 PM
Fonn http://www.surefireon] ine. net/csp/sfon Iine/App.DocCommon.ISS. For...
Weathermaster Building Products Inc. INVOICE
112 Central Park Place 2016-04-26 09:31:32
wEAThERMASTER Michelle
WINDOWS & DOORS Sanford, FL 32771twiHaAm.M.yy,.vin..
407) 324-2080
CusCode Invoice# Order# Invoice Date Ship VIA PO? Sales Tax Terms
0086 104539 305838 2016-04-29 Purchase TAXUSE ,
N15
Sold To: Job Info:
CASH
FLORIDA ENGINEERING
SOLUTIONS
JEREMY MEYER RES.
175 BRISTOL FOREST TR.
SANFORD,FL
Cust Phone# Cust Fax# Sales Person Job Contact Job Phone
DG
Lot
175
BILL TO:
12620 CURLEY ST. SUITE 105
SAN ANTONIO FL 33576
Line Room Qty Full Description for Item
10 2 WINDOWS INSTALLED INCLUDES DEMO/REMOVALAND REINSTALLATION
20 1 PERMITTING
30 1 MATERIALS
Materials Installation Grand Total
593.38 $ 735.30 $1,328.68
1 of 1 4/26/2016 9:47 AM