1000 Cypress Ave 11-361 (roof)RECE'll/�r
NO V 2 2 20 r0
` CITY OF SANFORD
! BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: _ L 6 I Documented Construction Value: $
'-"Job Address: ,/ (� �j (, ��Z_„ — Historic District: Yes ❑ No ❑
Parcel ID• Zoning:
Description of Work: _ T� - _Far_c� _N1, ,1
Phone: Fax: E-mail:
Name
Street: /0 �>
City, State Zip:
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
P operty Owner Information
Phone: �/( f '�
Resident of property?
Contractor Information
Phone:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage bender:
Address: .
PERMIT INFORMATION
Building Permit ❑
Square Footage: Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical ❑ Plumbing
New Service — No. of AMPS: New Construction - No. of Fixtures:
(Mechanical 11 (Duct layout required for new systems) Fire Sprinkler/Alarm ❑ No. of heads:
0
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. A NOTICE
i OF COMMENCEMENT MUST BE RECORDED AND POSTE— ON -THE XCWSI`>f`L�RE-FO` — HE
FIRST INSPECTION. 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.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
- -/!J
Sign Lure of weer/ t Date
e
Le
Print er/Agent' a e
I (2,2-[('-C)
Signature of Notary -State of Florida Date
Owner/Agent is
Produced ID
APPROVALS:
COMMENTS:
Type
Signature of Contractor/Agent Date
ENGINE FIRE:
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
i
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 appiiea ror
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
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
t
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.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
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. 1, as an owner -builder, may be held liable and subjected to serious financial risk for any
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.
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.my lorida.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
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
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:
I, 1
and 4capable of f
conditions speci
Form of Id
do hereby state that I am qualified
rming the requested construction involved with the permit application filed and agree to the
above.
(Must be Photo ID)
ate
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
Seminole County Property Appraiser Get Information by Parcel Number
Page 1 of 1
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VALUE'SUMMARY
`
2011
2010
VALUES
-
Working
Certified
GENERAL
Value Method
Cost/Market
Cost/Market
Parcel Id: 25-19-30-5AG-120A-0010
Number -of Buildings
2
.2
Owner: ALEXANDER SHIRLEY &
Depreciated Bldg Value
.; : $31,084
$32,699
Own/Addy: GIBSON IRMA
Depreciated EXFT'Value
_ $461
$461.
Mailing Address: 2976 TRUMAN BLVD
Laod Value (Market)
$11,250
$11,250
City,State,ZipCode: SANFORD FL 32771
Land Value Ag
- $0
..
$0
Property Address: 409 10TH ST E SANFORD 32771
Just/Market Value
" $42,795
$44,410
Subdivision .Nam e: SANFORD TOWN OF
Portablity Adj
$0
$0
Tax Districts S1-SANFORD
Save Our Homes Adj
- $0
$0
Exemptions:
Dor: 01-SINGLE FAMILY
Amendment 1 Ad j
,,- $0
$0
Assessed Value (SOH)
$42,7951
$44,410
Tax
Estimator
2011 TAXABLE VALUE WORKING ESTIMATE
Taxing Authority
Assessment Value
.Exempt Values _
Taxable Value
County General Fund
$42,795
$0
$42,795
(Amendment 1 adjustment is not applicable to school assessment) Schools
$42,795
s0
$42,795
City Sanford
$42;795
$0
$42195
SJWM(SaintJohns Water Management)
$42,795
$0
$42,795
County Bonds
$42,795
$01
$42,795
The taxable values and taxes are calculated using the current years working values and the prior years approved millage rates.
2010 VALUE'SUMMARY
SALES
2010 Tax Bill Amount:
$892
Deed. Date Book Page Amount Vaclimp Qualified
2010 Certified Taxable Value and Taxes
Find Comparable Sales within this Subdivision
DOES NOT INCLUDE NOWAD VALOREM ASSESSMENTS .
LAND
LEGAL DESCRIPTION
Land Assess Method Frontage Depth Land Units Unit Price Land Value
PLATS: Pick ��'
FRONT FOOT & DEPTH 50 117 .000 225.00 $11,250
LEG LOT 1 BLK 12 TR A TOWN OF SANFORD PB
1 PG 56
BUILDING INFORMATION
Bid Num Bid Type Year Bit Fixtures Base SF Gross SF Living SF Ext Wall Bid Value Est. Cost
New
Buildinq 1 SINGLE FAMILY 1930 3 630
Sketch
782 782 SIDING AVG $15,398
$38,495
Appendage / Sgft ENCLOSED PORCH FINISHED / 152
NOTE: Appendage Codes included in Living Area: Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished,Base'
Semi Finshed
Building 2 SINGLE FAMILY 1930 3 700
Sketch
860 860 SIDING AVG $15,686
$39,214
Appendage I Sqft ENCLOSED PORCH FINISHED / 160
NOTE: Appendage Codes included in Living Area: Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished,Base
Semi Finshed
EXTRA FEATURE
Description Year Bit Units EXFT Value Est. Cost New
ALUM CARPORT NO FLOOR 1980 288
$461 $1,152
NOTE:" Assessedvalues shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes.
*** If, ou'recentl urchased a homesteaded property your next ear's property tax will be based on,JustA4arket value.
http--//www.scpafl.org/web/re—web.seminole county__title?parcel=2519305AG12OA00IO..., 11/22/2010