NASSAU COUNTY BUILDING DEPARTMENT MOBILE/MANUFACTURED HOME APPLICATION CHECKLIST

Permit # Ap# NASSAU COUNTY BUILDING DEPARTMENT MOBILE/MANUFACTURED HOME APPLICATION CHECKLIST New Replacement Single Wide Double Wide Triple Wide Quad Mftr d Add INSTRUCTIONS: Complete Section A only. Submit Section B documents for plans review and permitting. A. Property Identification Number: - - - - - Owner Home or Cell # Licensed Dealer/Installer Name Business or Cell Phone #: License#: B. Documents Needed for Permit Application Processing: (2) Approved Site Plan (8-1/2x11)with minimum tree Requirements shown (1) Blocking Plan (2) Signed and Sealed Foundation Plans (if conventional foundation used) (1) Recorded Warranty Deed (1) Driveway Permit-must be received before permit issuance (1) Recorded Notice of Commencement must be received before 1 st inspection (1) Residential Site Clearance Form (1) Single Land Split Application (1) Septic Permit/Letter from Utility Co. must be received before permit issuance (1)Letter/Receipt from water supplier must be received before permit issuance (1) Signed Replacement Affidavit if replacing existing mobile home (1) Signed and Sealed Elevation Certificate within 21 days after slab or foundation approved inspection. C. **Inspections can be requested Monday through Friday 8:00A.M.-4:00 P.M. to be scheduled for the next business day. Separate permits are required on Electrical, Plumbing, and Mechanical and Gas(if applicable) before inspections can be requested. Any additional information needed please contact the Building Department between the hours of 8:00 AM and 5:00 PM Telephone 904-530-6250 or 800-948-3364

Page 3 of 3 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 or I will be subject to additional requirements of section 109.4 of the 5 th Edition 2014 Florida Building Code. AFFIDAVITS WARNING TO OWNER: Your failure to record a Notice of Commencement may result in you paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before commencing work or recording your notice of commencement. A Notice of Commencement must be recorded and posted on the job site before the first inspection. If you are not the owner of the property being permitted, you must, by law (FS 713.135 ( c) ) promise to inform the fee simple titleholder that the property in question is being subjected to possible liens and/or attachment. OWNER S AFFIDAVIT: I CERTIFY THAT ALL THE FORGOING INFORMATION IS ACCURATE AND THAT ALL WORK WILL BE DONE IN COMPLIANCE WITH ALL APPLICABLE LAWS REGULATING CONSTRUCTION AND ZONING. OWNER NAME (PRINTED) OWNER SIGNATURE DATE BEFORE ME,, PERSONALLY APPEARED ON THIS DAY OF, 20 AND IS PERSONALLY KNOWN TO ME OR HAS PRESENTED AS IDENTIFICATION AND WHO DID (DID NOT) TAKE AN OATH. NOTARY PUBLIC NAME (PRINTED) NOTARY PUBLIC SIGNATURE DATE CONTRACTOR S AFFIDAVIT: I CERTIFY THAT ALL THE FORGOING INFORMATION IS ACCURATE AND THAT ALL WORK WILL BE DONE IN COMPLIANCE WITH ALL APPLICABLE LAWS REGULATING CONSTRUCTION AND ZONING. CONTRACTOR NAME (PRINTED) CONTRACTOR SIGNATURE DATE BEFORE ME,, PERSONALLY APPEARED ON THIS DAY OF, 20 AND IS PERSONALLY KNOWN TO ME OR HAS PRESENTED AS IDENTIFICATION AND WHO DID (DID NOT) TAKE AN OATH. NOTARY PUBLIC NAME (PRINTED) NOTARY PUBLIC SIGNATURE DATE

Residential Building Site Clearance Form A residential building site clearance form shall be completed and submitted with all applications for a new or replacement single-family or two-family residential homes, including mobile homes. No permit application for a new or replacement single-family or two-family home, including mobile homes, shall be accepted or processed without a Land Subdivision Authorization Form accompanying the Building Permit Application. NOTICE: In addition to the requirements of this form, 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. Required Attachments: [If all required attachments are not included, the Building Permit will not be processed] Copy of Deed: Engineering Services Access Form (as applicable) Copy of Instrument Creating the Building Site (other than a recorded plat or Lot of Record (Article 32 LDC)): Family Land Division Split Supplemental Material (see below) (as applicable) Homestead Exemption Split Supplemental Material (see below) (as applicable) Parent Tract One Time Split Supplemental Material (see below) (as applicable) Homeowners Association Materials Supplemental Material (see below) (as applicable) BP# Owner s Name: Address: City: State: Zip Code: Phone Number: E-Mail: Tax Parcel Number (PIN): Site Legal Description (attach additional sheet if necessary): Date building site was created: Deed is recorded in Official Records Book: Page: Instrument/Exemption Creating/ Appling to the Building Site: Platted Subdivision per Plat Book: Page: (provide copies of the following) Property/Homeowners Association Certificate of Incorporation in Official Records Rural Subdivision per Plat Book: Page: (provide copies of the following) Property/Homeowners Association Certificate of Incorporation in Official Records Minor Development Recorded in Official Records Book: Page: Family Land Division per 22.04(A)(2)(1) LCD (Provide copies of the following) Deed establishing ownership recorded in Official Records Book Page Survey/scaled exhibit depicting the parent parcel and each building site created from the parent tract since January 23, 2017 along with the date of creation and reference to each deed by Official Records Book and Page. The survey/exhibit shall include all applicable site data such as, but not limited to, gross and net area, jurisdictional wetlands, means of ingress and egress, any easements, all existing and proposed structures, and other material deemed necessary to adequately review the proposed division of land. Name of Grantor and Grantee with defined relationship One Time Land Split Application approval letter from the Department of Planning and Economic Opportunity 1

Residential Building Site Clearance Form Homestead Exemption per 22.04(A)(2)(2) LCD (provide copies of the following) Deed establishing ownership recorded in Official Records Book Page Proof of current Homestead Exemption Survey/scaled exhibit depicting the parent parcel and each building site created from the parent tract since January 23, 2017 along with the date of creation and reference to each deed by Official Records Book and Page. The survey/exhibit shall include all applicable site data such as, but not limited to, gross and net area, jurisdictional wetlands, means of ingress and egress, any easements, all existing and proposed structures, and other material deemed necessary to adequately review the proposed division of land. One Time Land Split Application approval letter from the Department of Planning and Economic Opportunity Parent Tract One Time Split Exemption per Article 32 LDC (provide copies of the following) Deed establishing the parent parcel as a Lot of Record per Article 32 LDC as recorded in Official Records Book Page Survey/scaled exhibit depicting the parent parcel and each building site created from the parent tract since January 23, 2017 along with the date of creation and reference to each deed by Official Records Book and Page. The survey/exhibit shall include all applicable site data such as, but not limited to, gross and net area, jurisdictional wetlands, means of ingress and egress, any easements, all existing and proposed structures, and other material deemed necessary to adequately review the proposed division of land. One Time Land Split Application approval letter from the Department of Planning and Economic Opportunity OWNER S AFFIDAVIT: I certify that all foregoing information is accurate. Print Owner s or Owner s Agent s Name Sign Owner s or Owner s Agent s Name State of Florida County of Signed and sworn before me on this day of, 20. By Identification verified: Oath sworn: Yes No Notary Signature My Commission expires 2 BP# Application checked for completeness by: Date:

HOMEOWNERS ASSOCIATIONS Reference Sec. 29-5.18.1 of the Nassau County Code of Ordinances Each Subdivision, including Rural Subdivisions, shall have a property/homeowners association that is responsible for the maintenance of roads, easements, amenities, and the appropriate documentation shall be provided that sets forth the by-laws and covenants of the property/homeowners association and the certificate of incorporation and shall be recorded in the public records of Nassau County prior to the issuance of a building permit. Articles of Incorporation Recorded in OR Book Page Declaration of Covenants, Restrictions and By-laws Recorded in OR Book Page I attest the above captioned information is true to the best of my Knowledge. Print Name: Signature: Date:

Nassau County Single Land Split Application Nassau County Department of Planning & Economic Opportunity 96161 Nassau Place Yulee, Florida 32097 Taco E. Pope, AICP Director APPLICATION AND INSTRUCTIONS FOR SINGLE LAND SPLIT The purpose of this application is to provide the requirements for a single land split in Nassau County according to the Land Development Code. This application may be used for the one-time parent tract split, for homestead land splits per 22.04(a)(2) LDC, and for family land divisions per 22.04(a)(1) LDC. The information herein is abbreviated from codified regulations. If any inconsistencies exist between this application and the codified regulations, the codified regulations take precedent. This application does not substitute for the review of codified regulations. Recommended Steps: 1. Submit a single land split application with all materials to the Department of Planning and Economic Opportunity. 2. The Department of Planning and Economic Opportunity and Engineering Services will review the materials and either approve the land split, or provide the applicant with comments regarding the requirements within fourteen (14) days of submittal. If the land split application is not approved, the applicant will have to re-submit their application with the required changes. 3. Once all comments have been addressed, the DPEO will provide the applicant with an approval letter. 4. After approval by DPEO and Engineering Services, the applicant will record the deed with the Nassau County Clerk of Courts. 5. The applicant or property owner may apply for building permits after the deed is recorded (The application must be approved by the DPEO prior to the issuance of a building permit new or replacement dwelling). Definitions: Lot of Record: Lot of Record: A lot which is part of a subdivision, the map of which has been recorded in the Office of the Clerk of the Circuit Court of Nassau County, or a parcel of land the deed of which was recorded in the Office of the Clerk of the Circuit Court prior to the adoption of this ordinance and which met the minimum Lot, Yard and Frontage requirements of Nassau County at the time the lot was created. (ref. Article 32 LDC) Parent Tract: refers to a Lot of Record that existed on January 23, 2017, the date of the Nassau County adoption of this ordinance, and will also mean, for the purpose of this ordinance, a parcel of land fronting on a publicly maintained road. A Parent Tract may be divided once without complying with the subdivision regulations provided the tract meets the minimum Lot and Yard requirements of the respective zoning district, does not exceed residential density limitations as defined in the Comprehensive Plan and meets the minimum Lot frontage requirements as defined in Section 28.03 LDC. Any further division of a Parent Tract shall be deemed to be a subdivision and must comply with the subdivision regulations. This provision does not apply to Lots created by a subdivision plat recorded with the Clerk of the Court of Nassau County via Plat Book and Page. An application to divide a parent tract, pursuant to this section, shall be submitted to the PEO on the provided form. The application to divide a parent tract shall be approved prior to the issuance of a building permit. (ref. Article 32 and Sec. 28.03 LDC) Homestead Land Split Exemption (22.04(a)(2) LDC): a. Land with a future land use map (FLU) designation of agricultural (parcels of property exceeding 320 acres in size as recorded on January 28, 1991): Twenty (20) acres. (2) May divide a maximum of two (2) parcels, a minimum of one (1) acre in area per calendar year, providing the property has been held by the current owner for a minimum of five (5) years and Homestead Exemption is current in the year(s) subdivided. Family Land Division (22.04(a)(1) LDC): a. Land with a future land use map (FLU) designation of agricultural (parcels of property exceeding 320 acres in size as recorded on January 28, 1991): Twenty (20) acres. (1) May be subdivided into minimum of one (1) acre parcels if occupied by members of the immediate family. 1

Nassau County Single Land Split Application Single Land Split Process The single land split process ensures that all new lots created are conforming lots approved by the Department of Planning and Economic Opportunity (DPEO) and Engineering Services (ES). This flow chart can be used for one-time parent tract splits, homestead landsplits, and family land divisions. No building permits will be issued without approval from the DPEO and ES. STEP 1 STEP 2 Submit the application and required materials to Department of Planning and Economic Opportunity (DPEO). The DPEO will distribute the materials to the necessary recepients The DPEO, Engineering Services and the County Attorney will review the application and materials. The DPEO will consolidate provide written comments within 14 days of receipt, or issue an approval letter Example of Materials that may be required: -Property Deeds: existing and proposed -Documents approved by the County Attorney -Survey STEP 3a -OR- STEP 3b If the application is denied the applicant may re-apply once all necessary changes have been made. The review process will take 14 days. The DPEO will provide the applicant with comments or an approval letter. If approved, record deed with the Clerks office After the deed is recorded, building permits may be applied for. Step 3a will continute until the land split complies with the Nassau County Code of Ordinances. Note: The application to divide (single land split application form) shall be approved prior to the issuance of a building permit (Article 32, LDC) 2

Nassau County Single Land Split Application Nassau County Department of Planning & Economic Opportunity Taco E. Pope, AICP 96161 Nassau Place Director Yulee, Florida 32097 Parcel Identification Number - Property Location Location or Address - Name: Property Owner Address: Telephone #: E-Mail: Name: Agent Address: Telephone #: E-Mail: (Owner Authorization Required, Separate Sheet) Brief Description of the Proposed Project 3

Nassau County Single Land Split Application 1. Required Attachments (this may not be a complete list, other items may be required): a. Application b. Certified Boundary Survey c. Legal description d. Deed showing ownership of the property e. Unrecorded deed for the proposed parcel f. Documents to be approved by the county attorney, as applicable 2. Applicant must address review criteria on page 6. Responses attached. Signature of Owner: Signature of Applicant: Signature of Agent: Address: Telephone: Fax: Email: NOTE: If prepared or signed by an agent, a notarized Agent Authorization Form must be provided. This application must be complete and approved by the Department of Planning and Economic Opportunity prior to the issuance of a building permit for a new or replacement dwelling. 4

Single Land Split Criteria: Nassau County Single Land Split Application A. A certified boundary survey of the proposed land split completed by a surveyor registered in the State of Florida. This survey shall indicate the individual lots/parcels within the property boundary. B. The minimum building setbacks and width required are those stipulated in the respective zoning district. C. The minimum required frontage for the zoning district. D. Location of access to parcels, including any access easements. Depiction of ingress and egress to the properties. E. Depiction of National Wetlands Inventory with twenty five (25) foot buffer. F. Minimum lot and yard requirements for the zoning district. G. The lot in question may not be established in an already existing plat. H. Hold harmless Agreement per 28.03(2)(b) LDC (as applicable) I. Affidavit per 28.03(2)(a) LDC(as applicable) J. Sufficient information for Engineering Services to review access including easements and any related data, including, but not limited to information related to existing roadways and development patterns. K. Future Land Use Map designation per the 2030 Comprehensive Plan L. Deed of the existing property, including the legal description. Use the metes and bounds description as shown on the deed or survey. A reference to the Township, Range, or Deed Book will not be sufficient; A.TXT file of the metes and bounds description of the boundaries of the property is required. Notes: Access Shall be approved through the Nassau County Engineering Services Department If any inconsistencies exist between this application and the codified regulations, the codified regulations take precedent. The division of land shall not been done in such a manner that a nonconformity is created. 5

Nassau County Single Land Split Application CONSENT FOR INSPECTION I,, the owner or authorized agent for the owner of the premises located at do hereby consent to the inspection of said premises by an employee of Nassau County, Florida, in conjunction with application, without further notice. Dated this day of, 20. Signature of Owner or Authorized Agent Telephone Number STATE OF FLORIDA: COUNTY OF NASSAU: The foregoing instrument was acknowledged before me the day of, 20, by who is personally known to me or who has produced as identification. Notary Public Signature Name (typed or printed) F. (Seal) 6

Nassau County Single Land Split Application OWNERS AUTHORIZATION FOR AGENT is hereby authorized TO ACT ON BEHALF OF, the owner(s) of those lands described within the attached application, and as described in the attached deed or other such proof of ownership as may be required, in applying to Nassau County, Florida, for an application related to Development Permit or other action pursuant to a: Rezoning/Modification Variance Appeal Concurrency Minor Development Conditional Use Preliminary Binding Site Plan Final Engineering Plan Plat Rural Subdivision BY: Signature of Owner Print Name Signature of Owner Print Name Telephone Number State of Florida County of Signed and sworn before me on this day of, 20. By Identification verified: Oath sworn: Yes No Notary Signature My Commission expires: 7