Permit # Ap# NASSAU COUNTY BUILDING DEPARTMENT SWIMMING POOL & POOL SCREEN ENCLOSURES CHECKLIST Swimming Pool Pool screen enclosure Other INSTRUCTIONS: Complete Section A only. Submit Section B documents for plans review and permitting. A. Property Identification Number: - - -_ - -_ Owner Home or Cell # Contractor s Name Business or Cell Phone #: License#: B. Documents Needed for Permit Application Processing: (2) Approved Site Plan (8-1/2x11) (1) Recorded Notice of Commencement showing septic system & drainfield must be received by 1 st inspection (2) Signed & Sealed Construction Plans (1) Owner/Builder Affidavit if applicable (1) Recorded Warranty Deed _ (2) Screen enclosure footer detail (1) Permit Subcontractor List C. Inspections Required: **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 Electrical, Plumbing, before inspections can be requested. BUILDING/POOL Pool Steel-500 Pool Decking-501 Pool Safety -505 Final Inspection -999 ELECTRICAL SCREEN ENCLOSURE Pool Electrical-240 Final - 999 Electrical Final-299 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
Permit # AP # PAGE 1 of 3 Revised 12/31/17 Cost $ Check # Receipt # NASSAU COUNTY BUILDING PERMIT APPLICATION SWIMMING POOLS, POOL ENCLOSURES 6 TH EDITION (2017) OF THE FLORIDA BUILDING CODE IS IN EFFECT Are there other structures (barn, shed, etc.) located on this property? No Yes How Many? Property Identification Number: - - - - - Job Site/Property Address: City: State: Zip Code: Job/Project Name Specific Directions to site Owner s Name (Please Print) Phone: Day ( ) Alternate: ( ) Owner s Present Address: City: State: Zip Code Fee Simple Titleholder s Name (if other than owner) (Please print) Fee Simple Titleholder s Address (if other than owner) City: State: Zip Code: Contractor Business Name (Please Print) Name of Licensed Contractor Contractor s Business Address: City: State: Zip Code: State Certification or Registration # Phone # ( ) Mobile/Beeper ( ) Fax # ( ) Architect/Engineer/s Name(Please Print) Architect/Engineer s Address City: State: Zip Code:
Page 2 of 3 Bonding Company Name:(Please Print) Bonding Company Address: City: State: Zip Code Mortgage Lender s Name:( Please Print) Mortgage Lender s Address: City: State: Zip Code: Type of Construction: New Addition Remodel/Repair Deck Footer Screen Enclosure Footer (Must provide screen enclosure footing detail) SPECIFIC DESCRIPTION OF WORK: Above-Ground Pool In-Ground Pool Estimated Construction Cost $ Pool Screen Enclosure Sq Footage Estimated Construction Cost $ UTILITIES Water Supply: Electric Company: JEA City NAU Private FPL REA FPU Other (Describe): Sewage Supply: JEA City: NAU Septic System: Other (Describe): (If septic, show location of septic and drain field on site plan). Please contact the Nassau County Health Department for review before submitting application to the Building Department 904-875-6100
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 6 th Edition 2017 Florida Building Code. 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. I HAVE RECEIVED WRITTEN INFORMATION FROM THE CONTRACTOR ON POOL SAFETY, ALARMS AND BARRIERS AS SET FORTH IN FLORIDA STATUTES 515.33 AND 515.31 AND 6 th Edition 2017 Florida Building Code, SECTION 454.2.17. (SUPPLEMENTIAL INFORMATION MAY BE OBTAINED AT NASSAUFLBUILDING.COM.) 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