Permit # Ap# NASSAU COUNTY BUILDING DEPARTMENT MOBILE 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 (1) Septic Permit/Letter from Utility Co. minimum tree Requirements shown must be received before permit issuance (1) Blocking Plan (1)Letter/Receipt from water supplier (2) Signed and Sealed Foundation must be received before permit issuance Plans (if conventional foundation (1) Signed Replacement Affidavit if replacing used) existing mobile home (1) Recorded Warranty Deed (1) Signed and Sealed Elevation Certificate (1) Driveway Permit-must be received within 21 days after slab or foundation before permit issuance approved inspection. 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 on Electrical, Plumbing, and Mechanical and Gas(if applicable) before inspections can be requested. BUILDING ELECTRICAL PLUMBING MECHANICAL Footer(if applicable) Final Final Final Slab(if applicable) Mobile Home tie down GAS within 30 days of Final(if applicable) permit issuance Final Certificate of Occupancy 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 1 of 3 Permit # AP # Revised 12/31/17 Cost Check # Receipt # MOBILE HOME PERMIT APPLICATION (NOTE: Separate Permits are Required for Electrical Mechanical and Plumbing Installations) I hereby certify that there are no other structures (other than this mobile home) that would allow for an individual to reside within and that are located on this property for which the permit application is being submitted. Yes there is No there is not Are there other structures (barn, shed, etc.) located on this property? No Yes How Many? Property Identification Number: - - - - - Physical Address (Placement Site): Subdivision City: State: Zip Code: Specific Directions to Site: Owner s Name (Please Print) Date Phone Number: Day ( ) Alternate ( ) Owner s Present Address: City: State: Zip Code Agent s Business Name (Please Print) Date Name of Agent Agent s Business Address: City: State: Zip Code Phone Number ( ) Mobile/Beeper ( ) Fax ( ) INSTALLER INFORMATION Name of Licensed Dealer/Installer: Address: City: State: Zip Code: License Number: Phone #: Installation Standard Used: (Check One) Manufacturer s Manual 15C-1 MOBILE HOME CHARACTERISTICS (Check ) New **Replacement Single Wide Double Wide Triple Wide Quad Mftr d Add ** Existing mobile/manufactured home must be removed from the premises within 30 days of issuance of Certificate of Occupancy ** Year/Make: Serial Number: Size (width/length): Color/Trim: # of Bedrooms: # of Bathrooms: Wind Zone II sticker: Yes No A/C Window Unit Yes No
AP # Page 2 of 3 SITE PREPARATION Debris and Organic Material Removal: Compacted Fill: Water Drainage: Natural: Swale: Pad: Other: FOUNDATION Blocking Plan Submitted (on frame foundation) with application?: Yes No I-Beam Pier Supports: 1780 Lbs. 2775 Lbs. Load Bearing Soil Capacity: or Assumed 1000 PSF: If conventional foundation (off frame) is used a separate application with signed and sealed plans is required. UTILITIES Water Supply: Electric Company: JEA City NAU Private FPL REA FPU Other (Describe): Sewage Supply: JEA City NAU Private Other (Describe): NOTE: If existing septic system, 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 DRIVEWAY INFORMATION Is the primary access to the property, for which the permit application is being submitted, utilizing an easement? No Yes IF YES, A COPY OF THE RECORDED EASEMENT MUST BE SUBMITTED WITH THIS APPLICATION. HOW MANY DWELLINGS, INCLUDING THIS ONE, WILL USE THIS EASEMENT FOR ACCESS? Is it an existing or new easement? Existing New Recorded Private Easement (Date of Recording ) County Road State Highway Private Street/Road
AP# Page 3 of 3 Application is hereby made to obtain a permit to do the work and installations as indicated. I verify 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 recording your notice of commencement. A Notice of Commencement must be recorded and posted on the job site by the first inspection. 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
ATTENTION MOBILE HOME INSTALLERS Nassau County is reaffirming the codes & set up standards required for Mobile Home installations. Please ensure your set-up crew I subcontractors are made aware of this to prevent reinspection fees and delays in obtaining the final inspection & C.O. Most common corrections are : 1. Anchor holes must have soil firmly repacked in 6" increments around stabilizer plates and ground anchors. ( 15C-1 Set up Standards) 2. 4" High 911 assigned address numbers are required on MIH & mailbox or post at roadway. ( 6 th Edition (2017) FBC Residential R319.1) 3. No. 8 Cu. Bonding wire is required between chassis of double & triple wide MIH ( 2014 N.E.C sec. 550.16(c) 4. Ground rod clamps must be uncovered for inspection on grounding electrodes. ( 2014 N.E.C. sec. 250.53(g) & 250.68(a) ) 5. Heat pump I condensing units must be 3" min. above finished grade & properly strapped or anchored. ( 6 th Edition(2017) FBC Residential sec. M1305.1.4.1 & M1307.2) 6. Provide 4" clearance from earth on all duct work. (6 th Edition (2017) FBC Residential sec. M1601.4.7) or as per manufactures installation instructions. Thanks, Building Dept. Staff 12/31/17
MOBILE HOME REQUIREMENTS Installer is required to install State Certification Label per f.s. 320.827 on mobile home HUD sticker/permanent plate. Up to a $1,000.00 State fine if found in violation per f.s. 320.831. Mobile Home to be unlocked to inspect four-wire connection in electrical panel for isolated neutral. Mobile Home Manufacturers set-up manual to verify proper set-up and installation to be at site. Data plate for wind zone requirements must indicate wind zone II or III in the State of Florida. (Wind zone I is not allowed within the State of Florida.) Water lines installed and insulated at all crossovers. Electrical Power Pole installed per Nassau County requirements Underground wiring in conduit at 18 depth Direct burial at 24 in depth. (Uncovered for required inspection) Grade under Mobile Home level and graded to direct water away from unit. Anchor requirements 3150 lb. To 4725 lb. Uplift 48 min. 4000 lb. To 6000 lb. Uplift 57 min. (Per Department of Highway Safety & Motor Vehicles Mobile Home installation standards Section 15C- 1.0104-Revision 406) Anchors must be flush with and not extended above grade. Stabilizer plates required on all tie downs, except over the roof tie downs. Entry stairs and landings at main doorway to comply with FBC Code, Section 1009. SEE ATTACHED DIAGRAM FOR ADDITIONAL REQUIREMENTS FOR MOBILE HOMES INSTALLED IN SPECIAL FLOOD HAZARD AREAS Exterior mounted equipment (AC Compressor Well Pump) elevated to BFE by use of decay resistant platform and must be properly secured. Revised 12/31/17