HERNANDO COUNTY PERMIT APPLICATION PACKET USED MOBILE HOME

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HERNANDO COUNTY
PERMIT APPLICATION PACKET
USED MOBILE HOME
Introduction
This is an application for a building permit for the placement of a USED mobile home in Hernando
County. The minimum living area for mobile homes is 600 square feet, and the minimum width is 12
feet (Ordinance 85-4 and 85-19). All used mobile homes must be inspected before a building permit
can be issued to ensure that the mobile home meets the minimum code standards.
All items listed in the Checklist must be submitted with your completed application. Your application
cannot be processed if any one of the items listed is incomplete or missing. An application for any
proposed work becomes void if not picked up within 180 days.
There is a non-refundable administrative review fee to be paid at the time your application is
submitted. This fee will be credited toward the cost of your permit, if the application is approved.
Many of the forms required to be submitted with this permit application are required to be notarized.
Notary services are available in our office. Fees for notary services are included in the non-refundable
administrative review fee.
Mobile Home Pre-Inspection
All used mobile homes must have a pre-inspection to ensure that the mobile home meets the
minimum code standards. A “Mobile Home Pre-Inspection” form is included with this application, and
must be submitted with your building permit application. In addition to the administrative review fee, a
pre-inspection fee will be due at the time the permit application is submitted. The pre-inspection fee is
not credited toward the cost of the building permit. Upon payment of the required fees, your
application will be processed, and you will be contacted when the review has been completed to
schedule the pre-inspection. Pre-inspections are done by a Development Services Inspector or by a
State Certified mobile home dealer or engineer.
Impact Fees
You may be required to pay an impact fee when the permit is issued. An impact fee is a one-time
assessment placed on all new development or construction.
Deed Restrictions
The Hernando County Development Department does not enforce deed restrictions. It is the
owner/contractor=s responsibility to verify any deed restrictions that may apply to the property. Copies
of your deed restrictions may be obtained from the Hernando County Recording Office.
Notice of Commencement
If the valuation of the job is greater than $2,500, a NOTICE OF COMMENCEMENT (NOC) must be
recorded at the Hernando County Recording Office and posted on the job site. A certified copy of the
recorded NOC must be mailed, faxed, or hand delivered to the Development Department prior to
issuance of the building permit. Please read the important information on the Construction Lien Law
included with this packet.
Inspections
A list of required inspections will be given to you when your permit is issued. It is the contractor=s
(owner/builder=s) responsibility to ensure that all required inspections are made prior to proceeding
with work on projects. You must call for a final inspection within ten (10) working days of completion
of your project. Final inspections that have been red tagged must be reinspected within seven (7)
working days. All red tag fees must be paid prior to final inspection. Upon issuance of your permit,
work must begin within 180 days. If work is not begun within 180 days from permit issuance, or work
is suspended or abandoned for a period of 180 days, your permit will become inactive and will be
void. Be advised that lack of inspection activity for a 180 day period is considered suspension or
abandonment of the permitted work.
Additionally, it is the contractor or owner/builder=s responsibility to ensure corrections are made to
items that have been red tagged, the red tags paid, and re-inspections performed and approved prior
to proceeding with work. Red tags must be recalled for inspection and paid, if applicable, within seven
(7) working days. Failure of the contractors or owner/builders to request and receive re-inspections
before proceeding with additional work may result in disciplinary action or a fine against the contractor
or owner/builder.
Thirty days after the last final inspection has been completed, inspectors will make a site
inspection on right-of-way sod, final driveway compliance, skirting, landscaping and
compliance with mobile home removal, if needed.
Permit Expiration
A valid permit may be extended past the 180 day time frame if an extension is requested in writing
and justifiable cause has been demonstrated. Additional fees apply for an extension of the permit.
Inactive permits must be reactivated before work may continue under the permit. Additional fees
apply for reactivating a permit. A building permit is only valid for a period of 2 years from date of
issuance. Any permit not finaled or voided within 2 years is expired. Construction work not completed
pursuant to an expired permit shall be re-permitted, and additional fees will apply.
Hernando County Development Department
789 Providence Boulevard
Brooksville, Florida, 34601
(352)754-4050 | Fax: (352)754-4416
HERNANDO COUNTY
PERMIT APPLICATION CHECKLIST
USED MOBILE HOME
The following items are required with submission of your building permit application:
APPLICATION:
• Building Permit Application filled out completely.
• Key Number of property. This can be found on your tax bill. If this is a newly created parcel,
you will need to contact the Property Appraiser=s Office at (352)754-4190.
• Owner/Builder Disclosure Statement (attached with this packet).
• If this is rental property, a copy of the recorded lease agreement and a notarized authorization
letter from the property owner are required.
• Conditional Affidavit for Certificate of Occupancy (attached with this packet).
• Copy of Septic Tank Permit or copy of Hernando County Utility Department deposit receipt (if
applicable).
• Title of Mobile Home.
• Two copies of the Landscape Design Worksheet.
• Addressing Receipt.
• Notarized subcontractor affidavits from the electrical, plumbing, mechanical, and aluminum
subcontractors stating that they are doing the work for this job, or you may submit the
ASubcontractor Signature [email protected] attached with the application. Owner/Builder permits also
require a notarized subcontractor affidavit from the licensed mobile home set-up
contractor.
PLANS:
• Two (2) Copies of:
• Pocket Penetrometer Test Report
• Mobile Home tie-down manufacturing, size, and type from approved list
•
Two (2) floor plans from Mobile Home Manufacturer with engineering for:
• Pier/Location
• Footing Size
• Tie-Down Location
• Lateral Tie-Downs
• Longitudinal Tie-Downs or Approved Alternate System
• Mobile Home Size
ZONING:
• Two (2) site plans using County site plan form or survey only. Site plan must:
• Be drawn in blue or black ink only.
• Be drawn to scale.
• Show any lake, canal, or river frontage.
• Show property dimensions, shape and size.
• Show all existing and proposed structures and their dimensions, and identify them. Be
sure to include the size of the proposed mobile home.
• Show ALL street frontages (corner lot, double frontage, etc.)
• Show distances in feet and inches from all property lines to all structures.
• Show any driveway on site plan.
• Show all easements (utility, drainage, ingress/egress, conservation, etc.)
• Show all surrounding golf courses.
• Two (2) completed copies of the Landscape Design Plan.
• Legal description of your property (subdivision name, lot, block, unit).
• A copy of your recorded deed for the property when not located in a platted subdivision or
when the property has been divided.
• Proof of legal access to a County maintained road.
• If the proposed residence is a replacement of an existing residence, you must provide proof
(letter from Property Appraiser=s Office or equivalent) that the residence was existing on the
property prior to 1986 to the present time.
• If your property is in either a V or A zone, or in a flood way, a sealed grade elevation survey is
required. In the V zone, the construction plans must be certified by an architect or an engineer
and be submitted with a V zone construction certificate.
Hernando County Development Department
789 Providence Boulevard
Brooksville, Florida 34601
(352)754-4050  Fax: (352)754-4416
HERNANDO COUNTY DEVELOPMENT DEPARTMENT
Used Mobile Home Pre-Inspection Instructions/General Information
1. A pre-inspection will be required on any used mobile home proposed to be set up in Hernando
County before a building permit will be issued. You must complete the AMobile Home PreInspection [email protected] and submit it with your completed building permit application.
2. In addition to the $280 advanced payment towards your building permit, you will be required to
pay a $50 pre-inspection fee. Both fees are due at the time your permit application is
submitted. The pre-inspection fee is a separate fee, and is not credited toward the total cost of
your building permit.
3. Upon payment of the above fees, your permit application will be reviewed for compliance with
adopted zoning regulations and building codes. Once your permit has been reviewed and is
ready to be issued, you will be contacted by one of our plans examiners to schedule a time for
the pre-inspection.
4. Once the pre-inspection has been completed and it has been determined that the used mobile
home meets all minimum code standards, your building permit can be issued.
5. After you have picked up your building permit, you may proceed with moving the unit onto the
property and setting it up.
NOTE: A sample of the mobile home pre-inspection checklist used by our inspectors is attached for
your information.
Hernando County Development Department
789 Providence Boulevard
Brooksville, Florida 34601
(352)754-4050  Fax: (352)754-4416
MOBILE HOME INSPECTION SCHEDULE
In order for our Building Division to operate smoothly and more effectively, the following sequence will be used
when calling for inspections. The Block and Tie-Down inspection must be complete prior to calling for
remaining inspections. Skirting shall not be installed at the time of the Block and Tie-down, Final Plumbing,
Final Electric, Final Gas and Final A/C (mechanical) inspections.
1. Block and Tie-Down - The Block and Tie-down inspections must be completed before the
skirting is installed.
2. Final Plumbing - Water supply ditch needs to be left open, will also check septic connection. Used
mobile homes will require access inside unit to check required minimum facilities. The Final Plumbing
Inspection must be completed before the skirting is installed.
3. Final Electric - Will require access into unit to check main electric panel box and will include electric
hook-up to well, if any. All exterior doors shall have permanent or construction stairs and stoop. The
Final Electric Inspection must be completed before the skirting is installed.
4. Final A/C (Mechanical) - All duct work must be 6 inches off the ground and secured with proper
strapping. All metal must be insulated and covered so the metal does not show. All connections must
be completed. The unit must have be anchored on approved pad per code. The Final A/C Inspection
must be completed before the skirting is installed.
5. Rough Driveway - A rough driveway inspection is required prior to the Final Mobile Home
inspection.
6. Final Mobile Home - The following items will be checked on the Final Mobile Home Inspection.
A. All exit doors lock properly.
B. Steps, handrails and a stoop at all exit doors. Stoop - a 3' x 3' minimum platform at every exit
door. (Handrails are required if there are more than three risers)
C. House numbers 4" in height to be installed on mobile home.
All mobile homes within a Flood Zone area must submit a sealed elevation certificate certified as
finished construction to the Development Department=s Zoning Division prior to the block and tie-down
inspection. Mechanical equipment and components must also be elevated above the Base Flood
Elevation.
REMINDER:
A list of required inspections will be given to you when your permit is issued. It is the contractor=s
(owner/builder=s) responsibility to ensure that all required inspections are made prior to proceeding with work
on projects. Upon issuance of your permit, work must begin within 180 days. If work is not begun within 180
days from permit issuance, or work is suspended or abandoned for a period of 180 days, your permit will
become invalid and will be void. Be advised that lack of inspection activity for a 180-day period is considered
suspension or abandonment of the permitted work.
Additionally, it is the contractor or owner/builder=s responsibility to ensure corrections are made to items that
have been red tagged, the red tags paid, and re-inspections performed and approved prior to proceeding with
work. Failure of the contractors or owner/builders to request and receive re-inspections before proceeding with
additional work may result in disciplinary action or a fine against the contractor or owner/builder.
Thirty days after the last final inspection has been completed, inspectors will make a site inspection on
right-of-way sod, final driveway compliance, skirting, landscaping and compliance with mobile home
removal, if needed.
Hernando County Development Department
789 Providence Boulevard
Brooksville, Florida 34601
(352)754-4050  Fax: (352)754-4416
FLORIDA=S CONSTRUCTION LIEN LAW
Florida Department of Agriculture and Consumer Services
Things You Should Know Before Starting
The most frequently cited complaints concerning home remodeling, home improvements and home repair are
cost overruns, missed deadlines and inferior workmanship. Another persistent problem is [email protected]
contractors who take deposits or payments before finishing or starting work.
When you need something done to your home, choose a contractor carefully. Be wary of door-to-door
salespeople and telephone solicitors promising [email protected] bargains. Make sure your contractor is
properly licensed and insured.
The Construction Lien Law is complex and cannot be covered completely in this information. We recommend
that whenever a specific problem arises, you should consult an attorney.
To register a complaint or to learn if complaints have been filed against a prospective contractor, call:
Florida Department of Agriculture and Consumer Services………………………………………..1-800-HELP FLA
Florida Department of Professional Regulation……………………………………………………….1-800-342-7940
Local Better Business Bureau……………………………………………………………………..Check Local Listings
To check on a contractor=s license:
Florida Department of Professional Regulation……………………………………………………….1-800-342-7940
Hernando County Contractor Licensing………………………………………………………………….352-754-4050
Florida law allows people who work on your property or provide construction materials and are not paid to
enforce their claim for payment against your property. This claim is known as a construction lien.
That sounds fair - most people expect to pay for work done by others. Not one wants to pay twice, though. Or
worse yet, lose their home! That=s a very real possibility, however, if you aren=t familiar with Florida Statute
713, also known as the AConstruction Lien [email protected]
The statute states that Athe right, title, and interest of the person who has contracted for the improvement may
be subject to attachment under the Construction Lien [email protected] This means that your property may be sold against
your will in a court proceeding if a lien is filed on your property as a result of an unpaid bill for labor, materials
or other services performed in connection with the improvement of your property.
This document explains State Statute 713 as it pertains to home construction and remodeling, and provides
tips on how you can avoid construction liens on your property.
■ PROTECTING YOURSELF
If you hire a contractor and the improvements cost more than $2,500, you should know the following:
•
•
•
•
•
You may be liable if you pay your contractor and he then fails to pay his suppliers and subcontractors.
There is a way to protect yourself: a “Release of Lien” is a written statement which removes your
property from the threat of lien. Before you make any payment, be sure you receive this waiver
covering the materials used and work performed.
If your contract calls for partial payments before the work is completed, get a APartial Release of [email protected]
covering all workers and materials used to that point.
Before you make the last payment to your contractor, obtain an affidavit that specifies all unpaid
parties who performed labor, services or provided materials to your property. Make sure that your
contractor obtains releases from these parties before you make the final payment.
Always file a Notice of Commencement before beginning a home construction or remodeling project.
The local authority that issues building permits is required to provide this form. You must record the
form with the Clerk of the Circuit Court of the county where the property being improved is located.
Also post a certified copy at the job site. (In lieu of a certified copy, you may post an affidavit stating a
Notice of Commencement has been recorded. Attach a copy of the Notice of Commencement to the
affidavit.)
The Notice of Commencement notes the intent to begin improvements, the location of the property, description
of the work and the amount of bond (if any). It also identifies the property owner, contractor, surety, lender and
other pertinent information. Failure to record a Notice of Commencement or incorrect information on the Notice
could contribute to having to pay twice for the same work or materials. It could also prevent the property from
passing code inspection.
■ WHOSE RESPONSIBILITY IS IT TO GET THESE RELEASES?
You can stipulate in the agreement with your contractor that he must provide all releases of lien. If it is not a
part of the contract, however, or you act as your own contractor. YOU must get the releases.
If you borrow money to pay for the improvements and the lender pays the contractor(s) directly, instruct the
lender to get releases before making any payments. If your lender then fails to follow the legal requirements, it
may be responsible to you for any loss.
NEVER MAKE a payment without receiving a RELEASE!
■ WHAT CAN HAPPEN IF YOU DON=T GET RELEASES OF LIEN?
You will not be able to sell your property unless all outstanding liens are paid. Sometimes a landowner can
even be forced to sell his property to satisfy a lien.
■ WHO CAN CLAIM A LIEN ON MY PROPERTY?
Contractors, laborers, material suppliers, subcontractors and professionals such as architects, landscape
architects, interior designers, engineers or land surveyors all have a right to file a claim of lien for work or
materials. Always get a release of lien from anyone on this list who does work on your home.
■
ADDITIONAL TIPS ON HOME CONSTRUCTION
•
•
■
If you intend to get financing, consult with your lender or an attorney before recording your Notice of
Commencement.
Insist that the contractor/remodeler secures a building permit and adheres to all building codes and
ordinances.
INFORMATION ALL CONSTRUCTION CONTRACTS SHOULD CONTAIN:
The contractor=s name, address, telephone number and contractor=s license number.
A precise description of work and materials to be supplied. The contract should specify the grade of
construction, flooring and trim materials to be used. Don=t accept the phrase Aor [email protected]; the
contract should specify appliance models and alternates for models not available.
•
A completion date.
•
A complete list of companies or individuals supplying the contractor with labor or materials. Be sure
they are insured so you are protected against theft or damage to their supplies or work.
•
Financing information and the payment schedule.
•
All necessary building permits or licenses.
•
Agreement regarding site clean-up and debris disposal.
•
All warranty agreements.
Ask for explanations and clarifications of legal terms or confusing language. Be sure you understand
completely what you are signing before you sign, AND REMEMBER, promises are difficult to enforce unless
they are in writing. Even in small jobs, have a written contract spelling out the details. Be wary of anyone who
says, AWe don=t need to bother putting it in [email protected]
•
•
Some contractors require a down payment of 20-30% of the total and an additional payment at the halfway
point. Pay only when the work is done to your satisfaction and you have releases of lien as described earlier in
this pamphlet. If the completion date is critical, like a swimming pool planned for summertime use, link payment
to on-time performance. Changes to a contract after construction has begun can cost you. Specify in the
contract how changes are to be handled.
■ CANCELLATION OF CONTRACTS
Some home repair/improvement contracts can be canceled in writing (preferable by certified mail), without
penalty or obligation by midnight of the third business day after signing. They include:
•
•
•
Those signed anywhere other than the seller=s normal place of business.
Those signed as a result of door-to-door solicitation except emergency home repairs.
Those paid on an installment basis.
Other contracts are binding as soon as they are signed, so be sure before you sign.
FLORIDA=S CONSTRUCTION LIEN LAW - NOW YOU KNOW
(FL-LIENLAW.WPD 9-26-02)
NOTICE
POSTING OF STREET NUMBERS
The Hernando County Board of County Commissioners has adopted an ordinance entitled the
AHernando County Street and Road Naming and Addressing [email protected] (No. 94-03) which enforces
the present system for naming streets and roads and addressing in Hernando County. This action
has been taken to provide rapid central dispatch for the Sheriff=s Department, Fire Departments and
Emergency Medical Services and to expedite more efficient mail delivery.
Ordinance No. 89-19 requires your correct address number be displayed in a conspicuous place on
the principal building so that the number is clearly legible from the street or road on which it is
addressed.
If the principal building is not visible from the road, or obstructions such as fences, trees, or walls
would limit visibility, the address number shall be posted at least two (2) feet above ground level, in a
conspicuous place at the driveway or property entrance. Such place may include, but is not limited to
mailboxes, fences, fence posts, freestanding signs, and such number shall be clearly legible from the
street and not posted as to be confused with address numbers posted for nearby parcels.
Freestanding signs must be outside all public rights-of-way.
Numbers used in addresses, lot numbers, unit identifications, and all such ranges shall be Arabic
numerals. Letters used in unit identifications and such ranges shall be standard capital letters. Both
numbers and letters shall be in a color contrasting with the structure or background surface and not
be less than six (6) inches in height for commercial and four (4) inches for residential properties.
The post office requires that the address number also be posted on the mailbox. The numbers on the
box must be inscribed in contrasting color in neat numerals not less than one (1) inch high on the side
of the box visible to the carrier=s regular approach, or on the door if boxes are grouped. If the box is
located on a different street, the street name and house number must be inscribed on the box.
Any different numbers which might be mistaken for, or confused with, the official number assigned by
the County shall be removed.
Ordinance No. 94-03, Section 12 states that a violation of any provision of this ordinance shall
constitute a misdemeanor and shall be punished as provided in Section 1.8 of the Hernando County
Code of Ordinances.
We regret any inconvenience this may cause you, but we know you will recognize the importance of
posting your address number.
If you have any questions regarding this matter, please feel free to contact:
Hernando County Development Department
789 Providence Boulevard
Brooksville, Florida, 34601
Phone: (352) 754-4050
Fax: (352) 754-4416
Board of County Commissioners
Hernando County
Waste Management Division
UTILITIES DEPARTMENT
Dear Soon-to-be Hernando County Homeowner:
Hernando County assesses all residential units (single family and multi-family) annually for solid waste
disposal. The Hernando County Interim Solid Waste Disposal Assessment Ordinance (#99-17) became effective
on September 1, 1999. The ordinance establishes that the solid waste disposal assessment is due and payable for
all new residential units for the interim between construction completion and placement of the assessment on
the property tax bill. This ordinance affects all conventional houses, duplexes, triplexes, and quadruplexes for
which construction permits, and mobile homes for which set-up/tie-down permits are issued on or after
September 1, 1999.
When your new home is ready to occupy, you will receive an invoice for the prorated interim solid waste
disposal assessment due on your home. Depending on when your home is completed, and when the assessment
can be added to your tax bill, your interim assessment may be prorated for four (4) months= up to 16 months=
assessment. (Please see fee schedule on back). The annual Solid Waste Disposal Assessment is $63.05 for
single family homes and $57.55 for each unit of multi-family homes.
You may pay the interim assessment in person at the Hernando County Utilities Department, 21020 Cortez
Boulevard, Brooksville, Florida, 34601, or mail your payment to: Hernando County Utilities Department, P.O.
Box 10899, Brooksville, Florida, 34601. Make checks payable to the Hernando County Board of County
Commissioners.
The Solid Waste Disposal Assessment is not to be confused with the fee that you may choose to pay a private
solid waste collection company for hauling away your household garbage. These companies charge only for the
collection and hauling of household garbage. If you do not want to hire a solid waste collection company, you
may transport your household garbage to any of the three (3) county solid waste facilities. There is no charge at
the facilities for residents who have paid the annual Solid Waste Disposal Assessment.
If you have any questions, please call Brooks Ahrens at 754-4112, extension 120, or Alisa Pike at 540-4368,
extension 114.
The single family unit and multi-family unit fee schedule is attached.
14450 Landfill Road | Brooksville, FL 34614 | ( 352) 754-4112 Ph | (352) 754-4118 Fax
Solid Waste Single Family Unit Fee Schedule
Month Certificates Of Occupancy Issued
January
February
March
April
May
June
July
August
September
October
November
December
Amount
Owed
$ 57.80
52.54
47.29
42.03
36.78
31.53
26.27
21.02
78.81
73.56
68.30
63.05
Solid Waste Multi-Family Unit Fee Schedule
Month Certificates
Of Occupancy
Issued
January
February
March
April
May
June
July
August
September
October
November
December
Amount Owed
One (1) Unit
$ 52.75
47.96
43.16
38.37
33.57
28.77
23.98
19.18
71.94
67.14
62.35
57.55
Amount Owed
One (2) Units
Amount Owed
One (3) Units
$ 105.50
95.92
86.32
76.74
67.14
57.54
47.96
38.36
143.88
134.28
124.70
115.10
$ 158.25
143.88
129.48
115.11
100.71
86.31
71.94
57.54
215.82
201.42
187.05
172.65
Amount
Owed
One (4)
Units
$ 211.00
191.84
172.64
153.48
134.28
115.08
95.92
76.72
287.76
268.56
249.40
230.20
HERNANDO COUNTY
USED MOBILE HOME
BUILDING PERMIT APPLICATION
Want a Deficiency Report Faxed to you?
Please Provide Your Fax Number:
NOTICE:
No structure,building or improvement
can encroach or be constructed within
an easement.
Permitting Service Fax Number:
Permit Application #:
Key #:
(For Office Use ONLY)
Date:
Check ALL That May Apply: - Mobile Home Set-Up
- Replacement Mobile Home
- Additions
Total Value of Proposed Project: $
(Include value of all improvements and installation.)
Legal description: Lot :
Block :
Address of job site No.:
Street:
Subdivision:
Unit :
Specific Directions to job site:
Property owner:
Address:
Interest in property:
Phone:
City:
Name of fee simple titleholder (If Other Than Owner):
Address :
City:
Permitting Service Name:
Phone :
Contractor:
Address:
License Number:
City:
State:
Zip:
State:
Zip:
Contact Name:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Sub-Contractor List (Complete as Necessary)
MH Dealer:
License Number:
Phone:
(State Certification or Hernando County # ONLY)
MH Set-up Contractor:
License Number:
Phone:
(State Certification or Hernando County # ONLY)
Electrical:
Address:
License Number:
City:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Plumbing:
Address:
License Number:
City:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Mechanical:
Address:
License Number:
City:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Roofing:
Address:
License Number:
City:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Aluminum:
Address:
License Number:
City:
Phone:
State:
Zip:
(State Certification or Hernando County # Only
Bonding Company Name:
Address:
City:
State:
Zip:
Architect/Engineer’s Name:
Address:
City:
State:
Zip:
Mortgage Lender’s Name:
Address:
City:
State:
Zip:
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 the standards of all laws regulating construction in this jurisdiction. I understand that a 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: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER
PART 1, SEC 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.
THE
713,
FOR
AND
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Owner/Contractor or Authorized Agent
State of
County of
affirmed and subscribed before me this
day of
by
, who is (
, 20
) personally known to me or who (
has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Name of Notary
Application Approved By Permit Representative:
Hernando County Development Department
789 Providence Boulevard
Brooksville, FL 34601-2893
Phone: (352)754-4050 | FAX: (352)754-4416
www.co.hernando.fl.us
)
HERNANDO COUNTY DEVELOPMENT DEPARTMENT
SUB-CONTRACTOR SIGNATURE PAGE
This page may be used in lieu of submitting individual Sub-Contractor Affidavit forms.
JOB NAME (or Application Number):
MOBILE HOME SET-UP CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
ELECTRICAL CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
PLUMBING CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
MECHANICAL CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
ROOFING CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
ALUMINUM CONTRACTOR:
Signature of License Holder or Authorized Agent
Printed Name
Name of Company
STATEMENT OF PRIMARY CONTRACTOR:
I, hereby certify that the above are the signatures of the license holder or their authorized agent of the
subcontractors who will be performing work on the job referenced above, of which I am the primary
contractor.
Signature of Primary Contractor or Authorized Agent
State of
Affirmed and subscribed before me this
by
who (
County of
day of
, 20
, who is (
)personally known to me or
) has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Name of Notary
Hernando Co. Dev. Dept., 789 Providence Boulevard, Brooksville, Florida, 34601 | (352)754-4050 | Fax: (352)754-4416
Building Permit Application # :
(To be completed by Permit Representative)
HERNANDO COUNTY DEVELOPMENT DEPARTMENT
SUB-CONTRACTOR AFFIDAVIT
DATE: _______________________
TO WHOM IT MAY CONCERN:
,
I,
d/b/a
,
License Number:
, will be the
(Example: Electrical, Mechanical,
___________________________________ contractor for this permit application. The job address
Plumbing, Roofing, Gas, Etc.)
is:
.
________________________________________
Signature of License Holder or Authorized Agent
State of
Affirmed and subscribed before me this
by
who (
County of
day of
, 20
, who is (
) has produced
)personally known to me or
as identification.
Signature of Notary Public
Print, Type or Stamp Name of Notary
Hernando County Development Department
789 Providence Boulevard
Brooksville, FL 34601-2893
Phone: (352)754-4050 | FAX: (352)754-4416
www.co.hernando.fl.us
HERNANDO COUNTY DEVELOPMENT DEPARTMENT
Mobile Home Pre-Inspection Form
To be Filled out and Signed by Applicant
1. Mobile home must be located in Hernando County.
2. The unit SHALL NOT be brought onto the property, where it is to be set-up, without a permit.
3. If located outside Hernando County, the pre-inspection must be performed by a licensed mobile
home dealer or engineer.
Pre-Inspection Fee: $50
NOTE:
Our inspector must have access to the interior of the mobile home.
If any personal possessions are inside the mobile, the owner must be
present when the inspection is being done.
Owner=s Name:
Phone #:
Owner=s Address:
Name of Person to contact regarding setting up the pre-inspection appointment:
Phone number of person to be contacted to set up pre-inspection:
Location of Mobile Home for Pre-Inspection:
Box Size of Mobile Home:
Year Manufactured:
Serial Number:
Key Number of Property Mobile Home is to be located on:
Directions to where the mobile home is presently located. Please give exact directions to the mobile home. (It
would be helpful to include signs or landmarks and the color of the mobile home.)
Signature of Owner/Applicant
Date
The Development Department will contact you to schedule the pre-inspection once your permit application has
been approved.
For Office Use Only
Scheduled Date Of Pre-Inspection:
Time Pre-Inspection Scheduled:
MOBILE HOME PRE-INSPECTION CHECKLIST
Name:___________________________________________________________
Address:_________________________________________________________
Permit Application #: __________________ Serial #: ____________________
FIRE SAFETY
1
Smoke Detector: ( )Missing ( )Location ___________________________
1
Electrical System: Checked ( )Continuity ( )Converter ( )Exposed Wiring
Distribution Panel: ( )Missing ( )Loose ( )Main missing ( )Breakers missing
( )Unplugged openings ( )Loose connections ( )Not accessible ( )Raceway missing
( )GFI missing
Electrical Fixtures: ( )Missing ( )Installed improperly ( )Improperly wired
( )Improperly supported ( )Loose Wire
Electrical Ground: ( )Chassis ( )Exterior Metal ( )Main panel ( )Furnace ( )Range
( )Water heater ( )Water inlet ( )Gas piping
Face Plate Covers: ( )Missing ( )Broken
Application
Final Insp.
Viol
Viol
OK
OK
ELECTRICAL
2
3
4
5
CONSTRUCTION
1
Exit Doors Operable: ( )Front ( )Back ( )Other __________________
2
3
4
5
6
7
8
Exit Doors Locks: ( )Operable ( )Missing
Egress Windows: ( )Missing ( )Inoperable (Eff.1975 models)
Windows: ( )Inoperable ( )Broken
Screens: ( )Missing ( )Damaged
Floor System: ( )Damaged Location ___________________________________
Interior Paneling: ( )Missing ( )Loose
Rodent Proofing: ( )Piping ( )Duct ( )Insulation missing ( )Other ________
Leaks (apparent): ( )Roof edge ( )Middle ( )Windows ( )Holes exterior metal
( )Doors ( )Ceiling ( )Floors
Tie Downs-Over roof: ( )Missing ( )Too short ( )Kit required
( ) Structural Modifications since manufactured
9
10
11
PLUMBING
1
2
3
4
5
Traps: ( )Missing ( )Not Connected ( )S Traps ( )Double Trapped
( )Other __________________________________________________
Plumbing Fixtures: ( )Missing ( )Not installed ( )Not Vented
Relief Valve: ( )Missing ( )Inoperable ( )Undersize drain pipe
( )Drain term below bottom ( )Drain pipe missing
Drainage Piping: ( )Missing ( )Not capped ( )Not supported ( )Road Hazard
Water Piping: ( )Not capped ( )Line kinked ( )Damaged
HEATING & A/C
1
2
3
4
5
6
7
8
9
10
Heating Appliances: ( )Missing ( )Not anchored ( )Not connected
Deleted Heating & A/C System: ( )Duct not installed ( )Dropout not installed
Thermostat: ( )Missing ( )Inoperable
Air Registers: ( )Missing ( )Inoperable
Ducts: ( )Not sealed ( )Collapsed ( )Missing
Furnace/Water Heater Vent: ( )Missing ( )Loose ( )Crooked
Return Air: ( )To furnace ( )To A/C ( )From rooms ( ) ______________________
Range/Bathroom Ceiling Vent: ( )Open in ceiling ( )Inoperable ( )Stack Missing
Gas Valve (Eff.5/75): ( )Not Applicable ( )Missing ( )Not approved
Gas Piping: ( )Not capped ( ) Not supported ( ) Kinked ( ) Missing
WINDLOAD
1
2
3
Is State of Florida Hurricane Resistance Seal in place?: ( )Yes
Have over the roof tie-downs been installed?: ( )Yes ( )No
Is Data Plate in Place?: ( )Yes ( )No
( )No
If none of the above are installed, the mobile home cannot remain in or be set in Hernando County, unless the
home is re-engineered by an engineer licensed in the State of Florida.
Is remodeling permit required? Yes ______ No ______
Inspected by_____________________________________
Reviewed by:
Plans Examiner
State of
County of
The foregoing instrument was acknowledged before me this _______ day of
, 20
,
by _______________________________________, who is ( ____ ) personally known to me or who ( ______ )
has produced
as identification.
Notary Public
Print, Type or Stamp Name of Notary
If the information provided on this inspection form is false or erroneous, there may be re-inspection and penalty
fees required.
OWNER/BUILDER DISCLOSURE STATEMENT
STATE OF FLORIDA,
COUNTY OF HERNANDO
Building Permit #
State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to
that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not
have a license.
(1) You must provide direct, onsite supervision of the construction yourself.
(2) You may build or improve a one-family or two-family residence or farm outbuilding. You may also build or improve
a commercial building provided your costs do not exceed seventy-five thousand dollars ($75,000).
(3) The building must be for your own use and occupancy. It may not be built or substantially improved for sale or
lease. If you sell or lease a building you have built yourself or substantially improved yourself within one (1) year
after the construction is complete, the law will presume that you built, or substantially improved it for sale or lease,
which is a violation of this exemption.
Additional permits may not be issued to a violator of this exemption. Penalties will be sought against a
violator/unlicensed contractor.
(4) You may not hire an unlicensed person as your contractor or to supervise people working on your building.
(5) It is your responsibility to make sure that people employed by you have licenses required by state law and
Hernando County Construction Licensing Code.
Any person working on your building who is not duly licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A., Medicare and withholding tax and provide worker=s
compensation for that employee, all as prescribed by law.
(6) You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to
perform the work being done.
(7) Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations.
(8) You must furnish copies of all contracts concerning the work being permitted, if requested.
(9) You must change the permit from your name to a licensed general contractor if you hire a contractor to complete
the work.
As the owner/contractor on this permit, I,
(10)
(11)
(12)
(13)
understand:
(Please Print Name)
That I am responsible for all work performed pursuant to this permit;
That Hernando County will look to me for corrections of any deficiencies in the work;
That violating this exemption is grounds for permit revocation;
That the Building Official shall have the authority to require me to secure a licensed contractor to complete the
work authorized under this permit if inspections by the Building Division reveal that I am not competent to
accomplish the construction.
I HAVE READ AND FULLY UNDERSTAND THE ABOVE DISCLOSURE STATEMENT AND AGREE TO ABIDE BY
THE PROVISIONS REGULATING OWNER/BUILDER PERMITS SET FORTH ABOVE AND IN HERNANDO COUNTY
CODE OF ORDINANCES.
_________________________________
Property Owner's Signature
State of
Sworn to (or affirmed) and subscribed before me this
by
who (
County of
day of
, 20
, who is (
) has produced
)personally known to me or
as identification.
Signature of Notary Public
Print, Type or Stamp Name of Notary
Hernando Co. Dev. Dept., 789 Providence Boulevard, Brooksville, Florida, 34601 | 352-754-4050 | Fax: (352)754-4416
CONDITIONAL AFFIDAVIT for CERTIFICATE of OCCUPANCY
& NOTICE of CODE VIOLATION for MOBILE HOMES
STATE OF FLORIDA
COUNTY OF HERNANDO
Permit No.
BEFORE ME the undersigned authority personally appeared
(Please print Affiant=s name)
who was sworn and says:
1. Affiant understands and agrees to perform the below marked stipulations on or before thirty (30) days
from the date of issuance of a Certificate of Occupancy (C.O.) for the above described permit number.
2. Affiant further agrees and understands that failure to comply with the obligations set forth herein, within
the time established herein, will cause this Affidavit to be considered a Notice of Violation pursuant to
Section 162.21, Florida Statutes, as it may be amended from time to time and will allow Hernando
County to have issued by a Code Enforcement Officer a citation for violation of a Hernando County
Code provision without the necessity of allowing the affiant any period of time to correct the violation.
3. Affiant understands that the issuance of a citation may subject affiant to civil penalties/and or fines up to
$500.00, and/or the loss or revocation of a C. O. permitted by law, recision of the C.O., discontinuance
of electrical service, or any other action Hernando County may lawfully undertake against affiant.
4. Affiant agrees to perform the following indicated obligations:
a) ____Sod the right-of-way within thirty (30) days from the issuance date of the C.O. Plugs, mulch,
seeding, ornamental plants, or stone shall not be used in lieu of sod. Adjacent/damaged areas will be
repaired. (Hernando County Code of Ordinance, Chapter 24, Section 24-3)
b) ____ Install a driveway apron, designed to meet the requirements of Hernando County=s Department of
Public Works= Facility Design Guidelines within thirty (30) days from the issuance of the C.O. (Hernando
County Code of Ordinance, Chapter 24, Section 24-3)
c) ____Comply with all landscaping requirements to include ground cover and tree placements within thirty
(30) days from the issuance of the C.O. Ground cover requirements for lots may be achieved by sodding
or seeding. Trees will be left or replanted to meet the requirement of two trees per lot, or as specified
according to lot size. (Hernando County Code of Ordinance, Chapter 10, Section 29)
d)
Install skirting around mobile home within (30) days from the issuance of the C.O. (Hernando
County Code of Ordinance, Appendix A. Article IV, Section 2)
e) ____ Remove any home replaced by this permitted structure within thirty (30) days of issuance of the
C.O. for the proposed residence. Hernando County Code of Ordinance, Appendix A Article II, Section
2D(2)
5. By signing this affidavit, affiant hereby acknowledges that failure to achieve compliance with the
aforementioned will be deemed a willful violation of the Hernando County Code of Ordinances and
punishable as provided by Hernando County Code of Ordinances and Florida state law and that affiant
is personally responsible for these provisions.
__________________________________________
Signature of Owner, Contractor or Authorized Agent
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
,(
has produced
day of
, 20
, by
) who is personally known to me, or (
) who
as identification.
Notary Public
(Stamp, Type, or Print Name of Notary)
Hernando Co. Dev. Dept., 789 Providence Boulevard, Brooksville, Florida, 34601 | 352-754-4050 | Fax: (352)754-4416
Key No.
Permit No.
NOTICE OF COMMENCEMENT
THE UNDERSIGNED hereby gives notice that improvement will be made
to certain real property, and in accordance with Chapter 713, Florida Statutes,
the following information is provided in this Notice of Commencement:
THIS SPACE RESERVED FOR RECORDER
1.
Description of Property: Parcel No.:
(Legal description of the property and street address if available)
2.
General Description of Improvement:
3.
Owner Information: Name:
Address:
Interest in Property:
Name of Fee Simple Titleholder (If other than owner):
Address:
4.
5.
6.
City:
State:
Zip:
City:
State:
Zip:
City:
State:
Zip:
State:
Fax No.:
Zip:
State:
Zip:
Contractor: Name:
Address:
Phone No.:
Fax No.:
Surety: Name:
Address:
Amount of Bond: $
City:
Phone No.:
Lender: Name:
City:
Address:
Phone No.: ___________________________________ Fax No.: __________________________
7.
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.13(1)(a)(7), Florida Statutes:
Address:
City:
State:
Name:
Fax No.:
Phone No.:
8.
In addition to himself or herself, Owner designates
of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
Phone No. of person or entity designated by owner:
9.
Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified.)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SEC 713.13, FLORIDA STATUTES, AND CAN 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
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Y
Signature of Owner or Owner=s Authorized Officer/Director/ Partner/Manager
*** Signature Required by same below by >Y= mark ***
STATE OF
Signatory=s Title/Office
COUNTY OF
The foregoing instrument was acknowledged before me this
day of
, 20
, by
.
(Name of Person)
for
as
(Type of authority e.g., office, trustee, attorney in fact)
.
(Name of party on behalf of who instrument was executed)
Signature of Notary
Print, Type or Stamp Name of Notary
Personally Known
OR Produced Identification
Type of Identification Produced:
Verification pursuant to Section 92.525, Florida Statutes: under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it
are true to the best of my knowledge and belief.
Y
Signature of Natural Person Signing Above
(NOC 9-24-07)
HERNANDO COUNTY DEVELOPMENT DEPARTMENT
SITE PLAN
#
(RESIDENTIAL USE ONLY)
SCALE
1" =
SITE PLAN MUST:
• Not exceed 11”x 17”
• Be drawn in blue or black ink only.
• Be drawn to scale.
• Show any lake, canal, or river frontage.
• Show property dimensions, shape and size.
• Show all existing and proposed structures and their dimensions, and identify them.
• Show all street frontages (corner lot, double frontage, etc.)
• Show distances in feet and inches from all property lines to all structures.
• Show any driveway on site plan.
• Show all easements (utility, drainage, ingress/egress, conservation, etc.)
• Show all surrounding golf courses.
Hernando Co. Dev. Dept., 789 Providence Boulevard, Brooksville, Florida 34601  (352) 754-4050  Fax: (352) 754-441
Pocket Penetrometer Test
X ____
X ____
X ____
8
•
•
•
Test the perimeter of the home at six (6) locations.
Take the reading at the depth of the footer.
Using 500 LB increment, take the lowest reading and round down to that increment.
8
X ____
Perimeter
X ____
X ____
8
Test Locations
This Site Rounded Down to
•
Test must be performed by a licensed installer.
Date Tested:
Licensed Installer Name:
License Number:
I hereby certify that this test was performed at the address.
___________________________________________
Licensee Signature
Hernando County Development Department
789 Providence Boulevard
Brooksville, FL 34601-2893
Phone: (352)754-4050 | FAX: (352)754-4416
www.co.hernando.fl.us
PSF
Required Information
Approved per County Landscape
Ordinance (Department use only)
Application No.:
Lot/Block/Unit/Subdivision:
Date:
Name:
Name:
Address:
LANDSCAPING DESIGN PLAN FOR APPROVAL
(2) COPIES REQUIRED
Number of tree(s) required
(Department Use ONLY)
TREES:
Number of existing trees preserved
Size of tree(s) preserved
Number of existing Specimen tree(s)
Number of existing Majestic tree(s)
Square footage of property
SF
Square footage of Impervious Area
(House, Pool & Encl, Driveway, Sidewalks, etc)
SF
Square footage of landscaped area with high-water use
(No more than 75% of the landscape area shall be HWU)
SF
Square footage of landscaped area with low-water use
(25% of the landscaped area must be landscaped with LWU)
SF
Percentage of natural vegetation preserved
%
Please acknowledge by initialing in spaces below.
NOTE: ANY SPECIMEN OR MAJESTIC TREE MUST BE GRANTED APPROVAL PRIOR TO
REMOVAL.
SPECIMEN TREE- A tree with a DBH of eighteen (18) inches or greater but less than thirty-six (36) inches
MAJESTIC TREE- A tree with a DBH of thirty-six (36) inches or greater. Palm trees shall be excluded.
Trees to be planted-minimum size two (2) inch caliper and must be shade trees.
I, understand that this is a synopsis of Ordinance 2004-13, which was adopted by the Board of County Commissioners and is not
inclusive of all landscape requirements and restrictions contained in the Ordinance. These requirements are subject to amendment by the
BCC. I, also understand it is the applicant=s responsibility to ensure that all sections of Ordinance 2004-13 are complied with.
_______________________________________
Signature of Owner
_______________________________
OR
Signature of Contractor
State of __________________ County of_______________________
The foregoing instrument was acknowledged before me this
By
day of
, 20
,
, who is (___) personally known to me or who (____) has produced
as identification.
__________________________________
Notary Public
(Stamp, Type, or Print Name of Notary)
RESIDENTIAL LOT LANDSCAPING REQUIREMENTS:
When clearing a vacant single-family residential lot/parcel, two-family residential lot/parcels, and mobile home lot/parcels, a
Land Clearing Permit shall be required. An application for a Land Clearing Permit shall be submitted which shall include a
Land Clearing Plan.
When the land is being cleared in conjunction with the construction of a single family dwelling, two family dwelling or mobile
home, a Landscape Plan is required as part of the permit application process. The Plan shall demonstrate that no more than
75% of the developed area is in a high water use zone.* This means that no more than 75% of the landscaping shall be
turfgrass unless varieties with excellent drought tolerance are used. 25% of the developed area must be landscaped as a
low use waterzone.** The minimum number of trees required for the lot shall also be demonstrated. Any specimen or
majestic trees must be included on the plan.*** Planted trees must be shade trees and a minimum of two (2) inch caliper.
The Plan must also show the proposed natural vegetation areas to be preserved and the proposed areas to be cleared.
*
**
***
A high use water zone consists of plants or shallow-rooted turf grass associated with moist soils and requiring
watering to supplement natural rainfall.
A low use water zone consists of plants which survive on average natural rainfall once established.
A specimen tree is defined as having a Diameter Breast Height (DBH) of eighteen (18) inches, or greater, but less
than thirty-six (36) inches. Palm trees are excluded.
A majestic tree is defined as having a DBH of thirty-six (36) inches or greater. Palm trees are excluded.
TREE REQUIREMENTS
Residential Lot Size
Minimum Number of Preserved or Planted Trees
Lots up to and including 5,000 sq. feet
Lots over 5,000 sq. feet, but less than or
equal to 10,000 sq. feet
For each additional 3,000 sq. feet above
10,000 sq. feet or lot size
Two (2) trees
Three (3) trees
One additional tree
HERNANDO COUNTY BUILDING DEPARTMENT
789 PROVIDENCE BOULEVARD
BROOKSVILLE, FLORIDA 34601
Telephone: (352) 754-4050 | Fax: (352) 754-4416
PERMIT APPLICATION/MANUFACTURED HOME INSTALLATION
Attach engineering floor plans and pages referenced from manual to this sheet. This form not applicable in flood zones.
Date:
Permit #
Applicant
Site Location
Phone #
Manufacturer=s Name
Serial #
Wind Zone
Roof Load
Dealer/Installer Name
License Number
Fax #
Installation Decal #
Installation Standard Used: (Check One) Manufacturer=s Manual
Number of Sections
Width
Length
Year
15C
SITE PREPARATION:
Debris and Organic Material Removal
Compacted Fill
Water Drainage Natural
Pad
Swale
Page #
Other
Page #
FOUNDATION:
Load Bearing Soil Capacity:
or Assumed 1000 psf
Footing Type: Poured in place
Precast
ABS Size & Thickness
I-Beam or Mainrail Piers: Single Tiered
Double Interlock
Size of Piers
Placement of O/C
Perimeter Pier Blocking: Size
Placement of O/C
Ridge Beam Support Blocking: Size
Number
Location(s)
Ridge Beam Support Footer: Size
Number
Location(s)
Center Line Blocking: Number
Location(s)
Pad Size 1.
Pad Size 2.
Pad Size 3.
Pad Size 4.
Pad Size 5.
Special Pier Blocking: Required (Fireplace, Bay Window, Etc.) Yes
No
Mating of Multiple Units: Mating Gasket
Type Used
Page #
Fasteners: Roofs Type & Size
Spacing
O/C
Endwalls Type & Size
Spacing
O/C
Floors Type & Size
Spacing
O/C
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
ANCHORS:
Type 3150# Working Load
4000# Working Load
Height of Unit: (Top of Foundation or Footer to Bottom of Frame)
Number of Frame Ties:
Spacing
O/C Angle of Strap
Number of Over Roof Ties: (if required)
Number of Sidewall Anchors
Zone II
Endwall/Longitudinal Anchors
Zone II
Zone III
Number of Centerline Anchors
Number of Stabilizer Devices
Vents Required for Underpinning (1 SF/150 SF of Floor Area) Number
Degrees
Zone III
Page #
Page #
Page #
Page #
Page #
Page #
Page #
Page #
I,
, hereby attest that I have been trained in the use of this installation manual and
the above information is true and accurate.
Signature
State of __________________ County of_______________________
The foregoing instrument was acknowledged before me this
By
day of
, 20
,
, who is (___) personally known to me or who (____) has produced
as identification.
__________________________________
Notary Public
_____________________________________
(Stamp, Type, or Print Name of Notary)
If the information provided on this application is false or erroneous, there may be re-inspection and penalty
fees required.
NOTE FOR STAFF USE ONLY – TO INSERT THE FOLLOWING DOCUMENT SHEETS INTO
MOBILE HOME PACKETS:
(Insert Mobile Home Drawing)
(Insert Single Wide Pier Location Report)
(Insert Double Wide Pier Location Report)
(Insert Electrical Drawing Here)
(Insert Illustration of Water Connections)
(Insert Mobile Home Plumbing Information)

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