Fillable FENCE/WALL PERMIT CHECKLIST (Village of Wellington)

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FENCE/WALL PERMIT CHECKLIST (Village of Wellington)

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Signature of Applicant Date
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Planning, Zoning & Building
Dept.
12300 Forest Hill Blvd
Wellington FL, 33414
Phone (561)753-2430
Fax (561)791-4045
www.wellingtonfl.gov
FENCE/WALL PERMIT CHECKLIST
The following information & documents are required for permit processing.
Completed Permit Application
Completed and signed Fence/Wall Permit Checklist
One copy of a survey showing the location of the proposed fence/wall. Please identify by XXXXX on
the survey.
Completed and signed Miscellaneous Improvements Form
Approved Easement Consent forms from the four utility companies and a signed and notarized Hold
Harmless Affidavit (if the fence is to be located in an easement).
Completed and signed Landscape & Fence Affidavit
If it is a proposed wall or gate with columns/lights, plans for construction are required. Plans to
include footers, reinforcement, elevation, and height.
Owner/Builder Affidavit, if applicable.
GENERAL INFORMATION
Residential fences within the side and rear setback may not exceed 6 feet in height. In most areas of Wellington the
front setback is twenty-five (25) feet from the front property line. Please confirm with the Planning and Zoning
Division to determine if the front setback is different. Please remember that the front property line is usually NOT
the edge of the road pavement.
SPECIFIC REQUIREMENTS
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Fences shall not be located in the safe sight triangle nor closer than three (3’) feet to any street right-of-
way.
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Fences may not be located closer than five (5’) feet to the front corners of the principal structure.
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No fences shall be erected or maintained which has an electric charge except in Land Use Category A & B.
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The finished side of all fences shall face the street or adjoining property.
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Major thoroughfare fences: wood, pvc, decorative, board on board, vertical shadow box, and chain link.
These fence types shall be screened on the street side with hedge plants three (3) gallon (36 inches high)
in size and planted two (2) feet on center.
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All hedges shall be irrigated with a permanent irrigation system. The irrigation system must be installed in a
manner to guarantee irrigation of hedges outside fences or walls along major thoroughfares.
______________ _______________
____________ _____________
________________________________________
□
□
PROPERTY OWNER:_______________________________________
TENANT:________________________________________________
ADDRESS: ____________________________________UNIT:______
CITY: __________________________STATE: ______ZIP:__________
PHONE: __________________________FAX:___________________
EMAIL:__________________________________________________
□ □ □
□ □ □ □
□
_______________________________
PRIMARY PERMIT #:
_____________________
PROJECT NAME: _____________________________________________
PCN: __ __- __ __- __ __- __ __- __ __- __ __ __- __ __ __ __
LEGAL DESCRIPTION:__________________________________________
ADDRESS: ___________________________________________________
CITY: _______________________________________________________
FURTHER WORK DESCRIPTION
□ □ □ □ □ □ □
: ____________________________________________________________________________
VALUE: _____________ PERMIT FEE: ____________ NET S.F (for SFD’s): ____________
(SEE FEE SCHEDULE) (AS APPLIES) (AS APPLIES)
□
□
DBA (COMPANY NAME):
_______________________________________
Contact Person:
________________________________
(CERT. HOLDER): _______________________________________________ License #: ________________________
ADDRESS: _____________________________________STE:______ CITY: ____________________STATE: ________ ZIP:________
PHONE:
____________________________ _______________________ ________________________________________
FAX: EMAIL:
________________________________________________________________________________
(Signature of Owner or Agent) (including contractor)
Print Name
: _______________________________________
COUNTY OF _______________________________________
_______
__________________
________________________________________________________________________________
(Signature of Owner or Agent) (including contractor)
Print Name
: ________________________________________
COUNTY OF ________________________________________
_______
_____________________
____________________________________________________
_
(Name of person making statement)
_________________________________________________
(Signature of Notary Public - State of Florida)
____ OR ______
Type of Identification Produced_______________________
____________________________________________________
(Name of person making statement)
_________________________________________________
(
Signature of Notary Public - State of Florida)
____ OR _______
Type of Identification Produced_______________________
Page 1 of 2
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
UNIVERSAL COUNTY-WIDE/MUNICIPAL
BUILDING PERMIT APPLICATION FORM
July 2013 Edition
Approved for use throughout Palm Beach County and Municipalities
FOR OFFICE USE ONLY
FBC Version: Permit Type:
Accepted By: Application Date:
Application #:
1
KIND of PERMIT (CHECK ONE):
PRIMARY PERMIT
SUB-PERMIT -
If Fee & Value of a Sub-Permit are
covered under a Primary Permit, complete boxes 1, 3, 4, 5, 6 &
8 only to apply. If not covered under a Primary Permit,
complete the entire application to apply.
2
3
TRADE (CHECK ONE):
STRUCTURAL ROOFING ELECTRICAL
MECHANICAL PLUMBING FIRE GAS
OTHER:
4
5
Type of Work: New Addition Alteration Repair Demo Temporary Other
6
OWNER BUILDER PER FL. ST. 489 (AS NAMED ABOVE, FOR CONTACT INFORMATION SEE BOX 2)
CONTRACTOR
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 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 the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
7
NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /
BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me this
day of ,
20
, by
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known Produced Identification
8
NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /
BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me this
day of ,
20 , by
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known Produced Identification
Fee Simple Titleholder’s Name (If other than owner): ____________ Bonding Company : ________________________________
__________________________________________________________________ ________________________________________________
Fee Simple Titleholder’s Address
(If other than owner): _______ Bonding Company Address: _________________________
________________________________________________ ________________________________________________
City: ___________________ State:
_____ Zip: __________ City: _____________________ State:_____ Zip: __________
□ □
Architect/Engineer’s Name : ________________________ Mortgage Lender’s Name : ___________________________
________________________________________________ __________________________________________________
Architect/Engineer’s Name Address: _________________ Mortgage Lender’s Address: __________________________
________________________________________________ __________________________________________________
City: ______________________ State:
_____ Zip: __________ City: ________________________ State:_____ Zip: __________
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_________________________________________________
□ ___________________________________
________________________________________________
________________________________________________________________ _____________________________
_________________________________________________________ ___________________
________________________________________________________ ___________________
Page 2 of 2
______________________________
______________________ ________________________ ____
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
FEE SIMPLE TITLEHOLDER, BONDING COMPANY, ARCHITECT/ENGINEER AND MORTGAGE LENDER INFO IS REQUIRED WHEN THE
AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS & NOT JUST WORK AUTHORIZED BY THE INDIVIDUAL PERMIT) IS $2,500 OR
MORE (EXCEPT HVAC REPAIR /REPLACEMENT < $7500). PLEASE ADDRESS ALL ITEMS.
9
Same as Owner
10
Not Applicable
11
Not Applicable
12
Not Applicable
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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.
NOTICE TO CONTRACTOR: FOR A DIRECT CONTRACT GREATER THAN $2,500 (EXCEPT FOR HVAC SYSTEM REPAIR OR
REPLACEMENT LESS THAN $7500), FLORIDA STATUTES REQUIRE THE APPLICANT TO FILE WITH THE ISSUING AUTHORITY,
PRIOR TO THE FIRST INSPECTION, EITHER A CERTIFIED COPY OF THE RECORDED (BY OWNER) NOTICE OF COMMENCEMENT
OR A NOTARIZED STATEMENT (BY OWNER) THAT THE NOTICE OF COMMENCEMENT HAS BEEN FILED FOR RECORDING,
ALONG WITH A COPY THEREOF. IN THE ABSENCE OF A CERTIFIED COPY OF THE RECORDED NOTICE OF COMMENCEMENT,
NO SUBSEQUENT INSPECTIONS CAN BE PERFORMED UNTIL THE APPLICANT FILES SUCH CERTIFIED COPY WITH THE ISSUING
AUTHORITY. THE CERTIFIED COPY OF THE NOTICE OF COMMENCEMENT MUST CONTAIN THE NAME AND ADDRESS OF THE
OWNER, THE NAME AND ADDRESS OF THE CONTRACTOR, AND THE LOCATION OR ADDRESS OF THE PROPERTY BEING
IMPROVED.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
R
ECORDING YOUR NOTICE OF COMMENCEMENT.
OFFICE USE ONLY BELOW THIS LINE
13
CODE EDITION/NOTES :
14
USE (CHECK ONE):
1 & 2 FAMILY TOWNHOUSE CONDOMINIUM
MULTI-FAMILY COMMERCIAL INDUSTRIAL
AGRICULTURAL - BLDG CODE EXEMPT OTHER:
USE CHANGE:
15
APPROVED BY:
Permit Officer
DATE:
AUTHORIZED FOR CERTIFICATE OF OCCUPANCY:
Building Official or Designee
DATE:
AUTHORIZED FOR CERTIFICATE OF COMPLETION:
Building Official or Designee
DATE:
WELLINGTON ARB APPROVED FENCE DESIGNS AND MATERIALS
WOOD FENCES
Shadow
Box
Fence/Gate
(4',5'
or
6'
Heights)*
*Fence
design require hedges
when
adjacent
to
right-of-way/street.
Board
on
Board
Privacy
Fence/Gate
(4',5'
or
6'
Heights)*
Picket
Fence/Gate
(4',5'
or
6'
Heights)
Three
or
Four
Board
Fence/Gate
(4',5'
or
6'
Heights)
VINYL FENCES
WHITE FENCES NOT ALLOWED
Vinyl
Lattice
Top
Fence/Gate (4',5'
or
6' Heights)*
*
Fence
design
require hedges
when
adjacent
to
right-of-way/street.
Vinyl
Estate
Style
Board
on
Board
Privacy
Fence/Gate (4',5'
or
6'
Heights)*
Vinyl Coated Chain Link Fence/Gate (4'.5' or 6' Heights)**
""All
Chain
Link
Fence require hedges.
ALUMINUM
FENCES
Aluminum
Rail Fence/Gate
(4',5'
or
6'
Heights)
Rall
TOP
VIEW
Boards
Shadow
Box
Fence
t
Notice Overlap
TOP
VIEW
Board on Board Privacy Fence
Board
t
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Approved colors: beige, brown and gray
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RAILS
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Owner Name: Home Phone:
Property Address:
Subdivision:
Work Phone:
Lot: Block:
Applicant/Owner Signature:
Date: Permit No:
PLANNING, ZONING AND BUILDING DEPARTMENT
12300 West Forest Hill Boulevard
Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045
www.wellingtonfl.gov
MISCELLANEOUS IMPROVEMENTS
AFFIDAVIT/CHECKLIST FOR MINIMUM DESIGN AND MATERIAL STANDARDS FOR SINGLE FAMILY,
TWO FAMILY/MULTI-FAMILY AND NON-RESIDENTIAL DWELLINGS IN THE URBAN SERVICE AREA (USA)
Pursuant to Sections 6.5.19 and 6.6.4 of the Land Development Regulations (LDR), Wellington has adopted minimum design and
material standards for single-family, two-family/multi-family and non-residential lots within the Urban Service Area. Building permit
applications for principal and accessory structures in the Urban Service Area must include this affidavit/checklist prior to permit
processing by Wellington’s Planning, Zoning and Building Division. In the corresponding box, please check to indicate compliance or
put the letters “NA” if not applicable to the permit application.
1. Fence Design: Fence Material: Fence Height:
will be constructed in compliance with the design standards contained in the LDR Section 6.6.4.
2. Five (5) foot black vinyl chain link major thoroughfare fences & hedges will be constructed, installed and irrigated in compliance with the
design standards contained in the LDR Section 6.6.4.
3. ALL chain link fences require hedge material and shall be constructed in compliance with the design standards contained in the LDR Section
6.6.4.
4. Awning material: Awning color and # as selected from the approved
materials schedule and color chart as adopted by the Architectural Review Board. LDR Section 6.5.19.5
5. Screen enclosure screens are in color with the superstructurebeing in color.
6. Storm shutters, storm panels and storm rollups meet the design standards contained in the LDR Section 6.5.19. 8
7. Solar heating panels and other mechanical equipment will be installed consistent with the design standards contained in the LDR Section
6.5.19. 7
8. Flag poles shall be installed in compliance with the design standards contained in the LDR Section 7.14.17.11
9. Basketball backboards and hoops shall be installed in compliance with the design standards contained in the LDR Section 11
10. Docks shall be constructed in compliance with the design standards contained in the LDR Section 6.5.19. 13
11. Tennis courts shall be constructed in compliance with the design standards contained in the LDR Section 6.5.19.14
12. Sheds shall be installed or constructed and screened from view from adjoining properties and abutting rights of ways in compliance with the
design standards contained in the LDR Section 6.5.19. 15
AFFIDAVIT OF COMPLIANCE
Wellington will issue a building permit provided that the structure meets the above stipulated requirements and other requirements set forth
in the ordinances and regulations promulgated by Wellington. The issuance of a permit shall not be construed to mean that the project
is in conformance with any specific deed restrictions or restrictive covenants that may be applicable to the property. Wellington
will not consult private Homeowner Associations prior to issuing a permit. The applicant, and not Wellington, is responsible for
determining whether any private deed restrictions exist and whether the project is in conformance with such restrictions. I have read and
understand the above regulations and do hereby covenant and agree that the plans submitted conform to these requirements and
construction will proceed according to the aforesaid stipulations. I further understand that any violation of the stipulations may result in
a permit denial, a stop work order being issued, or code enforcement action being initiated.
__
_______________________________________
___________
_________________________
______________________ ____________
________________________________________
PROPERTY OWNER’S NAME: ______________________________________
PROPERTY OWNER’S SIGNATURE: _________________________________
Name of easement holder: _______________________________________
By: _____________________________________________
Title: ____________________________________________
Date: _________________________
Applicant contact information: _______________________________________________
Planning
, Zoning & Building Department
12300 Forest Hill Boulevard Wellington, FL 33414
Phone: (561) 753-2430 Fax: (561) 791-4045
www.wellingtonfl.gov
UTILITIES EASEMENT CONSENT FORM
Circle 1 utility per form and fax it to the number indicated
Ple
ase make sure you fax a copy of the Survey
Comcast Cable Fax: (561) 454-5899
Email:
Sa
ndra_Stockner@comcast.com
T
el: (561) 881-3293
AT&T
Fax: (561) 272-8695
Email: G30576@att.com
FP&L
Fax: (561) 616-1625
Tel: (561) 616-1601
Florida Public Utilities Fax: (561) 838-1769
Tel: (561) 838-1817
Email: engineering-wpb@fpuc.com
I am the record title holder of property located at
I propose to apply for a permit from the Village of Wellington to construct or install a
in the easement on my property. The legal description of this
prope
rty is LOT: BLOCK:
SUBDIVISION: .
In the event your company has no objections to this improvement, please complete this form. I
under
stand that your company will not be responsible in any way for repairs to, or replacement of,
any portion of the above referenced improvement and that any removal or replacement of this
improvement necessary for your use or access of this easement will be done at the expense of the
property owner or their successors in interest.
ACKNOWLEDGEMENT:
We agree to the proposed improvement under the circumstances described above.
Please return this form to the applicant for submittal with the application.
__________________________________________________________
__________________________________________________________
______________________________________
________________________________________________
__________________________________________________________
Parcel ID
Address
Address
________________________ (Description
of Improvement)
____________________________________________ (Property Owner)
______________________________ (Description of
Improvement)
_______________________________ (Description of Improvement)
____ ____ ____ ________________________ (Property Owner)
Signature: _____________________________Title:_______________________ Date: ____________
STATE OF ___________________________
COUNTY OF __________________________
____________ _______________
_____ _________________________________________
________________________________________
Signature of person taking Acknowledgement
Printed Signature My Commission Expires:
Planning, Zoning & Building Department
12300 West Forest Hill Boulevard Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045 www.wellingtonfl.gov
HOLD HARMLESS / PERPETUAL MAINTENANCE AGREEMENT
SUBJECT:
In consideration of Wellington permitting the construction of
in the Easement Right-of-Way areas within or abutting the subject property, the
Property Owner hereby accepts and affirms the following:
shall hold Wellington
harmless for any and all damages to the
caused by the construction or repairs Wellington may perform within the said
Easement/Right-of-Way area. Further, the undersigned agrees that any repair or replacement of the
shall be performed as directed by
Wellington and will be at the expense of the undersigned.
Accepted and acknowledged on: / / by:
NOTARY
The foregoing instrument was acknowledged before me this day of ,
20 By , who is personally known to me or has
produced as identification and who did/did not take
an oath.
~LrNdToN
...............
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Permit #: _________________________
Address: _____________________________________________________
Subdivision: ______________________ Lot: ______ Block: _____
Contractor Signature: ________________________________ Date: _______________
Property Owner Signature: ____________________________ Date: _______________
C:\Users\wjones\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\XEQMBGS3\landscape fence affidavit 2011.doc
6/30/2011
Wellington Planning, Zoning & Building Department
12300 Forest Hill Blvd, Wellington, Florida 33414
Phone: (561) 753-2430
www.wellingtonfl.gov
LANDSCAPE & FENCE AFFIDAVIT
Building permit applications for fences must include this affidavit/checklist prior to permit processing by the
Wellington Planning, Zoning and Building Department. In the corresponding box, please check to indicate
compliance or put the letters “NA” if not applicable to the permit application.
1. Fences shall not be located closer than three (3’) feet to any street right-of-way.
2. Property owners shall landscape the area outside privacy fences and walls which are adjacent to streets
t
o reduce the visual impact of the fence or wall.
3. Property owners shall landscape ALL chain link fences, including side & back yard.
4. The landscaped area shall be irrigated.
5. Plants shall be three (3) gallons and a minimum of thirty-six (36) inches high at time of planting.
6. Plants shall be installed two (2) feet on center.
7. It is the responsibility of the property owner to maintain the landscaping at a height not less than the
height of the fence or wall; provided that the height of the hedge shall be five (5’) feet within twelve (12)
months of planting and six (6) feet within twenty-four months of planting.
8. Landscaping adjacent to fences surrounding schools, parks and other public properties shall include
annual
s and low shrubs and flowering plants along the fence with trees planted at a minimum height of
twelve (12) feet spaced a maximum of thirty (30) feet on center. All landscaping shall be irrigated.
Architectural Review Board & Tree Board
Approved Species List
For Thoroughfare Fencing & Barrier Hedges
Common Name Latin Name Native/Non-Native
Sandankwa Vibernum Vibernum suspensum
Coco Plum Chrysobalanus icaco Native
Podocarpus Podacarpus macrophylla
Greenbuttonwood Conocapus erectus Native
Simpson Stopper Myrcianthes fragrans Native
Florida Privet Forestera segregata
Sweet viburnum Viburnum odoratissimum
Pinwheel/Jasmine
I CERTIFY THAT I HAVE READ AND UNDERSTAND THE LANDSCAPING REQUIREMENTS WITH REGARD TO FENCES AS
OUTLINED ABOVE, AND THAT THE PROPOSED FENCE WILL BE PROVIDED WITH LANDSCAPING AND IRRIGATION IN
ACCORDANCE WITH SEC. 6.6.4 OF THE LAND DEVELOPMENT REGULATIONS (LDR) PRIOR TO FINAL INSPECTION.
OWNER/BUILDER AFFIDAVIT
(Please Type or Print Clearly)
Owner/Builder Applicant Name:
1. Site address of the proposed building work
2. Name of legal title owner of the site address above
3. Describe the new construction or building work to be done at the site
4. How is the building or space going to be used?
(Name)
6. Who will supervise the trade work to meet all the various adopted codes?
7. What provisions are there for Public Liability and Property Damage Insurance?
8. What provisions exist for withholding Social Security and Federal Income Taxes, as
required by Federal Law, from wages paid to people you hire who are not licensed?
12300 Forest Hill Blvd. Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045
www.wellingtonfl.gov
NOTICE: Florida Statute 489.103 requiring construction to be done only by licensed
contractors provides an exemption from licensing for property owners acting as their
contractor under specific conditions. Answers to the following questions are essential to
determine if those state qualifications are satisfied by an Owner/Builder applicant.
THIS DOCUMENT MUST BE REVIEWED AND SIGNED BY A REPRESENTATIVE
OF WELLINGTON
5. Who will do the actual labor in each major trade area? Owner Alone, Owner with Hired
Help or By Licensed Contractor
Trade Owner Alone or Owner with Hired Help or Licensed Contractor
•
OWNER/BUILDER AFFIDAVIT
9. How will Workers Compensation be provided for any people hired who are not licensed?
10. After improvements are done, who will use the space.
11. Do you plan to rent, lease or offer for sale and if so, when?
13. What Code books do you own for reference?
Building Electric HVAC Plumbing
14. Do you realize that as the permit holder you are liable for following all Local, County, State
and Federal codes, laws and requirements? You are also liable for any one injured on the
construction site.
15. Have you consulted with your Homeowner’s Insurance Agent or Attorney?
Owner/Builder Signature Date
Reviewed and Accepted by VOW Personnel Date
12300 Forest Hill Blvd. Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045
www.wellingtonfl.gov
12. What previous Owner/Builder improvements have you done in Florida?(If “none”, state so)
Location Type of Work Done Year Done
I have read and understand all laws pertaining to Owner/Builder Construction and
agree to comply.
OWNER/BUILDER AFFIDAVIT
OWNER BUILDER AFFIDAVIT & DISCLOSURE STATEMENT PERMIT #
12300 Forest Hill Blvd. Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045
www.wellingtonfl.gov
The provisions of Chapter 489.103, F.S. 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. You must perform or provide direct on-site supervision of the
construction yourself. You may build or improve a one-family or two-family residence or improve a commercial building at
a cost of $75,000 or less in value within any 12 month period, provided the residence or building is 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 or
substantially improved yourself within one year after the construction is complete, the law will presume that you built it for
sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor or to
supervise people working on your building. It is your responsibility to make sure that people employed by you have licenses
and insurance required by State law and by County licensing ordinances. Any person working on your building who is not
licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A
and withholding tax and provide workers’ compensation for that employee, all as prescribed by law. The construction
must be performed according to all Building Codes and Zoning Regulations, and it is your responsibility as the
Owner/Builder to make sure this is done and correct any code violations. A Village Building Permit does not assure
compliance with your Homeowners Association’s rules, regulations and/or deed restrictions. We advise you to obtain
approval from your Homeowners Association before improving your property.
Disclosure Statement:
Therefore, I understand and agree:
1. That state law requires construction to be done by a licensed contractor and have applied for 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.
2. 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.
3. 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 licensed in Florida and to list his or her license numbers on permitsand
contracts.
4. 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 1 year after the construction is complete, the law will presume that I built or substantially
improved it for sale or lease, which violates the exemption.
5. That, as the owner-builder, I must provide direct, onsite supervision of the construction.
6. That I may not hire an unlicensed 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 county or municipal
ordinance.
7. 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. I, 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.
8. 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.
~LINGToN
OWNER/BUILDER AFFIDAVIT
(address of
property )
12300 Forest Hill Blvd. Wellington, FL 33414
Phone: 561-753-2430 Fax: 561-791-4045
www.wellingtonfl.gov
OWNER (Print) DATE OWNER (SIGNATURE) DATE
(Name of Person Acknowledging)
(Type of I.D.)
(Signature of Person Taking Acknowledgement) (Name of Officer Taking Acknowledgement Typed, Printed orStamped)
9. 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.
10. That 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 following address:
.
11. To notify Village of Wellington Building Department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure.
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 and Department of Business and Professional
Regulation 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 properly licensed and the status of the contractor's
workers' compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property
ow
ner and returned to the local permitting agency responsible for issuing the permit. A copy of the property
owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to
the local permitting agency is required when the permit is issued.
I, the owner of property legally described as (attach copy of Warranty Deed):
Address:
do hereby certify that I have read the foregoing, and am aware of my responsibilities and liabilities for construction work on
t
he above-described property. I do hereby covenant and agree to abide by each of the aforesaid stipulations. I further
understand that any falsification of the above statements constitutes fraud and may result in revocation of this permit.
STATE OF FLORIDA COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this day of , 20
by who is personally
known to me or who has produced as identification and who did/did not take an
oath. SEAL
Pursuant to Florida Law, Chapter 489 Part 1, property owners qualified to act as their own contractor must personally appear at the
Building Department and sign the permit application.
PERMIT NUMBER:_______________________________________________________________
ADDRESS:_______________________________________________________________________
Planning Zoning & Building Department
12300 Forest Hill Blvd, Wellington FL 33414
Phone: (561) 753-2430 Fax: (561) 791-4045
www.wellingtonfl.gov
POOL BARRIER REQUIREMENTS AFFIDAVIT
FBC 2017, 6
th
Edition
§454.2.17.1.1 The top of the barrier shall be at least 48 inches above grade measured on the side of the barrier which
faces away from the swimming pool. The maximum vertical clearance between grade and the bottom of the barrier shall
be 2 inches measured on the side of the barrier which faces away from the swimming pool. Where the top of the pool
structure is above grade the barrier may be at ground level or mounted on top of the pool structure. Where the barrier is
mounted on top of the pool structure, the maximum vertical clearance between the top of the pool structure and the
bottom of the barrier shall be 4 inches.
§454.2.17.1.2 The barrier may not have any gaps, openings, indentations, protrusions, or structural components that
c
ould allow a young child to crawl under, squeeze through, or climb over the barrier as herein described below. One end
of the barrier shall not be removable without the aid of tools. Openings in the barrier shall not allow passage of a 4-inch
diameter sphere.
§454.2.17.1.3 Solid barriers which do not have openings shall not contain indentations or protrusions except for normal
c
onstruction tolerances and tooled masonry joints.
§454.2.17.1.4 Where the barrier is composed of horizontal and vertical members and the distance between the tops of
the horizontal members is less than 45 inches, the horizontal members shall be located on the swimming pool side of the
fence. Spacing between vertical members shall not exceed 1-3/4 inches in width. Where there are decorative cutouts
within vertical members, spacing within the cutouts shall not exceed 1-3/4 inches in width.
§454.2.17.1.5 Where the barrier is composed of horizontal and vertical members and the distance between the tops of
t
he horizontal members is 45 inches or more, spacing between vertical members shall not exceed 4 inches. Where there
are decorative cutouts within vertical members, spacing within the cutouts shall not exceed 1-3/4 inches in width.
§454.2.17.1.6 Maximum mesh size for chain link fences shall be a 2-1/4 inch square unless the fence is provided with
slats fastened at the top or bottom which reduce the openings to no more than 1-3/4 inches.
§454.2.17.1.7 Where the barrier is composed of diagonal members, the maximum opening formed by the diagonal
members shall be no more than 1-3/4 inches.
§454.2.17.1.8 Access gates, when provided, shall comply with the requirements of §454.2.17.1.1 through §454.2.17.1.7
a
nd shall be equipped with a self-closing and self-latching locking device located no less than 54 inches from the
bottom of the gate. The device release mechanism shall be located on either side of the gate
and so placed that it cannot be
reached by a young child over the top or through any opening or gap. Gates that provide access to the swimming pool must open
outward away from the pool. The gates and barrier shall have no opening greater than 1/2 inch within 18 inches of the release
mechanism.
§454.2.17.1.9 Where a wall of a dwelling serves as part of the barrier, one of the following shall apply:
1. All doors and windows providing direct access from the home to the pool shall be equipped with an exit alarm complying with
U
L 2017 that has a minimum sound pressure rating of 85 dB A at 10 feet and is either hard-wired or of the plug-in type or battery.
The exit alarm shall produce a continuous audible warning when the door and its screen are opened. The alarm shall sound
immediately after the door is opened and be capable of being heard throughout the house during normal household activities. The
alarm shall be equipped with a manual means to temporarily deactivate the alarm for a single
________________________________________
_________________________________________
_______________________________________________
COMPANY NAME
CONTRACTOR PRINT NAME
CONTRACTOR (SIGNATURE) DATE
opening. Such deactivation shall last no more than 15 seconds. The deactivation switch shall be located at least 54 inches above the
threshold of the door.
EXCEPTIONS:
a. Screened or protected windows having a bottom sill height of 48 inches or more measured from the interior finished floor at the
p
ool access level.
b. Windows facing the pool on floor above the first story.
c. Screened or protected pass-through kitchen windows 42 inches or higher with a counter beneath.
2. All doors providing direct access from the home to the pool must be equipped with a self-closing, self-latching device with
p
ositive mechanical latching/locking installed a minimum of 54 inches above the threshold, which is approved by the authority
having jurisdiction.
3. A swimming pool alarm that, when placed in a pool, sounds an alarm upon detection of an accidental or unauthorized entrance
in
to the water. Such pool alarm must meet and be independently certified to ASTM F2208, titled “Standard Safety Specification for
Residential Pool Alarms,” which includes surface motion, pressure, sonar, laser, and infrared alarms. For purposed of this
paragraph, the term “swimming pool alarm” does not include any swimming protection alarm device designed for individual use,
such as an alarm attached to a child that sounds when the child exceeds a certain distance or becomes submerged in water.
§454.2.17.1.10 Where an aboveground pool structure is used as a barrier or where the barrier is mounted on top of the pool
structure, and the means of access is a ladder or steps, the ladder or steps either shall be capable of being secured, locked or
removed to prevent access, or the ladder or steps shall be surrounded by a barrier which meets the requirements of §454.2.17.1.1
through §454.2.17.1.9 and §454.2.17.1.12 through §454.2.17.1.14. When the ladder or steps are secured, locked or removed, any
opening created shall not allow the passage of a 4 inch diameter sphere.
§454.2.17.1.11 Standard screen enclosures which meet the requirements of §454.2.17 may be utilized as part of or all of the
"
barrier" and shall be considered a "non-dwelling" wall. One end of the barrier shall not be removable without the aid of tools.
§454.2.17.1.12 The barrier must be placed around the perimeter of the pool and must be separate from any fence, wall, or other
e
nclosure surrounding the yard unless the fence, wall, or other enclosure or portion thereof is situated on the perimeter of the pool,
is being used as part of the barrier, and meets the barrier requirements of this section.
§454.2.17.1.13 Removable child barrier must be placed sufficiently away from the water's edge to prevent a young child or
m
edically frail elderly person who may manage to penetrate the barrier from immediately falling into the water. Sufficiently away
from the water's edge shall mean no less than 20 inches from the barrier to the water's edge. Dwelling or non-dwelling walls, when
used as part or all of the "barrier" and meeting the other barrier requirements, may be as close to the water's edge as permitted by
this code.
§454.2.17.1.14 A wall of a dwelling may serve as part of the barrier if it does not contain any door or window that opens to provide
d
irect access from the home to the swimming pool.
§454.2.19 Final inspection. Final electrical, and barrier code, inspection shall be completed prior to filling the pool with water.
I CERTIFY THAT I HAVE READ AND UNDERSTAND THE POOL BARRIER REQUIREMENTS AS
FLORIDA BUILDING CODE 6
TH
EDITION 2017 WITH THE LATEST AMENDMENTS, 454.2
(RESIDENTIAL), AND THAT A POOL BARRIER MEETING THESE REQUIREMENTS, FROM
454.2.17.1.1 THROUGH 454.2.17.1.14, SHALL BE IN PLACE AT THE TIME OF FINAL INSPECTION.
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FENCEWALL PERMIT CHECKLIST (Village of Wellington)

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Completed 17 July 2020

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