Form B39
Revised 05/12
BAY COUNTY BUILDERS’ SERVICES DIVISION
COMMERCIAL
MANUFACTURED BUILDING PLAN REVIEW SUBMITTAL FORM
NOT FOR HUD APPROVED DWELLING UNITS
AVOID PROCESSING DELAYS
Please provide all applicable items listed below. This form is Not for Planning Division submittals.
1.
One set of scaled site plans showing: dimensions of property, all buildings
and structures, distances from property lines and between structures, etc.
2.
One set of plans approved per section 458 FBC. See also 553 Florida Statutes.
3.
One set of foundation plans sealed by a design professional
4.
One set of detailed plans for required decks/stairs/handicap ramps
5.
Approval from Planning Department for land use (Development Order)
6.
Receipt from serving utility company for sewer and water(Form B09) (if habitable)
7.
Legal description of property – Parcel Number:
8.
Complete, notarized Application for Modular Permit(Form B49)
9.
Notice of Commencement must be recorded prior to 1
st
inspection
Important note concerning the building’s occupancy classifications: Residential
Design manufactured buildings cannot be used for commercial use. The design
occupancy must match intended use.
Applicant’s Signature
Phone #
Cell #
For additional information see Manufactured Buildings
……………………….…………..DO NOT WRITE BELOW DOTTED LINE………..……………………………
INFORMATION
VALUATION
COUNTY IMPACT FEES
FEES
Stories
Type of
Construction
Library
$
Permit
$
Units
Flood Zone
Parks
$
Square
Footage
County
Area
Fire
$
Total County Impact Fees
$
Roads
B/A
EB
PC
S/S
TOTAL COUNTY FEES
$
$
Wholesale Water
$
City Impact Fees (if applicable)
$
Notes:
Total County & City Fees
$
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may be
additional permits required from other government entities such as water management districts,
state agencies, or federal agencies.
Form B49
Page 1 of 2
Revised 10/10
APPLICATION FOR MANUFACTURED BUILDING
Bay County Builders’ Services Division
6840 W. 11th Street, Panama City, FL 32401, Phone: (850) 248-8350 Fax: (850) 248-8384
NOTE: IF 180 DAYS ELAPSE WITHOUT AN INSPECTION, THIS PERMIT EXPIRES AND WLL HAVE
TO BE REPURCHASED
Date:
Permit Number:
OWNER’S NAME:
Phone #:
Address:
City, State & Zip Code:
CONTRACTOR’S NAME:
Phone #:
Address:
City, State & Zip Code:
State License #:
Competency Card:
ADDRESS OF PROPOSED SITE:
Parcel ID Number (Required):
Florida Tracking No. from DBPR web site for Manufactured Buildings:_________________________
If Construction/Job Site Trailer – STOP HERE - Sign Owner/Agent or Contractor Affidavit below
DESCRIPTION of DCA MODULAR (check one):
Commercial:
Residential:
Construction/Job Site Trailer:
Cost of foundation
$
State cost of all decks, stairs, and handicap ramps
$
AFFIDAVIT: I hereby certify that the information contained in this application is true and correct and that
all work will be done in compliance with all applicable laws regulating construction and zoning.
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.
Owner or Agent Affidavit
(Print Owner or Agent Name) (Signature of Owner or Agent)
STATE OF FLORIDA
COUNTY OF BAY
Sworn to (or affirmed) and subscribed before me this day of , 20 ,
by .
(Signature of Notary Public - State of Florida)
(Notary Stamp or Seal)
Personally Known _____ OR Produced Identification _____
Type of Identification Produced_______________
Contractor Affidavit
(Print Contractor Name) (Signature of Contractor)
STATE OF FLORIDA
COUNTY OF BAY
Sworn to (or affirmed) and subscribed before me this day of , 20 ,
by .
Signature of Notary Public - State of Florida)
(Notary Stamp or Seal)
Personally Known _____ OR Produced Identification _____
Form B49
Page 2 of 2
Revised 10/10
NOTE: Final approval on the septic tank from Bay County Health Department is required to be
submitted to Builders’ Services Division before a Final DCA Modular Inspection will be made.
NOTICE: Bay County Builders’ Services Division does not have the authority to enforce deed
restrictions or covenants on properties. You are advised to check for any restrictions that may affect
your property.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to
this property that may be found in the public records of this county, and there may be additional permits
required from other government entities such as water management districts, state agencies, or federal
agencies.
……………………….…………..DO NOT WRITE BELOW DOTTED LINE………..………………………………
Zoning: Flood Zone:
Application Approved By: , Permit Officer
Form B09
Revised 5/30/12
BAY COUNTY BUILDERS’ SERVICES DIVISION
STATEMENT FOR WATER
Site Address: _____________________________________
Please initial the boxes below that are applicable
WELL A working potable water well located on the site which will be used
water supply to the structure. (no public utilities are available)
SEPTIC TANK A new or existing septic system located on the site will be
used. (Provide a current septic permit or existing system letter from the Bay
County Health Department before building permit can be issued.
PUBLIC UTILITIES – WATER Are available and will utilized for water to the
structure. (Provide water receipt from serving utility company indicating
available service and that all tap fees and impact fees have been paid)
PUBLIC UTILITIES – SEWER Are available and will be utilized for sewer to
the structure. (Provide sewer receipt from serving utility company indicating
available services and that all tap fees have been paid)
Owner/Agent/Contractor Signature
Date
Form B05
Revised 5/30/12
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida
County of Bay
To Whom It May Concern:
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.
Description of property (legal description of the property, and street address if available):
General description of improvement:
Owner Name:
Address:
Owner’s interest in site of the improvement:
Fee Simple Titleholder Name:
Address:
Contractor Name:
Address:
Phone Number:
Payment Bond Surety:
Address:
Phone Number: Amount of Bond: $
Lender Name:
Address:
Phone Number:
Person 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:
Name
Address
Phone Number:
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 Number:
Expiration date of Notice of Commencement is one (1) year from date of recording
unless a different date is specified .
Signature of Owner
Sworn to (or affirmed) and subscribed before me this day of , 20 ,
by (name of person making statement).
Signature of Notary Public (State of Florida)
NOTARY SEAL
Personally Known or Produced Identification
Type of Identification Produced _____________________
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROVER PAYMENTS UNDER CHAPTER 713,
PART I, SECTION 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
ON RECORDING YOUR NOTICE OF COMMENCEMENT.