City of North Port Neighborhood Development Services 4970 City Hall Boulevard North Port, FL 34286

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1 City of North Port Neighborhood Development Services 4970 City Hall Boulevard North Port, FL Phone (941) Fax (941) Inspections (855) SUBMITTAL CHECKLIST FOR AN IN-GROUND POOL PERMIT Please Submit the following Information and this Checklist with the Application for Construction Building Permit Application (complete, with Parcel ID) Notice of Commencement (Recorded in South County Office, Venice) 3. 4 sets of site plans with setbacks (1 rear & 2 side) (show location of all equipment & equipment pads) (1 attached to ROW Use Permit) 4. 3 copies of the Residential Pool, Spa, Hot Tub Safety Act 5. 3 copies of pool specifications (w/electrical grid bonding identified) 6. 1 Right of Way Use Permit (with attached site plan) (see 3 above) 7. Subcontractor confirmation form (filled out by the subcontractor) 8. Contractor Affidavit 9. Notarized signature of Applicant 10. Sarasota Department of Health Approval (if pool is to be installed on property with a septic system, or with a potable water well or irrigation well) 11. Pool Heater (circle one) (gas/electric/solar/no heater) (gas heater requires a plumbing contractor) 12. Anti-Entrapment information (unless on pool plan) 13. Show access path on all site plans from street ROW to area of work. SUBMITTED APPLICATIONS ARE STAMPED IN AND HELD FOR SIX (6) MONTHS. IF THEY ARE NOT PICKED UP WITHIN SIX (6) MONTHS OF THE STAMPED IN DATE, THE APPLICATION WILL BE CONSIDERED VOID AND THE PAPERWORK DESTROYED! Submittal Checklist for an In-Ground Pool Permit / Revised / Jun 17

2 CITY OF NORTH PORT Neighborhood Development Services 4970 City Hall Boulevard North Port, Fl Permit No. Phone (941) Fax (941) Inspections (855) APPLICATION FOR A CONSTRUCTION PERMIT ( PLEASE PRINT CLEARLY ) RESIDENTIAL COMMERCIAL MISCELLANEOUS Property Owner / Name Property Owner / Address City State Zip Contractor's Company Name Contractor's Phone No. Architect Engineer License No. Architect's Reg. No. Engineer's Reg. No. Lot Block Addition Parcel I. D. No. Job Site Address Local Contact Sq. Ft. of Lot Contract Price Central Water Central Sewer Work Description Phone No. Fax No. Sq. Ft. of Total Under Roof Area Bldg. Dept. Computed Contract Price Well Septic Office Use Only Application is hereby made to obtain a permit to do the work and installation 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 may be required for Electrical, Plumbing, Mechanical, and Gas work, etc. Application for a Construction Permit / Revised / June 15 Page 1 of 2

3 Sub-Contractor Information ELECTRICAL / FIRE ALARM Phone PLUMBING / SPRINKLER Phone MECHANICAL / GAS Phone ROOFING / OTHER Phone State License City License State License City License State License City License State License City License Required Fees Departments Fees Required Approvals Department Initials Date Admin / Plan Review Fee Permit Clerk Convenience Fee 5 00 Building DPBR Fees Zoning 2 % Education Surcharge Public Works Building Permit Engineering Zoning Fire Public Works Utilities Fire Planning Engineering The Permit when issued will expire 180 days from the DATE Totals Application Approved By: issued if INSPECTIONS have not commenced or 180 days from the last APPROVED INSPECTION. FBC / "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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT." OWNER AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regarding construction and zoning. Signature Signature OWNER CONTRACTOR or AGENT STATE OF FLORIDA, COUNTY OF SARASOTA STATE OF FLORIDA, COUNTY OF SARASOTA The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of, 20 by day of, 20 by ( name of person ) who is personally known to me or who has ( name of person ) who is personally known to me or who has produced produced ( type of identification ) as identification. ( type of identification ) as identification. Notary Notary ( Seal ) ( Seal ) Application for Construction Permit / Revised: / June 15 Page 2 of 2

4 LOCATION TYPE OF WORK APPLICANT City of North Port Neighborhood Development Services 4970 City Hall Boulevard North Port, FL Phone (941) OFFICE USE ONLY PERMIT # PERMISSION IS HEREBY GRANTED TO Name (Print) Application for a Right of Way Use Permit Address Phone Number New Residential Construction New Commercial Construction Communication Facility/System Utility Bore Digging or FPL Pole Installation Street Number PID Number Block Land Clearing Culvert/Driveway/Sidewalk/Concrete Slab Fence/Shed/Garage/Pool Other Street Name Lot Addition If applicable, a Corporate Bond shall be filed with the City of North Port, Florida. It is agreed between Applicant and City, bond may be used to repair any damage done, correcting any violations of ordinances and/or cleaning/restoring the grounds occupied or used by the Applicant to condition prior to issuance of this permit. ULDC CHAPTER 33; Applicant shall be responsible for repair/restoration to roadway, right-of-way, swales and adjacent properties prior to final Public Works Department approval and/or issuance to Certificate of Occupancy. The construction authorization card shall be posted on the jobsite prior to any work being performed. The construction authorization card shall remain until a permit box for building construction is located on the property. At that time, the land clearing permit and right-of-way use permit shall be placed in the permit box. Applicant to schedule all required inspections including after completion final inspection. This Permit applies to Right of Way Use at ABOVE LOCATION ONLY. I HEREBY AGREE to all terms under which this Permit is being issued. Applicant Signature: Date: CITY OF NORTH PORT, FLORIDA Director, Public Works or Authorized Agent: Date: Application for ROW Use Permit/Revised/ Jun 2018 Page 1 of 2

5 Right-of-Way Use Permit for City of North Port General Provisions/Conditions a. No streets or sidewalks may be blocked or closed without prior permission from the Public Works department. b. Repair and restoration of work area is required in accordance with City Code. c. Fire hydrants must be accessible at all times. d. All equipment and materials are to be properly barricaded, lighted and secured. A day/night watchman may need to be employed for that purpose. e. Institute proper erosion control measures effecting positive drainage at all times within City right-of-way and, use Best Management Practices as required under City codes/ordnances. f. Provision be made for the continuous operation of all utility pipes, ducts and other lines. g. Assure affected public and private property is maintained and preserved from injury through-out work performance. h. Assure that all work performance is done in such matter as to promote public safety. i. Agree that all suits, actions or claims of whatever nature which may arise, occasioned either directly or indirectly by the work permitted or the special privileges granted hereunder, shall be assumed by the Applicant and that the City Commission, and all its officers, agents and employees, shall be indemnified and saved harmless there from, and that Certificates of Liability insurance be submitted by the Applicant. j. Assure that all lines and grades furnished for poles, ducts, pipes, sidewalks, buildings and other structures are in accordance with city standards/codes. k. The City reserves the right to revoke the Right of Way Permit without other formality than that of notifying the Applicant of this effect should there be a violation to the foregoing General Provisions or City codes/ordinances. Furthermore, to invoke the provisions of the Corporate Bond to restore the area to its original condition where deemed necessary. l. Adherence to the National Environmental Policy Act and Endangered Species Act. m. If this Right-of-Way Use Permit is specific to a wireless communication device or system to be located within a City right of way, the applicant shall comply with all requirements, standards and provisions set forth in State of Florida and City of North Port regulations governing same. I HEREBY AGREE to above General Provisions/Conditions under which this Permit is being issued. Applicant Signature: Date: Application for ROW Use Permit/Revised/ Jun 2018 Page 2 of 2

6 City of North Port Neighborhood Development Services 4970 City Hall Boulevard North Port, Fl Phone (941) Fax (941) Inspections (855) Contractor Affidavit Form I understand that it is my responsibility, as the Licensed Contractor for construction in the City of North Port, to hire only licensed and insured sub-contractors. The attached sub-contractor verification form includes the names of sub-contractors who have worked on this property and permit. They are insured and licensed with the City of North Port. Property Address Permit # Licensed Contractor s Company Name Licensed Contractor s Signature PRINTED NAME State of Florida, County of Sarasota The foregoing instrument was acknowledged before me by who is personally known to me or who has produced as identification. Witness my hand and official seal this day of 20. Notary Seal Contractor Affidavit Form / Revised / Apr 17

7 Building Division 4970 City Hall Blvd, North Port, FL Phone: (941) Fax: (941) SUB-CONTRACTOR CONFIRMATION SUB-CONTRACTOR CONFIRMS THAT HE/SHE IS RESPONSIBLE FOR THE WORK ON THIS SPECIFIC PROJECT, AND ALLOWS THE GENERAL CONTRACTOR TO OBTAIN A BUILDING PERMIT FROM THE CITY. Gen. Contractor: Permit Application #: Owner / Project Name: Job Address: Circle only one: Electrical Mechanical Plumbing Roofing Fire Sprinkler Other Fire Alarm Low Voltage Fire Suppression Fire Underground The qualifier of each major sub-trade (listed above) performing work under a general contractor must complete this form and submit it to the General Contractor PRIOR to issuance of permits. Sub-Contractor: Address: License #: Phone #: Qualifier's Affidavit Qualifiers Affidavit KNOW ALL MEN that I (name) qualifier/agent of (name of company) do hereby certify that my company is responsible for the work as stated above. Signature of Qualifier/Agent State of Florida, County of Sworn to and subscribed before me this day of, 20 by, who is personally known to me or has produced as identification. Signature, Notary Public - State of Florida (SEAL) Printed, Typed, or Stamped Name of Notary

8 Permit No. City of North Port Neighborhood Development Services 4970 City Hall Boulevard North Port, Fl Phone (941) Fax (941) Inspections (855) Residential Swimming Pool, Spa, and Hot Tub Safety Act Form Notice of Requirements I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at, and hereby affirm that one of the following Please print street address methods will be used to meet the requirements of the Florida Statutes, Chapter 515. Please initial the method(s) to be used for your pool The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute, Chapter & the Florida Building Code Section The pool will be equipped with an approved safety pool cover that complies with ASTM F (Standard Performance Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs, per the Florida Building Code Chapter (exception) All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that meets UL 2017 and has a minimum sound pressure rating of 85 decibels at 10 feet, per the Florida Building Code Chapter (1). All doors and windows providing direct access from the home to the pool will be equipped with self-closing, self-latching devices with release mechanisms placed no lower that 54 above the floor or deck, per the Florida Building Code Chapter (2). A pool alarm which must meet and be independently certified to ASTM Standard F2208, titled Standard Safety Specification for Residential Pool Alarms, which includes surface motion, pressure, sonar, laser and infrared alarms. I (We) understand that not having one of the above installed at the time of final inspection or when the pool is completed for contract purposes, will constitute a violation of the Florida Statutes, Chapter 515, and will be considered as committing a misdemeanor of the second degree, punishable by fines up to $500 and/or up to 60 days in jail as established in the Florida Statutes Chapter or s Contractor s Signature & Date Please Print Contractor s Name Homeowner s Signature & Date Please Print Homeowner s Name Residential Swimming Pool, Spa, and Hot Tub Safety Act Form / Revised / May 17

9 NOTICE OF COMMENCEMENT Permit No. Parcel ID: Tax Folio No. State of Florida County of Sarasota 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. 1. Description of Property: (legal description of the property and street address if available) 2. General Description of Improvement: 3. Owner Information a. Name and Address: b. Interest in Property: c. Name and Address of Fee Simple Titleholder (if other than owner) 4. Contractor a. Name and Address: b. Phone Number: 5. Surety a. Name and Address: b. Amount of Bond $. c. Phone Number: 6. Lender a. Name and Address: b. Phone Number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section (1)(a)7., Florida Statutes: a. Name and Address: b. Phone Number: 8. In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor s Notice as provided in Section (1) (b), Florida Statutes: a. Name and Address: b. Phone Number: 9. Expiration date of Notice of Commencement (the expiration date is 1YEAR 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, SECTION , 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. Signature of Owner or (Owner s Authorized Officer/ Director/Partner/Manager) Signatory s Title/Office Printed Name The foregoing instrument was acknowledged before me this day of, 20 by (name of person) as (type of authority e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed). Signature of Notary Public, State of Florida Commission Expires: Verification pursuant to Section , 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. Signature of Natural Person Signing Above NOC / Revised / Mar 12 Page 1 of 2

10 Notice of Commencement Instructions 1. Complete the NOC form, sign and have notarized. (NOC s are not required for contracts less than $2,500.00). 2. NOC s are required for A/C Replacements on contracts $7,500 and above. 3. Record original document either at the Clerk of Circuit Court Office, 2000 Main Street, Sarasota or 4000 S. Tamiami Trail, Venice 4. Submit a copy of the recorded NOC to the North Port Building Department with your Application Documents. 5. THE SEALED ORIGINAL NOC MUST BE POSTED AT THE JOB SITE PRIOR TO THE FIRST INSPECTION. NOC / Revised / Mar 12 Page 2 of 2