HomeMy WebLinkAboutAffidavit of Requirement CompliancePLANNING & DEVELOPMENT SERVICES ]DEPARTMENT
Building and Code Regulations Division
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT #
I (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
1310 Copenhaver Road Fort Pierce Fl- 34945 and hereby affirm that one of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515, Florida Statutes: (Please initial the method used for pool.)
The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F 1246-9 1 (Standard Performance Specifications for
Safety Covers for Swimming Pools, Spas, and Hot Tubs).
All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing, self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck.
I 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 Chapter 515, F.S., and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to $500.00 and/or up to 60 days in jail as established in chapter 775, F.S.
I understand that the St. Lucie County Building Inspections Department assumes no liability for the final inspection of one of the
above protective devices, or the lack of maintenance, or the removal of such after the swimming pool has been finalized.
I, the contractor, agree to instruct the owner of the proper use and
4CNT11ACTOR SIGNATURE
STATE OF FLORIDA, COUNTY OF Saint Lucie
5NOTARY PUBLIC
The foregoing instrument was acknowledged before me
this
by
rs 71C.114day of 4-kLQ 202
Hannah Becker
Personally Known " ' or Produced Identification
Type of Identification Produced:
;o1'xir'duBARWEN D ADAMS
'?(.•�,y1� Notary Public - State of Florida
, Commission # GG 272920
d1=:r
SLCPDS Revised 07/22/2014 °iF•`I My Comm, Expires Oct 31, 2022
Bonded through National Notary Assn.
maintenance o safe
OWNER SIGNATURE
STATE OF FLORIDA, COUNTY OF Saint Lucie
NOTARY PUBLIC
The foregoing instrument was acknowledged before me
th�, day of CiUL�- , 202
by Charlotte M Stahlberg
Personally Known " ' or Produced Identification
Type of Identification produced:
�11RY pG •.
io , eon: ARWEN D ADAMS
Notary Public - State of Florida
Commission#GG272929
My Comm. Expire, Bonded through National ct l Nota, 2022
ry Assn.
I
X
Y
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT # 2j l/—I -
I (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
1310 CoPa%4 14AJ'--2 &D . and hereby affirm that one of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515, Florida Statutes: (Please initial the method used for pool.)
The pool will be isolated from access to the home by an enclosure that tweets the pool barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F 1246-91 (Standard Performance Specifications for
Safety Covers for Swimming Pools, Spas, and Hot Tubs).
All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing, self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck.
I 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 Chapter 515, F.S., and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to $500.00 and/or up to 60 days in jail as established in chapter 775, F.S.
I understand that the St. Lucie County Building Inspections Department assumes no liability for the final inspection of one of the
above protective devices, or the lack of maintenance, or the removal of such after the swimming pool has been finalized.
I, the contractor, agree to instruct the owner of the proper use and maintenance of such safety device.
CONTRAC R SIGNATURE OWNER SIGNA RE
STA E OF FL OUNTY OF�—
NOTA Y PUBLIC
The foregoing instrument was acknowledged before me
this Ve day of f{ p1' t , 20 Z
Personally Known or Produced Identification
Type of Identification Produced:bT`JAfS L tCv�s'Qi
SLCPDS Revis 0 "' ' •,) ALEXA KRATT
• NotCorida
ommission # State Public _ GG 9841139
d My Comm. Expires May 4, 2024
Ass.
Banded through National Notaryn
STATE F FLORIDA, OUNTY OF
N TARY PUBLIC
S1. t"Gec-i e—
The foregoing instrumentwasacknowledged before me
this r4 day of Apr+'1 .20Z
by V1.ai�n L 6"1
Personally Known or Produced Identification
I
Type of Identification producel r �'�S r C C"- C—
;�'jiY P�'+ ALEXA KRATT
a� vN Notary Public - State of Florida
�'� Commission # GG 984139
cF f� My Comm. Expires May 4, 2024
Bonded through National Notary Assn.