HomeMy WebLinkAboutAffidavit Of Requirement Compliance 10-18-17PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building anti Code Regulations Division
2300 VIRGINIA AVE
FORTPIERCE, FL 34982
(772)462-1553 Fax(772)462-1578
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot. Safety Ac�CE' qq
j /� u i U Cli7%
PERMIT a 1 j / -. () I
I (We) acknowl_ed_g�j that anew swimming pop), spa, or hot tub will be constructed or installed at
_IVA o C t'►Od✓ � STOWS 021 , 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 5.15.29.
The pool ++ill 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 +gill 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 die 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 S500.00 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 o the final inspection of one of the
above protective devices, or the lack of maintenance, or the removal of such after the swinuhin pool has been finalized.
1. the contractor, agree to instruct the owner of -the proper use and maintenance of su 1 so ty device.
67
1
CONTRACT R SIGNATURE -L OIVNER S1 NATURE
ST O -FLORIDA. COUNTY OF �� ClIL� S *7RIDA, COUNTY OF Qi2�ng�
rw
NOTXRY PUBLIC Pula
The foregoing instrument was acknowledged before me
this 7 day of CiCIV09-%" . 24 7
by
Personally Known or Produced Identification
Type of Identification Produced:
J AMESROUAN
:P, P
�ti y MY COMMIS£10"I if GG COB
SLCPDSRevised 07/ f EXPIRES: tlovombor4,2020
'ca PabtiG UndentailetS
gondedlbru"ary
•;; orF;gr
The foregoing instrument was acknowledged before me
this 11 day of "J"� `-f , 20__
by M Lkeot.,:loA
Personally Known or Produced Identification_j
Type of Identification produced: t'1'0/(dti J)rot • Lreeo5<
2°.' P Y pVa��� Kaylene A. McKoy
State of Florida
,A�, QoQ My Commission Expires 12/10/2017
FOF FV° Commission No. FF 75463
RECEM-ED SEP ? ) 71L
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
° Building and Code Regulations Division
2300 VIRGINIA AVE
FORT I'I RCE, rl, 34952
(772),162-I5.53 Fax (772),162-1578
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT it
1(We) acknowledge that anew swimmin pool, spa, or hot tub will be constructed or installed at
a P im �' In � s � pi ,and hereby affirm that one of the following methods
(Plensc print street address)
will he , ed to nlect 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 float meets the pool barrier requirements of Florida Statute 515 29
The pool sill be equipped with am approved safety pool cover that complies with AS'1 �M F12d6.91(Standard Performance Specifications for
Safety Covers for Swimming Pools, Sims -mil llot'rubs).
All doors and windows providing direct access from the home to the pool will be cquipptrl wilt an exit alarm fhat has a minimum sound
pressure rating of85decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing. self lutching devices avth release mechanisms
placed no loner than 54 inches above lire floor or deck_
I understand flint not having one of'thc above installed at the time of final inspection. or when the pool is completed for contract
purposes,'vill 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 swi ling pool has been finalized.
I, the contractor, agree to instruct the owner of the proper use anti maintenance of r i afety device.
�CONTI , �rR
IGNATURE (M � t SIGNATURE
F rIDA, COUNTY OI+ G/ L / T zJ ST. IDA� COUNTY Or t
kk
NOTA , PURLIC ROT,tt?l-Plllll-
The oregoing instrument was acknowledged before me The foregoing instrument was acknowledged before me
this day of _ �5�' S✓ — . 20� this �_ day of ��"I 20
_ ,
by by .1 -q n C. • M Z-Ke.O t^• A
Personally Known or Produced Identification
Type of Identification Produced:
JAMESROUAN
MY COMMISSION # GG 006627
SI.CPUSites E'�q EXPIRES:November4,2020
•• Bonded Thru Notary Public Underwriters
°:,Y,,,
Personally Known or Produced Identification j�
Type of Identification produced: (y rl da. 1 1A *%?Cr L4 fie( 9-C.
=°LP,,Y P&O Kaylene A. MCKoy
State of Florida
Nq �oQ My Commission Expires 12/10/2017
�oF F�°�' Commission No, FF 75463