HomeMy WebLinkAboutAFFIDAVIT OF REQUIREMENT COMPLIANCEBOARD 01? COUx Y C01d14fjSgj0Nrft$
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lResideat121 Swlmrding Fools, Spa, and Hot Tub Safeq Act
AFFIDAVIT OF REQUIRFNt
, ENT COMPLIANCE
T (We) acknawledgo that a new : wimm, in& pool, apa, or hot tub will be constructed or installed at _
� _ e , _,, and hereirtaffirrn that one of ttw follpwint, methods will be
p AM0 print Street Mdrixs)
used to meet the regWramtrits of0opter115, Fbrlda Statutes. Ic a initial the methods Ad far our got .
The pool will be isolates fmm accom to the horse by an ancldsure thar, meets the poat harrier regvire ngats of
__ZFlorida 5f8tUtt: 515:29;
The pal will be agslipp ed with :. a approved saraty pool covet that complies with AS'Z'M F13.16-Pi (Standard
P"formhnce Speclfieati ans for ;afbty Covers for Swimming Pools, Specs, and Hot Tubs);
All doors and windows oroviding dlrecc access from tite bame to the pool will be aqulpped se th ap exit alem ,hat
has a minimurn sound p'essure Mtins of 85 decibels at 10 feet;
All doors providing df, :;ct access from the homy to the pool will be equipped with seli`tlosin;, aclt-latcft[nE
devises with release, ma ;hanisms place: no lower than Sri" abave the floor or desk.
X uixtlerstand that not hAving one of the above Installed at the time ogfinal inspection, or when the pool
is completed for contract purpols,as, w311 tonstatute a'violation of Chapter 515, I+.S,, and iuill be consid.
ared as tommitting a ftntsdemean it of the second dcgrte, punishable by fides up to 5500-OD andlor up to
50 days In fail as establUbed in chapter 77:5,F.S.
I understand that the St Lucie 0,anty Building Iinspestioris Dq2 rtme:nt assumes no lial.)% y for the
final inspection of One, of tVa abol e'protective devices, or the Jack Of ctt intenance, or the removal of such
after the svriT�,MIng pool has beet. finalized. ,
X, the contractor, agree to iinitruct the ownet' of the proper list and t olatenance of such safety device.
+CQNTRA CTOIt,IS NG—I ATURS
>�it?TAt�Y PUI�LTC, STATE OF FL.
AS TO CONT&4,CTop, /
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AND A1K UU1NDITWINERS, YENCEJ. E" I U., not otherwise included with this buildmg nerrnit application.
St. Lucie County makes no representat -' . uiat its granting of a permit will authorize the YG....it holder to build the subject structure
which is in conflict with any applicable Homeowner As�SociaticrL rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE 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 JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF I—M AC-A-r_I-I
The foregoing instrument was acknowledged before
me this of/�'� day of A-V6 20
by Cl El14t✓3 WY+SE12
who is personally known ✓or has produced
1 as identification.
Signature of Notary KATHI P. JENKINS
Notary Public - State of Florida
Commission No. '-1*p4Dmm. Expires Apr 12, 2014
=;? Commission # DD 963673
mW Bonded Through National Notary Assn.
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF j3#1_V 1 &? 04
The foregoing instrument was acknowledged before
me this a day of UCH , 20 1 t ,
by 1 EI AW) Wf+SEYL
who is personally known ✓ or has produced
as identification.
Signature of Not
*,� KATHI P. JENKINS a
Commission No. �`'� ��'
Notary �5b1�} State of Florida
•? My Comm. Expires Apr 12, 2014
Commission #E DD 963673
' . �i "'•, Bonded Through National Notary Assn. ff
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST E F AMp
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
`
OFFICE USE ONLY
SEC,TION
TOWNSHIP
Z 1.
��
LAND USE
LOT CVG %
ZONING
FLOOD ZONE
FIRM MAP #
ISTFLR ELV
OCCUP TYPE
MAXO
CONST TYPE
SEWER
SPRINKLERS
WATER
LOT OF REC
Hefore l/1990
KOTREC
990
LOT SPLIT
REQUm®
REPORT
HABITABLE
RADON
CODE
��
AREA
FEE
LIBRARY
PUBLICBM
PUBIC BLD
IMPACT
IMPACT FEE
BRACT
FEE
CORRECTION
FEE
GENERAL
SCHOOL
ROAD CREDIT
Y
IlVIPACT
BRACT
—
FEE
FEE
FIRE/EMS
DRIVEWAY Y N DRIVEWAY
IMPACT
REQUIRED FEE
FEE
SPECIFY
MECHANIC ROOF NON -CONFORMING
SUBS
ELECTRIC GAS LOT OF RECORD
REQUIRED
PLUMBING FEES
DATE SENT TO ADDRESSING: I I
MAP NO.
TAZ NO.
# OF FLRS
STORMWATER
LOT SPLIT
APPROVED
PERMIT
FEE
PARKS
IMPACT
FEE
N ILAW ENF
IMPACT
FEE
ADMINISTRATIVE
VARIANCE FEE
MISCELLANEOUS
FEES
REVIEWS I GAUNTER I REVIEW I SUPERVISOR
I VIEW I REVIEW N I REVIEW . I REVIEW