HomeMy WebLinkAboutAFFIDAVIT OF REQUIREMENT COMPLIANCE1,
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations DivisionCRCEIVED
® 2300 VIRGINI , AVE
FORT PIERCE, FL 34982 (772) 462-1553 Fax (772) 462-1578 20 g qSCANNED AFFIDAVIT OF REQUIREMENT COMPLIANCEy, Permitting
St Lucie CountyResidential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT #
I
I (We) cknowleNf6reA-5e
hat a new swimmin 1, spa�°r//��}}ot to 1 be constructed or installed at
4b b� �� 1-'7'i' 1C eby affirm that one of the following methods
(Please print street address)
77Tfic
to meet the requirements of Chapter 515, Florida Statutes: (Please initial the method used for pool.)
pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29.
i
The pool will be equipped with an approved safety pool cover' that complies with ASTM F1246-91(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 tines up to $500.00 and/or up to 60 days in jail I'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.
1, the contractor, agree to instruct the owner of the proper use and maintenance of such safety device.
IdI01141,
CONTRACTOR SIGFWFURE
ST OF FLORIDA, CO OF
NO Y PUBLIC
The foregoing instrument was acknowledged before me
this day of - M_.i/ 20
V
by t
Personally Known or Produced Identification
Jdsandra A Ingraham
Type of Identification
c l.dl� $rtAT ,OF FLORIOA
Comm*-GG032559
's� Expires 319/2020
SLCPDS Revised 07/22/2014
le"
OWNER SIGNATURE
STA OF FLORIDA, COUN F c5p— LuVt ,
OTARY PUBVC'
The foregoing instrument was,acknnowledged before me
this day of //�►� 20�
.2
Personally Known or Produced Identification
A.1r1g1>�ham
Type of Identification produc PUBLIC
" -,9 ATE;OF FLORGA
Comm#:gG032M
VW1� Expk s 3I912020