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' - - PLANNING & DEVELOPMENT SERVICES DEP R 17MENT
• Building and Code Regulations Division
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT # 1 10V
RSCE:rvED
JUN 2 7 2019
Permitting Department
St. Lucie County
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I (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
L�qwPDdcl j?n/ • 6 're 2. r'�- and hereby affirm that one of the following methods
(Please print street address)
will be u ed 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 1246-91(Standard Performance Specifications for
Safety Covers for Swimming Pools, Spas, and Hot Tubs).
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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.
Swimming pool alarm placed in pool meeting ASTM F2208
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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.
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j 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.
CONTRACTOR SIGNATURE OWNE6SIATUR
STATE OF FLORIDA, COUNTY OF
NOTARY PUBLIC
The foregoing instrument was acknowledged before me
this day of
by
Personally Known or Produced Identification
Type of Identification Produced:
SLCPDS Revised 03/28/2019
STATE OF FLORIDA, C Y OF -ST, LUGi
ARY BLIC
The foregoing instrument was acknowledged before me
20 this ZS day of J V
20 19
byR,c\4dg2� O� �A�tiS
Personally Known or Produced Identification
Type of Identification produced: 'he -IV LI < k-/°SL-
$CE1911;
Chdetopher J. Fryaufl
NOTARY PUBUC
-STATE OF FLORIDA
Comm# GG222758
Expires 7/17/2022