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Home My WebLink AboutAPPLICATION FOR SWIMMING POOL OPERATION PERMIT07124/2018 08:54 B&N O:r 72 5691063 - P.0021005 EMI. PUQLIIr'HEALTIt APPgcation Type: (check box, see Inetplpgorl@yer�cc{�� ; 5)f [ ] Initial Permit pq Modiflostlo �� [ ] Transfer, change of owner or name [ ] Renewal For Department ties Only Fee Received t Date Check From operating Permit# 5(a-(0q`00)?5- SCANNED BY STATE OF FLORIDA St. Lucie Countv DEPARTMENT OF HEALTH APPLICATION FOR A SWIMMING POOL OPERATING PERMIT This original form Is 10 be completed and submitted with one copy, a set of construction plans & space, a copy of the bulidhrg department's final inspection along vAh the appropriate fee. 1. Name ofPm*I/Fard➢ly PRINCESS CONDOMINIUM -SPA CountyST.LUCIE Address of Pool NO S. OCEAN DRIVE Cily .IENSEN BEACH _ _ Zlp_34➢R7_ 2. Noma of OwnerPR_ _NCESS CONDOMINIUM ASSOC. Fd�l P I 'CESSCONDOdbIELL_SOLRH.NET Phone rl721228.g8gm M911ing Address 0880 S. OCEAN DRIVE City JENSEN BEACH state-J;_2iP-44 7- 3. Bu➢ding DepanmeM Ntun@'�ygLWC,If CQ• PLAN,NLNQ & DEV�LP.�ER. (772) 462,2172 Canted Pmeon Phone Number 2900 VIRGINIA AVE, Fr. PIERCE. FL 34682 P.O. Bat or SbeatAddrew CiW Srpta, 21p Cede F,.meOAddraw 4. Pool Water Source ET PIERCE UTILITIES 5. Ughting (check one): (X) No Night binlmming () Outdoor. Throo toot candles ovedroad and 12 watt per square foot of pool awface area underwater (y Indoor. Ten foot candles overhead and 8/10 welt per square foot of pool surface area underwater S. Pool Volume in Gallons: Main Pool Wading Pool Spa Pool EX. 1134 Other 7. Pool Bathing Load: IX. 8 Number of Dwelling Units ran +o^ NON -TRANSIENT 8, Pool Dimensions; Vi(Mlh:EX, V Length: UL 9' Area: 83 SF Patimater.A _LEDepth: Mmc MIn, EX 3fl• 8hapW &QUM B. Water Treatment Equipment Make end Model: , (A) Recirculation Pump, EX. KrA-RITE — P2RA60L Flow % 38 GPM GPM ALM—TDH EX. 1 HP (8) Filter: Eft, HARMSCO BF428—CARTRIDGE AW In-.Sq. Ft Flow C813aelty,80 GPM MAX. (C) Dlslnfectlon EqulpmCapacity 90 GPD (GPD) or (PPO) (Secondary Die nfecdon uApp➢ceble), NIA (D) pH Adjustment Feeder-crwn;nrPk eKM Capacity 19 (G D1 (E) Tact KN: O nl I�GGAIT \AAA --- --. 10.EquipmentSubaftftne - DH 4159. Eff:1012014 (Dbsoletas DH818 70 and DH818 6A2 editions) NE•0A01, F.A.C. Page 1012 0712412018 08:55 B8W O:A))M M91063 P.0031005 CERTIPICAMON OF OMER The undoNlgned owner, or owner's representative, hereby agrees to operate the pool described In this application In accordance with the requirements of Chapter 514 of the Florida Statutes (F.S.), and Chapter 64E-9 of the Flodde Adminletrative Cade, end maintain the original construction approved under the Florida Building Code by the jurisdictional building department. This agreamem includes keeping a daily record of the information regarding pool apera(ton on the monthly report form furnished by the department or on other forma approved by the department and when requested, submission of the completed form to the appropriate county health department. men T (pdm or type) aau4�.—*/ % Titre M (print a type) Building Department Contraction Approval Date 1016 112 Approval Number--SL.M0g655 CERTIFlCATtON OF INSP@CTION I hereby certify. that an inspection of this pool has been made and the foregoing information is coned to the beef of my knowledge and belief. Aa"A- a [arecommended the Vol annual operating pemdt be granted subject to the provistwre of the Florida Administrative Coda.��23UL7gnatum 00H nglnver/Authartaed StaffDOM ngineer/Authariaed Staff ��Date a1J L:n I i 10 rd '%- ( ] Change date entered Into EHD by ondate entered Into EHD by on Instructions- Before submitting application to DOH: For Initiai Permit: Complete the entire application with owner certification. Include original and one copy of thla completed forth, a copy of construction plena & apace submitted to the building department (electronic copy In PDF, TIP or JPO format is acceptable), a copy of the building department final Inspection approval, and the appoopd to fee. The operating permit number will be entered by DOH staff. For ModlBcatlon: Complete Items 1 - 3, enter existing operating permit number, note proposed or completed changes In the appropriate seeliorfs, and complete the owner certification on page 2. Include a copy of the construction plans B: space submitted to the building department (electronic copy is acceptable) and a copy of the building department's Mal Inspection approval. For Transfer. Complete Items 1 and 2, enter existing operating permit number, then note changes In the page 2 owner remarks section, and complete the owner certification on page 2. There is no fee or building plena *tfamd for a transfer permit reissued due to change of ownership, name of facliity, phone number, or mal9ng address. For Renewal, Complete Items 1 and 2, enter existing operating permit number, and complete the owner cartifnxation on page 2. There is an annual operating permit fee charged for renewal. DH 4159. Eff. 10114 (Obaoletes DH916 WOB and DH918 6112 editions) 84E.9.001, F.A.C. Page 2 of 2 0712412018 08:55 B&W 0:4772 5691063 . P.0041005 STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT PUBLIC POOL AND BATHING PLACE INSPECTION REPORT Permit Number. 56.50-00176 Name of Facility: Princess Condominium Spa Pool Address: 9660 S Ocean Drive City, Zip: Jensen Beach 34957 In 1 of um Island, Inc. Inc. Phone: (772) 229-9690 RESULT: Satisfactory By: None InsRc!ff n Information Purpose: Rolnopec1 Begin Time. 09:30 AM Impaction Dale: 7/2312018 End Time: 10:00 AM None Addltlgnal Information Bremine .....VOLUME ..... 1134 POOLLOAD ..... 6 llllzer ....,FLOW =F0 RATE ..... 38 ..... 40NIGHTSWIM ..... tar ..... FILTER TYPE ..... Dlelomaceous Earth, Vacuum Hems marked below ere not in compliance the requirements of Chapters tWE-9 of the Florida AdminlstnrBve.Code and must be corrected. Continued operation of this fad6iy without making these corrections Is a v/olatlon of Chapter 64E-9 of the Florida Adminlsbative Code and Chaptere 386 and 514, Florida Statutes,Vlolations must be corrected as indicated In the Results section above or an administrative fine" other legal action w111 be Initiated. wnlatinn Marlins POOL AREA 17. Rules Posted 32. Vacuum Cleaner 1. Appearanca/Algoe Control 18. Certification 33. Flowmeter 2. DaeknMaWays SANITARY FACILITIES 34. Thermometer 3. TIIe/Pool Finish 10. Supplies 35. Pressurelvacuum Gauge 4. Depth Merkara 20. Clean 3e. Equip. Room 5. Handrail/Leddor WATER QUALITY 37, Cross Connection 8, Step Markings 21. Approved Teat Kit 38. Gas Chlor. Equip. . 7. Main Drain Grate 22. Free Chlor./Bromine 39. Waste Water Disposal S. Gutter Gratea/Skimmer 23, pH 40. D.E. Separator 9. Lighting 24. Chlor. Stabilizer 41. Other Equipment 10. No Dive Markings 26. Spa Requirements 42. Equipment Change 11. Diving Board EQUIPMENT ROOM 43. Approved Chemicals 12, Pool Cover 26. Wading Pool: Quick Dump 44. Maintenance Log 13. Pool Side Shower 27. Water Love6Control 45, Inspection Posted POOL SAFETY 26. Disinfection Feeder 46.-Electrical Equip, 14, Life Hook w/Poie 29. pH Feeder 47, Fences 15. Life Fling w/Rope 30, Chem. Container Label 48. Other is. Safety Line/2 Marking 31. Filter Pump 49. Other NOTE: It Is unlawful to madly a public pool or Its equipment without prior approval from the local bugding department end submitting an appikation to DOH. Inspector Signature: Client Signature: Form Number. DH 920 01104 6f660.00175 Princess Condominium Spa Pool 0712412018 08:55 B8W ffN(M 5691063 P.0051005 STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT PUBLIC POOL AND (BATHING PLACE INSPECTION REPORT 2 of General Comments Original Inspection 5/28: ape modification Inspection by Miranda Oliver. Facility corrected the violations and requested an early rednapection. An violations from the orlglnal inspection have been corrected: observed vacuum breakers, pressure gauges, and fiovnnetor Indicalino appropriate liovrrats. No other violations observed. Small Address(ss): pdncesecando@ballsouth.not Vlolatlons Comments No violation Comments Available Inspection Conducted By: Joanne Evans (80202) Inspector Contact Number: Work: 772-873-4931 Print Client Name: na Date: 7/23/2018 Inspector Signature: Client Signature: �L, s__e_ I (kr A". Form Number DH 920 01104 554MO175 Princess Condominium Spa Pool Department Use Only Fee Received $ Date Check# From 1=�v::Pt�sti�tt�eac�1� Application Type: (check box, see ins MOM" /- I Initial Permit 1X] Modificatio Ju� '� �i} Operating, Permit # 6; `u/ — 0212- Transfer, change of owner or name [ ] Renewal SCANNED STATE OF FLORIDA BY DEPARTMENT OF HEALTH St. Lucie Counter APPLICATION FOR A SWIMMING POOL OPERATING PERMIT Thisoriginal form isto be completed and submitted with one copy, a set of construction plans 8 specs, a copy of the building departmenl'sfinal inspection along with the appropriate fee. 1. Name of Project /Facifity PRINCESS CONDOMINIUM —SPA CountyaL1.UCIE Address of Pool 9650 S. OCEAN DRIVE City. JENSEN BEACH - Zip 34957 2. Name of Owner PRINCESS CONDOMINIUM ASSOC. E-MailRINCESSCONDOCM.BELLSOUTH.NET Phone (7n) 229-9690 Mailing Address 9650 S. OCEAN DRIVE - City JENSEN BEACH State FL Zip 34957 3. Building Department Name:. ST. LUCIE'CO. PLANNING B DEVELP. SEM (7 } 462-2192 Contact Person Phone Number 22300 VIRGINIA AVE. FT. PIE RCE.FL 34982 P.O. Box"StreetAddress City, State, Zip Code 4. Pool Water Source FT. PIERCE UTILITIES 5. Lighting, (check one): (X) NoNightSwimming ( ) Outdoor. 'Three foot candies overhead. and 112 watt per square foot of pool surface area underwater Indoor. Ten foot candles overhead and 8110 waft per square foot of pool surface area underwater 6. Pool Volume in Gallons: Main Wading Pool Spa Pool, EX.1134 Other T. Pool Bathing Load: EX..6 Number of Dwelling Units FX.190NON-TRANSIENT S. Pool Dimensions: Width: EX W Length:-V. IT _Area: 63 SF Perimeter. 28. LF Depth: MatLEX..38. Min..Ex..36•. Shape: ROUND 9. Water Treatment Equipment Make and Model: (A) Recirculation Pump: EX. STA-RITE'—P2RA5DL Flow EX. 38 GPM _ GPM At 60 TDH _ EX. 1 HP (B) Filter. EX. HARMSCO BF-126 —CARTRIDGE' Area 126 Sq. Ft. Flow Capacity 80 GPM MAX. (C) Disinfection Equipment: EX. STENNER 45M5 Capacity 50 GPD (GPD) or (PPD) (Secondary' Disinfection if Applicable) NZA (D) pH Adjustment Feeder: STENNER 45M2 Capacity 10_jGPD) (E)TestKit: TAYLOR—CURRENT .MODEL 10. Equipment DH 4159, Eff.1012014 (Obsoletes DH9167/08 and DH918 5M2 editions) 64E-9.001, F.A.C. Page t of 2 STATE OF FLORIDA s DEPARTMENT OF HEALTH tic COUNTY HEALTH DEPARTMENT PUBLIC POOL AND BATHING PLACE P INSPECTION REPORT 1of2 ractnuv inrormarion KCJULI: aansractory Permit Number:56-60.00175 Correct By: None Name of Facility: Princess Condominium Spa Pool Re -inspection Date' None Address: 9650.SOcean Drive City, Zip: Jensen :Beach 34957 Type: Exempt Pools > 32 Units Owner: Princess Condo. Assoc, o1 Hutchinson Island, Inc. Person In Charge: Princess Condominium, Inc. Phone: (772)229-9690 'Pool Operator: Princess Condo. Assoc. of Hulchlnson Island, Inc. Phone: (772) 229.9690 Inspection Information Purpose: Reinspedion Begin Time: 09:30 AM Inspection Date: 7123/2018 End Time: 10:00 AM Additional Information 22. Free Chlor./Bromine ..... VOLUME ..... 1134 23. pH ..... POOL LOAD ..... 6 - 24. Chlor. Stablillzer, ...... FLOW RATE ..... 38M. Flowmeter ..... 40 NIGHTSWIM ..... 34. Thermometer ..... FILTER TYPE ..... Diatomaceous Earth, Vacuum Items marked below are not in compliance therequirements of Chapters 64E-9 of the Florida Administrative Code and must be,corrected. Continued operation of thisfaciffty.wkhout making these corrections, Is a violation or Chapter 64E+9.ofthe Florida Administrative Code endChapters+386 and 514, Florida Statutes. Violations must be corrected as Indicated In the Results section above or an administrative fine or other legal action will be Initiated. Violation Markings POOL AREA: 17. Rules Posted 32. Vacuum Cleaner 1. Appearance/Algae Control 18. Certification 33. Flowmeter 2. DecklWalkways SANITARY FACILITIES 34. Thermometer 3. Tile/Pool Finish 19. Supplies 35. Pressure/Vacuum Gauge 4. Depth Markers 20. Clean 36. Equip. Room S. Handrail/Ladder WATER QUALITY 37.Cross Connection 6. Step Markings 21. Approved Test Kit 38. Gas Chlor. Equip. 7. Main Drain Grate 22: Free Chlor./Bromine 39. Waste: Water Disposal 8.Gutter Grates/Skimmer 23.,pH 40. D.E. Separator 9, Lighting 24. Chlor. Stabilizer 41. Other Equipment 10. No Dive Markings 25. Spa Requirements r42. Equipment Change 11. Diving,Board EQUIPMENT ROOM 43, Approved Chemicals 12. Pool Cover 26, Wading Pool: Quick Dump 44. Maintenance Log 13. Pool Side Shower 27, Water Level/Control 45. Inspection Posted POOL SAFETY 28, Disinfection Feeder 46. Electrical Equip. 14. Life Hook wlPole 29. pH Feeder 47. Fences 15. Life -Ring w/Rope 30. Chem. Container Label 48. Other 16. Safety Unel2 Marking 31. Filter Pump 49. Other NOTE., it is unlawful to modify a public pool Grits equipment withouttpriorapproval from the focal building department and submitting an application to DOH. Inspector Signature: Client Signature: cor 4" . Form Number: DH 920 01104 56-60.00175 Princess Condominlum'Spa Pool CERTIFICATION OF OWNER The undersigned ovmer, or owner's representative, hereby agrees to operate the pool described in this application in accordance with the requirements of Chapter 514 of the Florida Statutes (F.S.), and Chapter 64E-9 of the Florida Administrative Code, and maintain the original construction approved under the Florida: Building Code by the jurisdictional building department. This agreement includes keeping a daily record of the information regarding pool operation on the monthly report form furnished by the department or on other forms approved by the department and when requested, submission of the completed form to the appropriate county health department. �Slgne �� 1 S Date Name. fir' t/'_Sc�r-� Title_ Ni a G (&'11— (print ortype) 8 (printortype) Building Department Construction Approval Date LQ Approval Number S I1 110 n519 CERTIFICATION OF INSPECTION I hereby certify that an Inspection of this pool has been made and the foregoing information is correct to the best of my knowledge and belief. It is recommended the first annual operating permit be granted subject to the provisions of the Florida Administrative Code. Signature DOH EngineerlAuthodzed'Staff —� Date, ] ] Change data entered into EHD by on Instructions- Before submitting application to DOH: For Initial Permit: Complete the entire application with owner certification. Include original and one copy of this completed forth, a copy of construction plans & specs submitted to the building department (electronic copy in PDF TIF or JPG format is acceptable), a copy of the building department final inspection approval, and the appropriate fee. The operating permit number will be entered by DOH staff. For Modification: Complete items 1 - 3, enter existing operating permit number, note proposed or completed changes in the appropriate sections, and complete the owner certification on page 2. Include a copy of the construction plans & specs submitted to the building department (electronic copy is acceptable) and a copy of the building department's final Inspection approval. For Transfer: Complete items 1 and 2, enter existing operating permit number, then note changes in the page 2 owner remarks section, and complete the owner certification -on page 2. There is no fee or building plans required for a transfer permit reissued due to change of ownership, name of facility, phone number, or mailing address. For Renewal: Complete items 1 and 2, enter existing operating permit number, and complete the owner certification on page 2. There is an annual operating permit fee charged for renewal. DH 4159. Eff. 10114 (Obsoletes DH9167/OB and DH918 5112 editions) 64E-9.001,'FA.C. Page 2 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH.DEPARTMENT PUBLIC POOL AND BATHING -PLACE INSPECTION REPORT 2of2 C,pnpral- Comments Original inspection 6128: spa • modification inspection by Miranda Oliver. Facility corrected the violations and requested an early re -inspection. All Violations from the originaliinspection have been corrected: observed vacuum: breakers, pressure.gauges, and 0owmeier Indicating appropriate flowrate. No other violations observed. . Email Address(es): princesscondo@bellsouth.net _ Violations Comments inspection Conducted By: Joanne Evans (802.02) Inspector Contact Number: Work: 772-873-4931 Print Client Name: na Date: 7/23/2018 Inspector Signature: Form Number. DH 920 01104 Client Signature: ✓a" .: 56.60.00175 Princess Condominium Spa Pool < — COUNTY-, LiJu p- [ ] New construction [vYModification/ Repair SCANNED STATE OF FLORIDA BY DEPARTMENT OF HEALTH St. Lucie County PUBLIC SWIMMING POOL INITIAL OPERATING PERMIT INSPECTION REPORT 46aa %.00EW pt'agl Name of Pool Location 51E1.1SEt1�19EKkA, VL 5495i 1\ -(' Name of Owner �tllJ FCC 11D0 E1SCn ti Address W. Plan Approval Number&C (-��a.(]7J�7 Date / �/n�/� Bathing Load Persons Operating. Permit Numbers b190_ no I -16 Items marked "X" are not in compliance with the requirements ofChapters .64E-9, Florida A Chapter4 of the Florida Building Code, and may result in a pool that Is inoperable In a safe Department of Health (DOH) to deny your request for an Operating Permit. Use of this pool Chapter 64E-9; FAG, and Chapter514, Florida. Statutes (FS), and will place the owner subj Department of Health agent listed below when corrections am made so that m4nspectior with Disabilities Act (ADA) and. Florida Building Adcessibility Code may apply;.owner is adv FILTRATION Hose Bibb Vacuum Breakers ( ) Pressure ( ) Vacuum ( j Test lgt ( )Sand (( D.E. (./j Cartridge Manuf,,0A. _ Manuf. t1 P Model# QC>"� Model # Testing Capabilfties: -Filter Area (Jd),FAC (J)FAC I -H Drawdown Water Level Test ( V'CH ( \YTA. (.,4 CYA Equipment Room. Ventilation Equipment Room Lighting Equipment Room Drainage np Manuf.. `RAE ITE )Model # 2Ft. L )Horse Power 3 I,Halr and Lint Strainer j Flowmeter(gpm) C ressum Gauge Inf. osi Eff,. osl PAaamw'Gauge Peadk,4 im.+ �TherThermometer Location mometer'Tempemture 103 °F I Chlorine/Bromine Feeder/Gen, Manuf. Model #' Level Controller Cross Copy of this Inspection Report Received Slip Resist. Bench Edges Marked )h Handrails Mounted Dept. Pool Size 1134 Gallons. s (FAC), or Section 454.1, lidon; and may cause the mriftis a violation of Please notify the I. NOTE: The Americans. local Building DepartmenL ( -j sl6V. Underwater Lights # i Watts_ 237A I r1r) VHealer Manuf. SY IY1 O 6C) NT Model # V)Bypass ( Protected S*R*1R*4Arh 1LES . ApprvvaHGtL—_ POOL SIGN ( ) Prohibits: Food& Drink on Wet Deck or in Pool; Animals & Glass in: pool area or 50' ( ) Provides Bathing Load ( ) Shower Before Entering 5 ( ) Pool hours y� ( )4" NO DIVING. as Required ` ( ) Do not swallow water ( ) No use wlillness OPERATION (✓) 24 HrJDay Equipment Operation or Time Clock (Vf Free Chlorine 1o.0 mg/L ( pH -1.4 (.,Pool Clean, Water Clear ( XNater level: ( )High( ) Low SPA (✓.Clock& 15.Mn. Timer ( Additional Rules Signage Cutoff Alarm &'Closed Signage. (.�.O.R.P. & PH controller U-C SV53 Received by Print Name and Title: / ?vs� Date of inspection; (0 j [r OI �i DOH Engineer/SanittaArianSignature �1 Print DOH Name 1 I V-A$M'N DOH Email: PWI IW$ P f;G ft?ous'F Qo FLHealth.gov Telephone Number for DOH Agent(_.b!0114' 2q%8 DH 1350, Effective 12/2016 (Replaces 7198 jeciIlon) 64E-9.001, FAC DOH PermitNo. RD .I - oo\A-f) Countyt Pool Owner/Operator Verification of E/natrapment Safety Features 1. Name of Facility Pool: `'C �ara`�5 l t ci rr�� num Jv lirawI ` 2. Street Address: quno S• (YC-n.n lea`. _ City: A6",, .l `.L G(n Zip- 3tiqaFacility Phone:' - 2Z q- 4'1n 4S6 3:.Owner's'Name: -Vt\P, C'Y rwx-%. ,� OLSSrrtctktnv, 6Q A&M\rohu,.,- 4.Owners Phone: l�l2- ZZci-CiU00 Email: nrrnce=s r_ordo ?.Ve�ls�� 4�,reT S. Suction Outlet Drain Cover(s)asrequIred.bysection 514.0315(1), FS: Meke & Model Number: ArerePRQ' 'N IW 2, (You may use additional shoots Iffacilitil has more llianonddewceorsystem.i �� Installation Date: �-1 V9 FL Approved Flow (GPM _g 1 _ __Life Years: 6. Type -of Safety Dev)ce Installed as required by section 514.0315(2), FS:;(check one) [ ] a. Safety Vacuum Release System Make & Mode) Number. (UseadditIonalshoots fl.fad6ry{msmore-thanonedavieeorsystam.) [ Jb. Suction Limiting Vent System Wgmper-Resistant Atmospheric Opening ] c. Automatic Pump Shut-off System Make & Model Number: '(Use addlrlo;misheete 11fadiltyy has moml um one dovice cr system.) .[ ] d. Dual Drains.(must been the some drain line& 36' apart on canter). ( ]. a. Drain Disablement (requires a eonstmclion or moffmatren pemdt) [ ] f. Gravity Drainage with Collector Tank (mgwres aconstruown ormoduiceurn pamdt) Installation Date: Licensed pool contractor that Installed the de Name: L y-(de.A! . ►w -"' Phone Number. 7 rl/aS `r37G`D License Number: C f G 15 SLo /R E-mail• 7. Ownees X,44 0 ri � w . �G L 1?-* Print Name OH 4157. 912015. Rule 64E-9.008(10)(6)2. & maintenance manuals on site and ;efsystem in accordance with the de. code testing; requirements: i tRA J�r_�ll••�s:- .nr Application Type: (check box, see instructions on back) [ ] Initial Permit [X] Modification Fr,w 11,ipartment Use Only Fee Received Date Check# From Operating Permit #- [ ] Transfer, change of owner or name SCANNED [ ] Renewal BY AUG 17 211 ' St. Lucie County STATE OF FLORIDA PERi'isnTiPJG St. Lucie County, FL DEPARTMENT OF HEALTH APPLICATION FOR A SWIMMING POOL OPERATING PERMIT This original form is to be completed and submitted with one copy, a set of construction plans & specs, a copy of the building department's final inspection along with the appropriate fee. I 1. Name of Project/Facility PRINCESS CONDOMINIUM — SPA County ST. LUCIE Address of Pool 9650 S. OCEAN DRIVE City JENSEN BEACH Zip 34957 2. Name of Owner PRINCESS CONDOMINIUM ASSOC. E-Mail PRINCESSCONDO(a)BELLSOUTH.NET Phone (772) 229-9690 Mailing Address 9650 S. OCEAN DRIVE City JENSEN BEACH State FL Zip 34957 3. Building Department Name: ST. LUCIE CO. PLANNING & DEVELP. SER. 772) 462-2172 Contact Person Phone Number 2300 VIRGINIA AVE. FT. PIERCE, FL 34982 P.O. Box or Street Address City, State, Zip Code E-mail Address 4. Pool Water Source FT. PIERCE UTILITIES 5. Lighting (check one): (X) No Night Swimming () Outdoor: Three foot candles overhead and 1/2 watt per square foot of pool surface area underwater () Indoor. Ten foot candles overhead and 8/10 watt per square foot of pool surface area underwater 6. Pool Volume in Gallons: Main Pool Wading Spa Pool EX. 1134 Other 7. Pool Bathing, Load: EX. 6 Number of Dwelling Units EX. 190 NON -TRANSIENT 1 8. Pool Dimensions: Width: EX, 9' Length: IX. 9' Area: 63 SF Perimeter: 28 LF Depth: Max.EX- 38' Min. IX. 36" Shape: ROUND 9. Water Treatment Equipment Make and Model: (A) Recirculation Pump: EX. STA-RITE—P2RA5DL Flow EX. 38 GPM GPM At 60 TDH EX. 1 HP (B) Filter: EX. HARMSCO BF-126 — CARTRIDGE Area 126 Sq. Ft. Flow Capacity 80 GPM MAX. (C) Disinfection Equipment: IX. STENNER 45M5 Capacity 50 GPD (GPD) or (PPD) (Secondary Disinfection if Applicable) NIA (D) pH Adjustment Feeder: STENNER 45M2 Capacity 10 (GPD) (E) Test Kit: TAYLOR —CURRENT MODEL 10. Equipment Substitutions DH 4159, Eff: 1012014 (Obsoletes DH916 7108 and DH918 5/12 editions) 64E-9.001, F.A.C. Page 1 of 2 -, CERTIFICATION OF OWNER The uhdersigned owner, or owner' o_ : esentative, hereby agrees to operate the poc .. cribed in this application in accordance with the requirements of Chapter 514 of the Florida Statutes (F.S.), and Chapter 64E-9 of the Florida Administrative Code, and maintain the original construction approved under the Florida Building Code by the jurisdictional building department. This agreement includes keeping a daily record of the information regarding pool operation on the monthly report form furnished by the department or on other forms approved by the department and when requested, submission of the completed form to the appropriate county health department. )&-lined Name (pint or type) DatePA P te Title g=tn (a G Q�- 8 (print or type) Building Department Construction Approval Date Approval Number CERTIFICATION OF INSPECTION I hereby certify that an inspection of this pool has been made and the foregoing information is correct to the best of my knowledge and belief. It is recommended the first annual operating permit be granted subject to the provisions of the Florida Administrative Code. Signature DOH Engineer/Authorized Staff [ ] Change data entered into EHD by on InMi'detions- Before submitting application to DOH: Date For Initial Permit: Complete the entire application with owner certification. Include original and one copy of this completed form, a copy of construction plans & specs submitted to the building department (electronic copy in PDF, TIF or JPG format is acceptable), a copy of the building department final inspection approval, and the appropriate fee. The operating permit number will be entered by DOH staff. For Modification: Complete items 1 - 3, enter existing operating permit number, note proposed or completed changes in the appropriate sections, and complete the owner certification on page 2. Include a copy of the construction plans & specs submitted to the building department (electronic copy is acceptable) and a copy of the building departments final inspection approval. For Transfer: Complete items 1 and 2, enter existing operating permit number, then note changes in the page 2 owner remarks section, and complete the owner certification on page 2. There is no fee or building plans required for a transfer permit reissued due to change of ownership, name of facility, phone number, or mailing address. For Renewal: Complete items 1 and 2, enter existing operating permit number, and complete the owner certification on page 2. There is an annual operating permit fee charged for renewal. DH 4159, Eff. 10/14 (Obsoletes DH916 7108 and DH918 5/12 editions) 64E-9.001, F.A.C. Page 2 of 2