HomeMy WebLinkAboutAPPLICATION FOR A SWIMMING POOL54.
Application Type: (check box, see instructions on back)
[ ] Initial Permit _DC] Modification Resurface
[ ] Transfer, change of owner or name
[ ] Renewal
°or Department Use Only
Fee Reaw6ed $ Date
Check# From
operating Permit# 56-60-00412
SCANNED
STATE OF FLORIDA By
DEPARTMENT OF HEALTH St. Lucie County
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 fined Inspection along with the appropriate fee. '
1. Name of Project/Facility Morninciside SWP (Palm Breezes POA Inc. County St. Lucie
Address of Pool 9631 Windrift Circle City Ft. Pierce 34945
2. NameofOwner Palm Breezes POA Inc.
Mailing Address 3900 Woodlake Blvd. Ste.
dkarnes@campbellproperty.com
E-Mail Phone f7 7 9 —'i 4 S- 2 9 01
309 City Lake Worth State FL Zp33463
St. Lucie County
3. Building Department Name: Building�pt 772 U 462-1553
2300 Virginia Avenue Contact Person Phone Number .
Ft. Pierce, FL 34982 P.O. Box or Street Address CRY, State, Zip Code
E-mail Add2ss
4. Pool Water Source Ci
5. Lighting (check one): (X) No Night Swimming
( ) Outdoor. Three That candies overhead and 112 watt per square foot of pool surface area underwater
( ) Indoor. Ten foot candies overhead and 8110 watt per square foot of pool surface area underwater
6. Pool Volume in Gallons: Main Pcoi 88,600 Wading Pool Spa Pool
P Other
7. Pool Bathing Load: 96 Number of Dwelling Units �c /
25x45
8. Pool Dimensions: Width:_ Length- 100 Area:_Perimeter.275 Depth: Max. 6 Min. 0 Shape: Free Form
9. Water Treatment Equipment Make and Model:
(A) Recirculation Pump- Leeson 480 400
Flow GPM At 4 8 0- TDH HP 10
(B) Flter: Vac DE
Area 21 5 Sq. Ft. Flow Capacity 5 0 0— 5 5
(C) Disinfection Equipment Stenner
Capacity 4 5 (GPD) or (PPD)
(Secondary Disinfection if Applicable)
(D) pH Adjustment Feeder. Stenner
(E)Test IQt:_ Taylor
10. Equipment Substitutions
Capacity-- 45 (GPD)
DH 4159, Eff. 1012014 (Obsolates DH916 7108 and DH918 5112 editions) 64E-9.001, F.A.C. Page 1 of 2 1
CERTIFICATION OF OWNER
The undersigned owner, or owner's repro` , I ative, hereby agrees to operate the pool desc :.—' 7 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 forth to the appropriate county health
department �/
Signed_ _ /'9G+1�/ 4 iL Date A% L2-7//t/ /p
//
Name dAtH 'E g Tit
'TilrYTfw� �N'V �✓fgQrA
(print or type)
(print or'�typ )e
REMARKS: Install new 6" x 6" the with new depth markers - Install new white
plaster with blue quartz 3/8-1/2" thick - Bring main drain covers to Code
Desian Enaineer/Architect Name- Telephone:
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/Author¢ed Staff
Print Name
[ ] 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 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. Provide
design engineer's name and phone number in REMARKS. 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. Provide design engineer's name and phone number in REMARKS.
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 DH916 7/08 and DH918 5/12 editions) 64E-9.001, F.A.C, Page 2 of 2