Fillable AFFIDAVIT OF UNDERSTANDING MUST ACCOMPANY POOL PERMIT APPLICATION (Florida)

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AFFIDAVIT OF UNDERSTANDING MUST ACCOMPANY POOL PERMIT APPLICATION (Florida)

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U:\Building\Permit Center- New Millenium\Pool Affidavit of Understanding 8-28-19
RESIDENTIAL SWIMMING
POOL
SAFETY REQUIREMENTS
AFFIDAVIT OF UNDERSTANDING
MUST ACCOMPANY POOL PERMIT APPLICATION
Permit Request (PR) Number:__________Address:__________________________
Section R4501.17.1.1, 2017 Florida Building Code, Residential Volume (FBC-R), and Chapter
515, Florida Statutes (F.S.), require pool barriers to be installed around the entire perimeter of a
pool, spa or hot tub. In addition to this executed affidavit, all provisions for the required pool barrier
shall be shown on the plans.
I acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at the above
address, and hereby affirm my understanding that one of the following methods shall be used to
meet the requirements of Section R4501.17, 2017 FBC-R, and Chapter 515, F.S.
Options available to create a 360-degree barrier around pool, spa or hot tub:
1. The pool will be equipped with an approved safety pool cover that complies with ASTM
F1346-91(2010), Standard Performance Specifications for Safety Covers for Swimming
Pools, Spas and Hot Tubs.
2. A new, continuous barrier, such as a fence, wall or screen enclosure, will be placed
completely around the pool perimeter to provide the required 360-degree protection. Identify
method(s) below and on site plan or pool layout:
• Four foot or higher perimeter fence (wood, chain link, aluminum, PVC or other).
• Aluminum screen enclosure with self-closing, self-latching door with a latching device
that is a minimum 54 inches above the threshold.
• Child-safety barrier that is compliant with Section R4501.17.1.15, 2017 FBC-R.
• Other barriers compliant with Chapter 553, F.S., and Section R4501.17, 2017 FBC-R.
3. A combination system such as a perimeter (partial) barrier used in conjunction with a child-
safety barrier between house and pool meeting Section R4501.17.1.15, 2017 FBC-R,
window/door alarms meeting UL 2017 and Section R4501.17.1.9, 2017 FBC-R, or window
alarms with doors meeting self-closing, self-latching requirements of Section R4501.17.1.9,
2017 FBC-R. Identify proposed combination below and on site plan or pool layout:
• Screen enclosure with child safety barrier between house and pool.
• Screen enclosure with window & door alarms (or complying doors) at required
locations (indicate type of alarm and who is installing).
• Perimeter fence with child safety barrier between house and pool.
Initial Here
Palm Beach County
Planning, Zoning & Building
Building Division
U:\Building\Permit Center- New Millenium\Pool Affidavit of Understanding 8-28-19
Perimeter fence with window & door alarms (or complying doors) at required locations
(indicate type of alarm and who is installing).
Existing four foot or higher perimeter privacy fence converted (with permit) to pool
barrier fence with child safety barrier between house and pool.
Existing four foot or higher perimeter privacy fence converted (with permit) to pool
barrier fence with window & door alarms (or complying doors) at required locations.
I understand that not having a complete barrier around the perimeter of the pool is a violation of
Section R4502.17.1, 2017 FBC-R.
I further understand that filling a pool with water before passing a final electric inspection and a
final barrier inspection by Palm Beach County is a violation of Section 109.3.A.6, 2017 FBC, as
amended by Palm Beach County. The Building Division will consider these violations willful and will
commence the appropriate disciplinary actions against those responsible.
__________________________________________________________________
Owner’s Name (Please Print) Owner’s Signature and Date
__________________________________________________________________
Pool Company’s Name
__________________________________________________________________
Qualifier’s Name (Please Print) Qualifier’s Signature and Date
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AFFIDAVIT OF UNDERSTANDING MUST ACCOMPANY POOL PERMIT APPLICATION (Florida)

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Completed 11 August 2020

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