PRESSURE TEST CERTIFICATION
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 6/4/2020
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
In accordance with the Florida Building Code 6
th
Edition (2017) , 454.2.12.1; all pool piping shall be inspected
and approved before being covered or concealed. It shall be tested and proved tight to the satisfaction of the
administrative authority, under static or air pressure test, of not less than, thirty-five (35) P.S.I. for fifteen (15)
minutes. This affidavit is to certify that this portion of the code is in compliance.
Test Data Required:
Start Date: _______________ Start Time: _________________
Beginning Pressure: _____________________________________________________
End Date: ________________ End Time: __________________
End Pressure: __________________________________________________________
Company Name: ________________________________________________________
Company Address: ______________________________________________________
Phone # : __________________ Email: ______________________________________
Permit #: ______________________________________________________________
License Holder: _________________________________________________________
License Holder’s Signature: _______________________________________________
Date:______________________
Exemption: Circulating pumps need not be tested as required in this section.
I, _____ (Property Owner), hereby certify that
_______________________________________ is my authorized agent/representative of the property described herein. All
answers to the questions in this registration and any supplementary information attached to and made part of this
registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of ____ physical presence
OR____online notarization,
this ______day of ___________________, 20_____, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
