REVISED 7/13/2020
BUILDING DEPARTMENT
104 North Riverside Drive
Edgewater, Florida 32132
Phone: (386) 424-2400 X 1514 FAX: (386) 424-2423
POOL/SPA SAFETY AFFIDAVIT
RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY REQUIREMENTS
Section R 4501.17, Florida Building Code- Residential
I (we) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at
and my contractor
(PLEASE PRINT STREET ADDRESS)
has informed me that prior to the use of my pool, I will need a safety barrier installed in accordance with the Florida Building
Code-Residential (FBC-R) and that all inspection approvals, including final inspection, will need to be obtained. FBC-
Residential requires private pools to be enclosed by a barrier meeting the requirements of FBC-R Section R4501.17. Residential
swimming pools with permit applications filed after October 1, 2005 must meet at least one of the pool safety barrier
requirements (please see options listed below).
Please initial all methods to be used for your pool.
The pool will be equipped with an approved safety pool cover that complies with ASTM F1346 (Standard
Performance Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs) per FBC R4501.17,
Exception
The Pool will be isolated from access by a mesh safety barrier that meets the requirements of FBC R4501.17.1.15.
The Pool will be isolated from access by a screen enclosure that meets the requirements of FBC R4501.17.1.11.
The pool will be isolated from access by a fence and Pedestrian Gates that meet the requirements of FBC
R4501.17.1.1 through R4501.17.1.14.
Does any part of the barrier consist of dwelling walls which contain doors or windows?
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All doors and windows providing direct access from the dwelling to the pool will be equipped with an exit alarm
that meets the requirements of FBC R4501.17.1.9 (1) unless exceptions a, b, or c apply.
All doors providing direct access from the dwelling to the pool will be equipped with self-closing, self-latching
devices installed 54” above the threshold that meet the requirements of FBC R4501.17.1.9 (2).
A swimming pool alarm that meets and is independently certified to ASTM Standard F2208 will be provided per
FBC R4501.17.1.9 (3).
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 515.27, F.S. and will be considered as committing a
misdemeanor of the second degree, punishable as provided in Chapter 775.082 F.S. or 775.083 F.S.
I also understand that steel & ground and deck inspections are required in addition to the final inspection.
Inspection access to the interior of the home is required if alarms on windows & doors or if self-closing/self-latching
doors are used to meet the above requirements.
Owners Name (Please Print)
Contractor Name (Please Print)
click to sign
signature
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