Planning & Development Department
2725 Judge Fran Jamieson Way
Building A, Room 114
Viera, Florida 32940
(321) 633-2187 Phone
RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT
Building Permit Number
Property Owner and Site Address
___________________________ ________________________ ___________________
First Name Last Name Telephone Number
___________________________ ______________________ ________ ____________
Street City State Zip Code
We acknowledge the new swimming pool, spa, or hot tub will be constructed or installed at the
above referenced property and hereby affirm one of the following methods will be used to meet the
minimum requirements of Chapter 515, Florida Statues.
The pool will be isolated from access to the home by an enclosure that meets the pool barrier
requirements of Florida Statute 515.29
The pool will be equipped with an approved safety pool cover that complies with the Standard
Performance Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs.
All doors and windows providing direct access from the home to the pools will be equipped
with an exit alarm that has a minimum sound pressure rating of 85 decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self-closing,
self-latching devices with release mechanisms placed no lower than 54 inches above the floor
I understand 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, Florida Statutes, and will
be considered as committing a misdemeanor of the second degree, punishable by fines up to
$500.00 and/or up to 60 days in jail as established in Chapter 775, Florida Statues.
Reference: Florida Building Code Residential R4101.17
Signature of Contractor Date
Signature of Property Owner Date