1861 Selva Marina Dr IRR21-0019 Irrigation 7 HeadsOWNER:ADDRESS:CITY:STATE:ZIP:
BLUMENTHAL PHILIP VON
MECKLENBURG 1861 Selva Marina Drive Atlantic Beach Fl 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 0844 SELVA MARINA UNIT 10C
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1861 SELVA MARINA DR IRRIGATION add 7 sprinkler heads $1000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 10/26/2021
PERMIT NUMBER
IRR21-0019
ISSUED: 10/26/2021
EXPIRES: 4/24/2022
IRRIGATION PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
3 PUBLIC UTILITIES RPZ BACKFLOW INFORMATIONAL
Notes:
A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow
preventer must be tested by a certified tester and a copy of the results sent to Public Utilities.
2 of 2Issued Date: 10/26/2021
PERMIT NUMBER
IRR21-0019
ISSUED: 10/26/2021
EXPIRES: 4/24/2022
IRRIGATION PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $64.00
IRR21-0019 Address: 1861 SELVA MARINA DR APN: 172020 0844 $64.00
BUILDING $60.00
BUILDING PERMIT 455-0000-322-1000 0 $60.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R17815 $64.00
Printed: Tuesday, October 26, 2021 10:27 AM
Date Paid: Tuesday, October 26, 2021
Paid By: BLUMENTHAL PHILIP VON MECKLENBURG
Pay Method: CREDIT CARD 536926508
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R17815
TPlumbing Permit Application ALL INFORMATION
HIGHLIGHTED IN
A City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone:(/
h r (
904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: `Ov!C hbiA Kit( r kC5 ?2233PROJECT VALUE$ ` DU u•p
NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS
Seer Replacement
lama low Preventer
itv awn Sprinkler System (number of sprinkler heads)
i i Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
f I Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
1 i Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation constructiontor the performance of construction.
n
Owner Name: 0WtVk1,111i' .10Phone Number: 454) 21 3(065
Plumbing Company: Office Phone: Fax
Co. Address: (CAA Ali°L 4(1/ D(lrt City: W^"ki c 1,7t4 ate: f-1— Zip: 222-3
License Holder:StateCertification/Registration #
Notarized Signature of License Holder VA4...1
The foregoing instrument was acknowledged be e this IS day of OC,t 20 a A, in the State of Florida,
County of 101A-V c't t
Signature of Notary Public
Y JENNIFER JOHNSTON
c• MY COMMISSION Il HH 057579 [
I Personally Known OR [IA-Produced Identification1,•a: EXPIRES:October 27,2024
f. •'f°"' BondedlnruNotary Pubic Unienvriars Type of Identification: rL ani)_„, ,j Lc-0-7? 1-(
Updated 10/17/18
I
sL,v, ,, Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
fl
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: I (.Q t JAI/a l l Q wt.,
Owner Name: hk4 t Phone Number: ta(e 23-1 J(D
Mailing Address: le8 Q ik 1,
14 A'c. OrGity:v c4.- State: ?t Zip: 32233
Notarized Signature of Owner
The foregoing instrument was acknowledged re me this ].S day of 0C. Q(,20 in the State of Florida, County
of YJ L Ci l
Signature of Notary Public
Personally Known OR [I, odu ed Identification
JENNIFER Type of Identification: f L riO S `C-1L11 J—(
MY COMMISSION#HH 057579
n` EXPIRES:br Public 2024 Updated 10/24/18
tkX101wkea •
Js
0 `tri,, IRRIGATION PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
Y City of Atlantic Beach FILE#
fair.
r Community Development DepartmentJw800SeminoleRoadAtlanticBeach,FL 32233
ft:.
r. P)904-247-5800
SITE INFORMATION
ADDRESS I 4bLig t JnjJMt Kay ( & v L ( k cL P1, 32233
APPLICANT INFORMATION
NAME G),S,T 04.tAt -k) A. t ENER LEGAL AUTHORIZED AGENT
ADDRESS 1 CO , )4V'DL VA.nil A. Vi(VC.CITY 0,fr'I4, ISWASTATE Pt. ZIP CODE 32-2 23
PHONE# ({ 2.36k 3(,POS EMAIL Cam CAI utit tPA4 A ( 0 JAI l _ t r
Step 1. Calculate Maximum High Volume Irrigation: High volume irrigation is limited to 60%of the landscaped/
pervious area of a lot. Low volume irrigation may be used for remaining areas.
Total Landscape/Pervious Area=q34("Square Feet(Total Lot Area minus Impervious Surface)
Max High Volume Irrigation =443 -4quare Feet(60%of Total Landscape Area)
Step 2. Proposed Plan:HYDROZONE shall mean an irrigation watering zone in
which plant materials with similar water needs are grouped
Proposed High Volume Irrigation=300Q Square Feet
together.
Proposed Number of Sprinkler Heads= 4'
HIGH VOLUME IRRIGATION shall mean an irrigation system
that does not limit the delivery of water directly to the root
Step 3. Attach a Hydrozone Plan:zone and which has a minimum flow rate, per emitter, of
Indicate areas to be irrigated and show low,moderate,and thirty (30) gallons per hour(gph) or one-half(.5) gallons per
high water use areas. Plans may be prepared by property minute(gpm)or greater.
owners or contractors on a copy of the survey or a site plan.
IRRIGATION ZONE shall mean the grouping together of any
At least one moisture sensor shall be located in each type of water emitter and irrigation equipment operated
irrigation zone and emitters shall be sized and spaced to simultaneously by the control of a timer and a single valve.
avoid excessive overspray on to impervious surfaces. See Section 24-178 for more information.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO
COMPLY WITH ALL PROVISIONS OF CHAPTER 24(LAND DEVELOPMENT REGULATIONS)AND ALL
OTHER APPLICABLE CODES AND ORDINANCES OF THE CITY OF ATLANTIC BEACH.
I Vitu ovm 64 Ktt-rt.4t 1 l.f 21
SIGNATUR: • tt WNER or AGENT PRINT OE NAME DATE
Signed and sworn before me on this day of 0 tu 2 d O. by State of F L
C (ilS -12 9 d`1.1 Mt rl-M (County of 0tA f
Identification verified: FL a ( to sk) Li' i -2osk_
Oath Sworn: Yesk‘loietzs A
MY COOMMISSIONENNIFERJOHNs •
i .r•n' T re
71,. o',•' EXPIRES.Oclober27,2024 1
Bcnd•dThuNotaryPuma . •.i mission expires
30 IRRIGATION PERMIT APPLICATION 08.25.2021
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