650 Begonia St IRR23-0007 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
HOLSTAR LLC 6685 BOWIE RD JACKSONVILLE FL 32219
COMPANY:ADDRESS:CITY:STATE:ZIP:
FLORASCAPE IRRIGATION
&PO BOX 19744 JACKSONVILLE FL 32246
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170921 0000 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
650 BEGONIA ST IRRIGATION IRRIGATION $1800.00
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. Any digging requires calling 811 to have ALL public utilities located.
2 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. Tester Form Attached
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: 3/24/2023
PERMIT NUMBER
IRR23-0007
ISSUED: 3/24/2023
EXPIRES: 9/20/2023
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
2 of 2Issued Date: 3/24/2023
PERMIT NUMBER
IRR23-0007
ISSUED: 3/24/2023
EXPIRES: 9/20/2023
IRRIGATION PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
IRR23-0007
City of Atlantic Beach—BACKFLOW PREVENTION ASSEMBLY TEST REPORT
902 Assisi Lane Jacksonville, Florida 32233 Phone: 904-247-5886
Name of Premises: _____________________________________________ Account No: ____________________________
Service Address: _______________________________________________________________________________________
Mailing Address (If Different): ____________________________________________________________________________
Contact Person: ________________________________________ Phone Number: __________________________________
Type of Service: Process Fire Domestic Irrigation Other: ________________
Type of Assembly: ___________________________________ Manufacturer: _____________________________________
Model: ____________________________________________ Serial No: _________________________________________
Size: ______________________________________________ Location: _________________________________________
Gauge Manuf: _________________________Serial No: ________________________ Date Calibrated/Verified: _____________
Remarks: ______________________________________________________________________________________
I certify that the data in this report is accurate.
Tester Name (print) : _______________________________________ Date: ________________________________
Tester Signature: __________________________________________ Phone: _______________________________
Affiliation: ________________________________________________Cert No.: ______________________________
Tester Company: __________________________________________ Address:______________________________
THIS ASSEMBLY PASSED FAILED
Email completed form to Ebrown@coab.us/jdsmith@coab.us Initial Repairs Final Check Valve #1 Check Valve #2 Relief Valve PVB or SVB
Closed tight
at __________ PSI
Leaked
Closed tight
at ___________PSI
Leaked
Opened at
__________PSI
Did Not open
Air inlet opened at _________ PSI
Did not open
Check Valve Held at _________PSI
Leaked
Cleaned only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Closed tight at
___________PSI
Closed tight at
___________PSI
Opened at _____PSI Air Inlet ______________PSI
Check Valve _____________PSI