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170 Club Dr IRR23-0027 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: DAVIS JONATHAN MICHAEL 825 ALHAMBRA DR N JACKSONVILLE FL 32207 COMPANY:ADDRESS:CITY:STATE:ZIP: FUTCH'S LANDSCAPING, INC.PO BOX 725 PALATKA FL 32178 TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 170317 0000 CLUB MANOR JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 170 CLUB DR IRRIGATION Irrigation $1200.00 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. State Law requires calling Sunshine 811 to have ALL public utilities located BEFORE beginning the work. 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: 12/21/2023 PERMIT NUMBER IRR23-0027 ISSUED: 12/21/2023 EXPIRES: 6/18/2024 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. 4 PUBLIC UTILITIES ADDITIONAL COMMENTS PUBLIC UTILITIES INFORMATIONAL Notes: RPZ Backflow Tester Form Attached 5 PUBLIC UTILITIES SEE ATTACHMENT INFORMATIONAL Notes: See Attachment -Tester Form Attached 2 of 2Issued Date: 12/21/2023 PERMIT NUMBER IRR23-0027 ISSUED: 12/21/2023 EXPIRES: 6/18/2024 IRRIGATION PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 IRR23-0027 IRR23-0027 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