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800 Seminole Rd IRR24-0003 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach FL 32233 COMPANY:ADDRESS:CITY:STATE:ZIP: Conserva Irrigation 51 HUDSON WAY STE 6 PONTE VEDRA FL 32081 TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 170389 0000 SALTAIR SEC 02 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 800 SEMINOLE RD IRRIGATION Irrigation $4945.00 FEES 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 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 PUBLIC UTILITIES SEE ATTACHMENT INFORMATIONAL Notes: See Attachment - Backflow Test Form 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: 1/10/2024 PERMIT NUMBER IRR24-0003 ISSUED: 1/10/2024 EXPIRES: 7/8/2024 IRRIGATION PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $75.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $116.50 2 of 2Issued Date: 1/10/2024 PERMIT NUMBER IRR24-0003 ISSUED: 1/10/2024 EXPIRES: 7/8/2024 IRRIGATION PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 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 IRR24-0003