Permit Well 805 Plaza 2012 ,.j► sl
=A oa� CITY OF ATLANTIC BEACH
' a 800 SEMINOLE ROAD
'' . ATLANTIC BEACH, FL 32233
a INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 12- 00000062 Date 1/18/12
Property Address 805 PLAZA
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
new well
Owner Contractor
AUGUSTINE, JAMES AMERICAN WELL & IRRIGATION INC
805 PLAZA 49 ARDELLA RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249 -5400
Permit WELL PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee .00
Issue Date Valuation . 0
Expiration Date . . 7/16/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
A reduced pressure zone backflow preventer must be
installed on the customer's side of the City water service.
Backflow preventer must be tested by a certified tester and
a copy of the results sent to Public Utilities.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Graham Shirley
From: Kaluzniak, Donna
Sent: Tuesday, January 17, 2012 11:47 AM
To: White, Debbie; Graham Shirley
Cc: Showman, Lisa
Subject: 12 -0062
Debbie & Shirley, Joe from American Well called to see if I would OK the permit for the irrigation well at 805 Plaza. I
looked at the site on GIS and see no problem — so I will approve in the system — but you won't get hard copy till next
time go to Public Works — Let me know if any problem — thanks, Donna
Donna Kaluzniak
Utility Director
City of Atlantic Beach
902 Assisi Lane
Atlantic Beach, FL 32233
PH: 904 - 270 -2535
FAX: 904 - 242 -3475
dkaluzniak(ci oab. us
Please note: Florida has a very broad public records law. Most written communications to or from city officials
regarding city business are public records available to the public and media upon request. Your e-mail communications
may be subject to public disclosure.
LSAT r
�s 1yr ap 1, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
' RoJf
Application Number 12- 00000062 Date 1/20/12
Property Address 805 PLAZA
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
new well
Owner Contractor
AUGUSTINE, JAMES AMERICAN WELL & IRRIGATION INC
805 PLAZA 49 ARDELLA RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249 -5400
Permit WELL PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . . .00
Issue Date . . . 1/18/12 Valuation . . . . 0
Expiration Date . 7/16/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
A reduced pressure zone backflow preventer must be
installed on the customer's side of the City water service.
Backflow preventer must be tested by a certified tester and
a copy of the results sent to Public Utilities.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
E -- IV
.,
,,1 , Cit of Atl Beach
APPLICATION NUMBER
40:41.. Building Department JAN 17 2012 (To be assigned by the Building Department.)
^' 800 Seminole Road
a Atlantic Beach, Florida 32233 -544 3y: _ /y. - c2 2 2-
Phone (904) 247 -5826 • Fax (904
E -mail: building- dept @coab.us Date routed: API/
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (® ?/f1 Z_ /.] Department review required Yes No
Building
Applicant: / 'y) ,e ems/? //0i- II n &i Zo
Tree Administrator
Project: Ail a) 60 L Pubr
ublic Utilities
P ty
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
el • RK Comments:
Or UTILITI
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
i t
J e! 9,.
CITY OF ATLANTIC BEACH
WELL PERMIT APPLICATION
Date 1 /,
Owner's Owner's Name: ddress: gag
Well Address (if different than above):
Well Location on Property (i.e. northeast corner, etc.) t z f- S ..t4 ►g a-c ,c
Well Installation Contractor: Ccry / 47)- - ).5 / 47)- - ).5-7 2 ) �' e /I
£_
Contractor License No.: 75" 7 Phone: Fax:
Contractor Address: 62.E x /1-- ,
Check Use of Well: Domestic Irrigation u Other
# of Wells to be installed: # of Pumps to be installed:
Estimated- Well Depth: IL 6 Casing Depth: d Screen Interval from -3
Well Diameter: 3 1 l L Casing Material P L/ C
Is address currently connected to the City water system?
Is address currently connected to the City sewer system? r
Has a Well Permit been obtained from the City of Jacksonville?yea n Permit #
Does the well require a permit from the St. Johns River Water Management District?
(Not required for wells under 2- inches diameter installed by resident or wells under 6-
inches diameter if installed by licensed well contractor). .__C2- - - - --
If permit is required, note Permit Number r-- and attach a copy.
NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST
INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PREVENTER ON
THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER.
THE BACKFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.