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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.