586 Timber Bridge Lane PLRS19-0113 bar sink permit PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0113
800 SEMINOLE ROAD ISSUED: 6/12/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 12/9/2019
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK-
586 TIMBER BRIDGE PLUMBING RESIDENTIAL install bar sink at pool house $2000.00
shelter
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1695052120 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HERZER PLUMBING 3453 E RED OAK CIR ORANGEPARK FIL 32073
SERVICE
OWNER: ADDRESS: CITY: STATE: ZIP:
Mark & Becky Walden 586 Timber Bridge Ln Atlantic Beach FL 32233
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date:6/12/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0113
ISSUED: 6/12/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 12/9/2019
TOTAL:$66.001
Issued Date:6/12/2019 2 of 2
Plumbing Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: P(-I;Ls -0 (13
JOB ADDRESS: 586 Timber Bridge Lane PROJECT VALUE $2,000.00
ONEW OR REPLACEMENT INSTALLATION and/orE]RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
E14ISCELLANEOUS
Elsewer Replacement
[]Back Flow Preventer
F Lawn Sprinkler System (number of sprinkler heads)
03rease Interceptor (Trap)_gallons (Requires 3 sets of plans)
F-]Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department forfinal inspection.
Fv Other (1)bar sink at pool house
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation construction or the performance of construction.
Owner Name: M a�-V- 0 nd f5ec-x \/\I 0 1 (� e V) Phone Number:
Plumbing Company: HERZERS PLUMBING SERVICE Office Phone: 264-6171 Fax
Co. Address: PO BOX 422 City: ORANGE PARK State: FL zip: 32067
License Holder: GLENN BUCHMAN State Ce rtif i cation/Regist ration# CFC033873
Notarized Signature of License Holder P
i��
The foregoin trument was acknowledged before me this day of 20 in the State of Florida,
County of 9(�! CA
1110, Signature of Notary Public
..........:""i...............................i.....................................................................
"JLI P"' NotafY Puvic state of Florida
o,.n M Lehan.
G 282187 Pf Personally Known OR Produced Identification
my cc)mmisston G
ai VdP Expires 121M2022 Type of Identification:
Updated 10117118
Cash Register Receipt Receipt Number
City of Atlantic Beach R9288
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $66.00
PLRS19-0113 Address: 586 TIMBER BRIDGE APN: 169505 2120 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R9288 $66.00
Date Paid: Wednesday,June 12, 2019
Paid By: Mark & Becky Walden
Cashier: CT
Pay Method: CREDIT CARD 04789Z
Printed:Wednesday,June 12,2019 10:21 AM 1 of 1