499 Helmsman RES21-0046 Garage DoorOWNER:ADDRESS:CITY:STATE:ZIP:
QUILLIN LEGENIA K 499 HELMSMAN LN ATLANTIC BEACH FL 32233-4104
COMPANY:ADDRESS:CITY:STATE:ZIP:
PRECISION DOOR SERVICE
OF N FL 6676 COLUMBIA PARK DR S JACKSONVILLE FL 32258
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170703 0412 SEASPRAY
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
499 HELMSMAN LN RESIDENTIAL
WINDOWS/DOORS GARAGE DOOR $892.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $86.50
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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: 2/23/2021
PERMIT NUMBER
RES21-0046
ISSUED: 2/23/2021
EXPIRES: 8/22/2021
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 2/23/2021
PERMIT NUMBER
RES21-0046
ISSUED: 2/23/2021
EXPIRES: 8/22/2021
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $86.50
RES21-0046 Address: 499 HELMSMAN LN APN: 170703 0412 $86.50
BUILDING $55.00
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PLAN REVIEW $27.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14975 $86.50
Printed: Tuesday, February 23, 2021 10:12 AM
Date Paid: Tuesday, February 23, 2021
Paid By: PRECISION DOOR SERVICE OF N FL
Pay Method: CREDIT CARD 426378741
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14975
~+; CENTRALSQUARE
RES21-0046
Building Permit Application
City of Atlantic Beach Building Departmen
800 Seminole Road, Atlantic Beach, FL 3223
Updated 10/9/18
Phone: (904) 247-5826 Email: =-B=ui=ld:.:.:in..:.a....:=:...µ...-=-===
Job Address: mer:;.-~
-Heated/Cooled____.,~-"-11~~---
•
•
•
Class of Work: □New □Addition □A lterati on □Repa ir □Move
□Commercial ~esident
If an existing structure, is a fire sprinkler system installed?: □Yes
□Pool "t::jwindow/Door
Owner or Agent {If Agent, Power of Attorney or Agency Letter Required ) ----1---------------------
Contractor Information
-~~::-l~~-,-....... ~~~~~-~J.Aaq~.\,L.J;41V'-i
State Certification/Registration # ~.c;;:i,~-.....:.::"-a&.._.c:..J.:
Mai l,::..L ___ _.., ___ :..__~_.;_ __ ............ ______ .._
Architect Name & Phone #-----------------f-------------------
Engineer's Name & Phone #--...-.==:--=,-,-,,..__=--,,,,,..,~---------+--------------==:::-=---;;---:--s,,----,::::-----::=
Workers Compensation Insurer ~~~----,;.....,:~.....,~"'-------IOR Exempt a Expi r ati on Date.,,..·-~ ...... -------
Application is hereby made to obtain a permit t o do the work and installatio as indicated. I certify t h at no work o r instal lation has
commenced prior to the issuance of a permit and that all work w ill be perfor ed to meet the standards of all the laws regulati ng
construction in this jurisdiction. I understand that a separate permit m ust be ecured for ELECTRICAL WORK, PLUMBING, SIGNS,
WE LLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS , and AIR CONDITIONE S, etc. NOTIC€: In addition to the r equirements of tITis
pen:n:it, there may be additional restrictions ap.plicable to this property that ay be found in the pubf:ic records of this county, and
):here may be additiQnal p~mlts requirecl from other :o ernmental entities ch as water m~~ement dlstriftS, ,state agencies, or
fedetaJ agencies.
OWNER 'S AFFIDAVIT: I certify that all the foregoing information is accurate a d that all w ork will be done in compliance w ith all
applicable laws regulating construction and zon ing.
WARNING TO OWNER: YOUR FAILURE TO RECORD A OTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAVI NG TWICE FOR IMPROVEMENT TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSU LT WITH YOUR LE R V BEFORE
~~OMMENCEME
'?~{\ Notary Pu bli c · State of Flo rid a
.'~~.if Comm i ssion# GG 203567
[ ) Personally Known , R:?'o, f';~/ My Comm. Expires Jul 29. ZOZZ
[ ] Produced ldentifi t ion Bonded throuah Nation al Notary Assn.
Type of Identification: _____________ _
of
'o,._~··jj:~i;i;,. MICHELLE VAN VUREN
[ ] Perso ally Known OR (.~\ · •~ ':; Nota ry Pubhr · state or Florida
•·•.Jo,f\.O."",''/ Comm1ss1on_ # GG 203 567 [ ] Produ ed Identificat ion •. ..... My Comm . Expires Jut 29 2022
Type of I entification : _.....,, __ 8•0
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