335 Country Club Ln GSRS21-0055 FireplaceOWNER:ADDRESS:CITY:STATE:ZIP:
PROVIDENCE
CONSTRUCTION COMPANY ROBERT NELSON JACKSONVILLE
BEACH FL 32250
COMPANY:ADDRESS:CITY:STATE:ZIP:
CONSTRUCTION
SOLUTIONS & SUPPLY, LLC 5225 EDGEWOOD CT JACKSONVILLE FL 32254
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171961 0000 SELVA MARINA UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
335 COUNTRY CLUB LN MECHANICAL RESIDENTIAL GAS 1 Fireplace: NEW SINGLE
FAMILY HOME $7862.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
PREFABRICATED FIREPLACES 455-0000-322-1000 1 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
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: 6/7/2021
PERMIT NUMBER
GSRS21-0055
ISSUED: 6/7/2021
EXPIRES: 12/4/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
TOTAL: $89.00
2 of 2Issued Date: 6/7/2021
PERMIT NUMBER
GSRS21-0055
ISSUED: 6/7/2021
EXPIRES: 12/4/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $89.00
GSRS21-0055 Address: 335 COUNTRY CLUB LN APN: 171961 0000 $89.00
MECHANICAL $85.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
PREFABRICATED FIREPLACES 455-0000-322-1000 1 $30.00
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: R16017 $89.00
Printed: Monday, June 7, 2021 9:59 AM
Date Paid: Monday, June 07, 2021
Paid By: CONSTRUCTION SOLUTIONS & SUPPLY, LLC
Pay Method: CREDIT CARD 464979756
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R16017
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