771 CAVALLA ROOF 2016 CITY OF ATLANTIC BEACH
J - ` S
14,
‘ "` - f 800 SEMINOLE ROAD
\ -) ATLANTIC BEACH, FL 32233 ,,,,,...._____)—
INSPECTION PHONE LINE 247 -5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- ROOF -692
Job Type: ROOF PERMIT
Description: REROOF
Estimated Value: $5,900.00
Issue Date: 3/22/2016
Expiration Date: 9/18/2016
PROPERTY ADDRESS:
Address: 771 CAVALLA RD
RE Number: 171348 -0000
PROPERTY OWNER:
Name: OSWALD, JASON
Address: 771 CAVALLA
GENERAL CONTRACTOR INFORMATION:
Name: Llc, Kayco Roofing
Address: 1966 Lakeshore DR
Phone: - -
FEES:
BUILDING PERMIT FEE $79.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $83.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Fl County of D
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 31 -1 38- 2S -29E Royal Palms Unit 2 A Lot 8 BLK 15
77
Address of property being improved. 1 Cavalla Rd Atlantic Beach Fl 32233
General description of improvements: Re -Roof
Owner Jason Oswald
Address 771 Cavalla Rd Atlantic Beach Fl 32233
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor KayCo Roofing, LLC
Address PO Box 66385 Orange Park, FL 32065
Phone No. 904- 742 -6790 Fax No.
Surety (if any)
Address Amount of bond $
Phone No. Fax No
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY
Signed: � DATE 3 -
Doc # 2016063475, OR BK 17499 Page 1801 Before Me this day of UUr
in the
Number Pages: 1 &aunty of 4udel St'at'e of Florida, has ersona ly ...eared
22'2016 at 10:31 AM, t'JQ ' OA TAGLIARINI
V'
Recorded 0 _ himself/ herself and affirms that all statements an
Ronnie usselV CLERK CIRCUIT COURT DUV'A_
COUNTY
are true and accurate /1
f =*: 0': MY COMMISSION # FF942250
RECORDING $10 00 1 EXPIRES December 09, 2019
; N aMNwtr.can+
Notary at Large, State of , County of
My commission expires: � h �"
Personally Known ' G or
Produced Identification
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 11 1 C 01 Va 1 1 ei Peimit lyp�► b��
Legal Description 3 I - I 3S - 2S - Z 9 F goy Pa I w, S V� i �1arc # d � - -- 29 E
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ c9 O U Proposed Work heated /cooled (13 Zr non - heated/cooled f 3 ` /D
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial ' esid- s •.
If an existing structure, is a fire sprinkler system installed? (Circle one): ' es No N /A
Florida Product Approval # `414. 751, / FL a i- nr
For multiple products use product approval form 1
Describe in detail the type of work to be performed: Y' e p1 c e it f
Property Owner Information:
Name: ,T9 S 0) w Q Address: - i "` 1 a
City A-) la.,+; I t , c' State fk--Zip 32233 Phone 61 c , q 2 - (o'")
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: 1 " -o n 1� 1 � q Qualifying Agent C (A ✓ — Q - �'� S Z3 .
Address: ( R �(p l0 3$ c ✓ City Q r t. (09 -/k— State ip '� ) ( V'
Office Phone q 315 0 g Job Site/ Contact Number 9 o■-/ yp 3 - - 0 /7x:Fax # c) obi. to yy -3/ 13
State Certification/Registration # C C. L 13 2$ g 03
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. l certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six f6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby ertify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor 7(.-
Print Name . S6‘,50/1 OSta a( dC Print Name C/4 f . L - i )) S v*
Sworn to and subscribed b , • re me Swo to and subscri • ed befo e me
this - 24 b Da • • . c ► this Day of - 'eT.�1ar. .. •
: . •.L : ' - -
Notary Public - State of Florida
• r;�
• .:•• ? �J. BA Y t I 1 ,0au F942250
Notary Public = "; -.: = M y Comm. Exp. March 18, 2017 Notary 1' bltc : ; _ S D.c.mb.r 09.201•
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