543 Aquatic Dr RERF20-0195 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
ROLEWICZ MICHAEL W 543 AQUATIC DR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
Cost Plus Roofing 1438 Lewis Street Fernandina Beach FL 32034
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171818 5326 AQUATIC GARDENS
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
543 AQUATIC DR REROOF SHINGLE SHINGLE ROOF $4800.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $79.00
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 1Issued Date: 10/19/2020
PERMIT NUMBER
RERF20-0195
ISSUED: 10/19/2020
EXPIRES: 4/17/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $79.00
RERF20-0195 Address: 543 AQUATIC DR APN: 171818 5326 $79.00
BUILDING $75.00
BUILDING PERMIT 455-0000-322-1000 0 $75.00
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: R13842 $79.00
Printed: Monday, October 19, 2020 11:54 AM
Date Paid: Monday, October 19, 2020
Paid By: Cost Plus Roofing
Pay Method: CREDIT CARD 387612538
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13842
e Building Permit Application
City of A�lantic Beach Buil�ing Department
800 Seminole Road, Atlantic Beach, Fl 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updated 10/9/18
••ALL INFORMATION
HIGHLIGHTED IN GRAV
IS REQUIRED.
Job Address: .S::¥3 A&Ull'T1C. {2rlvf..Permit Number: __________ _
Legal Description / JE-7/ l7�1$-l'l£2 dfrfl81JC (Aelll{S , � {o-CZ:Z,G RE# 171 !,/ g-$3Z(a
Valuation of Work (Replacement Cost) $ _4,800______ Heated/Cooled SF ____ Non- Heated/Cooled ____ _
•Class of Work: □New □Addition □Alteration □Repair □yove □Demo □Pool □Window/Door
• Use of existing/proposed structure(s): □Commercial Qt(esidential
•If an existing structure, is a fire sprinkler system installed?: □Yes ✓•
Florida Product Approval #�-----�""""'--"''---+---------for multiple products use product approval form
Property Owner Information
Name: /11(/L� &2L€.WIC.2.-·,. ,. Address' 6'. Al /445C'Qfi e,u;a . /Jay'lf (/felfl. Et. !W'l?-City· State Zip· Phone -Jol.f-'177-573$ ---E-Mail /11(/,<., t • ;e.ot-f_W(C,2= € f..Y-Prlf.d'-r/,C,VV\Owner or Agent (If Agent, Power of Attorney or Agency letter Required) __________________ _
�ntractor Information
Name of Company ,·con:.· PL lt.S t!Wf-t,v'
Address·: Z.ll,.e lfif!fS ( "i'.-: ()£ .s ·, Qualifying Agent_,.·------..--------
Citv � pf/!.ff State 'f" '--Zip..,Jl,g...._-='JM--.. __Office Phone · fe, Y--u 2. ft, -8KZ.'-f State Certification/Registration II ca_ I :3 z.,. iSZ.. 3 Job Site Contact Number-�------------
E-Mail P,ftv. 5rfc,,7l:/C; @CCMCA$L-,Aik[
Architect Name & Phone# ________________________________ _ Engineer's Name & Phone#-.,.,-.-,----,..---------------..,.,,...-----·--,,-.------_,,.Workers Compensatidn Insurer i" · OR Exempt ij Expiration Date ______ _
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the iss.uance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. 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
Jederal agencle5,
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAVING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN INANCIN , ONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC I , v.. .. CE OF COMMENCEM�NT. P-==>
(Signali,Mlll��ner or Agent) � (Signature of Contractor)
Signed and sworn to (or affirmed) before me this it;..._ day of ,t?e.ntJJ& , tl4a,., , by M,�M,A:::(.,,,2-tl <:w ,·c. �
$<< < @.---,(Signature of Notary) .,��.. CRISTINA HAWBA gnat {m. ��·,, Notary Public • Stitt of FiorlCI
\ a.1 commtulon 01H0212,,
\.,. OF�'.,JAJ.E!!"A"';.; Explff'I Jul 20. 2024[ I ersona� National Not1r1 AHl'I,
r •J.. .............. _...,__...,.�
RERF20-0195