830 Cavalla Rd RERF21-0058 ShingleOWNER:ADDRESS:CITY:STATE:ZIP:
FOSTER AMY N 1122 NANIALII ST KAILUA HI 96734
COMPANY:ADDRESS:CITY:STATE:ZIP:
A CROWN ROOFING INC 9791 Old St Augustine Rd JACKSONVILLE FL 32257
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171717 0210 ROYAL PALMS UNIT
02A3.00
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
830 CAVALLA RD REROOF SHINGLE Shingle: FL10124R20 $6400.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $85.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $89.00
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: 3/4/2021
PERMIT NUMBER
RERF21-0058
ISSUED: 3/4/2021
EXPIRES: 8/31/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 3/4/2021
PERMIT NUMBER
RERF21-0058
ISSUED: 3/4/2021
EXPIRES: 8/31/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $89.00
RERF21-0058 Address: 830 CAVALLA RD APN: 171717 0210 $89.00
BUILDING $85.00
BUILDING PERMIT 455-0000-322-1000 0 $85.00
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: R15090 $89.00
Printed: Thursday, March 4, 2021 1:12 PM
Date Paid: Thursday, March 04, 2021
Paid By: A CROWN ROOFING INC
Pay Method: CREDIT CARD 429750505
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R15090
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATIONft.„.w..,
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: X36 (Ck-VCAL(CI_ gd1A 4-1"iC eaChii=L 3z733ermitNumber:
Legal Description Il-lb 17-i ' /? ?toFRoyu(Palrhsi/n,riMin/1-1K4,Z5 rt OFL 57.,x1'
1ut561Ky
y 7z(RE# I 1 / 1 ( "0I6
Valuation of Work(Replacement Cost)$ 6, z/po Heated/Cooled SF /6'56 Non-Heated/Cooled (/8y
Class of Work: New Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial PResidential
If an existing structure, is a fire sprinkler system installed?: Yes j&o
Will tree(s) be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:)e-Uf ` St, o,/+-- 5h,'11/(,e 1 sI/p +1hLi c 4& (mty-+-
sq .r>;5) 3/i. P,- fch
Florida Product Approval# Pt--10 LLi RZo for multiple products use product approval form
Property OwnerInformation`
1 LANamern JP/LL Z- Address 7O/ U\I lizifW Cr Li
City i,ivis Pill!!State At- Zip e,l _Phone QG(/_ 237-7, 6
E-Mail Ary\V 5(.."4.-1-Z.V Ma.;I, LOVA
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company A • n I1n Qualifying Agent W, \. jWi c .v Ot hl(l
Address9 r7/ G(. 5-/- u_s i Inti
P.
City ,T(ALI< ilk, If State 7:t_ zip - 2 2 c7
Office Phone 9G- `1,(9- g /'7U Job Site Contact Number
State Certification/Registration# CGG 13 Z 9 5-2_/ E-Mail w Kahn e pv rl,J Y (yrt (05, GVYI
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer Gert n , 11-15(4641 6. com r OR Exempt o Expiration Date (ll ze
Application is hereby made to obtain a permit to do the work and instaations as indicated. I certify that no work br installation has
commenced prior to the issuance 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
federal agencies.
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 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN a TTORNEY BEFORE
RECORDIrlIOUR,NOTICE OF COMMENCEMENT.
t'1"
O
Signature of Owner or Agent)Signature of Contractor)
g'Sled and sworn to(or affirmed before me his day of Signed and sworn to(or affirmed) before me this b day of
rc/>nt.‘,, __...)0:-.) I ,b Aril 4
i 1r
L. C l"Cl7ruc y, 2OZ I , by Of/44 1?oA,j
ijc" 4 moi.
IS':nature of Notary) Si nature of No a
r. ,} 0'.,:.(%:-,. DON MICHAEL WATERS,JR.
BRUCE MY COMMISSION N GG 319490OMEN
t wico memoNa>e0fi."141.'•.:.
Personally Known OR onally Known OR
EXPIRE*Wintber7. E , =
EXPIRES:A gust 3,2023
r• •r .uced Identification Jd.'.,.• BorMed Thru MWuy Public UnderwifasProducedIdentificationi.,. le of Identification: Bonded The Wert Mc
Identification: rSeNc//v
iy`w
RERF21-0058
NOTICE OF COMMENCEMENT
PREPARE INDUPLICATE)
Ir,
Permit No. Tax Folio No ` 7 `7' I — `"
1 7 J zA V
State of L. County of D i v rA l
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.
r1
L gal description of propery, being improved: 6 r
O\Ic i YO.A nS UV\ tZ a. s o 5T,7 \k _ A s
Address of property being improved:3 Q (JA-6--I(c. `LL J l I L 6 2-131
General descnption of improvements: e y04-
Owner Ami L\r\ 17—
Address 7L0\r,)-L CT N(,..A. v t AL 3 4S 1 t
Owners interest in site of the improvement `5(If
I
Fee Simple Titleholder Of other than owner)
Name
Addressn jT
Contractor l )W 1k 1
Address 9 lrtStA v.)-tn c l l So VI lf _ L 3LZ5 r
Phone No. 9t1 y'G/9 - !X)--1FaxNo. to L6 I 1
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
ahone No.Fax No.
Name of person within the State of Florida,other than himself or herself,designated oy owner upon whom
notices or other documents may oe served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienors Notice as
provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's optic
Name A C 10,\J h tOoY't
tr)(
3Address5CA/ 1 e--
PhonePhone No. Fax No.
Expiration date of Notice of Commencement(tire expiration date is one(1)year from the date of recording unless a
oifferent date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: y I DATE r _ "v1/
Betae me thb of ,. .,_ .. > _ • In e
County of Duva S Redd" has person I appeared
y 1 CJ1 herein by
f. selp*rsa and atf'rrrs!`",at.?::Statements end dac'arat- 't herein
era true and accurate
BRUCE J.O EN
14 MY co1Yt16S+1 i GG 335709
Aip i EXPIRES:September 7,2023
s•.of Thni tbtary Public Umierwilae•
No at ' blic at Large.Stile of _ C
My commission expires. 7-7
Personally Known
Produced Idenallcation )t .3Z)C.-