2025 SEMINOLE RD - GENERAL REPAIRS ,` if x`1'`1 r16
�� A, CITY OF ATLANTIC BEACH
;. s J 800 SEMINOLE ROAD
OF
�, r� ATLANTIC BEACH, FL 32233
\ INSPECTION PHONE LINE 247-5814
.013191'
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1528
Job Type: RESIDENTIAL ALTERATION
Description: GENERAL REPAIRS - REMOVE AND REPLACE
SHEATHING, FRAMING AND GARAGE DOOR BUCKS, LAP SIDING AND TRIM
Estimated Value: $5,364.00
Issue Date: 7/21/2016
Expiration Date: 1/17/2017
PROPERTY ADDRESS:
Address: 2025 SEMINOLE RD 102
RE Number: 169723-0204
PROPERTY OWNER:
Name: FORD ET AL, SHERRY DIANE
Address: 14711 NW 58TH AVE
GENERAL CONTRACTOR INFORMATION:
Name: LANG'S GENERAL CONTRACTING LLC
Address: 2201 SAWGRASS VILLAGE DR QA JOHN R. LANG
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $38.41
BUILDING PERMIT FEE $76.82
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $119.23
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
01.1.14:0, City of Atlantic Beach APPLICATION NUMBER
JsrI Building Department (To be assigned by the Building Department.)
' 800 Seminole Road // D
15111 �r Atlantic Beach, Florida 32233-5445 -�
`�
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: —7/7// CQ
City web-site: http://www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
! OZ
Property Address:Z025 SnIoL / r De ent review required Yes No
LAMEN-S uildin
Applicant: GE/�[-�A-( Qrti,1' Planning &Zoning
Tree Administrator
Project: i REp IT 1 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: 113tilloProved. ❑Denied.
(Circle one.) Comments:
BUILDIN\
PLANNING &ZONING Reviewed by: Date: '7' 16
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH FILE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ( (0-R AAR-1 5 Z8
Job Address: 2025 Seminole Road#102 Permit Number:
Legal Description 09-2S-29E North shore Condominium Dwelling Unit A-2 Parcel# 169723-0204
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$5,364 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): ,
Commercial �
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o N/A
Florida Product Approval
For multiple products use pr uc approveform
Describe in detail the type of work to be performed:
Pressure wash exterior forpainting
Paint 2 coats Sherwin Williams superpaint
Left side Chimney agproximately 16sf lap siding
Left of slider approximately 1If of band and cap
R&R trim around top chimney
R&K approximately 15sf of lap sidin on left wall
R&R approximately 251f of top band cap on left wall
R&R approximately 5sf of lap siding on left front wall
R&R approximately 22If of band & top cap on left front wall
R&R Garage door buck
R&K approximately 4sf of lap siding& top cap left of garage door
R&K any damaged sheathing and or framing found behind siding& trim
Property Owner Information:
Name: Karen S Keresztes Address: 2025 Seminole Road#102
City Atlantic Beach State FL Zip 32233 Phone 323-896-3589
E-Mail or Fax#(Optional) So„-a,r.'.¢.CcGS��at�•C�?'Ct�wtic►;�� , C�•rc�
Contractor Information:
Company Name: Lang's General Contracting& Renovation,LLC Qualifying Agent: John R.Lang
Address:13653 Macapa Road City Jacksonville State FL. Zip 32246
Office Phone 904-422-6690 Job Site/Contact Number 904-626-1962 Fax#na
State Certification/Registration#CGC 062543
Architect Name& Phone# na
Engineer's Name&Phone#no
Fee Simple Title Holder Name and Address na
Bonding Company Name and Address na
Mortgage Lender Name and Address na
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
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 if 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. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells,Pools, Furnaces, Boilers, 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 herebycertify that I have read and examined this 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 taw regulating construction or the
performance of construction.
Signature of Owner
gn Signature of Contrac
Print Name 0,trS s Print Name 694/o
Sworn •, . ribed before me Swo e • d 'scr'r. be o - me
this Day of 20 this tvr Ia.01/ _.
Notary Public See Attached Notary Public - 1
ZOU� gt.)n\NOTARIZED CERTIFICATE ised 01.26.10
. TONI GINDLESPERGER
' • _. MY COMMISSION*FF 924951
n j EXPIRES:October 6,2019
?p`,'i Bonded Tbru Notary Pubic Unden ricers
FILE CCI7
CALIFORNIA JURAT
(CALIFORNIA GOVERNMENT CODE § 8202)
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
STATE OF CALIFORNIA
COUNTY OF 40s- AVG
Subscribed and sworn to (or affirmed) before me on this S77fday off(11U/lie , 204,
by K19 Q EN 6S. /(e2esz I E's , proved to me on the basis of
(Name of Signe
satisfactory evidence to be the person(s).who appeared before me.
RONALD NORRIS MCGHEE
, , ,,:,,_ Commission#2003044
•
`y44''',1� Notary Public-California
r r / C i Z �` ' Los Angeles County
. i _ // i �_ _ __ My Comm. Expires Jan S,2017
Signat e of Notary Public (Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
Description of Attached Document 1
Title or Type of Document:�oj LDi j�// � '/J'/'�r 041 Document Date: Juw e 2 y 20/
Number of Pages: e/J Signer(s) Other Tha,n Named Above: N 6 Ai
Additional Information: /V/fr
revision date 01/01/2015
Permit No. /6-- QUA R_)s NOTICE OF COMMENCEMENT
State of Florida, County of Duval
FILE COPY Tax Folio No._________
169723-0204
THE UNDERSIGNED hereby give notice that the improvement will be made to certain
real Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement in accordance with
1. Description of property(legal description of property and address if available):
09-2S-29E NORTH SHORE CONDOMINIUM DWELLING UNITA-2
2. General Description of improvements:
Wood rot repair and painting
3. Owner Information:
a)Name and Address: KAREN S KERESZTES 2025 SEMINOLE RD# 102 ATLANTIC BEACH, FL 32233
b)Interest in property:residence
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
\ a)Name and Address: John R Lang 13653 Macapa Road, Jacksonville, FL. 32246
Phone Number:904-422-6690
5. Surety Information:
a)Name and Address:
b)Phone Number:
c)Amount of Bond: $
6. Lender Information:
a)Name and Address: NI v\S 9,r (.1. C�v� , ,Q,O 56.ox A 5 6%5 \ so1/4n3 LLS, ` L 3. .
NA.b)Phone Number: C\ o .-k-1 1- 1/43.c5c5 a o l
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a)Name and Address: ?,..cSl.o,.r1, A, ,�k,p„kg . a o I,\ $4,6,(31-, Pja,nv.d‘P\'SQ er.1J c,Zao,cc)-,�k...�a ,3
b)Phone Numbers of Designated Person: Qo I-1- S Q,o-pock oma.
8. In addition to himself/herself, Owner designates of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief.
•
Signature of Owner or Owner's Authorized-Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office.
The foregoing instrument was acknowledged before me this day of ,2016 , by
as for .
(Name of Person) (Type of Authority,i.e.Officer/Attorney) (Name of Party Instrument was Executed for)
NOTARY PUBLIC, STATE OF FLORIDA
Doc#2016152888,OR BK 17622 Page 1575, Print Name:
Number Pages:2
Recorded 07/05/2016 at 01:46 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL ❑ Personally Known
COUNTY ❑ Identification/Type:
RECORDING$18.50
Revised 10/1/2010