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559 SELVA LAKES CIR ACC22-0033 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: GALEANI JOHN J 555 SELVA LAKES CIR ATLANTIC BEACH FL 32233 COMPANY:ADDRESS:CITY:STATE:ZIP: TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 172027 5522 SELVA LAKES UNIT 02 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 559 SELVA LAKES CIR ACCESSORY SINGLE OR TWO FAMILY ACCESSORY WOODEN DECK $2000.00 LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL Notes: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247- 5814) to request an Erosion and Sediment Control Inspection prior to start of construction. 2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 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 3Issued Date: 9/14/2022 PERMIT NUMBER ACC22-0033 ISSUED: 9/14/2022 EXPIRES: 3/13/2023 ACCESSORY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $65.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00 3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container cannot be placed on City right-of-way. 4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration, including sod, is required. 5 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 6 PUBLIC WORKS GRASS INFORMATIONAL Notes: Full site to be grassed. 7 PUBLIC WORKS REVISION INFORMATIONAL Notes: Any plan change must be submitted as a Revision to the Building Department. 8 PUBLIC WORKS DECKING REMOVED INFORMATIONAL Notes: All old decking and debris must be removed from job site by Owner. 9 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL Notes: Any damage done to infrastructure must be repaired by Owner. 11 PUBLIC WORKS DECK BOARDS INFORMATIONAL Notes: Deck board spacing must be 3/16" or 1/8" at best to be permeable and to allow for proper drainage. Deck must be 3" minimum off ground surface. This will be verified at inspection. 12 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL Notes: All construction debris must be removed from job site by Owner. 2 of 3Issued Date: 9/14/2022 PERMIT NUMBER ACC22-0033 ISSUED: 9/14/2022 EXPIRES: 3/13/2023 ACCESSORY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 TOTAL: $226.50 3 of 3Issued Date: 9/14/2022 PERMIT NUMBER ACC22-0033 ISSUED: 9/14/2022 EXPIRES: 3/13/2023 ACCESSORY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 l Building Permit Application Updated 10/9/18 fLi. City of Atlantic Beach Building Department ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Lu;t»- IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us y Z s J,J< and l 0 Z Z--O03 3JobAddress: // _/vQ 1 a3,nZ .Q Permit Number: Legal Description y ? // `7 ' a s._ r 9 f' RE#/7 27 `s.5.2 0. Valuation of Work(Replacement Cost)$g© Heated/Cooled SF Non-Heated/Cooled Class of Work: JNew Addition Alteration Repair Move Demo Pool Window/Door Use of existing/proposed/ 'structure(s): Commercial Residential If an existing structure,is a fire sprinkler system installed?: Yes 12CNo Will tree(s)be removed in association with proposed proiect? Yes(must submit separate Tree Removal Permit) ,1:441.o Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information Name.77 n 3 7/c /iL gaea-l Address- 9 _Q./4z 6-ck City ali2.,1 1 7 State / - Zip 3Zz 33 Phone 97y s-97-7/ G ( E-Mail r'/pre-_,--- 0203 6) r d`, 0 ea-n-2 Owner or A nt(If Ageent, Power of Attorney or/Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact ' •mber State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Expiration Date Application is hereby made to obtain a permit to dot • work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and t•.t all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand th. a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS,FURNACES, BOILERS, HEATER ANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions :pplicable to this property that may be found in the public records of this county,and there may be additional permits required om 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 e :TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RR. ' DING UR NOTICE OF COMMENCEMENT. ar--V -- Signature of Owner or Agent)Signature of .ntractor) Signed and sworn to(or af, :d)before e this• 4y ofSigned and sworn to(or affi' ed)before me this day of 7)?7 ,b : ..a _:s • 11,A c...1€tent. Y T"!..t It 'rIrr) IP Signature of Notary) Personally Known OR PY ;,R,, TONI GINDL1EIly Kn n OR Produced Identification MY COMMISSIc ii 'ggy&le ification Type of Identification: EXP!RFS:OTfld®gr®fp fgptific. on: c.F'-°? Bonded ihru Notary Public Underwriters Owner Builder Affidavit ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: _cc( ' J C /k4- Or,;777L Owner Name: Phone Number: fyy 7/ L (- Mailing Address: c5q S-c'Lo. C' (;r pyz./7- State: /47 Zip: 2,2;2 3 3 Notarized Signature of Owner ,Iu-47 ? T eTo regoinginstrun;Ient was a. nowle ged before me this day of rat 202 Z.in the State of Florida, County 1\IP Signature of Notary Public Personally Known OR [ ] Produced Identification Type of Identification: -- ar c its _ Updated 10/24/18 ptY P QC; TONI GINDLESPERGER MY COMMISSION#GG 353178 EXPIRES:October 6,2023 O;'V• Bonded Thru Notary Public Underwriterstea A. Settlement Statement U.S.Department of Housing and Urban Development OMB Approval No 2502-0265 B.Type of Loan 1. FHA 2. RHS 3. Cony.Unins. 6.File No. 7.Loan No.8.Mortgage Insurance Case No. 22-1616 4. n VA 5. n Cony Ins. C.Note: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: John J.Galeani and Virginia M.Galeani Sandra J.Haden 559 Selva Lakes Circle 3554 Governors Island Drive Atlantic Beach,FL 32233 Denver,NC 28037 G.Property Location: H.Settlement Agent: I.Settlement Date: 559 Selva Lakes Circle Ponte Vedra Title,LLC 07/27/2022 Atlantic Beach,FL 32233 Funding Date: Place of Settlement: 07/27/2022 50 A1A North,Suite 108 Ponte Vedra Disbursement Date:Beach,FL 32082 07/27/2022 J.Summary of Borrower's Transaction K.Summary of Seller's Transaction 100.Gross Amount Due from Borrower 400.Gross Amount Due to Seller 101.Contract sales price 550,000.00 401.Contract sales price 550,000.00 102.Personal property 402.Personal property 103.Settlement charges to borrower(line 1400) 168.50 403. 104. 404. 105. 405. Adjustment for items paid by seller in advance Adjustment for items paid by seller in advance 106.City/Town Taxes 406.City/Town Taxes 107.County Taxes 407.County Taxes 108.Assessments 408.Assessments 109.HOA 07/27/2022 to 10/01/2022 96.85 409.HOA 07/27/2022 to 10/01/2022 96.85 110. 410. 111. 411. 112. 412. 120.Gross Amount Due from Borrower 550,265.35 420.Gross Amount Dueto Seller 550,096.85 200.Amount Paid by or in Behalf of Borrower 500.Reductions in Amount Due to Seller 201.Deposit 5,000.00 501.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) 29,593.75 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204. 504.Payoff to Wells Fargo 130,996.90 205. 505.Payoff of Second Mortgage 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210.City/Town Taxes 510.City/Town Taxes 211.County Taxes 01/01/2022 to 07/27/2022 1,736.73 511.County Taxes 01/01/2022 to 07/27/2022 1,736.73 212.Assessments 512.Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total Paid by/for Borrower 6,736.73 520.Total Reduction Amount Due Seller 162,327.38 300.Cash at Settlement from/to Borrower 600.Cash at Settlement to/from Seller 301.Gross amount due from borrower(line 120) 550,265.35 601.Gross amount due to seller(line 420)550.096.85 302.Less amounts paid by/for borrower(line 220) 6,736.73 602.Less reductions in amounts due seller(line 520) $162,327.38 303.Cash I x I From To Borrower 543,528.62 603.Cash X To n From Seller 387,769.47 N06'45'00`W 1" 4 35.00' to e.,. sfor(v cac:sry (n,wra4) 1 e,..wore 1 PI 1 IF toArcRftf 14 e3 PoRcAr. --, It" 1 1— c: 1 - t3 8' 14.4.101 a 14.1 CO--- o /f.'7' y A EvOo w 1 A i U Q 1y I. br m . 1Z x It c, a' t.. k) 1146_V41 14% e© o t0 y0 4'! i d f zIF 8 zw 1 4t hZF!N/fN fccoa Id JIn r Lay C ii.J ) 8 vkq 40 10.8' a s• z N. r v rk AC. L Ki'' E 04 i ro. 1 ci: toa 11 ( 40 ocsrSI rit06'47.77* No4 -124$. eR' 2 774,46 R f1 • KvEY /!-2v x. writ,frrwv ALL i,eo,vs. 1 FINAL SURVEY 2-5-'7 a "owe T" i,vaws 1FY THAT THIS SURVEY. PERFORMED UNDEP MY RESPONSIBLE DIRE C.T?ON MEETS THE LEGEND: ICAL 5'f,,/IpARDS FOR LAND SURVEYORS *4 ACCORDANCE +MTr CHAPTER 61FUR RG' TiF 1+T idLM1G •'011C1tEfE Y 1!DA 71VE CODE (Pi)RSUAIIT TO SECTION 472037, FLORIDA STATUTES), AND AS Sh+OVYPI. li () Li' SET O IRON Tti. 1,12' SET 3Qai - LB ' ARE NO ENCROACHMENTS UPON THESUBJECT PRIERWit. BUS.ON( RESTRH 11014 A CENTRAL hMo!E FLOOD ER+/ CLARSONRSON mo ASSOQATES, MC. R RACK'S OOD CERTIFICATE: "^'E LO1 SHOMN HEREON 6 *4 cL000 S n n .`_O CIA * t. 32207t Utt :ENCTk ZONE `X' F. -IWN ON THE RODE !NSURM4CE RATE p+ 5-- OOOi RATE.: 4-17-89. cHoile P.0 POINT OF CURVATURE x1Ay ':1tAlS/R7Y RANEE P T. PONT Of ThNW CY I ,' S P.R.C. 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TORctn a' i ik Totackn iJ ii § 011 i 111 ' : IIHIP 'IILIISoKs I f 4 ff. , ff. ----- Tkertiox. _ i, ' -, i , ______> 3 i________, ')1 X " )( XX X ' v. . xxx X xX XXX + A cropeT UI14T Fence l Building Permit Application Updated 10/9/18 fLi. City of Atlantic Beach Building Department ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Lu;t»- IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us y Z s J,J< and l 0 Z Z--O03 3JobAddress: // _/vQ 1 a3,nZ .Q Permit Number: Legal Description y ? // `7 ' a s._ r 9 f' RE#/7 27 `s.5.2 0. Valuation of Work(Replacement Cost)$g© Heated/Cooled SF Non-Heated/Cooled Class of Work: JNew Addition Alteration Repair Move Demo Pool Window/Door Use of existing/proposed/ 'structure(s): Commercial Residential If an existing structure,is a fire sprinkler system installed?: Yes 12CNo Will tree(s)be removed in association with proposed proiect? Yes(must submit separate Tree Removal Permit) ,1:441.o Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information Name.77 n 3 7/c /iL gaea-l Address- 9 _Q./4z 6-ck City ali2.,1 1 7 State / - Zip 3Zz 33 Phone 97y s-97-7/ G ( E-Mail r'/pre-_,--- 0203 6) r d`, 0 ea-n-2 Owner or A nt(If Ageent, Power of Attorney or/Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact ' •mber State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Expiration Date Application is hereby made to obtain a permit to dot • work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and t•.t all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand th. a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS,FURNACES, BOILERS, HEATER ANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions :pplicable to this property that may be found in the public records of this county,and there may be additional permits required om 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 e :TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RR. ' DING UR NOTICE OF COMMENCEMENT. ar--V -- Signature of Owner or Agent)Signature of .ntractor) Signed and sworn to(or af, :d)before e this• 4y ofSigned and sworn to(or affi' ed)before me this day of 7)?7 ,b : ..a _:s • 11,A c...1€tent. Y T"!..t It 'rIrr) IP Signature of Notary) Personally Known OR PY ;,R,, TONI GINDL1EIly Kn n OR Produced Identification MY COMMISSIc ii 'ggy&le ification Type of Identification: EXP!RFS:OTfld®gr®fp fgptific. on: c.F'-°? Bonded ihru Notary Public Underwriters Owner Builder Affidavit ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: _cc( ' J C /k4- Or,;777L Owner Name: Phone Number: fyy 7/ L (- Mailing Address: c5q S-c'Lo. C' (;r pyz./7- State: /47 Zip: 2,2;2 3 3 Notarized Signature of Owner ,Iu-47 ? T eTo regoinginstrun;Ient was a. nowle ged before me this day of rat 202 Z.in the State of Florida, County 1\IP Signature of Notary Public Personally Known OR [ ] Produced Identification Type of Identification: -- ar c its _ Updated 10/ 24/18 ptY P QC; TONI GINDLESPERGER MY COMMISSION#GG 353178 EXPIRES:October 6,2023 O;'V• Bonded Thru Notary Public Underwriterstea A. Settlement Statement U.S.Department of Housing and Urban Development OMB Approval No 2502-0265 B.Type of Loan 1. FHA 2. RHS 3. Cony.Unins. 6.File No. 7.Loan No.8.Mortgage Insurance Case No. 22-1616 4. n VA 5. n Cony Ins. C.Note: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked"(p. o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: John J.Galeani and Virginia M.Galeani Sandra J.Haden 559 Selva Lakes Circle 3554 Governors Island Drive Atlantic Beach,FL 32233 Denver,NC 28037 G.Property Location: H.Settlement Agent: I.Settlement Date: 559 Selva Lakes Circle Ponte Vedra Title,LLC 07/ 27/2022 Atlantic Beach,FL 32233 Funding Date: Place of Settlement: 07/ 27/2022 50 A1A North,Suite 108 Ponte Vedra Disbursement Date:Beach,FL 32082 07/27/2022 J.Summary of Borrower's Transaction K.Summary of Seller's Transaction 100.Gross Amount Due from Borrower 400.Gross Amount Due to Seller 101.Contract sales price 550,000.00 401.Contract sales price 550,000.00 102.Personal property 402.Personal property 103.Settlement charges to borrower(line 1400) 168.50 403. 104. 404. 105. 405. Adjustment for items paid by seller in advance Adjustment for items paid by seller in advance 106.City/Town Taxes 406.City/Town Taxes 107.County Taxes 407.County Taxes 108.Assessments 408.Assessments 109.HOA 07/27/2022 to 10/01/2022 96.85 409.HOA 07/27/2022 to 10/01/2022 96. 85 110. 410. 111. 411. 112. 412. 120.Gross Amount Due from Borrower 550,265.35 420.Gross Amount Dueto Seller 550,096.85 200.Amount Paid by or in Behalf of Borrower 500.Reductions in Amount Due to Seller 201.Deposit 5,000.00 501.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) 29,593.75 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204. 504.Payoff to Wells Fargo 130, 996.90 205. 505.Payoff of Second Mortgage 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210.City/Town Taxes 510.City/Town Taxes 211.County Taxes 01/01/2022 to 07/27/2022 1,736.73 511.County Taxes 01/ 01/2022 to 07/27/2022 1,736.73 212.Assessments 512.Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total Paid by/for Borrower 6,736.73 520.Total Reduction Amount Due Seller 162,327.38 300.Cash at Settlement from/to Borrower 600.Cash at Settlement to/from Seller 301.Gross amount due from borrower(line 120) 550,265.35 601.Gross amount due to seller(line 420)550.096.85 302.Less amounts paid by/for borrower(line 220) 6,736.73 602.Less reductions in amounts due seller(line 520) $162,327.38 303.Cash I x I From To Borrower 543,528.62 603.Cash X To n From Seller 387,769.47 N06'45' 00`W 1" 4 35.00' to e.,. sfor(v cac:sry (n,wra4) 1 e,..wore 1 PI 1 IF toArcRftf 14 e3 PoRcAr. --, It" 1 1— c: 1 - t3 8' 14.4.101 a 14.1 CO--- o /f.'7' y A EvOo w 1 A i U Q 1y I. br m . 1Z x It c, a' t.. k) 1146_V41 14% e© o t0 y0 4'! i d f zIF 8 zw 1 4t hZF!N/fN fccoa Id JIn r Lay C ii.J ) 8 vkq 40 10.8' a s• z N. r v rk AC. L Ki'' E 04 i ro. 1 ci: toa 11 ( 40 ocsrSI rit06'47.77* No4 -124$. eR' 2 774,46 R f1 • KvEY /!-2v x. writ,frrwv ALL i,eo,vs. 1 FINAL SURVEY 2-5-'7 a "owe T" i,vaws 1FY THAT THIS SURVEY. PERFORMED UNDEP MY RESPONSIBLE DIRE C.T?ON MEETS THE LEGEND: ICAL 5'f,,/IpARDS FOR LAND SURVEYORS *4 ACCORDANCE +MTr CHAPTER 61FUR RG' TiF 1+T idLM1G •'011C1tEfE Y 1!DA 71VE CODE (Pi)RSUAIIT TO SECTION 472037, FLORIDA STATUTES), AND AS Sh+OVYPI. li () Li' SET O IRON Tti. 1,12' SET 3Qai - LB ' ARE NO ENCROACHMENTS UPON THESUBJECT PRIERWit. BUS.ON( RESTRH 11014 A CENTRAL hMo!E FLOOD ER+/ CLARSONRSON mo ASSOQATES, MC. R RACK'S OOD CERTIFICATE: "^'E LO1 SHOMN HEREON 6 *4 cL000 S n n .`_O CIA * t. 32207t Utt :ENCTk ZONE `X' F. -IWN ON THE RODE !NSURM4CE RATE p+ 5-- OOOi RATE.: 4-17-89. cHoile P.0 POINT OF CURVATURE x1Ay ':1tAlS/R7Y RANEE P T. PONT Of ThNW CY I ,' S P.R.C. 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TORctn a' i ik Totackn iJ ii § 011 i 111 ' : IIHIP 'IILIISoKs I f 4 ff. , ff. ----- Tkertiox. _ i, ' -, i , ______> 3 i________, ')1 X " )( XX X ' v. . xxx X xX XXX + A cropeT UI14T Fence ACC22-0033 By Toni Gindlesperger at 10:27 am, Sep 01, 2022 By Mike Jones at 1:38 pm, Sep 02, 2022 50.00 By Mike Jones at 1:39 pm, Sep 02, 2022