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Permits 30 Ardella Rd (vault) y PSR-38x4 15896 DEPARTMENT OF BUILOINt CITY OF ATLANTIC BEACH PERRIT INFORMATION - ------ LOCATION INFOP14 TIO Permit N '` ex,, 15896 Address: 30 ARDELLA ROAD Permit ,Type, *REMODELING ATLANTIC BEACH . FLORIDA 32231- 1 "lav Wcrk,.RI 40DEL LEGAL DESdRIPTION w. . Constr o Type,WOOD FRAHE Black, Lot ".Cala, 0 Propose Use: Section: 0 Subd:0 ling: 01 13 a� n Subdi vi a i on,*DONNEN Est. Valu w 0100 Improv. Cost: 10 ,053.00 Total Fe 97 . 50 Amount :F � '� �P;?�:" 97 .50 Date P. 98 'fid RIM Wear D, �9':' � OWS AND 'VINYL SIDING Nk w . TION LaAPPLICATION FEES �.,.- w Ltl m g PERMIT " �. 4} ROAD fi x B i tORID �k �W d WA ORMT 10 Name. SOS EROME ` IOIUG`I' L NtI d b AC SONV� FL 322 .1C OS " 47" Ext" ^y��'. ; q} rr ,A ptxfip,'Z K 5 ow J-int a'�i``�� �1X!� k°Ni",€is'9 4� F Sah` 4 ro 'X',.,• ,:cun4wd.,,a ud*',vun.ma.x t`hM.r v.^'..aaa,�`d i pig} ".-m 4o NOTES. NOTICE-INSPECTIONS. MUST BE REOUESTED AT LEAST 24.HOUR$ PRIOR TO INSPECTION , BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT QE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.". ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REV FOR VIOLATION OF APPLICABLE PROVISIONS`OI=LAW. �« 1 1 Recei � 8A311?3f ATLANllrBEACH BUILD G DEPARTMENT „ ,::_ —______ CITY OF ATLANTIC BEACH PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS DEMOLITIONS Owner(s) : di A i Address : f7 ON r)14 --Phone: Lot # _ Block or Unit S Subdivision: fAT Contractor: Irl/ ll n Q 'i Address : �!�p (� Z Phone No: �Q3 -7�qL Describe work to be done: � �r'��, i 11JI4 Present use of building: G Valuation of Proposed Construction: A), Proposed use: ��// Is this an addition? Al C) es If. yes , what are the dimensions of the added space: ftX • ft • Will the added area � be heated and cooled? New electrical (or increase)? New plumbing fixtures? New fireplace? New Heat/AC? -- SUBMIT THREE COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY, ENERGY CODE FORMS, NOTICE OF COMMENCEMENT, AND OWNER/CONTRACTOR AFFIDAVIT, IF OWNER IS CONTRACTOR. Signature OWNER Y ate: Signature CONTRAC Date: ��3Cvy7��3 �Q a C I s� a � 17 as 19 !. Sol 8830 Pg 2000 To whotsm 11 amwv. ot►ncar+►:,, r4o V+mdwrt+�^� 1►•rob� accordoMe W, Q► Cp .XC Nc . • ►• .N7, 1rloYlorNuty �tw y� w�l madw tw cwrtwtw real ymw lotlow�� t^lor�494 + Prop.rty ♦wd w 1- �• awe a w.. NCT1u --------------- v - - ..........." 1----------- ---------- - '!�:..... . Y • _ ----.._...-- ....... --------------------------• •......_......._..._----•...._...... .. GwrarN tlOacrtpt �p+'•Y - •-`�•. _. ----- ----• • ----------- 4---Z--- C ............ ..... -•....... owtuu •------1 Y'i S%�.'u' _----=S��u >>� _-- A4"U e" .__j5 0 - fi b l _ .�.............................---- •- ---•... ..... -_ ._�! ----.--. .............. X71 ti� .... ......... - - - ---.... .�f�..._3 � z 33 �ar+W sfY•iw•A{ ........... ren SuuDle TWO bolder .................I..... V&M'e ----------------------------------------------------- ---------------- ......................................... ' C'.rmKm�+r - --------------- -------------- -- - •-------------................................................ ------------------- - •---... � T�-IEI�------------------J �--B'Q.OU .. r t+Jmyl .................. ........ ....... . � _ ._.• .. .i��mt of ary Wrww e^aju _ -Amount of bond ... .... .. • . . .. 'til Iww for the con+truct►on of Cho lmorovem•ntt. ' Ngo -------•----•--•------------------- - .................................... kw trrv.i: Scatw of t6t a, otbur thaw buw+�I mated by owty� "Pow whom notes _......... w other t,ta - ------ T,.................... .._. LA addmt►"A to buna*1 ., ownerd�ms+metww the following . Wv�wd mn Sectwo 7t�.(� owner Ib per to recuvo w 1. 1•rae;w St•wtww 11111 copT at in wt Owttw'. o NO&W.. v �.rWtMTw+�m-•-M{f.�.Cd HOAA .................•.----•_.....------«...._.. ---•--....•-----------•- »_-__----_•___••_...-- -- wA.0Yw90844,y ............................................ mcr-m 7r 1 c�cma ►rn •• •. i DATE:------------- PRE-SERVICE DIVISION JACKSONVILLE ELECTRIC AUTHORITY 233 WEST DUVAL STREET JACKSONVILLE, FLORIDA 32202 THE FOLLOWING FINAL INSPECTIONS) HAVE BEEN MADE AND ARE SATISFACTORY: --- ---------------- ------------------- ------ -------------------------------------------------- ------ -------------------------------------------------- ------ --------------------------------------------------. Enclosed are the blue copies of the permits. SIN LY, BUILDING INSPECTION DIVISION cc:FILE r r DATE: PRE-SERVICE DIVISION JACKSONVILLE ELECTRIC AUTHORITY 233 WEST DUVAL STREET JACKSONVILLE, FLORIDA 32202 THE FOLLOWING FINAL INSPECTIONS) HAVE BEEN MADE AND ARE SATISFACTORY: -------- ----------------------- ------------------------------- ---------------------------------- ------ ------------------------------------------------- i f ------- SINCERELY, r BUILDING INSPECTION DIVISION cc: FILE � r t r 10526 , DEPARTMENT OF BUI�.QING o ; r CITY OF ATLANTIC BEACH G � '" N '0RNAT ION - ----- LCGAT3 1 NFDMA' 4N Ems " R�tis POA R, ROOF, Address: ,.30 ARDILLA ROAD 1ok RL 'RATIt? i A'TLAPE' C BAOR VTlFLORIDA 2 2 3 kre�aaI. .».., ....,.«...,.,, * c! 4 Alt Lot * 0' 0810d Uss* SINOLZ FAl4ILY 8locls. Sectic�� l i ngs s Township:Ca y : pSuiei$120.00 on DONNRR a T pr*V' , ,Gosh: $0.00 $0 .00 $0. 00 Ti ON �Wla „�.� _ ADPL I CAT 0 DSSPERMIT es �.... A es Lei ROD AD WA's" T>I PACx $0"00 Aim PLOR .(?(} " » Air 0 ' " 0 ; ss �� � RA*1JDN � P .. ........,. ' 'QRtf 4L� .��,:.-.. QAs_W.R.S. $0.00 W e�* �R1�I N $0.00 A, y}}Yy`yRQ O } ANS' C I'I'I L ZR) Rt3VL t o iJt� ,Yw{0ash■ } +� ILtE, ISL 322.1 . CROSS CONNECTION Lazo 4 � �" 0 SRC H imp ACT Q 00 n CONST.SbfRd'HARGE s+"00 a ya a R ° .er$ v,a,xa Wk NOTES: Fs(FA ALL CONCRETEFORM'S AND FOOTINGS MUST BEINSP)rGTEt3BEFORE i�QURiNG PERMIT VOID SIX MONTHS AFTERDA"Z"E OF ISSUE ATERIAL,"RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN IIUBLIC SPACE,AND MUSTP AND I-�AULEC7AWA' BY EITHi�P CONTFiACI'OR OR OWNER BE E TCS Ct DL1AllTH THE ECHAN °S LEEN LAWOF3 ' R` ' C*NEA A N TWICE FORTHE, BUtLDINC iIV PR+13/ 11 LT IN ENTS', ISSUED ACCCQR©WG,TO APPROVED PLAIDS WHICH ARE PART OF THIS PERMIT AND.SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS cfi LAw AeTLA�: H I3UI�DING I?EPAR IMEN. .I�jr CITY OF ALANTIC BEACH ROOFING PERMIT APPLICATION owner(s) : C"u-Ri_ T,M 5,qu0Fg!S Address: TLAOIT Phone: 24'7• Lq-573 Lot # Bl ck or Unit # Subdivision: Contractor: Address : City, State and Zip /.,X Q'"'1(iPhone L� 2 •� � � � ��J 02 State License � �(„ Describe work to be performed: - Valuation of Proposed Construction:4/.2oo .00 Materials to be used: Signature of Owner; 1 Signature of Contractor: Liability Insurance Supplied Workers Compensation Insurance Supplied License Information 2�< a 84,4 1449f DEPARTMENT OF Bt1LD1NG CITY OF ATLANTIC BEACH' LSAT I ON I NP"CI�i,T I ON P� nilT '> er; 10496 Addre # I�RILLLA-ROAD Types: BUILDING ATLANTIC SACH, I�LCIRII�A�3223` iA s " " 10 rk, �y.y +��yy[yj PT (�y{ --------- I 3 ! r.s wF----WrW LZ ypL DESVRY�#'1F�1RN WwMWMMM.0+'�w.W c nffitr. Typo: WOOD P'R ZIP Lc�t:" w Y4i r�pr, rid I I�tCI;LE `, NI LY! l cask: S,6t i on R 1i 1' C i : RN(;: 0 " Eubct uii cin DONNER. REPLT E�cti etec ' V ► u+ 59465.0() Imprc�u. C05 B0,.00 I r Nark A RIMIODZL PER PLANS NamRim ON a anari c= ...«. �IPFLICA'P2�3N. FELLS �.._,. '' � � '' AdtOD � s" o.QU �" WATER IMPACT "FEE 0.00 P CH, P'LORID� 3, 33 S Imp4 ° PER $0.00 RADON OAS wH;R. ,� 1-F. ..�.. W INP`OR ON R#I4DDR G1�i Efl.4Q Name: +C?R IU ENS'P1tJ�ION COM ANY CAPITAL IMPROVE.ress Q .OI3 ld FL 32233 CROSS CONNECTION $o .00 L �� � CRC TYP�'� SE�C�{H IMPACT P * �.o0 r NQTES: NOTICE--ALL CONCRETE FORMS AND FOOTINGS MUST`BE INSPECTED-BEFORE POURING PERMIT VOID SIX MONTHS AI=TER,DATE OF ISSUE BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK,MUST f�Cr BE PLACED IN PUBLIC SPACE,AND MUST CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNEh BE "FAILURE'`TG Com''PLY KITH THE MECHANI 'S LIEN LAW CAN RESULT IN THE RROPER 'Y OWNER PAYING TWICE FOR THE:BUILDING Il�I�ROYI4IVIENTS" � ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE!PROVI5ILj1 IS:OF LAW. H1311ILf IN, IY3I=P T �k x OF ATLANTIC BEACH D PERMIT APPLICATIONYREMODEL, ADDITIONS OR ALTERABg IONiS and Zoning DEMOLITIONS Owner(s) : CµR��,Tul� Sn.inER� Address : 10 ARlDEL1..A- Phone:_ 2y7• B5'73 Lot # Block or Unit # Subdivision: r Contractor:_Cot We jus COKSTRuc7EnN State License # cg co 4 gq brl Address : 241 ATLAIJTic �IEp BcH 3226 °Phone No:__2141 • o6ag Describe work to be done: sEE , -,a.GN �p Present use of building:_ SGG.• FM1,1. Valuation of Proposed Construction: 4q4(05.00 Proposed use: SPME- Is this an addition? hfO If yes, what are the dimensions of the added space: ft . X ft . Will the added area be heated and cooled? New electrical ? (or increase) y,ES New plumbing fixtures? no New fireplace?too New Heat/AC?-Y±-5 SUBMIT THREE COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY, ENERGY CODE FORMS, NOTICE OF COMMENCEMENT, AND OWNER/CONTRACTOR AFFIDAVIT, IF OWNER IS CONTRACTOR. Signature OWNER: �G"�`'"� Date: Signature CONTRACTOR: ,---_;p, ������ Date: 7•-,IV •50- License Supplied: x4tek t° Liability Insurance: APL Worker's Compensation Insurance�� BID F CHRISTINE SANDERS (Home Owner) 3O ARDET.T.A STREET (Address) Material Specifications 1. ROOF: Tear off and replace deteriorated and missing wood and , metal components. Install 301 felt paper and 20yr shingles. 2. PLUMBING: Install metal P—trap drain to the kitchen sink. Install drain connection to bathtub. 3. ELECTRICAL: Repair faulty fixture and daficient wiring at the interior and exterior service. 4. BATHROOM: Tear out and install a 3/4 ' sub-floor and install new vinyl floor coverings. Install a new tub surround and seal tub with caulk. Repair the vanity door. 5. WINDOWS: Repair all broken panes and make all windows operational. Caulk all seams to be weathertight. 6. EXTERIOR SIDING: Replace all deteriorated and missing siding and trim with consistent materials. Prep and paint new-wood. 7. FRONT STEPS: Build new pressure treated wood steps. 8. EXTERIOR PAINT: Prep and paint exterior with two coats of low luster finish. Subtotals : Totals : (Date) BITS F CHRISTINE SANDERS (Home Owner) PAGE 2 (Address) Material Specifications 9. REAR ENTRY: Install a pre-hung steel door unit including hardware, threshold, and acrylic finish. Subtotals : Totals : (Date) Return to:(enclose self-atldressed stamped envelope) Name: NOTICE or COMMENCEMENT r$ 71s.13 RAMCO FORM .: Address: C3 °f a 4 This Instrument Prepared by: V Address: Property Appraisers Parcel Identification (Folio) Number(s): SPACE ABOVE THIS LINE FOR PROCESSING DATA SPACE ABOVE THIS LINE FOR RECORDING DATA Permit No. NOTICE OF COMMENCEMENT State of Florida County of.;UL I�p,(� 3 The undersigned hereby gives notice that improvements will be made to certain real property, I section 713.13 of the Florida Statutes, the following information is provided In this NOTICE OF COMMENCEMENT. With ' Legal description of property (Include Street Address, If available) h�E14Gti . FL06210A ! i I General description of improvementsoyAT�onl Owner C Address 3o A ELc.q AT L. 322-43 In roement Owner's nInterest eSimpleTit eholder (if other te of the nth nvowner) I Name Address Contractor C6McWUS (.1:0- &1 Co. i Address_ 241 AT rjNt-r1r tai_ .rp IkEP FL 3ZZ(0(0 Surety Address i Any person making a loan for the constructlon of the improvements: Amount of bond $ Name Address — Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name (f N RIS-T 'Sig, o� Address 3o ARnaLL-4 Q-r�g r, Ic f3cE, 1 EL 32235 In addition to himself, owner designates Of --- to receive a copy of the Lienor's Notice as provided to Section 713.13(1)(b), Florida Statutes. Expkation date of Notice of Commencement(the expiration date is 1 year from the date of recording unless a different date Is specified). (� Emm me this � 1st 1 Slpnaturo of owner — Primed Signature of Owner -- PATRICIA ANIONETTE i Prin1ed N° rr` 'STATE OF FLORIDA My Commission expires: �LIBLIC My CornrrI Exp$%)7/96, COMM wBR CC220011 DEPARTMENT OF BUILDING FOR ..OFFICE USE ONLY CITY OF A-'LANTIC BEACH, FLORIDA._ . . ' Date Permit „LFee 5 7 Application for Permit for Valuation 5 a Q-o Miscellarneous Alterations, HOUSE ._ and Relsairs (State if to repair, alter, add to or move building, ever-t a ntngs, Signsetc. ) Building on: Dot No. / �81k No. .eas D Sub. Valuation Owner 's 5_j � Nie y r f j BUILDINGS ANDCC Cy Building Use RP idential or Business What Plumbing work td be dQ� Size of Prescrit a1.dg. + `�' Size of Extension T o. of stories now 1 after alter d t Material oY= roof dot S ze _f Its Materia], of 'Present Buildin Material of Extencj on NECESS:AR.Y PLANS TO BE SUBMITTED HERE LIT' OIL` BiJRNER OR GASOLINE koux l.1t-NT Name af Oil Burner ar aaso].ine Pump. Name and Address of " -=-- -,TYPe of Model Ma tsu heturer I cera ect an here ithy applitation ig also made to instals: g1Zl. CaP&city tank(s) rtt a by 11 Of ge r.etal (Under Above grduncl.: (Name of Manufacturer) �C�i ,;i�?:► or Above) of buildingi. For aine 5f Pur;cbiger FURNISH DRAWING SHOWING ENTIRE LAYOUT ON REVERSE S.sDr, aF THIS BLANK SIGNS Size Cl.assificatien (State whether group , roof, wall, pro,}ec ng, a7- ) Material of Construction illuminated? Type of illumination a ewe er .dam —o r eon Will sign be over public property? SUBMIT DRAWING SHOWTI19G CONSTRUCTION OF SIGN Am, Mt m�r3C'�_P _ _ OF I'.?!1TGING WRITE ADDITIONAL INFORMATION BELOW (Fer canvas awnings provide dimensioned dr1.. 4. re ve Nice) t . r IMPORTANT NOTICE: In consideration of permit given for doing the wor}c a, described in the arhove statement, we hereby. agree to perform sa,d in accordance with the attached plans and specifications, c�h �.ch a e a part hereof:, and in•accordance with the building rer•ulation^, of the City of Atlantic Beach. (Southern Standard Building Code) . Signature of Bui der or Owner Y' Adres } C Phone No._ SIG,. (� s. i MORTGAGE NOTE Atlantic Beach,Florida For value received, the undersigned (jointly and severally, if more than one), promise to pay to the order of the City of Atlantic Beach, a municipal corporation, 800 Seminole Road, Atlantic Beach, Florida 32233, the principal sum of Nine Thousand Four Ii mdrwd Sixty-five and 00/100 Dollars (x,46 00)being payable in lawful money of the United States of America at 800 Seminole Road,Atlantic Beach,Florida 32233 or at such other address as the holder from time to time may specify by written notice to the maker. Said principal sum shall bear no interest and shall be reduced in amount at the rate of 1/10th per year until reduced to a zero balance at the end of 10 years. Any unforgiven balance shall become immediately due and payable if the maker transfers title to or moves from the premises securing this note within the 10 year period. In the event of the death of the maker of this note, this note shall remain in effect and the principal sum reduced at the above rate of 1/10th per year only if a member of the makers immediate family takes up residence in the subject home,under any other circumstances the note shall become immediately due and payable. This note is to be construed and enforced according to the laws of the State of Florida, and is secured by mortgage on real estate of even date herewith If default be made in the payment of any of said sums or in the performance of any agreements contained herein, then, at the option of the holder of the same, the principal sum then remaining unpaid shall immediately become due and collectible without notice, time being of the essence of this contract, and said principal sum shall bear interest at the highest rate allowed by applicable law,from such time until paid. Each maker and endorser waives presentment, protest, notice of protest and notice of dishonor and agrees to pay all costs, including a reasonable attorney's fee, whether suit be brought or not, if counsel shall after maturity of this note or default hereunder or under said mortgage, be employed to collect this note or to protect the security thereof cl�: (seal) Name of Maker (seal) Makers Address: 30 Ardella Road Atlantic Beach,FL 32233 STATE OF FLORIDA DOCUMENTARY STAMPS IN TBE AMOUNT OF S HAVE BEEN AFFIXED TO TBE MORTGAGE SECURING THIS NOTE AND CANCELLED. ._.J PRE-CONSTRUCTION CONFERENCE REPORT READ CAREFULLY BEFORE SIGNING I (WE) THE UNDERSIGNED HAVE ON THIS DATE AT PARTICIPATED IN A PRE-CONSTRUCTION CONFERENCE PRIOR TO THE SIGNING OF A CONTRACT FOR THE REHABILITATION OF MY (OUR) PROPERTY. ACKNOWLEDGE THAT WE UNDERSTAND THE TERMS OF THE CONTRACT, THE EXP WE b WORK TO BE PERFORMED BY THE CONTRACTOR, THE ROLE OF THELAVATION OF THE CONTRACT ADMINISTRATOR OF THE REHABILITATION LOAN PROGRAM, AND OUR RESPONSIBILITIES DURING THE CONSTRUCT- ION UR QUESTIONS PHASE. I (WE) HAVE BEEN GIVEN AN ADEQUATE EXPLANATION TO 0 F I ANY, AND ARE AWARE THAT ASSISTANCE WILL BE PROVIDED , F BY THE STAFF OF THE REHABIL- ITATION LOAN PROGRAM IF REQUESTED. WE FURTHER UNDERSTAND AND ACKNOWLEDGE THAT THE REHABILITATION LOAN PROGRAM ASSUMES NO RESPONSIBILITIES FOR THE WORK PERFORMED AND DOES NOT WARRANT ANY WORK PERFORMED. gnature o roperty wner ��--s`--t9�t S to gnature of P rope rty ner tate I, THE UNDERSIGNED, HEREBY CERTIFY THAT THE PRE-CONSTRUCTION CONFERENCE WAS HELD ON THIS DATE BETWEEN THE HOMEOWNER(S) , REHABILITATION LOAN PROGRAM CONTRACT ADMIN- ISTRATOR AND MYSELF. I UNDERSTAND THE PROCEDURES TO BE ,FOLLOWED FOR CHANGE ORDERS AND REQUESTS FOR PAYMENT. I UNDERSTAND AND AGREE THAT THE WORK PERFORMED MUST MEET THE STANDARDS OF PERFORMANCE REQUIRED BY THE REHABILITATION LOAN PROGRAM AND ESTABLISHED BY THE REHAB STANDARD PERFORMANCE MANUAL. 9 u t�.ontrac •r �'/�'9-� - I, THE UNDERSIGNED, HEREBY CERTIFY THAT I PARTICIPATED IN A CON- FERENCE THIS DATE AND THAT I HAVE COMPLIED WITH PRE-CONSTRUCTION ALL OF THE PROVISIONS OF THE REHABILITATION LOAN PROGRAM PROCEDURAL MEMORANDUM #49. �� . . �JlJ 14: 3o PAGE . 004 PROCEED ORDER A DATE: TO: � y�P!/ 5 �7� �/ ✓gun 7�.r,.� ' 422/4 This is to authorize you to proceed with work specified in our contract dated for improvement work on the property L� /� � p ert P y located atcA�l� 3733 ilitation Agreement The amount specified in the Rehab- is � $ �__ , Please proceed in accordance with the Contract. You are to commence work no. later than All work shall be completed according to the Work Write-•U ' p, plans, Change Orders, Addenda and Specifications within Sixty (60) calendar days after start- ing construction. N (s) of _• � ��25 (Uwner's Signature) (Owner sSignature) .ADDRESS: (Local P licr Agency presentative) Copy; REHABILITATION LOAN PROGRAM RESPONSIBILITIES OF HOMEOWNER AFTER CONTRACT IS SIGNED Until Work Be ins Start planning ahead. -...- ge tools, equipment and Plan adequate store get into materials. Make arrangements Spacefor r the contractor' Your Property if you will not be home duringthe contractor t. To avoid mutual confusion the day. the spokesman to discuss , one member of the family should be delegated a; If all household members work questions that may come up. consider designating °T will not be home during tive not living g an agent such as a g the construction, g with you to the close friend or neighbor or responsible to make sure the Contractor does the contractor's zela- he would do in your contract. work. You are work exactly as he stated Prepare Your Property Period to send and furnishings for the rehabilitation There will end your drapes to the dry cleaners in s and probably be dust androm - wash - use this g clothes - put all breakable and valuablethe items your curtains. be broken to misplaced. - Protect your furnish- ings away so they won 't When the Work Be ins Keep your copy of the work description with your Case Manager if P n hand Remember there Y and refer to it often. You are responsible for is anything you do Check work correctly as bid. ensuring not understand. work must be acceptable to Assistance will g that the contractor does the you. be Provided if required but the .Try to stay out of the construction area help prevent injuries and allow the workmen ro ecially children; this will om to work. 11 Try to keep a good relationship again, delegate someone to be the spokesman your family Y and the contractor - spokesman for the family. Stop problems before they start - if feel it should, or if somethin once and the way you You don t understand it g -isn't going too far. get an acceptable explanation or speak to the contractor at stop the wo k andIf calltractor cannot give youan correction before it progresses the Case Manager acceptable explanation, for assistance.Expect the unexpected and exciting to - in most cases changes and improvements and a ms i You and will give you much will be new a Chan y be uncovered duringPleasure; however change to the contract. Bethe course of the work which� ma unforeseen changes with the contractor prepared if this should ha y require required and why, Tr and get a good explanation Peen discuss flexible. All Chan es to .visualize what the change will of the change Case Manager and must be in the c n tract must be a look like. pproved b Be Y you and your Your contractor is responsible for cannot be present,tions a sure that he tells youo Supervision his workers. If a problem or he to talk to if you have Win cooperation from the waterpPreciation - unexpecteti ,. with good basic human ,-0, ,�2 __ CONTRACTOR'S AFFIDAVIT STATE OF FLORIDA COUNTY OF DUVAL SS BEFORE ME, the undersigned Notary Public, Personally appeared me, eposes an says : who, being first duly sworn—ST That on as owner, an ' 19"""—' as contractor, entere n • a certain cons ruc on contract w re y sa contractor agreed to provide certain labor and materials for said owner upon the following described lands belonging to said owner, located in the City of County of and State of Florida, to-wit: E That deponent is the of said corporation, herein referred to as the contractor, an of said contract. as persona y supervised the performance That said contract, has been fully and completely performed, and said contractor and all persons , firms and corporations contracting or dealing with , or directly employed by said contractor in connection with said building operation or in connection with said contract, have been paid in full. This affidavit is made in compliance with the provisions of the Uniform Mechanic's Lien Law as approved June 4, 1935, as revised, Laws of Florida , and to enable said contractor to receive his full and final payment from the owner, under the construction contract above referred to. ------------ Subscribed and cW^N., +,. v-;ONTRACTOR PAYMENT REQUEST Homeowner: Address: Payment #1 - 40$ Complete #Z - 80$ Complete . #3 - 100* Complete Contractor: Amount Requested: $ ----------------------------------- ------------------------ . ------------------- Contractor: I hereby request an inspection to receive payment # for the amount of $ I certify that I have b satisfactorily completed the necessa work to this request and that all bilis incurred for labor Bused and materials furnished in making im- provements have been paid in full o this date. and Attached is a description of the work completed and amount of payment requested by work item. the Contractor's Signature: —_Date: --------------------------------------------------------- Homeowner: I/We hereby agree that the work stated by the - has been completed and approve contrapayment to the contractor in accordance with the contract and contingent upon in- spection and concurrence by the Rehabilitation Inspector. It is understood that the actual amount disbursed will be based on the findings of that inspection. Owner's Signature: • Owner' s Signature: Date: Date: -------------------------------------------------------- Rehabilitation Inspector: - I hereby certify that I exercised reasonable care to determine that the work performed at the above address meets specifications and was completed in a satisfactory manner: however, neither the undersigned nor Jacksonville HUD is in any wqy responsible for the acts or omissions of the contractor, any subcontractor contractor's' agents or employees °r any of the other performing work under the construction any.agreement. person The contractor has provided a release of all liens, if any, in connection with this contract and has provided the proper- tY owner with a copy of each warranty property owner from the contractor fr° Performed. uarantee due the performed, I hereby certify that all work is completed as indicated on the contractor s payment request and recommend to to the contractor in the amount of $ P yment Rehab Specialist: Date: ------------------------------------------- -------------------- At 1.00$ completion: . . CHANGE ORDER No. Date of Contract Owner Name; Date Property Address.. Contractor Name; Contractor Address: Description of Work Change; No. AMOUNTS CATEGORY: + _ SUM Changes and work affected hereby, are subject to all contract stipulations covenants. This Change Order'is made a part of the contract dated first above Parties have hereunto set their signatures: and $ Contract Price + or - $ Change $ Total Owner Approval: Date: Contractor Approval: Date: Sr. Rehab Specialist Approval: Date: Program -Ad Approval: Date: Source of Funds: $ Contingency $ $ Owner Contract Copy: Owner, Contractor' -Loan file, Technical file Financial. Institution (If contract price changed) RLP-155 Rev. 12/6 HOMEOWNER - CONTRACTOR ACRFF. Fr7T Property Improvements To: --- YC� (/C�_ /�, ?1�� ------- i ---_----_ (Address)\ Owner (s) . �31r ----S=�t �� ------------ (Name) --- --------------------------------------------------- (Legal Description) 1. HOLD HARMLESS. Contractor shall agree to defend, indemnify, and hold harmless the Owner, City of Atlantic Beach, Florida from liability and claim for damages because of bodily injury, death, property damage, sickness, disease of loss and expense arising from Contractor s performance under this agreement to install or construct home improvements to be paid out of the proceeds of the Owner's rehabilitation loan. Contractor is acting in the capacity of an independent Contractor with respect to the Owner. 2 . LIEN WAIVERS. Contractor agrees to protect, defend and indemnify, Owner from any claims for unpaid work, labor or materials with respect to Contractor' s performance. Final payment shall not be due until the Contractor has delivered to the Owner complete release of all liens for work completed arising out of Contractor's performance, or a receipt in full covering all labor and materials for which a lien could be filed or a bond satisfactory to the Owner indemnifying him against any lien. 3 . SCOPE OF WORK. Contractor acknowledges that he has prepared the Contractor' s Proposal (Part II of this Agreement) and that such proposal is accurate and consistent as to the name of the Contractor will undertake, and the price. Contractor acknowledges the performance requirements established in the General Specifications of the Rehabilitation Standard Performance Manual effective June 1, 1982 and warrants that all work undertaken will conform to said specifications. 4 . CONTRACT AMOUNT AND PAYMENT SCHEDULE. The City of Atlantic Beach shall pay the Contractor for the performance of the rehabilitation work, subject to additions and deductions by approved Change Order, the contract sum of ---------------- ------ ---- ---- cs , --- Pay �_�% scheduled as follows, subject to the Owner' s) acceptace nts lll work to be done: of the Upon completion of 40% of the work, a progress payment of 30% will be made. Upon completion of 80% of the work, an additional payment of 30% of the contract price will be made. Upon completion of .100% of the work, the remaining funds will be disbursed. 5. TIME OF COMMENCEMENT AND COMPLETION. Owner shall provide written authorization to Contractor to commence work. Contractor agrees to start work ten (10) calenda.z days after the receipt of the written Notice to Proceed. If the Contractor fails to commence work within ten (10) days of the Owner's notification to commence, Owner shall have the right to terminate this Agreement. Such notice of termination shall be in writing. executed Change Order. No extra costs will be paid to the Contractor when he has neglected to properly evaluate_ the extent of the rehabilitation work. Under no circumstances will the contingency fund, if any, be authorized for work other than circumstances arising after the commencement of the workally unforeseen 7. TERMINATION OF AGREEMENT. If the Contractor defaults or neglects to carry out the work as specified under the paragraph "Scope of Work" or fails to perform any provision of the Contractor documents, the Owner may, after fifteen (15) calendar days written notice, terminate this contract and , select a substitute Contractor. If the expenses of finishing the work exceeds the unpaid balance on this contract, the Contractor shall pay the difference to the Owner. If the Owner fails to perform any applicable provisions of the Contract, the Contractor may, after fifteen (15) calendar days, terminate the contract and recover from the Owner payment for all work satisfactorily completed including reasonable profit and damages . 8. WARRANTY. For good and valuable consideration, the Contractor hereby agrees to provide a full one-year warranty to the Owner, which shall extend to subsequent Owners of the property to be rehabilitated. The warranty shall extend to subsequent Owners of the property to be rehabilitated. The warranty shall provide that improvements, hardware and fixtures of whatever kind or nature installed or constructed on said property by the Contractor are of good workmanship or materials or deicienciestysubject retofrthedewarranty contained in this paragraph. Contractor and Owner agree, however, that the warranty set forth in this paragraph shall apply only to such deficiencies and defects as to which the Owner or subsequent Owners shall have given written notice to the Contractor, at its principal place of business, within one (1) year from the date of Contractor's final payment . The Contractor further warrants that failure b the Contractor to respond to valid complaints by the Owner, or subsequent Owners, that causes additional damages to the property are also subject to the warranty contained in this paragraph. 9. ARBITRATION. If a dispute arises as to the validity of a complaint not satisfied under the warranty clause of this contract, a panel of three (3) independent professionals shall be chosen by the Beach to arbitrate the dispute. City of Atlantic The panelists shall be ' chosen on a rotating basis. The finding of the panel shall be irrevocably final, conclusive, and binding on the Homeowner and the Contractor. 10 . SUB-CONTRACTORS. Contractor agrees that all warranties contained herein shall apply to all work performed under the Contract, including that performed by any sub-contractor. 11 . ACKNOWLEDGMENT. The above warranties are in addition to, and not in limitation of, any and all other rights and remedies to which the Owner, or subsequent Owners, may be entitled, at law or in equity, and shall survive the conveyance of title, delivery of possession of the property, or other final settlements make by the Owner and shall be binding on the undersigned notwithstanding any provision to the contrary contained in any instrument heretofore or hereafter executed by the Owner. 12 . INTEREST OF CERTAIN FEDERAL OFFICIALS. No member of or delegate to the Congress of the United States, and no Resident Commissioner, shall be admitted to any share or part of this Agreement or to any benefit to arise. from the same. 12b.BONUS, COMMISSION,OR FEE. The Borrower will not pay any bonus, commission, or fee for the purpose of obtaining the Government' s approval of his application for this loan, or any other approval or concurrence required by the Government nr ii-a _,.i._L_ , . . . . Homeowner-Contractor Agreement cont'd or ' employee of the Public Body who exercises such functions or responsibilities, shall have any interest, direct or indirect, in the proceeds of this loan, or in any contract entered into by the Borrower for the performance of work financed in whole or in part with the proceeds of this loan. 12d. INTEREST OF OTHER LOCAL PUBLIC OFFICIALS. No member of the govern- ing body of the locality in which the property to be rehabilitated is situated, and no other public official of the locality who exer-1, cises any 'functions or responsibilities in connection with the administration of the loan shall have any interest, direct or indi- rect, in the proceeds of this loan, or in any contract entered into by the Borrower for the performance of work financed in whole or in part with the proceeds of this loan. 13. CIVIL RIGHTS. The Grantee agrees to abide by the spirit and intent of the Civil Rights Act of 1964, as amended, and the Civil Rights Act of 1968, as amended, and the anti-discrimination provisions of Chapter 120 of the City Ordinance Code, in that its operation under this contract is free of discrimination against its employees, persons, or groups of persons on the basis or race, color, sex or national origin. 14. EQUAL EMPLOYMENT OPPORTUNITY. The Grantee agrees to abide by the Equal Employment Opportunity Clause for Contracts subject to Execu- tive Order Number. 11246, as described in Attachment 1, attached hereto and made a part thereof. 15. LEAD BASE PAINT HAZARD ACT. The Grantee agrees that no lead based paints or substances containing lead shall be used in any part of this project. Treatment necessary to eliminate immediate hazards shall, as a minimum, consist of the following: a. All surface conditions identified as immediate hazards shall be thoroughly cleaned (washed, sanded, scraped, wire brushed or otherwise cleaned) so as to remove all cracking; scaling, peeling, chipping and loose paint on applicable surfaces. Such surfaces that have been so treated shall then be repainted with two (2) coats of a suitable non-leaded paint. b. Where the paint film integrity of the applicable surface cannot be maintained, the paint shall be completely removed or the surface covered with a suitable material such as gypsum wall board, Plywood or plaster, before any repainting is . undertaken. C...0�2�vEfaUS �N�'T�2vcrio,J �o• `�i�.�.S�,�.�, Name of Contractor Name(s) of Owners) �Si re Contractor Date Sig ature of Owner Date ATTACHMENT 1 EQUAL EMPLOYMENT OPPORTUNITY = USE FOR CONTRACTS SUBJECT TO EXECUTIVE ORDER 11246 During the performance of this contract, the contractor agrees as follows: 1 . The contractor will not discriminate against any employee oer applicant for employment because of race, color, religion, sex, or nation- al origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to the following: employ- ment, upgrading, demotion, or transfer; recruitment or recruitment adver- tising; layoff, or termination; rates of pay or other forms of compensa- tion; and selection for training, including apprenticeship. The contrac- tor agrees to post in conspicuous places, available to* employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. 2. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all quali- fied applicants will receive consideration for employment without regard to race, color, religion, sex or national origin. 3. The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency con- tracting officer, advising the labor union or workers ' representative of the contractor's commitments under Section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The contractor will comply with all provisions of Executive Order No. 11246 of September 24, 1965, and of the rules, regulations, and rele- vant orders of the Secretary of Labor. ATTACHMENT 1 Page -2- 6 . In the event of the contractor' s noncompYiance with the nondis- crimination clauses of this contract or with any of such rules, regula- tions, or orders, this contract may be cancelled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order No. 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order No. 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. 7. The contractor will include the provisions of Paragraph ( 1 ) through ( 7) in every sub-contract or purchase order unless exempted by rules, regulations, or orders of the Secretary of labor issued pursuant to Section 204 of Executive Order No. 11246 of September 24, 1965, so that such provisions will be binding upon each sub-contractor or vendor. The contractor will take such action with respect to any sub-contract or Purchase order as the contracting agency may direct as a means of enforc- ing such provisions including sanctions for noncompliance; provided, however, that in the event the contractor becomes involved in, or is threatened with, litigation with a sub-contractor or vendor as a result of such direction by the contracting agency, the contractor may request the United States to enter into such litigation to protect the interests of the United States. The offerer' s or bidder' s attention is called to the "Equal opportu- nity Clause" and the "Standard Federal Equal' Employment Opportunity Con- struction Contract Specifications" set forth herein. The goals and timetables for minority and female participation, ex- pressed in percentage terms for the contractor's aggregate work force in each trade on all construction work in the covered area, are as follows: I . The goals for minority participation are 21.8% for each trade. 2. The goals for female nartirinn+;__ ___ _ •/3 BID FORM CHRISTINE SANDERS Gop'NEI.105 Gov. CO . (Home Owner) (Coptractor or Bidder) 30 ARDELLA STREET 241 A&CLA NTtC (Address) (Address )) 1:1EP• SC 14.) 241' 06 (8 (Phone) Material Specifications Material Labor 1. ROOF: Tear off and replace deteriorated and missing wood and metal components. Install 30# felt paper and 20yr shingles. 2. PLUMBING: Install metal P-trap drain to the kitchen sink. Install �j� . Oct J CIDDO drain connection to bathtub. 3. ELECTRICAL: Repair faulty fixture and deficient wiring at the interior '180 . 00 and exterior service. 4. BATHROOM: Tear out and install a 3/4 ' subfloor and install new vinyl 165,00 floor coverings. Install a new tub surround and seal tub with caulk. Repair the vanity door. 5. WINDOWS: Repair all broken panes and make all windows operational. $ JJo .00 0 0 Caulk all seams to be weathertight. a a 6. EXTERIOR SIDING: Replace all deteriorated and missing siding and trim with consistent materials. Prep 520 0 O and paint new wood. 7. FRONT STEPS: Build new pressure treated wood steps. JP 2-00. 00 8. EXTERIOR PAINT: Prep and paint exterior with two coats of low 4J Q _0U luster finish. (p 00, Subtotals : $ q ,2qO , 00 $ Totals : $ (Date) Con ac or or Bidder Signature) BID FORM CHRISTINE SANDERS (Home Owner) LIOS CpugT,� PAGE 2 (Cpntractor or Bidder) (Addressri Arns is Swo. (Address ) IAPL, 3??3774.4,E�. f3cN• , Zy 1 • aG48 (Phone) Material Specifications Material 9. REAR ENTRY: Install a pre-hung Labor steel door unit including hardware, threshold, and acrylic finish. Z 0 .00 0 Subtotals : $ a50. 00 Totals : $ (Date) -- Con r or or Bid der Signature) � yl�� SID FO - ---- --------R-----M ALEXANDER CERTIFIED BUILDwSALFE, INC. 101 CENTURY 21 OTRACTOR JACKSONVILLE,F SUITE 211 LILLIE MCQUEEN L 32216 (Home Owner) (Contractor or Bidder) 50 ARDELLA STREET (Address) (Address ) (Phone) [Material Specifications Material Labor I. OOF: Tear off and replace all iorated wood and metal compone isll 30# felt and 20 yr shingles ECTRICAL: Troubleshoot and r illegal and faulty wiring anres. Install refrigerator circuit and bathroom receptacle. Replace exterior electrical service including meter box, line, and weatherhead. 3. SIDING: Replace all deteriorated exterior wood siding, trim and ceilings with consistent materials. ^? 4. EXTERIOR FINISH: Prep and paint completely. Prime all bare and new �r �� s wood finish with two coats low luster paint. 5. ENTRY DOORS: Install pre-hung Y t� steel door units including hardware threshold, and acrylic finish at front of unit #1 and rear of #2. 6. KITCHEN: Install new pre-finishe O base cabinet with stainless steel (�" ,3 v sink, plumbing and fixtures. 7. INSULATION: Insulate attic to R-19 with blown in fiberglass. J J Subtotals : Totals : v v� $- e Fid (Date) - {ContractororBidderSignature ) NOTICE TO THE OWNER AND ALL PERSONS INTERESTED IN THE ATTACHED PROPERTY This property, to wit: ,rf%� located at: f is improperly stored and is in violation of the Ordinance Code of the City of Atlantic Beach, Florida; Chapt0lrticle 11, Division 1, Section 21-24 (a) and must be removed within otherwise it shall be presumed to be abandoned property and may be removed and destroyed by order of the City of Atlantic Beach. If the property is a motor vehicle, the owner will be liable for the costs of removal and destruction. Dated: Signed: Code 1&forcement Officer City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233 (904) 247-5826 VEHICLE TOWING,AND/OR NOTICE OF IMPOUNDMENTF5. H.YEAR; 2.MAKE a MODEL 4.C.E.C.# REPORT ; ATLANTIC BEACH CODE ENFORCEMENT LOR s.TAG NUMBER STATE YEAR 800 Seminole Road• 247-5800 1&WAS VEHICLE IMPOUNDED? 7.VEHICLE IDENTIFICATION NUMBER YES ❑NO THE OWNER HAS BEEN NOTIFIED OF THIS ACTION &OWNER'S NAME(LAST,FIRST,MIDDLE) YES ❑NO NOTIFICATION BY PLACARD &OWNER'S ADDRESS CITY STATE or ❑NOTIFICATION BY PLACARD AND U.S.MAIL 10.DAY,DATE,TIME OF OCCURENCE 17.ARTICLES TAKEN FROM VEHICLE(MUST BE PLACED IN PROPERTY ROOM) 1, �1 LOCATIONXEHICLE REMOVED FROM NUMBER i 18.INVENTORY AND CONDITION OF VEHICLE 12.NAME OF WRECKER FIRM YES NO YES NO 13.ADDRESS VEHICLE REMOVED TO RADIO STRAIGHT WIRED 'L` 14.REASON VEHICLE TOWED TAPE DECK ] KEYS IN LOCK TAPES( ) a DOORS LOCKED C.B.RADIO TRUNK LOCKED SPARE TIRE VEHICLE DAMAGE 15.RELEASE OF VEHICLE TOOLS AREA OF DAMAGE ]NA BATTERY ❑1 HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REOUESr MY VEHICLE BE RELEASED: OTHER ITEMS ❑1 HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REQUEST A HEARING. ❑1 HAVE NOT PAID CHARGES BUT REQUEST A HEARING AND UNDERSTAND THAT MY 19.THE OF THIS CORRECT VEHICLE WILL Nor BE RELEASED UNTIL THE CONCLUSION OF HEARING., DRIVER SIGNATURE LZ AUTHORIZATION TO RELEASE VEHICLE 20.HEARING DATE TIME: Date: Code Enforcement Officer HEARING OFFICER FINDINGS: i SIGNATURE OF HEARING OFFICER 21, IMPORTANT NOTICE TO OWNER•IMPOUNDED VEHICLES 4 A. You are hereby noti d that the above described vehicle is being impounded pursuant to Atlantic Beach City Ordinance E Number 't Towing and storage charges will be assessed against,your vehicle.You may elect to: 1. Pay tow y s orage charges to the towing company; 2. Request a hearing as to the propriety of the impoundment and as to the owner's liability for charges; 3. Pay the towing company and storage charges and then request a hearing as stated in #2. B. Failure by the owner to request a hearing within five(5)days after receipt of this notice may act as a waiver of his right to a hearing and may result in the placing of a lien against the motor vehicle for the towing and storage charges without a further notice to the owner. C. It will be necessary for the owner to obtain a vehicle release at the Atlantic Beach Code Enforcement Office before the vehicle can be claimed. Proof of ownership and payment of charges to the towing company must be presented at the time of the release. 22.OFFICER'S NAME 23.I.D.NUMBER 24.SUPERVISOR LD NUMBER COPIES: White-Atlantic Beach Code Enforcement Department Canary-Release Copy Wrecker Company Pink-Owner Copy VEHICLE TOWING AND/OR NOTICE OF IMPOUNDMENT1.VEH.YEAR 2.MAKE 3.MODEL a.c.E.c.a REPORT "i ATLANTIC BEACH CODE ENFORCEMENT 5.COLOR 6.TAG NUMBER STATE YEAR 800 Seminole Road • 247-5800 ,,� 16.WAS VEHICLE IMPOUNDED? 7.VEHICLE IDENTIFICATION NUMBER YES ❑NO THE OWNER HAS BEEN NOTIFIED OF THIS ACTION 8.OWNER'S NAME(LAST,FIRST,MIDDLE) ❑YES ❑NO NOTIFICATION BY PLACARD 9.OWNER'S ADDRESS CITY STATE EI NOTIFICATION BY PLACARD AND U.S.MAIL 10.DAY,DATE,TIME OF OCCURENCE 17.ARTICLES TAKEN FROM VEHICLE(MUST BE PLACED IN PROPERTY ROOM) CI .LOCATION VEHICLE REMOVED FROM ZIA 01-1 A/r J hetf NUMBER 18,INVENTORY AND CONDITION OF VEHICLE 12.NAME OF WRECKER FIRM .s YES NO YES NO 13.ADDRESS VEHICLE REMOVED TO RADIO STRAIGHT WIRED 65^ 14,REASON VEHICLE TOWED TAPE DECK KEYS IN LOCK TAPES( ) X DOORS LOCKED Y C.B.RADIO TRUNK LOCKED SPARE TIRE VEHICLE DAMAGE TOOLS Y AREA OF DAMAGE ❑NA 15.RELEASE OF VEHICLE BATTERY /` El HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REQUEST MY VEHICLE BE RELEASED. OTHER ITEMS 111 HAVE PAID ALL CHARGES TO 1 //�J f~' G. ❑I HAVE NOT PAID CHARGES BUl ( y( }, � .5'3c;4��--' MY 19.THE I OF THIS CORRECT VEHICLE WILL NOT BE RELEASE l/ DRIVER SIGNATURE ------- `"" 77 -- - AUTHORI; 20.HEARING DATE TIME: - Code Enforcement Officer HEARING OFFICER FINDINGS: SIGNATURE OF HEARING OFFICER 21. IMPORTANT NOTICE TO OWNER- IMPOUNDED VEHICLES A. You are a eby notifiPad that the above described vehicle is being impounded pursuant to Atlantic Beach City Ordinance Numb e . Towing and storage charges will be assessed against your vehicle. You may elect to: 1. Pay towing an4 storage charges to the towing company; 2. Request a hearing as to the propriety of the impoundment and as to the owner's liability for charges; 3. Pay the towing company and storage charges and then request a hearing as stated in #2. B. Failure by the owner to request a hearing within five(5)days after receipt of this notice may act as a waiver of his right to a hearing and may result in the placing of a lien against the motor vehicle for the towing and storage charges without a further notice to the owner. C. It will be necessary for the owner to obtain a vehicle release at the Atlantic Beach Code Enforcement Office before the vehicle can be claimed. Proof of ownership and payment of charges to the towing company must be presented at the time of the release. 22.OFFICER'S NAME 23.I.D.NUMBER 24.SUPERVISOR I.D.NUMBER COPIES: White-Atlantic Beach Code Enforcement Department Canary-Release Copy-Wrecker Company Pink-Owner Copy