Permit 751 Sailfish Dr (vault) 71
FAX MEMOIANDUM
City of Atlantic Beach - 800 Seminole Road - Atlantic Beach, Florida 32233-5445
http://www/ci.atlanti c-beach.fl.us
TO: Jacqueline B. Dukes FAX: 630-4626
Community Development Division PHONE: 630-7030
Planning and Development Department
FROM: Sonya B. Doerr, AICP FAX: 247-5877
Community Development Director PHONE: 247-5817
E-MAIL: sdoerr*ci.atlantic-beach.fl.us
DATE: September 22, 2003
REGARDING: 751 Sailfish Drive
Jacque, here is correspondence and a copy of the check remitted to the COJ related
to the repayment of rehab funds after Mrs. Spillers passed away.
I intend to have a payment request to you by I he end of the week for our remaining
rehab house. I will coordinate with Builders C ire today.
Number of pages includi ig cover page:
CITY OFATIANTIC BEACH
800 SEMINOLE ROAD
ATLkNTIC BEACH,FLORIDA 32233-5445
TELEPHONE:(904)247-5800
FAX:(904)247-5805
SUNCOM:852-5800
http://ci.atlantic-beach.fl.us
November 05, 2002
Jacqueline B. Dukes
Community Development Division
Planning and Development Department
Florida Theatre Building, Suite 600
Jacksonville, Florida 32202
Re: Repayment of Mortgage Note from sale proceeds of 751 Sailfish Drive
Dear Jacque':
The City of Atlantic Beach recently received a return of FY 2000-2001 Housing Rehabilitation
funds that were used to renovate Mrs. Edna Spillers home located at 751 Sailfish Drive. As you
recall,Mrs. Spillers passed away while renovation wo�-k was underway, and the house was gifted
to her sister,Mrs.Lena Ikner. Mrs.Ikner recently sold the home,and in accordance with the grant
agreement, which had been signed by Mrs. Spillers, repaid the 90% balance of funds used to
renovate the house back to the City of Atlantic Beach
The City requests that these funds be"re-programmed' to the City of Atlantic Beach to be used for
housing rehabilitation projects during the current grant year. For your information,the Fiscal Year
2000-2001 original project numbers for these funds were: Project#: 1055 $16,052.61
Project #: 1229 $15,137.40
Total $31,190.01
Recipient qualified for 1/10 of grant receipt based up(n year residency. -$3,119.01
Amount reimbursable to granting agency $28,071.00
Please advise as to any administrative procedures or amendments to our contract as may be
required. As always, thanks so much for your continued assistance.
Sincerely,
-Sonya B. oe AICP
Community Development Director
cc: Jeri Benjamin, Deputy Finance Director
FILE Copy
1-44+� cn
do U)
ot ,,;
33
m 0
m
00
5i.
5w -av�
Z-M-—41
41,0-
e5
LM
'aJ Wu-
U)
c:
P m
40�
%% 0 c)
Z.,
c;2a '0
(D L�—
r1s)
R) m
CL
Ul
Cl
P
z
lk
z
CD
CD
LO
00
CrrY OF ATLANTIC BEACH
800 SENUNOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
-5800
TELEPHONE:(904)247
FAX:(904)247-5805
SUNCOM:852-5800
http://ci.atlantic-beach.fl.us
September 11, 2002 FILE Copy
Lena 1kner
432 South 1 Oth Street
Jacksonville Beach, Florida 32250
Re: Repayment of Mortgage Note for CDBG fun led rehabilitation to 751 Sailfish Drive
Dear Ms. lkner:
As of this date, the outstanding amount due on t Mortgage Note signed by Ms. Spillers is
$28,071.00. The original amount spent last year to renovate the home was $31,190.01, and that
amount has been reduced by ten percent in accordal�ce with the terms of the agreement. If you
recall, the CDBG program is set up so that after ten i 10) years, a homeowner will not be required
to repay the funds used to make the repairs, provid d that they continue to live in the house for
that period of time. Each year the amount of the Mortgage Note is reduced by ten percent, so
that at the end of ten years, there is no obligation on the part of the homeowner to repay funds.
However, if the home is sold or rented during this ten-year period of time, any outstanding
balance must be returned to the grant program.
Also, as we discussed earlier, in the case that the .iome were sold to another person, and that
person met the income and other eligibility require,nents of the CDBG program, and agreed to
sign a Mortgage Note, (with a lien recorded) accepting the obligation to repay any outstanding
balance under the same terms, then the funds would not have to be repaid. If the new owner is
not qualified, or does not wish to participate in the rogram, the outstanding balance must be re-
paid to the City of Atlantic Beach for return to the Community Development Block Grant
program. Please feel free to call me at 247-5 8 t 7 wil h any questions.
Sincerely,
Sonya B. Doe� CP
Community Development Director
HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier
Sep 22 2003 10:26am
Last Fax
D=.. L= i= Identification Duration- PaLyes . Result
Sep 22 10:24am Sent 96304626 2:18 4 OK
Result:
OK.- black and white fax
MEMORANDUM
City of Atlantic Beach - 800 Seminole Road � Atlantic Beach, Florida 32233-5445
http://www/ci.atlant c-beach.fl.us
TO: Alan Jensen
City Attorney
FROM: Sonya B. Doerr, AICP
Community Development Director
DATE: Friday, February 08, 2002
REGARDING: Lien information for 2000-2001 CDBG Housing Rehabilitation recipients
Alan, enclosed are legals for the fi've CDBG rehab houses. Late this week, I located some
additional information that had been misfiled; below is a summary of this additional information.
The mortgage notes were signed, but never recorded. I would like to first attempt getting the
property owners to sign the new documents Sandy is preparing, with the revised amounts as
indicated below. If I cannot get their cooperation, can we record the ones signed last March?
1. Carolyn P. Blake Property Location: 464 h ex Road
Original Contract Amount: $15,893.00
Total CDBG funds expei ded per change orders: $28,530.51
Signed Mortgage Note ai aount: $15,893.00 (Signed 03/07/01)
Current Income verificat'on in file: No
2. Anna Rivera Property Location: 78 Fo estal Circle, South
Original Contract Amour 1: $21,3 12.00
Total CDBG funds exper ded per change orders: $31,093.50
Signed Mortgage Note aniount: $21,312.00 (Signed 03/07/01)
Current income verificatim in file: Yes
3. Carol Wriaht Property Location: 41 Ar lella Road
Original Contract Amourt: $5,237.00
Total CDBG funds expended per change orders: $8,747.00
Signed Mortgage Note ariount: $5,237.00 (Signed 03/07/01)
Current income verification in file: Yes
4. Neomi Rouse Property Location: 860 Amberjack Lane
Original Contract Amoimt: $15,161.00
Total CDBG funds expended per change orders: $15,160.80
Signed Mortgage Note -mount: $15,161.00 (Signed 03/07/01)
Current income verifica�,ion in file: Yes
5. Edna Spillers, Property Location: 751 3ailfish Drive
Original Contract Amoi nt: $7,313.00
Total CDBG funds expc nded per change orders: $31,190.01
Signed Mortgage Note �mount: $7,313.00 (Signed 03/07/01)
Current income verifica ion in file: No
(Ms. Spillers died June .1, 2001 while renovation was underway.
Estate settled June 28, 2)01. Estate probated to sister, Lena 1kner.)
VED BYr RECORD RETURN TO:
C. JENSEN, ESQUIRE Book a078 Pg 1099
Box 50457
knonville Beach, FL 32240-0457
C
B
0
Rk: a078
a 1099 - 1100
QM-CLAW D ED 90C# 95077737
Filed I Recorded
04/23/95
99 12:21tst P.M.
Made this Plq day of April, 199 between HWY V. en
WIELLzARD LEE IXNER aid LENA PRACOCX I R, his wife, MEN CIWJIT CUT
Grantors, whose address is: 432 South 1 th Avenue, WA MIMIR
Jacksonville Beach, FL 32250, and EDNA L. SPILLERS, KC- S10.50
Grantee, whose address is: 751 Sailfish Drive, K0 6 0.70
Atlantic Beach,. FL 32233 , Social Security No. : 118-24-4931.
WITNESSETM - ---that ' Gka' ntors, for ani in consideration of the
sum of TEN AND N01100 DOLLARS ($10. 00) , and other good and valuable
consideration, in hand paid by Grantee, the receipt whereof is
hereby acknowledged, have remised, released and quit-claimed, and
by these presents do remiss release and quit-claim unto Grantee,
and her heirs, successors and assigns forever, the following
described land, situate, lying and being in the County -of Duval,
State of Florida, to-wit:
Lot 17, Block 6, Royal Palms, Unit 1,
according to plat thereof 'recorded in Plat
Book 30, pages 60 and 60A, of the current
public records of Duval County, Florida.
75-1
SUBJECT to covenants, restrictions and easements of record and to
any ad valorem property taxes for the current year.
TITLE NEITHER EXAMINED NOR INSURED
PARCEL IDENTIFICATION NO. : 171235 0000
co
W
P-
IN THE CIRCUIT COURT FOR DUVAL COUNT V,
c-n
FLORIDA PROBATE'DIV ISION co
IN RE: ESTATE OF
EDNA T. SPILLERS File No.: 01 0 13 3 0
Division:
Deceased.
M
LETTERS OF ADMINI STRATION
(single personal representative)
717
TO ALL WHOM IT MAY CONCERN
WHEREAS, EDNA T. SPILLERS, a resident ( f Duval County, Fr&fda, died7on J��e I
2001, owning assets in the State of Florida, and
WHEREAS, LENA H�NER has been appointed personal representative of the estate of the
decedent and has performed all acts prerequisite to issuance of Letters of Administration in the
estate,
NOW, THEREFORE, I, the undersigned circuit judge, declare LENA U(NER duly
qualified under the laws of the State 'of Florida to act personal representative of the estate of
EDNA T. SPILLERS, deceased, with full power to adrr inister the estate according to law; to ask,
demand, sue for, recover and receive the property of the decedent; to pay the debts of the decedent
as far as the assets of the estate will permit and the I directs; and to.make distribution of the
estate according to law.
ORDERED on June 28, 200 1.
CIRCUIT,JUDGE
Pitytessefil: That the grantor, for and in consiAeration of de sum ot zo ThN 11JU/ LVV-1-
valuable considerations# receipt whereof is hereby acknowledged, hrreby grants, bargains, sells, oliens, remises,
releases, conveys and confirms unto the grantee, all that certain land situate in Duval
County, Florida, viz: !�
EACH VILLA, Unit No. 1, according r
Lot 4, Block 12, ATLANTIC B
to plat thereof recorded in Plat Book 30, Page 56, of the
=C! E
Current Public Records of Duval Count) , Florida. 1
cc 5.
SUBJECT TO covenants, restrictions, easements of record and
C1.1
taxes for the current year. It'l
Subject to that certain mortgage to SlEARSON LEHMAN MORTGAGE
y 27 , 1987 , recorded March 3, 1987,
CORPORATION, dated Februar corded in
in 0,fficial Records Volume 6288, Page 1.235, as re-re public
Official Records Volume 6300, Page 1098, of the current
records of Duval County, Florida, in the original principal
amount of $44 , 440 . 00, which sum SCOTT R. STEWART and ANA C.
STEWART, his wife, expressly assume and agree to pay, and also
assume and agree to pay all the oblightions of JOHN W. LEWIS and
CYNTHIA A. LEWIS, his wife, under the terms of said mortgage and
the Veterans Administration guarantee .
Zoget4er with all the tenements, hereditaments and at purtenances thereto belonging or in anywise
appertaining.
til "llyi1b, the same in fee simple fori vet. N
wfully seized of said land in fee
&0titb the grantor hereby covenants with said grantee that e grantor is la
simple;that the grantor has good tight and lawful authority to sell at d convey said land;that the grantor hereby fully
watrants the title to said land and will defend the same against tile lawful claims of all persons whomsoever;and that
said land is free of all encumbrances, except taxes accruing subsequent to December 1 31, 19 88
cljn Pitnges 04cred, the said grantor has signed and sealed these presents the day and year first
above written.
Signed, sealed and delivered in out presence:
�RN LEW
Aab--m
C T Ll N�
Y T4HIA A. LEWIS
J STATE OF= FLORID-,
-Jl-- DOCUMENTARY,,eg,-- 'AMP TAXI
C�l
Ft—PT:6—F *hf-V—EN6T-
00
DEC 13,88
STATE OF
Florida 11029
COUNTY OF MINIM. 7.- 1- L-f- ann[Arer
lo,
ltz�
Duval County Property Appraiser-Parcel Summary Page I of 2
JParcei Summary-Values from the 2001 Certified Tax:R:o�1]1
IRE No.: 770000
Owner's Name: PAYNE , SARAH WASHINGTON
ESTATE
�'Property 41 ARDELLA RD Unit No.
Address: — I
1ATLANTIC BEACH 3 233
IMailing Addr [C-10 CAROL A WRIGHT
1ATLANTIC BEACH , FL 3 233-4305
JProperty Use77F1292 RES/COMM ZONING
'Legal 17-2S-29E PT GOVT LOT 3 RECD O/R 2464-599
deseription:
jNeighborh��[129241 1292'S MAYPORT Isec-Twn-Range: IF17--2S-29E
--;T ---]F55-6,T2
JOR BK& Pag . 1 4-0599 11map Panel,
ISale Date: 717/7/1965 [No. Buildings: III
-- ]F-
ISale Price: $300.00 jF910
ILand Value: 1$5,750.00 lHeated Area:
$0 Exterior Wall: JFCONCRETE
Flass Value: .00 IBLOCK
Improvements: $30400.00 Taxing us 3
IlAuthority:
Market Value: 1$36,150.00 [county Tax:
jAssessed Valu 473.00 ISchool Tax: IF$28.77
lExempt V 000.00 FDistrict Tax: JF$10.53
73.00 10ther Tax: JF$1.73
�Taxable Value.
Isr.Exemp �so.00 IVoted Tax: $2-12
jjSr. Taxable: 75-0,00 ITotal Tax: JF$67.65
This page displays values from the 2001 Certified!,Tax Roll with weekly updates of
RE PARCEL ID#:171145-0000
BUYER!STIN:
WARFANI Y DEED
THIS WARRANTY DEED made this 3rd day of May, 995 by MATTIE LEE FREEMAN, A MARRIED WOMAN9
hereinafter called Grantor, and whose address is 12334 MASTIN cbVE ROAD, JACKSONVILLE, FLORIDA 3222S to
NEOMI L. ROUSE, UNMARRIED, hereinafter called Grantee and whose address is 860 AMBERJACK LANE,ATLANTIC
BEACH,Florida 32233.
(Wherever used herein the term "grantor" and *grantA' include all the parties to this instrument and the
heirs, legal representatives and assigns of individuals and the successors and assigns of corporations.)
WITNEMETH:
THAT the Grantor, for and in consideration of ti e sum of Ten and N01100 Dollars and other valuable
considerations, receipt whereof is hereby acknowledged, heri by grants, bargains, sells? aliens, remises, releases, conveys
and confirms unto the Grantee, all that certain land si uate, lying and being m DUVAL County, Florida, viz:
Lot 5, Block 3, ROYAL.PALMS, UNIT ONE, according to plat thereof recorded In Plat book 30,pages
60 and 60A of the current public records of Duval Couv ty,Florida.
The real propertj described in this instrument Is not the constitutional homestead nor the primary
physical residenceof the Grantor.
0-1 El("' cop
IL
0
4�Q.a
0
v*1
7-A A,
kc)
-0
t.CY
eo.C".
RECEA - --
FEB 2 1998
City of Atlantic Beach
Building and Zoning
NOT VALID UNLESS EMBOSSED WTH SEAL OF 7HE UNDERSIGNED. BEARINGS BASED ON LINE AS SHOW,
THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE AS SCALED FROM FLOOD
INSURANCE RA7E MAP 0001 FOR FLORIDA, DA7ED 1-1 -P)Q
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE: (904)247-5800
FAX:(904)247-5805
SUNCOM:852-5800
http://ci.atlantic-beach.fl.us
r
STATE OF FLORIDA
COUNTY OF DUVAL
CITY OF ATLANTIC BEACH
I, Maureen King, the undersigned Cite Clerk for the City of
Atlantic Beach, Duval County, Florida,
DO HEREBY certify that the Community Development Block Grant
Mortgage Note was paid and there are no unpaid liens, special
assessments or water/sewer bills due the City of Atlantic Beach
against:
RE#171235-0000
Royal Palms Unit 1, Lot 17 Block 6
As Recorded in OR Book 10048, Page 2194, Duval County Public
Records.
IN WITNESS WHEREOF I have hereunto set my hand and affixed the
official seal of the City of Atlantic Beach, Duval County,
Florida, at the City Hall this 16th day of October 2002 .
//,ya,6,��-Z 5�'/'
(SEAL) -MAVreen King'-�17
City Clerk
Your Reference Response: 751 Sailfish Drive
J. Howard Sheffield/733-7900
CffY OF ATLANMC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE:(904)247-5800
FAX:(904)247-5805
SUNCOM:852-5800
http://ci.atlantic-beach.fl.us
September 11, 2002
Lena lkner
432 South 10th Street
Jacksonville Beach, Florida 32250
Re: Repayment of Mortgage Note for CDBG fu+d rehabilitation to 751 Sailfish Drive
Dear Ms. lkner:
As of this date, the outstanding amount due on thd Mortgage Note signed by Ms. Spillers is
$28,071.00. The original amount spent last year to jenovate the home was $31,190.01, and that
amount has been reduced by ten percent in accordan-,e with the terms of the agreement. If you
recall, the CDBG program is set up so that after ten(10) years, a homeowner will not be required
to repay the funds used to make the repairs, provide I that they continue to live in the house for
that period of time. Each year the amount of the Mortgage Note is reduced by ten percent, so
that at the end of ten years, there is no obligation or the part of the homeowner to repay funds.
However, if the home is sold or rented during this ten-year period of time, any outstanding
balance must be returned to the grant program.
Also, as we discussed earlier, in the case that the home were sold to another person, and that
person met the income and other eligibility requirements of the CDBG program, and agreed to
sign a Mortgage Note, (with a lien recorded) accepting the obligation to repay any outstanding
balance under the same terms, then the funds would not have to be repaid. If the new owner is
not qualified, or does not wish to participate in the program, the outstanding balance must be re-
paid to the City of Atlantic Beach for return to the Community Development Block Grant
program. Please feel free to call me at 247-5817 wiffl any questions.
Sincerely,
6';
Sonya A`XDoe� CP
Community Development Director
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE: (904)247-5800
FAX: (904)247-5877
SUNCOM: 852-5800
http://ci.atlantic-beach.fl.us
January 14, 2002
Lena lkner
751 Sailfish Drive
Atlantic Beach, Florida 32233
Re: Verification of income for 2001 CDBG grant ri cipients—Edna Spillers 751 Sailfish
Dear Ms. 1kner:
The City of Atlantic Beach is in the process of wr pping up our files for houses that were
renovated as part of last year's Community Developm.-nt Block Grant (CDBG) project. Federal
auditing regulations require that we have proof of ineome eligibility for all recipients of grant
Rmds. In reviewing our files, we have discovered tha-. Ms. Spillers income information has not
been kept as required or has been mis-filed. Please bear in mind that her eligibility to have
received grant ftirids for renovation of your residence is not in question. This was determined
prior to work being done on the house.
In order comply with these audit requirements, plea e provide a copy of Ms. Spillers' Tax
Return for the year 2000, or some other document that verifies her income. If you wish to come
by City Hall, I will be glad to make �copy of this for you, or you may return a copy to me in the
envelop provided. I appreciate your help, and please feel free to call me at 247-5817 with any
questions.
Sincerely,
Sonya B. Doerr
Community Development Director
PR&CONSTRUCTION CONFERENCE REPORT
READ CAREFULLY BEHORE SIGNING
MVE)THE UNDERSIGNED HAVE ON THIS DATE PARTICIPATED IN A PRE-CONSTRUCTION
CONFERENCE WITH THE CONTRACTOR PRIOR TC THE SIGNING OF A CONTRACT FOR THE
REHABRITATION OF MY (OUR) PROPERTY. WE A XNOWLEDGE THAT WE UNDERSTAND
THE TERMS OF THE CONTRACT,THE EXPLANATION OF THE WORK TO BE PERFORMED BY
THE CONTRACTOR,THE ROLE OF THE CONTRAC--ADMINISTRATOR OF THE
REHABILJTATION LOAN PROGRAM, AND OUR RRS PONSIBILJTIES DURING THE
CONSTRUCYTION PHASE. I (WE) HAVE BEEN GIVE AN ADEQUATE EXPLANATION TO OUR
QUESTIONS, IF ANY, AND ARE AWARETTIAT ASSR TANCE WILL BE PROVIDED BY THE
STAFF OF THE REHABRITATION LOAN PROGRAM IF REQUESTED. WE FURTHER
UNDERSTAND AND ACKNOWLEDGE THAT THE R U-IABIIITATION LOAN PROGRAM
A_,S:S,U ES NO RESPONSIBILJTIES FOR THE WORK FERFORMED.
rty�(�
rignZtureofPro rtyOwncr Property adress
ire Da"tc-
1,THE UNDERSIGNED, HEREBY CERTIFY THAT THP PRECONSTRUC-nON CONFERENCE
WAS HEID ON THE ABOVE DATE BETWEEN THE I IOMEOWNER(S), REHABILJTATION LOAN
PROGRAM CONTRACT ADMINISTRATOR AND MYS FJT. I UNDERSTAND THE PROCEDURES
TO BE FOLLOWED FOR CHANGE ORDERS AND REQUESTS FOR PAYMENT. I UNDERSTAND
AND AGREE THAT THE WORK PERFORMED MUST EET THE STANDARDS OF
PERFORMANCE REQUIRED BY THE REHABILITATION LOAN PROGRAM AND ESTABIJSHED
BYTHE TANDARD PERFORMANCE MANUAL
/ /1" 67:31z-cl
�,Sign �reof C�qc�tor Tide Date
1, THE UNDERSIGNED, HEREBY CERTIFY THAT I RTICIPATED IN A PRE-CONSTRUC7nON
CONFERENCE THIS DATE AND THAT I HAVE COMPHED WITH ALL OF THE PROVISIONS OF
THE REHABILITATION LOAN PROGRAM PROCEDURAL MEMORANDUM #49.
Sigriature,,8f R�hab Spe&hst D�
CONTRACTOR PAYME�T REQUE
Homeowner:-----------------—--—----—---------- Paym-nt #1-33%Complete.........
Address:--------------................... ... Payment #2-33%Complete-----------
Atlantic Beach,Florida 32233 Payment#3-100%Complete------
Contractor: ---------------------------------------- Amount Requested$.................
Contractor: I hereby request an inspection to receive payment# for the amount of$
certO that I have satisfactorily completed the necessary work to justify this requt st and that all bills
ftffl to this date. incurred for labor used and materiaJs furnished in making s uid repairs and improvements have been paid in
Attached is a description of the work completed and the am(Y mt of payment requested by work item.
Contractoes Signature:---------------------------------------- Date:
Homeowner: I/We hereby agree that the work stated by die contractor has b�en completed and approve payment to the contractor'in
accordance with the contract and contingent upon inspection and concurrence by die Rehabilitation Inspector. It is understood that the actual
amount disbursed will be based on die findings of that inspection.
Owner's Signature------------------------------------------ Date:
Rehabilitation Inspector:
I hereby certify that I exercised reasonable care to deternime that the wo rk performed at the above address meets
specifications and was completed in a satisfactory manner however,neither the uir lersigned nor Jacksonville HUD is in any way responsible for the
acts or ornissions of the contractor,any subcontractor,or any of the contractor's�gents or employees,or any other person performing work under
the construction agreement. The contractor has provided a release of all liens,if a ny,in connection with this contract and has provided the property
owner with a copy of each warranty or guarantee due the property owner from the contractor for work performed.
Rehab Inspector: -------------------------------------------- Date:
Approved. Forward to Finance Department for payment this date.
------ -------------—------- Date
-�a
Loan Program
iiirec or,
CONTRACTOR'S AFFIDAVIT
STATE OF FLORIDA
SS
COUNTY OF DUVAL
BEFORE ME, the undersigned Notary Public, perso y appeared
who, beii ig fust duly sworn By me, deposes and says:
That on -, 19--,
as owner, and
as contractor, entered into a certain construction contract whet cby said contractor agreed to provide certain labor
and materials for said owner upon the following described Ian(s belonging to said owner, located in the City of
County of and State of
Florida, to-wit:
That deponent is the of said corporation, herein referred to
as die contractor, and has personally supervised the perfon-nar cc of said contract.
That said contract, has been fully and completely perlormed, and said contractor and all persons, firms
and corporations contracting or dealing with, or directly empl ed by said contractor in connection with said
building operation or in connection with said contract, have be en paid in Hl.
This affidavit is made in compliance with die provisior s of the Uniform Mechanic's Uen Law as
approved June 4, 1935, as revised, I-aws of Florida, and to e le said contractor to receive his full and final
payment from the owner, under the construction contract above referred to.
Subscribed and sworn to before me this
day of 119---.
Notary Public, State of Florida at I-,arge,
My conunission expires:
8
CHANGE ORIPE
No.
Date of Contract
0,Amer
Property Address:
Contracor Name:
Contractor Address: 'hone Number—__
DescriRtion of Work Change: AMOUrf r. CATEGORY:
(Please Type)
UM
Changes and work allected hereby,are subject to all contract stipulations arid covena rits. This Change Order is made a part of the contract dated first
above,parties have hereunto set their signatures.
Contract Price
+or- $ Change
$ Total
Owner Approva1:-___________ Date:
Contractor Approval: Date:
Rehab Specialist Approval: Date:
Program Administrator Approval:-___ Date:
Source of Funds: $
Contingency Owner 4�ontract
Copy,Owner,Contractor,Loan file,Technical file,Financial Institution(If contract price changed)
Categories of changes:
I. ffidden damages
2.Time extension
3.Deletions of non-required items or unusual allowances
4. Required items that were missed on initial inspection
5.Equal substitution of material or alternative cure for deficiency at same or lesser price
6.Totally unforeseen circumstances arising after commencement of work
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE:(904)247-5800
FAX: (904)247-5805
SUNCOM:852-5800
http://ci.atlantic-beach.n.us
May 10, 2002
Lena lkner
432 South 10th Street
Jacksonville Beach, Florida 32250
Re: Mortgage Note for CDBG funded rehabilitati)n to 751 Sailfish Drive
Dear Ms. lkner:
Enclosed is a copy of the Mortgage Note signed by Ms. Spillers acknowledging the terms that
applied to the use of Community Development Bloci Grant (CDBG) funds to make repairs and
improvements to her home. The original amount that was to be spent on the home was
$7,313.00. After the first work began, several change orders were approved, and the final
amount of CDBG funds spent to renovate the house was $31,190.01. It is my understanding that
Ms. Spiller's passed away before the work was co leted, and before the Mortgage Note was
amended to reflect the total amount of money spent or,her home.
It is the intent of the CDBG housing rehabilitation )rogram to provide financial assistance to
homeowners who plan to live in their home for an tended period of time. The program is set
up so that after ten (10) years, a homeowner will not tie required to repay the flinds used to make
the repairs, provided that they continue to live in the I ouse for that period of time. Each year the
amount of the Mortgage Note is reduced by ten percer t, so that at the end of ten years, there is no
obligation on the part of the homeowner to repay fund .
If the home is sold or rented at any time during those ten years, however, any remaining balance
must be paid back to the City so that those funds can be returned to the CDBG program. If the
home were sold to another person, and that person met the income and other eligibility
requirements of the CDBG program, and agreed to sign a Mortgage Note, (with a lien recorded)
accepting the obligation to repay any outstanding balince, then the fimds would not have to be
repaid.
If it is your intent to sell or rent the house at 751 Sailfish Drive, please call me to discuss this
further, and also,please feel free to call me at 247-5817 with any questions.
Sincerely,
Sonya B. Doerr, AICP
Community Development Director
HOMEOWNER-CONTRAcrOR AGREEMENT
Property Improvements To (Address): 751 Sailfish Drive
Owner (s) Name (s): Edna Spillers
Legal Description:
I . HOLD HARMLESS: Contractor shall agree to defend, indemnify, and hold hani-dess 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'!, performance under this agreement to install or
construct home improvements to be paid out of ffie 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 fuH covering all labor and material i for which a lien could be filed or a bond satisfactory
to the Owner indeninifying him against any lien.
3 . SCOPE OF WORK Contractor acknowledges that he prepared the Contractor's Proposal(Part 11 of this
Agreement) and that such proposal is accurate and consistent a;to the name of die Contractor will undertake,and the
price. Contractor acknowledges the perforniance requirements established in the General Specifications of the
Rehabilitation Standard Performance Manual effective June 1, 1982 and wan-ants that afl 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 ($7,313.00 payments will be schc duled as follows., subject to the City and the Owner's
acceptance of the work done:
Upon completion of 33%of the work, a progress p ent of 33%wrill be made.
Upon completion of 33%more of the work, an additi imal payment of 33%of the
contract price wiH be made.
Upon completion of 100%of die work, the remaining funds will be disbursed.
I of 6
5 . TIME OF COMMENCEMENT AND COMPLETION: Owner shall provide written authorization to
Contractor to commence work. Contractor agrees to start wort,ten(10)calendar days after the receipt of the written
Notice to Proceed. If the Contractor fails to commence wo within ten (10) days of the Owner's notification to
commence, Owner shall have the right to tenninale this Agreement. Such notice of termination shall be in writing.
1he Contractor agrees to complete the work within sixty (6�)) calendar days after the commencement of work
pursuant to the date of the Notice to Proceed. If completion is elayed for reasons beyond Contractor's control,die
Contractor shall provide timely notice to die Owner of the reasons for such delay. It shall be the Contractor's
obligation to substantiate its claim by adequate documentation.
6. CHANGE ORDERS: Except in an emergency end I ng life or property no changes in the work shall
be made by the Contractor unless he has received a prior writ kn order signed by the Owner and Authorized by
Community Development Director of the City of Atlantic Be;uch. The contract sum and the contract time may
be changed only by a properly executed Change Order. No extra costs will be paid to the Contractor when he
has neglected to properly evaluate the extent of the rehabilitai ion work. Under no circumstances will the
contingency fund, if any, be authorized for work other than to Ally unforeseen circumstances wising after the
commencement of the work.
7. TERMINATION OF AGREEMENT: If the Contracto,-defaults or neglects to carry out the work as specified
under the Par-agmph "Scope of Work" or fails to perform an) provision of the Contractor documents, die Owner
may,after fifteen (15)calendar days written notice,tenninate d ds contract and, select a substitute Contractor. If the
expenses of finishing the work exceeds the unpaid balance on Cis contract,the Contractor shall pay the difference to
the Owner. If the Owner fails to perfonn 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. 1
8. WARRANTY: For good and valuable consideration, th-. Contractor hereby agrees to provide a full one-
year warranty to the Owner,which shall extend to subsequent.Owners of the property to be rehabilitate(L The
warranty shall extend to subsequent Owners of the property t c) be rehabilitated.The warranty shall provide that
improvements, hardware and fixtures of whatever kind or n installed or constructed on said property by die
Contractor are of good quality, and free from defects in workr rianship or materials or deficiencies subject to the
wan-ant contained in d-ris paragraph. Contractor and Owner agree, however, dig 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 pla,-e of business,within one (1) year from die date of
Contractor's final payment. The Contractor further wan-ants C rat failure by the Contractor to respond to valid
complaints by the Owner, or subsequent Owners,that causes additional damages to the property are also subject
to die warranty contained in this paragraph.
2 of 6
9. ARBITRATION: If a dispute arises as to the validity Of,L complaint not satisfied under the warranty clause
of this contract, a panel of three (3) independent professionals shall be chosen by die City of Atlantic Beach to
arbitrate the dispute. 'Me panelists shall be chosen on a ro basis. The finding of the panel shall be
irrevocably final, conclusive, and binding on the Homeowner md 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 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 tide, delivery of possession of e property, or other final settlements make by the
Owner and shall be binding on the undersigned notwithstandii 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 Corurnissioner, shall be ad mtted 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, conunission, 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 or its designee to complete the rehabilitation work financed in whole
or in part with this loan.
12c. INTEREST OF PUBLIC BODY PERSONNEL: No member of the governing body of the Public
Body who exercises any functions or responsibilities in connection with the administration of the loan and no
other officer 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 die
performance of work financed in whole or in part with the pro--eeds of this loan.
12d. INTEREST OF OTHER LOCAL PUBLIC OFFICIALS: No member of the governing
body of the locality in which the property to be rehabilitated is situated, and no other public
official of the locality who exercises any functions or responsib lities in connection with the
adirrinistration of the loan shall have any interest, direct or ind�rect, in the proceeds of this loan,or
in any contract entered into by the Borrower for the performa rice of work financed in whole or in
part with the proceeds of this loan.
3 of 6
13. CIVIL RIGHTS: The Grantee agrees to abide by the sp irit and intent of the Civil Rights Act
of 1964, as amended, and the Civil Rights Act of 1968, as aint nded, and the anti-discrintination
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 group; of persons on the basis or race,
color, sex or national origin.
14. EQUAL EMPLOYMENT OPPORTUNITY: The G7antee I agrees to abide by the Equal
Employment Opportunity a part thereof.
15. LEAD BASE PAINT HAZARD ACT: Tire Grantee �grees that no lead based patints or
substances containing lead shall be used in any part of dris p .ect. Treatment necessary to
eliminate immediate hazards shall, as a minimum, consist of f re following-
a. All surface conditions identified as immediate hazards shall be thoroughly cleaned
(w&shed), sanded, scraped,wire brushed or otherwise cle ed) so as to remove all cracking, scaling, peeling,
chipping and loose paint on applicable surfaces. Such sufaces 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 sud ace cannot be maintained, the paint shall be
completely removed or the surface covered with a suitabld material such as gypsum wall board, plywood or
plaster, before any repainting is undertaken.
Sunstate Enclosures, Inc. __Edn i Spill rs
Name of Contract�o�r Name (s) of Owner (s)
Signature of Contractor Date Signature of
V,;!�,e &-�,d, . r
Tide (if officer of Corporation) Signature of Owner Date
-5-1
177 MlXle 141149 A) 7 ;1 Sailfish Drive
Address of Contractor Addressof Owner (s)
01/1
- :����__�_- - ;4�7�
WitnesseAy Date' Witness(41)y loo� Date
4 of 6
ATTACHMENT I
EQUAL EMPLOYMENT OPPORTUNITY CLAUSE
FOR CONTRACTS SUBJECT TO EXECUTIVE
ORDER 11246
During the performance of this contract, the contractor agre(s as follows:
1. The contractor will not discriminate against any employee or applicant for employment because of race,
color, religion, sex, or national origin. The contractor wifl ake af[irmative action to ensure that applicants are
employed, and that employees are treated during employme without regard to their race,color,reWon, sex,or
me
national origin. Such action shall include,but not be limited to the following-employment,upgrading,demotion,or
transfer;recruitment or recruitment advertising;layoff,or tern tination;rates of pay or other forms of compensation;
and selection for training,including apprenticeship. The contractor agrees to post in conspicuous places,available
to employees and applicants for employment, notices to he )rovided by the contracting officer setting forth the
provisions of this nondiscrimination clause.
2. 'Me contractor will, in all solicitations or advertis�e nts for employees placed by or on behalf of the
contractor, state that all qualified applicants will receive consi ieration for employment without regard to race,
color, religion, sex or national origin.
3. The contractor wiH send to each labor union or re sentative of workers with which he has a collective
bargaining agreement or other contract or understanding,a no tice,to be provided by the agency contracting officer,
advising the labor union or workers'representative of the cont.-actor'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. 'Me contractor wifl comply with aH provisions of Exe utive Order No. 11246 of September 24, 1965,
and of the rules, regulations, and relevant orders of the Secrc tary of Labor.
5. The contractor will fumish aH information and report,� required by Executive Order
No. 11246 of September 24, 1965, and by the rules, regulati )ns, and orders of the Secretary of
Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the
contracting agency and die Secretary of labor for purposes ef investigation to ascertain
compliance with such rules, regulations and orders.
5 of 6
AITACHMENT I
Page -2-
6.In the event of the contractor's noncompliance with the nondiscrimination clauses of this contractor with
any of such rules,regulations,or orders,this contract may be canceled,terminated or suspended in whole or in part'
and die contractor may be declared ineligible for further Government contracts in accordance with procedures
authorized in Executive Order No. 11246 of September 24, �965,and such other sanctions may be imposed and
remedies invoked as provided in Executive Order No. 1124 6 of September 24, 1965, or by rule, regulation, or
order of the Secretary of labor, or as otherwise provided by aw.
7. 'Me contractor will include the provisions of Paragra),h(1) through (7) in every sub-contract or purchase
order unless exempted by rules,regulations,or orders of the 'ecretary 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. 'Me contractor will take such action wifl i respect to any sub-contract or purchase order as the
contracting agency may direct as a means of enforcing such provisions including sanctions for noncompliance;
provided,however,that in the event the contractor becomes i Ived in,or is threatened with,litigation with a sub-
contractor or vendor as a result of such direction by the contr,Lcting agency,the contractor may request the United
States to enter into such litigation to protect the interests of the United States.
die "
8. 'Ile offerer's or bidder's attention is called to , al Opportunity Clause"and the "Standard Federal
Equal Employment Opportunity Construction Contract Specifications" set forth herein.
9. The goals and timetables for minority and female participation, expressed in percentage terms for the
contractor's aggregate work force in each trade on all constru don work in the covered area, are as follows:
1. The goals for minority participation are 21.8%for each trade.
2.The goals for female participation are 6.9%for each trade.
6 of 6
PROCEED OADER
DATE,
TO:---Sunstate Enclosures
This is to authorize you to proceed with work specified in our -ontract dated
for improvement work on the property located at
. 'I be amount specified
in the Rehabilitation Agreement is $ Ple tse proceed in accordance
with the Contract.
4
Y
You arc to commence work no later than
All work shall be completed according to the Work Write-Up plans, Change Orders, Addenda
and Specifications within Sixty (60) calendar days after starting onstruction.
wun
Name(s) bf Owner(s)
(Owner's Signature)
(Owner's Signature)
ADDRESS:
(Local PuMic Agjnc�Rep entative)
Copy:
City of Atlantic Bf�ach
CDBG Housing Rehak�ilitations
FY 2000/01 1
Recipient Address Amount
Spillers, E. 751 Sailfish Drive 1 $31,190.01
Rivera,A. 78 Forrestal Circle 1 31,093.50
Blake, C. 464 Irex Road 28,530.51
Rouse, N. 860 Ambedack Lan 15,160.80
Wright, C. 41 Ardella Road 8,747.00
$114,721.82
cdbgOl rehabs
Uln BY, RECORD & RETURN TO:
C. JENSEN, ESQUIRE
Book 8078 Pg 1099
Box 50457
ksonville Beach, FL 32240-0457
C
03 OW
a07a
1099 - 1100
()M-CLAIM DEED 9000 95077737
Filed A be, gd
MAW%
M Mi J2221:31 P.R.
ade this day of April, 191.19-1 , between HENRY V. COOK
HILLIARD LEE IXNER and LENA PEACOCX IXMR, his wife, MERK ClRWIT WRT
Grantors, whose address is: 432 South 1(th Avenue, WA MIMIFL
Jacksonville Beach, FL 32250, and EDNA L. SPILLERS, RM $ 10.30
Grantee, whose address is: 751 Sailfish Drive, KED $ 0.70
Atlantic Beach,. FL 32233, Social Security No. : 118-24-4931.
WXTNZSSZTK�.- --that ' Gkaintors, for and in consideration of the
sum of TEN AND N01100 DOLLARS ($10.00) , and other good and valuable
consideration, in hand paid by Grantee, the receipt whereof is
hereby acknowledged, have remised, released and quit-claimed, and
by these presents do remise release and quit-claim unto Grantee,
and her heirs, successors and assigns forever, the following
described land, situate, lying and beini� in the County -of Duval,
State of Florida, to-wit:
Lot 17, Block 6, Royal P' lms, Unit 1,
according to plat thereof reicorded in Plat
Book 30, pages 60 and 60A, lof the current
public records of *Duval Count)�, Florida.
SUBJECT to covenants, restrictions and easements of record and to
any ad valorem property taxes for the current year.
TITLE NEITHER EXAMINED NOR INSURED
PARCEL IDENTIFICATION NO. : 171235 0000
TO HAVE AND TO HOLD the same toget. er with all and singular
the appurtenances thereunto belonging ox in anywise appertaining,
and all the estate, right, title,- interest, lien, equity and claim
whatsoever of Grantors, either in law or equity, to the only proper
use, benefit and behoof of Grantee, her heirs, successors and
assigns forever.
—I
co
IN THE CIRCUIT COURT FOR DUVAL C�OUNT C)
E ] Cil
FLORIDA PRO13A DIV,1SION CID
W
IN RE: ESTATE OF -_J
File No.:
0 1 - 0 1330
EDNA T. SPILLERS
Division: :-1 '-7
Deceased.
M
LETTERS OF AD
MINIISTRATION
(single personal reprqentadve) .t7-:v�
TO ALL WHOM IT MAY CONCERN
r
WHEREAS, EDNA T. SPILLERS, a resident J�f Duval County, Frodda, died-on ARe 11,
2001, owning assets in the State of Florida, and
WHEREAS, LENA H<NER has been appointed personal representative of the estate of the
decedent and has performed all acts prerequisite to iss ance of Letters of Administration in the
estate,
NOW, THEREFORE, I, the undersigned cii"'Cuit judge, declare LENA MNER duly
qualified under the laws of the State of Florida to act �s personal representative of the estate of
EDNA T. SPILLERS, deceased, with full power to adrr1iruster the estate according to law; to ask,
demand, sue for, recover and receive the property of the decedent; to pay the debts of the decedent
as far as the assets of the estate will permit and the laiy� directs; and to.make distribution of the
estate according to law.
ORDERED on June 28, 2001.
CIRCUIT "GE
I E OF FLORIE A
DUVAL COUNTY
1.THE UNDERSI MED Clerk of the Circuit Court,Duval CauntV,
Florida, DO HEREI�Y CERTIFY the within and torega1mg is o true
and correct copy(f the original as it appears on record lnd file
in the office of tI e Clerk of Circuit of Duval County, FIbricle,
and the same is i i full force and effect.
WITNESS my h nd and seal of Cler o Circuit Court pt
Jacksonville, Flori a,this the;Z.2day , A,D.,2G�OL,
M FULLER
Clerk yr)
4 Circuit and, Go ty Courts
ty, .&d�
By
Deouty Clerk
CONTRACrOR P&IMM REQUEST
4 —Ificownar 4 Pal i i Wment #I-33%Coir.�
Address: Payment #2-S3%CoWPktC-2Y-2-?-O9r7
Atlantic Beach,Florida 32233 Payment#3-100%complete_
Conwactor
,r--f�CISZer
Amount Requested 2U4
Contractoll. I hereby request an inspection to receive payment# Ila Z forthemnountof$
cer*tht I have satidwto*completed the necessary work w.�n*dW rct pest and that all bills
incurred for labm used and materials fi� Merl in makin K said repairs and improvements have been paid in
fiA to this date.
Attached is a dwmiption.of completed and the am iount of paynxint requested by work item.
Contractoes Signatw= Date
Homeowner. I/We hereby agree that the work stated by the contractor ha i been completed and approve payment to the contractor in
'accordance with the contract and contingent upon inspection and concunence by the Rehabilitation Laspcctor It n understood that the actual
amount disbursed will be based an the findia ofthati On.
. Owner's signawre—,e�rj Date:
ReImbilitation Inspeaw.
I hereby an*that I eitercised reasonable care to determine that the,work performed at the abcw address me.;ts
specifications and was completed in a satisfictory manner however,neither the madersigned norjacksonville HUD is in any way responsible for the
acts or omissions of the contractor,any subcontractor,or any of the contractor s agents or employees,or any other person performing work under
the construction agreemenL The contractor has provided a release of all liens, f any,in connection with this contract and has provided the prop",
vw=with a copy of each wanwq or guarantee due the property owner fium i he contractor for work performed.
Rehab Inspector. Date:
..............
Approved. Forward to Finance Department for payment this date.
Date
Director,RehZ11"Itafion Loan Pr�griun
Lj r-,e
P A I D Date L) A*TL-- RECEIVED
Grc----.) !.� I APR 3 0
MAY 0 2 2001
Ari—C
CK# te VP DEPT
-Approvzl C-z;dl -3(5/0
Approval Date �-30 0
1 ! f OA Y 0
AP Ov U01
pr
VP
CoffA&-(;EOR PAYMENT REQUEST
116t 1�-e
— /t�, i Payment#1-38% ard el,
Add.. 7:!U :2g� /:f75 4 —1
payment #2-M%CoMpk*C-------�--
Adandc B=iL Flangia 3=
Payment#3-100%Complete-
Contrictor. "f 5,10 1-e �5,n Am,=t Requested
V
..................................................................................*................
CAX]traCtOr. I hereby request an inspection to receive pw.ment#-fbr die arnount of$ 7 7 0— 1 car*that I
have=bgfikCtO*
completed the necessary work to jus*this n quest and that all bills mmmed for Ia1w iised and nt"s finnished nim
aid repairs and improvements have been paid in full to this date
Attachedn' a description of die woapompl,ted arid die amourit of payment requested by work tem.
Contractor�s Signatu=--!!�����- Daw.
........... ........0....... .......... ..............0......*.A......
Homeowner I(We hereby agree that the work stated by the contractor has been completed and approve payment to the contractor
in accordance with the contract and contingent upon inspection s nd conciarence by the Rehabilitation Inspector. It is understood
that the actual amount disb� be based the tvd�i. of that inspection.
X
0/- 0
Ownces Signature.0 Date:
..................
...................0..........................
Rehabilitation Inspector
I hereby certify that I exercised reasonable car to deter mine that the work performed at the Wxm address meets
specffications and was completed in a satis&ctory nnntxw howew r,nettim the undersigned norjacksonville HUD is in any way responsible for die
acts or omissions of the contnictor,any itibcontm-tor,or any of he contractor's agents or employees,or any other person performirig work under
the construction agreement. The contractor has provided a relea ie of all ficris,if any,in connection with this contract and Ins provided die propert
owner with a copy of each warranty or guarantee du#m propest,owner from the contractor for work performed.
IV
(0 -
Rehab Inspector.
Date:
................ ..............
Approved. Forward to Fwance Department for pmanent i�&datc.
'/7
Date
iiw�cctor,Re'W'Mitaflon Loan Proiram,
A L(— -P-a,#*OE1VED
Group #IReq#
Amount'. JUN 0 4 70'
Approval I Date A/P DEPT
Appralqkl I Dote 7
Appreftl I
Tax .: 9D47799323 3u.n 11:18
COMM,6grOR PAYMENt RFAIUFST
#I-3ft CAM"..4
i p1w"M 02-OJ6 Camp
&Wgk U"amida M PwmcW NS-10,
ull Aniostut It4uluedcd
.............. ........... .................... .................. .. .....
Cowsawksr. I Isemlsy mqenA M iflApOMCM UP MIUAWC 181SY"W"S f1w t1w auMML a
,:ej*dw I IN"=dgfijL*.sjIy causlilded dic wx4=7 inni Initwiry dvis I Mimi dim#A bills
for Wxw uml wid insimiab fiwnisIwJ in ammwA"disag tqxiirs nal ituprownswas have hem paid in
AA to dds ad*.
Attached is a 7'��Owi the ww3w�t ar"nou mpnowl by work ilmn.
Daw-L
........... ........ .......... . ...........
110nownw. I/We JaWly qp=dw dw w4k stated by dr.t". iltusur Im I as coupicial and 4nwuw psymm to dw C(14tvM*M
its wMA-Mice with 411C Owilliect asul r"dinow 111WR kupwif)"aid concil"WIM 11 F dw It is insdawavad
tiat do wuW unumis olidnug4d will he 4w.vI tqt dw ruidiM ur dot i upwim.
7
acr's s4ft"art—L I
Rdsowumdan lnspww.
I Jvw*cortily,tba I eximiscd missebitalde amm lei iWasusna dint Ow pcsfum�dl d1c,SjxM fxldf4u.
qw&rdiaus wW vvia c(miplewd its a wisk-ussy nsweeter Isum"w,w4kr dw v4rwul norjudsexivilk HUI)6 4o any"sy ttspo"Aple for the
acts,or 01"issitsen 19 the cauttwor,wtv PANAMOrataw,at s.wr Am Lasamdoer. sits or cmjsInyrw4 or wxy Wier lxmn pailksmisig wwk uncla
flic wuwjtk%dmi opvcnmn#L The cauiradcw IwA pr;wWcti a rekwe afag hem ira, in cuixicriksts with 1his cutitsect mmi Jos lm*Wcd dic wMaM
Owsw WWI a CO"arcs U-1 VM(Mkty or pmtw*m t1sw tht l"=ty omwr Jim dic- imrsaur rur work pufannetf.
MAC:
Rcwb Inarcclov
....... 44 ft V 4D & ...... A-'-j j 23M
t to A Dqmtnfent fcw pr/asnat thk dom CK:&C�
D;wLM
DWO
RECEIVED
Giroup!# FAQ 0
2001
JUL 3 1 1601
A/P DEPT Appwo i�al / Date
Appro�61 / Date
CHANGE 9RDER-
03-0 7-ot-'
O.N.:
Prop"Address:
C.M.I.rN.
Cmwmx Addrew. le 4,-/�tz tO
D"critition of W-ark Chanze: AMOUNT, CATEGORY:
(Plenc T )
-rA 001( POO Ir 0119"'
Re rmn� -3,AV-�'
PA,-#f k('Iaen1Lp-o Cor . .
P ceik
ffeUJ,ekeC-,AX,4 ItIr—
ACA ^Ad
'VI
(Ovr
PeX'#f-t;V,'fif)1I
ReMWe a,j e W
Al e-
yekllOiC4eli atold 4A,44.4oVXcl"f1ztYY,15
f7
Chanscs and work affected hereby,we subject to an contract stipulaticris and covenants. Mis Order is Ena&a Pan Of dw ccintract dated first
ab—,Parties larve hercwwo set dwir
S 7:�r xyavct price
+or. 3,,9 7,7"0 c hp
S
IL
Owner Aqpw-vlx�az,,(� Date:
Datc:
C=ftacWr Approval-
RelvIbSpecisfistApprowak Dab el 0
w
Prop=Adzdwistrau
Source of Fumls: S S
C"Der Contract
C�vr-Owner,cmtractw,Lxwn fi1c,T=Wcal file,Fs.ncw Inatiftr6w(irwritract Price d=ged
Cat Mries of dMMM:
1.Hidden damages
2.Time extension
8-Del-ticus-f n--equired items or unusuid anowanma
4.Required it�that wure miswd ca,initial inapec:tiou
S.Equal substitutiOn Of nuftrilil or-Iternativ,cum for deficiency at=m or lesser priq�
6-Totally unfOrc2c=circumstances arising after conimcnmmcm of work
Duval County Property Appraiser- Parcel Summary Page I of 2
JParcel Summary - Values from the 2001 Certified Ta
IF717235 0000
IRE No.:
�m7e7. [I7KNER, LENA ET AL
jProperty 751 SAILFISH DR
F
1ATLANTIC BEACH
[mailing Address: [7571 SAILFISH DR
IATLANTIC BEA
jProperty Use: JF0 100 SINGLE FAMILY]
[Legal description:][30-60 17-2S-29E ROYAL PALMS UNIT I LOT 17 BLK 6
INeighborh F943807 ROYAL PALMS I[Sec-Twn-Ran 11 7-2S-29E
-]F5 576A I
JOR BK& F10048-2194 I Fmap Pai tel:
ISale Date: F6/28/2001 Buildings 11
[Sale Price:
5166.66
ILand Value: -1 F$17,010.00 J[Heated Area: [2012
IClass Value: 1 0 Exterior Wall: I FBOARD & BATTEN]
llmprovement;.7 560.00 JUSD3
IMarket Va 570.00 1$226.25
[�S_sessed Ta7lu7e7. 566.00 School 11ax: F$26 5.5 7
[Exempt V 500.00 District ax: 1$97-23 -------
[Taxable Vj71u7e7- _j 066.00 Other T x: 1$16.04
ISr. Exempt, 7 0 Voted T'x: [$19.59
ISr. Taxablee=. =$0.00 F$624.68
This page displays values from the 2001 Certified Tax Roll with weekly updates of
ownership & sales.
Map-it maps & data are updated & maintained byll COJ-GIS, not the Property
Appraisers Office.
Please direct inquiries regarding the maps & dat I a to Map-it Feedback (below), not the
Pro_pe�Appraisers_Office.
Map-it Feedba k
13
Payment FeedbOck
Home PRC M_aAJT Taxes
Appraisal Feedb ck
http://pawww.coj.net/pub/property/RENO.asp?RENUM=141235+0000 2/6/2002
FINANCIAL SURVEY
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CITY OF ATLANTIC B1 ACH, FLORIDA
Date:
1. Homeowner(s)Name:.
D 61-2
2. Address of House:
3. Telephone Number(s) where you can be reached duqng the day or early evening:
(Home)6'��— ��Z_(Work Oth�' r)
4. Is person completing survey the Head of Household' 4
5,Age of Head of Household
6. Is the Head of Household: female-1—Aale_�?
A minority ? yes 110
7. Number of handicapped living in household
8. Total number of rooms in household
9. Number of persons living in household (other than ead of Household):
Age 0-5 years Male F =ale
Age 6-17 years Male F .�male—
Age 18-39 years Male F .-male—
Age 64 and over Male F-,male
I O.Water supply is from: City-k-- Well Other (list)
11. Sewer service is by: city_�� Septic TE nk Other
12. Does your toilet flush? Yes No
regbcdbg.pkg
Page 2
Financial Survey- Community Development Block Grf nt
13. Have you had sewer or septic tank problems? yes- no
If yes, which of the problems have you experien' ed?
a. Foulodor
b. Seepage �f—septic tank into yard
c. Backed up household plumbing
d. Other
Do the problems increase during periods of heavy-ra,n fall? yes no— 1�1�
14. Is there hot running water in the household? yes no
Is there cold running water in the household? yes_! no
15. Do you have a complete kitchen (water, cooking, refrigeration)? ye no
16. On the chart below, circle your household's family s I ize. Is the total annual income of your
household:
more than less than—the income level hown below for your household size?
Family Size -Number Annual In
�ome Level
2 $r',900.
3 $20,100.
4 $22,350,
5 $2z,150.
6 $2f 950.
7 $2-),700.
8 or more $2S,500.
17. Are you on a fixed income (Social Security, SSI, Retirement) yes /no
18.List income source(s)
A--Z J(:�,
19. Do you : own
_V1 rent—your home?
If you own your home, please present a copy of your wai i�ranty deed and a most recent utility bill
(water or electric)l as proof of ownership and residency i1vith this survey..
If you rent your home, please present a co y of you S6 V'ri't s survey.
Signature of Homeowner(s)::
CITY OF
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE (904)247-5800
FAX (904) 247-5805
SUNCOM 852-5800
INCOME VERIFICA'J'rION FORM
PART L To be filled out by Applicant/Employee: i
Applicant/Employee Name:._ ig
Address:
Social Security Number:
I hereby authorize release of my income infortnati the Ci of Atlantic Beach, Florida.
Applicant/Employee Signature ate
PART 2. To be filled out by Social Security Administ �ionHRS or the Employer:
S.S. Administration, HRS or Employer: Please compete the following and return the requested
information to the Director of Community Developmeit, 800 Seminole Road, Atlantic Beach, Fl.,
32233.
Applicant/Employee's name:
Gross amount of income paid monthly:
Employment to be continued? Yes-No l,f no, please explain
Employer Signature: 1 Title:
Employer Telephone Number: Date:
JACKSONVILLE ELECT TH
ITC-AU ORITY
21 WEST CHURCH STREET, JACKSONVILLE. FLORIDA 31202-3139 (904) 632-5200
-(�CDUNT NUMBER BILL DATE
80830-00751-0000-4-01-E 9/29/98 SERVICE
7SI SAILFISH DR
RATE
RESIDENTIAL
SPILLERS CURTIS CONSUMPTION HISTORY
751 SAILFISH OR SEPT. 1998
1,990 KWH
ATLANTIC BEACH FIL 32233-4214 SEPT. 1997 2,414 KWH
AUG. 1998 2,254 KWH
AUG. 1997 2,002 KWH
ADDITIMIA1 wunofta
ETER NUMBER I REA DAYS CURRENT METER ON FiEVERSE SIDE
DATE
BILLED READING TYPE
-- - _.— __ -]C ON�$TANT OAVERAGE CA LY
49541171 1 r-NSUMPTION COST
9/23 29 SSS32 REGULAR
1,990 KWH $5. 11
I GH CONS U111111 !)I'�
For the next f ELECTRIC CHARGE. . . . . . . . . . . . . . . .$ 130. 18
ew months You water GROSS RECEIPTS TAX
and electric us Coul6 s r
ace oar due FRANCHISE FEE
to record tempera'ture!p and drought . 3.56
To help reduce our bill ATLANTIC BEACH TAX. . . . . . . . . . . . . 8.54
Y please:
Clean or replace air cor 5.78
filters.
Set the thermostat at
degrees or hi
?her Have your duct-
work checked or
ieaks and have the
the central air system tuned
Run your washing machine and di
wapher on upih-
1� when full . Fix lq-aky
toilets an use low volume fixtures
and shower h
,teads . Water your garden
and lawn w h care. Call us for a
free energy or water ev4luation . of
your home or to obtain information
on how to save energy and water .
632-5200 .
IT IS OUR PLEASURE TO SERVE YOU
NON-TAXABLE FUEL AMOUNT $26.85 @ $.01339/KWH TDTAL DUE
PLEASE INDICATE ADDRESS CORRECTION BELOW Bf 10/21/98 TO AVOID $148 .067
15% LATE PAYMENT FEE
0040 c4ccozo— -4'rr..0,
_40= =N0WrM3I'rnC �Iq�D N
>
rM rn rM-9 r,rM14 r-i
===-� 00 M r-
>
L4 > lcrn= M M C) C 0"
X. rn M, :1,z =--4 71
-I <1 V)
:3 C i U) =0 J= Z'
rn M , rM
rM M 0
00 :S = z I"rlj;iw Cr)Cf):k
C M
'z Z 0%rn�&0:0
(n --I C M M%0M'0 04
, n -4 = zz
> = . C
r- > 04 rT1 r-
> M r- M
C� 'G') M !
-4 Cn
M Cl)
M M M%Q >
C4 <00
N=
O%M z
C G.- i'-�
M
NM L4 L4 M I-%
03 0 41, -9� WIL"A 0 V12
%OM C3_& 61(31co u4OL4C 30 0> >
00 0%001 Vic"'II .4
M co
.4
PREPARED BY, RECORD & RETURN TO:
ALAN C. JENSEN, ESQUIRE Back a078 Pg 1099
P.O. Box 50457
Jacksonville Beach, FL 32240-0457
Ok: a078
P .. 1099 - 1100
20c# 95077737
OUIT-CLATM11 7 DEED Filed & Recorded
04/25/95
12:21:31 P.M.
Made this P4 day of April, 31995, between
HENRY N. COOK
HILLIARD LEE IKNER and LENA PEACOCK KNER, his wife, MERK CIRCUIT COURT
Grantors, whose address is: 432 Sout 10th Avenue, DUVAL COUNTYIFL
Jacksonville Beach, FL 32250, and E NA L. SPILLERS, REC. $ 10.50
Grantee, whose address is: 751 Sailf sh Drive, DEED 0.70
Atlantic Beach, FL 32233 , Social Secirity No. : 118-24-4931.
WITNESSETH: - -that G:�ant'ors, for and in consideration of the
sum of TEN AND N01100 DOLLARS ($10. 00) , and other good and valuable
consideration, in hand paid by Grantee, the receipt whereof is
hereby acknowledged, have remised, released and quit-claimed, and
by these presents do remise release and quit-claim unto Grantee,
and her heirs, successors and ass*gns forever, the following
described land, situate, lying and b ing in the County -of Duval,
State of Florida, to-wit:
Lot 17, Block 6, Royal'� Palms, Unit 1,
I
according to plat thereof! recorded in Plat
Book 30, pages 60 and 60k, of the current
public records of Duval Coq�nty, Florida.
SUBJECT to covenants, restrictions ar d easements of record and to
any ad valorem property taxes for the current year.
TITLE NEITHER EXAMINED NOR INSURED
PARCEL IDENTIFICATION NO. : 171235 OOCO
TO HAVE AND TO HOLD the same to4ether with all and singular
the appurtenances thereunto belonging or in anywise appertaining,
and all the estate, right, title, interest, lien, equity and claim
whatsoever of Grantors, either in law or equity, to the only proper
use, benefit and behoof of Grantee her heirs, successors and
assigns forever.
Book 8078 Pg 1100
IN WITNESS WHEREOF, Grantors havf� hereunto set their hands and
seals the day and year first above wiitten.
SIGNED AND SEALED IN OUR
PRESENCE:
Vlitness int name: e-- HILLIARD LEE IKNER
/ / '/� -4��
zdo� �-7� 411�1 —
"�itness print name: f)#Uy PEACOCK IKNER
STATE OF FLORIDA
COUNTY OF DUVAL
The foregoing instrument was ackniowledged before me this
day of April, 1995, by HILLIARD LEE IKNER and LENA PEACOCK IKNER,
his wife, who are personally known ito me or who have produced
L- as identification and w1h o did take an oath.
NOTARY PU IC:
4.4
Printed name: ......
State of Florida
My Commission Exp:-Ozes:
#Cc'�
C S' *1
Gle-neral Requirements
REPLACE IMF SHEATHING
Replace all rutted or damapd roo,'sheathing.New sheathing
shall match existing sheathing.All work subject to open roof
inspection by the Building And Zo ting Inspection Division.
All work shall conform with the bi fiding codes and shall be
permitted and inspected according ly.
SF
REPLACE SHINGLE ROOFING
Replace all shingle rooling with F1 A approved shingles,fek
and metals. Mfr's specs.and local oldg. Codes shall be adhered t(L
All areas of new flashings shall be�esded and step-roofing unds
shall not penetrate underside of sh athing. Color selection of
shingles by Owner. Contr�actor sh- give(7)yr.labor warranty
and(20)yr.Mfr's warranty in writ Ing to Owner.
SQ
REPLACE RAFTER TAHS
Replace all rotted/damaged rafter i using pressure treated
materials.New rafter tails shall ma�ch the existing rafter tSilL
All work shag be done as per stand ard trade practiceL
KA
REPLACE FASCIA BOARDS
Replace all rotted/damaged fascia 1:)ards using pressure
treated materildL New fascia boan s,work shun match the
existing fascia boards, All work sh A be done=per standard
trade practiceL AD joints shall fit t ght and shall be
caulked properly after installation.
LF
REPLACE SOFFIT
Replace all rotteW-damaged soffit u iing exterior grade
Plywood and screening for ventilatit�n. Include all required
trim. New soffit shall match the exh ting soffit. Ali work
shall be done as per standing trade I iractices.
SF
REPILACUINSTALL EXT SIDING
Remove all deteriorated siding and i utall new siding and
trim as specifted. Ali materials to be installed according to
the manufacturer's specifications an I all local building codes
and inspected accordingly. T-1-11
SF
Pantry REPAIRCEHING
Repair the damaged areas of the cell ng as per
Standard trade pmcticeL Ali repair i shall
match the existing ceiling finish.Prel o with Kh and paint
all needed areas in accordance with 111 local ordinances.
SF
Bathroom P"AIR CEILING
Repair the damaged areas of the miling as per
Standard trade practices. All repi irs shall
match the existing ceiling finish.P vp with Kh and paint
all needed areas in accordance wit i all local ordinances.
SIF
Bedroom Master
R"AM CEILING
Repair the damaged areas of the miling as per
Standard trade practices. Ali repa irs shall
match the existing ceiling finish.P-ep with MU and paint
all needed arm in accordance wit i all local ordinances.
SF
Livingroom
REPAIR CEILING
Repair the damaged areas of the ci iling as per
Standard trade practices. AD repa rs shall
match the existing ceiling finish.Pi ep with Iou and paint
all needed areas in accordance witl all local ordinances.
SIF
Total
REHABILITATION LOAN PAOGRAM
RESPONSIBILITIES OF HOMEOWNER FA,,R CONTRACT IS SIGNED
Until Work Beirins
Start planning ahead. Plan adequate storage space for the con(i ractor's tools, equipment and materials. Make
arrangements for the contractor to get into your property if yot�will not be home during the day.
TO avoid mutual confusion,one member of the family should e delegated as the spokesman to discuss
problems or questions that may come up.
If all household members work or will not be home during the,-onstruction,consider designating an agent such as a
close friend or neighbor or relative not living with you to supervise the contractor's work. You are responsible to
make sure the contractor does the work exactly as he states lie would do in your contract.
Prepare your property and furnishings forthe rehabilitation,use this period to send your dr-apes to the dry cleaners,
wash your curtains. 'Mere will probably be dust and dirt from tf ic work,protect your furnishings and clothes,put all
breakable and valuable items away so they won't be broken or rnisplaced.
When the Work Begins
Keep your copy of the work description handy and refer to idoften. Do not ask for work to be done if it is not
written in the work description. Check with the City Hall if ere is anything you do not understand. Remember
you are responsible for ensuring that the contractor does the work correctly as bid. Assistance will be provided if
required but the work must be acceptable to you.
Try to stay out of the construction area, especially children, thi;will help prevent injuries and allow the workmen
room to work-
Try to keep a good relationship between your family and the +ntractor again, delegate someone to be the
spokesman for the family.
Stop, problems before they start , if something isn't going the may you feel it should, or if you don't
understand it, speak to the contractor at once and get an accepLable explanation or correction
before it progresses too far. If the contractor cannot give you an acceptable explanation, stop
the work and call the City Hall for assistance.
Expect the unexpected,in most cases changes and improve nts will be new and exciting to you and will give you
much pleasure;however,unforeseen problems may be uncovexed during the course of the workwhich may require a
change to the contract. Be prepared if this should happen , ,liscuss changes with the contractor and get a good
explanation of the change required and why. Try to visualize wL at the change will look like. Be flexible. All changes
to the contract must be approved by you and the City and mu it be in writing.
Your contractor is responsible for supervision of his workers. If he cannot be present, make sure that he tells
you who to talk to if you have a problem or questions.
Win cooperation from the workmen with good basic human n 4ations. A word of appreciation , an unexpected
pot of coffee or even a pitcher of cold water. Small gestures li these usually produce more efficient and better
workmanship.
Last but not least.The work must be acceptable to you and mt:ist be done in accordance with the contract
documents. Make sure that you know what is being done to yp�ur home and diat you are getting exactly what the
work description states.
City of Atlantic Beach - 247-5817
City of Atlantic Beach, Florida
. 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Telephone (904) '2474800
Fax (904) 247-5805
Suncom 852-5800
HOMEOWNER/CO CTOR
REHABELITATION AI�REEMENT
This Agreement dated this the day of 2000 is between
lo(,Wed at
and Edna Spillers ,for the construction of property imp�rovements at 751 Sailfish Drive,Atlantic
Beach, Florida 32233.
Whereas,the Contractor is in the business of residential construction and is willing to provide
I
such services to the Owner and whereas, the Owner d sires to use those services.
Now,therefore, in consideration of the mutual covena ts and promises contained herein,the
parties hereto agree as follows:
1 SCOPE OF WORK. Contractor acknowledi)es that he/she has prepared the
Contractor's proposal (attached to and made part of this Agreement) and that such
proposal is accurate and consistent as to the r ame of Contractor, scope of work that the
Contractor will undertake, and price. Contractor acknowledges the perforTnance
requirement established in the write-up and warrants that all work undertaken will
conforTn to said specifications.
2. PROJECT DESCRIPTION. Contractor ag ees to furnish all labor, materials,
equipment, permits, licenses and services for he proper completion of the Project in
accordance with the attached work write-up ar d specifications. Contractor guarantees
that materials supplied will be as specified in t ie attached specifications and all work
performed will be completed in a workmanlike manner according to standard trade
practices. The Contractor will post at the job s l:e all permits required to renovate the
Project!
3. HOLD HARMLESS. Contractor shall agree to defend, indemnify, and hold harmless
the Owner and the City of Atlantic Beach. Florida from liability nd claim for damages
because of bodily injury, death, property dama)e, sickness, disease or loss and expense
arising from C
-ontre c-tor's performance under It is Agreement to install or construct home
improvements to be paid for out of the proceec s of the Owner's rehabilitation loan.
Contractor is acting in the capacity of an indep amdent Contractor with respect to the
Owner.
4. LIEN WAIVERS. Contractor agrees to protect,, defend and indemnify Owner from any
claims for unpaid work, labor, or material with r i espect to Contractor's performance. Final
payment shall not be due until the Contractor s delivered to the Owner complete
release of all liens for work completed arising dut of Contractor's performance or a receipt
in full covering all labor and materials for whict a lien could be filed or receipt of a bond
satisfactory to the Owner indemnifying him against any lien.
5. CONTRACTAMOUNT. The Contractor shO be paid for the performance of
rehabilitation work, subject to addition and dedi i�ctions by approved Change Order,the
contract sum of dollars
6. PAYMENT SCHEDULE. Payment will be ma I�de as follows subject to the Owner's
acceptance of work complete:
(a) Contractor shall submit a Contractors F�ayment Request form signed by the
i
homeow er. Upon completion of 100% of the work, all funds w 11 disburse.
_0
(b) Prior to issuing any payment, all work ii I i place will be verified and approved as
completed in accordance with all code� and program standard by the City. A
partial and/or full release of lien must b a.submitted with each draw request.
7. CONDITIONS OF PAYMENT. The Contrac-or acknowledges and agrees that the City
will not be obligated to make disbursements un ss and until the following conditions are
satisfied:
(a) There is no default under this Contract, the Loan Agreement, the notes,
or the Mortgages (as defined in the Loan Agreement).
(b) The City, or its designated agent, has n.-ceived a completed request for
disbursement in the form to be approved by the City. Such request may, at the
City's option, be required to be accompi i�nied by any one or all of the following:
Proof of paid, and unpaid cons ruction bills for Materialmen and
subcontractors which show ful payment (except for holdbacks) of such
bulls then due and payable, e)cept those covered under the current draw
request.
Lien waivers for all work and n Oterials as required by the We insurance
company for the issuance of e i hdorsements, except those covered by the
current request.
(3) Any inspection reports, architertural certificates with respect to the stage
of completion of the Project, and such other proof as the City may
reasonably require to establish that construction progress has been
made in compliance with the p!ans and specification,
(4) The current status of accounts1of Contractor and its subcontractors,
materialmen, and laborers furnishing labor, materials, or services in the
construction of the Project.
(5) Advice from the City or its age�t that all construction work already
performed on the Project is in I i 411 compliance with the plans and
specifications.
(6) Advice from the title insurancermpany that a search of the public
th
recorxJs discloses no ch; the condition of the title to the Property
which is unacceptable to the C ty.
(c) The City will not be obligated to make t ie last disbursement unless and until it
has received the following documentati Dn:
Approval by local governmenta authorities having jurisdiction of the
Property or the Project that the!Project has been completed in
accordance with all applicable I O, ws, rules, ordinances, and regulations,
All permits must be final by the Building Inspection Division.
(2) Advice from the City,the lendin institution, or its agent that the Project
has been completed in acr-ordEince with the plans and specifications.
(3) Final lien waivers, Ow Con ract r' a davits re uired un er the
-nees and! kt� - 0- s 00-a- -q,- , .
Florida Construction Lien Law.
(4) A complete release of all liens rising out the Contract or receipts in full
covering all labor, materials, ant equipment for which a lien could be
filed, or a bond satisfactoril to
-y - �he City indemnifying the City against any
lien arising under the Florida 0 i�nstruction Lien Law in connection with
the Project.
(5) If applicable, a satisfactory W(p!od Destroying Organism (VVDO) Report
from a licensed pest control a4i
�ency.
TIME OF PERFORMANCE. Ownershall rovide written authorization to Contractor
to commence work. Contractor agrees to start work within_calendar days after
receipt of a written Notice to Proceed. If Contractor fails to commence work within twenty
(20) days of the date of the Owners notificatiop to commence - --n-- ---_ -.-.v the righ
Ow er shall ha e
to terminate this Agreement. Such notice or tei i Fnination shall be in writing.
Contractor agrees to satisfactodly co,, plerter all 1 wo,k on or before
(not to exceed from the date wo commences). If completion is delayed for
reasons beyond Contractors control, Contractor shall provide timely notice to the Owner
of the reasons for such delay. If such good caL se is claimed by the Contractor, it shall be
Contractors obligation to substantiate his clainl by adequate documentation,
If Contractor fails to satisfactorily complete thework by the Completion Date(as
extended, if applicable), Contracto- shall pay to -h
r t e City of Atlantic Beach a a
.- - ----- -.$ -greed
upon, liquidated damages the sum of
Per day from and after the Completion Date until the work is completed,
In the event Contractor shall fail to complete work within the agreed upon period and fails
to provide evidence of good cause for such delay, or abandons the Project, Owner shall
have the right to declare Contractor in default. In such event, Owner shall be responsible
for Providing written notice to Contractor by reg!�stered mail of such default, If contractor
fails to remedy such default within 15 calendar Jays of such notice, Owner shall have the
right to select a substitute Contractor, If the ex;ense of finishing the work exceeds the
unpaid balance of this Contract,the Contracto shall pay the difference to the City of
Atlantic Beach.
9. SUBCONTRACTORS. Contractor agrees that all subcontractors will be bound by the
terms -and conditions of this contract insofar as it applies to their work and that all the
warranties contained herein shall apply to all rk performed under the Contract,
including th-at performed by Subcontractors, Cc ntractor will fumish in writing to the City a
list of all subcontractors proposed for the princi)al portions of the Pmject. Contractor will
not employ any subcontractor to whom the City,may have a reasonable objection, nor will
Contr'actor assign this Contractor without the wi I�itten consent of the City.
10. RESPONSIBILITIES OF CONTRACTOR 01) SUBCONTRACTORS.
(a) Contractor will supervise and direct the�construction of the Project using his best
skills and attentions,
(b) Contractor will provide Owner with evic ence that it has secured and paid for all
licenses and permits necessary for the proper execution of the Proiect, and upon
completion of the Pmiect will provide e/idence that all the work has been
inspected and approved by the approp iate building officials.
(c) Contractor agrees that ALL work shall �e completed in a professional manner
and shall be carefully inspected by him fher for completeness prior to requesting a
final inspection. Contractor acknowledges that City of Atlantic Beach shall
conduct one "fina[ inspection"to create a short punchlist, if required, and one
follow-up inspection.
(d) Contractor will not employ any person(;) on the Project who are unqualified or
unskilled in their assigned tasks or duties. Contractor will not allow any employee
to work upon the job site who cannot p arforTn his assigned tasks and duties in a
professional manner.
(e) Contractor will be responsible for the a�s and omissions of all employees, and
all subcontractors,their agents and employees, and all other persons performing
any work on the Pmject.
(f) Contractor at all times will keep the Prc perty free from accumulation of waste
materials or rubbish caused by his/her Nork.
(g) Contractor will permit the City to exami ie and inspect the construction work
perforTned under this Contract at any n iasonable time.
(h) Contractor will fumish Owner with the r ames, addresses and telephone numbers
of the firTns to be contacted for service �o any appliances or other equipment
installed or repaired on the Property, a,id guarantees and warranties covering
appliances and equipment installed ortepaired under this Contract.
(i) Contractor will be responsible for the protection of all supplies, materials,
equipment, completed work, and incorTiplete work at the job site during the
Contract period.
11. RESPONSIBILITIES OF OWNER.
(a) Owner will permit contractor the reasor�lable use of existing utilities such as
electricity, heat,water and sewage necessary for the proper execution and
satisfactory completion of the Project.
(b) Owner will cooperate with Contractor t 3 facilitate the perforTnance of the work.
including the removal and replacement of rugs, covering,furniture and clothing, if
necessary, Contractor will not be held responsible for damage caused by Owner
or any occupants.
(c) Owner will be re-sponsible for the prop4 i pr use and care of the Property, including
all equipment and appliances.
(d) Owner will confer with the City's autho ized representatives prior to issuing
instructions to Contractor concerning t ie work or changes to the work.
(e) Owner will allow Contractor access to,he Property during usual working hours on
regular workdays(i.e., Monday throug Friday, 7:00 a.m.to6:OO p.m., and
Saturday, 8.00 a.m.to 5:00 p.m,). Nov,work will be performed on Sundays
unless agreed to by the Owner and Cc ntractor.
12i RIGHTS OF THE CITY UNDER THE REHABILITATION PROGRAM.
(a) Contractor will allow the City's authorized representatives to perform periodic
inspeGtions of the work while it is in pnigress to determine if it is proceeding in
accordance with this contract.
M Contractor understands and agrees th,�t the City has the authority to reject work
which does not conform to this Contra4, local municipal codes, or adopted
program or rehabilitation standards,
(c) The participation of the City hereunder will in no way after, amend, or impair the
ri h , duties and obligations of the Owner and Contractor to each Other Under
this Contract. The assumption of any responsibility by the City in no way releases
Owner of its responsibilities under this ontract, or transfers any responsibility to
the City for the performance of the sen i�ices to be performed under this Contract.
(0) in consideration of the City agreeing to!assist in financing the Project,the Owner
and Contractor agree to indemnifNy, hol harmless and defend the City and its
officials, agents and employees from and against all claims, actions, losses,
damages, injuries, liabilities, costs, anc� expenses based upon injury or death to
persons or damage to property arising,out of, resulting from, or incident to this
Contract, unless the same is occasiono:�d by the sole negligence of the City.
13. CHANGE ORDERS. Except in an emerger�cy endangering life or property, Owner
and Contractor expressly agree that no materii i pi changes or alterations in the description
of work or price provided above shall be madelwithout a prior written order signed by an
i
authorized representative of the City. The Con I tract Sum and the Contract Time may be
changed only by a Change Order approved by',the City. No extra cost will be paid to
Contractor if it has neglected to evaluate proix�rly the extent of the rehabilitation work.
14. PERMITS AND CODES. Contractor agrees to secure and pay for all necessary
permits and licenses required for Contractor's 3erformance and to adhere to applicable
local codes and requirements whether or not GDvered by the specifications and drawings
for the work, including any Contractor registrat on requirements.
15. INSURANCE. The Contractor and subcontractors will at their sole expense maintain
adequate insurance coverage for liability and workers compensation as required by state
lawi Pro9f of such insurance coverage must b4p provided to the Owner and the City of
Atlantic Beach Program Administrator.
16. WARRANTY; For goods and valuable cons deration, Contractor hereby agrees to
provide a full one-year warranty to the Owner, Nhich shall extend to subsequent owners
of the property to be improved. The warranty all provide that improvements, hardware
and fixtures of whatever kind or nature installe,J or constructed on said property by the
Contractor are of gQod quality, and free from d 9fects in workmanship or materials or
deficiencies subject to the warranty contained n paragraph provided. Contractor and
Owner agreei however,the warranty set forth n this paragraph shall apply only to such
deficiencies and defects as to which Owner or subsequent owners shall have given
written notice t the Contract r. at his principa place of business, within one (1) year
I-�----- -�----- -9 _1 I I - ---_1 1_-M.
from the date of Contractor's request for final yment. A sevenstyear warranty will be
provided on the labor on all shingle rogfs insta led,with 20-year manufacturers guarantee
on the shingles.A five--year warranty will be pr 3vided on labor and materials on all buift�
up roofs,
17. REMOVAL OF DEBRIS. Upon completion!of work, Contractor agrees to remove all
construction debris and surplus material from lhe property and leave the property in a
neat and broom clean condition.
RESOLUTION OF DISPUTES. All claims ot disputes between the Owners and
Contractor arising out of or related to the work i shall be decided by arbitration in
accordance with the construction industry arbi*�ion rules of the Amedcan Arbitration
Association than obtain, unless the parties mutually agree otherwise. The Owner and
Contractor shall-submit all disputes or claims, egardless of the extent of the work's
progress,to the Amedcan Arbitration Associat on/Better Business Bureau unless the
parties mutually agree otherwise. Notice of the demand for arbitration shall be filed in
writing with the other party to this Agreement, nd shall be made within a reasonable time
after the dispute has risen. The decision. rendered by the arbitrator shall be final, and
judgement may be entered upon it in accordance with applicable law in any court having
judsdiction thereof4 If the arbitrator's award is I a sum which is less than that which was
offered in settlement by the Contractor,the arl drator may award costs and aftomey's
fees in favor of the Contractor, If the award of ft arbitrator is in a sum greater that that
which was offered in settlement by the Owner the arbitrator may award costs and
attomey's fees in favor of the Owner,
19. PROHIBITION OF KICKBACKS. Neither'the Contractor nor any of its officer,
partnersi ownersi agents, representatives, e i loyees or parties in interest has in any
way colluded, conspired, connived or agreed,i directly or indirectly with any other Bidder,
firm or person to submit a collusive or sham 8 i Id in connection with the Contractor for
which the attached Bid has been submitted onto refrain from bidding in connection with
such Contract, or has in any manner, directly r indirectly, sought by agreement or
collusion or communication or conference witt any other Bidder,firTn or person to fix any
overhead, profit or cost element of the Bid pd(e or the Bid pdGe of any other Bidder, or to
secure thrDugh any collusion, conspiracy, co T ivance or unlawful agreement, any
advantage against the City of Atlantic Beach c.ir any person interested in the proposed
Contract; and the price or pdces quoted are ft ir and proper and are not tainted by any
collusioni GonspiraGyj connivance or unlawful agreement on the part of the Bidder or any
of it agents, representatives, owners, employ es, or parties in interest, including this
affiant..
20. INTEREST OF MEMBERS, OFFICERS, EMPLOYEES OR PUBLIC BODY
MEMBERS OF LOCAL GOVERNING BODY, OR OTHER PUBLIC OFFICIALS.
No member, officer, employee of the Public Body, or its designees or agents, no member
of the governing body of the localities who exe rcises any functions or responsibilities with
respect to the program during his tenure or for one year thereafter, shall have any
interest, direct or indirect, in any contract to su Dcontract, or the proceeds thereof,for work
to be performed in connection with the prograr i assisted under the Agreement.
21. PROHIBITION OF BONUS OR COMMIS IONi The assistance provided underthis
Agreement shall not be used in the payment o'any bonus or commission for the purpose
of obtaining city or count approval of the appli4 ation for such assistance.
i
22. ACKNOWLEDGEMENT. The above warranties are in addition to, and not in limitation
of, any and all other right and remedies to which the Owner, or subse uent owners may
-q------ -...----,
be entitled, at law or in equity, and shall survive the conveyance of title, delivery of
possession of the property, or other final settl(�ment made by the Owner and shall be
binding and on undersigned notwithstanding 4 ny provision to the contrary contained in
any instrument heretofore or hereafter executed by the Owner.
23. ACCESS TO RECORDS. Contractorwill allow the United States Government ords
designee to examine and inspect the rehabilitation work performed on the Property. The
federal grantor agency,the Comptroller Gene'al of the United States, or any of their
authorized representotives will have access to the book-si documents, papers, and
records of Contractor which are directly pertinent to a specific grant or loan program for
the purpose of making auditsi examinationsi excerpts and transcriptions. All such records
will be maintained for a period of three (3)yes rs from the completion of the Project.
24. FEDERAL LAWS AND REGULATION& Contractor warrants and represents that it
has read and fully understands the provisions of the Contract and Contract General
Conditions, Contractor further acknowledges Is understanding that the work to be
performed must be completed in compliance with all the terms and provisions of each of
the f011owin laws and regulations marked as applicable (copies of all applicable
regulations are attached to this Contract and constitute provisions hereof):
CONTRACTOR AND OWNER HEREBY ACKNO�VLEDGE ACCEPTANCE OF THIS
AGREEMENT:
Owner Date
Owner Date
Address of Property to be improved: 751 Sailfish Drive, Atlantic Beach, Florida
32233
Contractor Date
Addre.ss
City of Atlantic Be ch, Florida
800 Seminole oad
Atlantic Beach,Moiriid 32233-5445
Telephone (904) 2 7-5800
Fax (904) 24718"'05
Suncom 852-5 300
City of Atlantic Beach Housin,-Y,Rehab Program
Bid Proposal
Notice to the Homeowner and Contractor
This bid should be submitted in confidence and should not be revealed to the other contractors.Evidence of a collusive
bid shall be cause for non-acceptance by the Program.
Date:March 24,2000
Contractor:
Property Owner:Edna Spillers
Property Address:751 Sailfish Drive,Atlantic Beach,Flork a 32233
L the undersigned contractor,having inspected your property,as h!ted above,understand the extent and character of
the work to be done I propose to furnish all labor,materials and ec uipment necessary to accomplish the work as stated
in the attached bid specifications and work description for the reha)ihtation of your property.
My total Bid Proposal for all items listed on my attached wc rk description is ($
All work proposed as described will comply with the City of Ad tic Beacb!s Building Codes and will conform to the
Property Rehabilitation Standard Specifications and Guidelines.if this proposal is accepted,I will obtain all required
building permits prior to starting construction.
I propose to commence the work within 10 consecutive calendar d tys from the date of award of a contract and a Notice
to Proceed and will complete the work within 45 calendar days starting the work.
Company Name Signahre and Titl#of Officer Date
SELECTION OF CONTRACTOR AND BID PROPOSAL I
I/we the owner(s)of the above listed property have read and wida Istand the rehabilitation work to be accomplished in
accordance with the work write-up and Specifications attached to �he below listed contractof bid proposal.
Contractor selected. Bid Price$
sipature of owner date witness date
sigmature of owner date witness date
Owner E&a Spffiers
Address: 751 Sailfish Drive
Atlantic Beach,Florida 322'
Phone Number: (904)249-2486
Date: March 24,2000
Time: 11:11 AM
PROPERTY DESC',�UPTION
Address: 751 Sailfish Drive
Atlantic Beach,Florida 32233
Dwelling Type: block
Floors: single story
Number of Rooms: 9
Area:
Mer Contents:
Inspector: Mr.BernardA.Wilson
Date Inspected: March 23,2000
Approved:
Date
Date
BLUDING DES MPTION
Date: March 24,2000
Time: 11:11 AM
Inspector: Mr. Bernard A.Wilson
Address: 751 Sailfish Drive
Atlantic Beach,Florida
Number of units:
Dwelling type:
Stories: single story
Construction Type: block
Other Comments:
General Requirements
REPLACE ROOF SMATMN
Replace all rotted or damage sheathing New sheathing
d f
shall match existing sheathing. work subject to open roof
inspection by the Building And Ding Inspection DivisioL
All work shall conform with the ilding codes and shall be
permitted and inspected acco ly.
SF
REPLACE SHINGLE ROOFINC.
Replace all shingle rOOftg with F,!A approved shingles,felt,
and metal& Mfr's specs.and local bldg. Codes shall be adhered to.
All areas of new flashings shall be sealed and step-roofing nails
shall not penetrate underside Of sheathing Color selection of
shingles by Owner. Contractor s*H give(7)yr.labor warranty
and(20)yr.Mfr,s warranty in wr#ing to Owner.
SQ
REPLACE RAFTER TAILS
Replace all rotted/damaged rafter WIS using pressure treated
materials.New rafter tails shall mi itch the existing rafter tails,
All work shall be done as per Stan lard trade practices.
EA
REPLACE FASCIA BOARDS
Replace all rOtted/damaged fascia I oards using pressure
treated MaterialL New fksda boar Is work shall match the
existing fascia boardL An work st mn be done as per standard
trade practices. All joints shall fit t ght and shall be
caulked Properly after installation.
LF
REPLACE SOFFIT
Replace all rotted/-damaged soffit 11 sing exterior grade
Plywood and screening for ventilati
dlati Include all required
trift New soffit shall match the exi Iting soffit An work
shall be done as per standing trade practices.
SF
REPLACFANSTALL EXT SIDIN(
Remove all deteriorated siding and�nstall Dew siding and
trim as specified. AD materials to b�installed according to
the manufacturer's specifications 8111 d all local building codes
and inspected accordingly. T-1-11
SF
Pantry REPAIR CEHX4G
Repair the damaged areas of the ceit ng as per
Standard trade PrftCtiCeL All repair i shall
match the existing ceiling finisk Pre]I with Mh and paint
all needed areas in accordance with I H local ordinanceL
SF
Bathroom REPAIR CEILING
Repair the damaged areas of the ceiling as per
Standard trade practices. All rel iain shall
match the existing ceiling finish.Prep with Wh and paint
all needed areas in accordance wi th all local ordinances.
Bedroom Master SF
REPAIR CEILING
Repair the damaged areas of the ing as per
Standard trade practices, AUJUl irs shall
match the e3dsting ceiling finisk p with Kilz and paint
all needed areas in accordance,wi h allf local ordinances.
LIVIngroom SIF
"PAM CEILING
Repair the damaged areas of the c Aling as per
Standard trade practices, All repi irs shall
match the existing ceiling finish.P-ep with W&and paint
all needed areas in accordance wit I all local ordinances.
SF
Total
CITY OF
A&4a&c Ve4elt - �Walid4
S U N"',f NQ I E' R 0 A!
ATLANTIC HFACH, FLORIDA 32233 5445
0 x F,
FAX 4904) 247-5S05
S(11 N1,7014, 2-51300
Taxl nw;ttab
Va te., Z�: IVo,
i4xll -4�6f-6Y7 7---
�7txlz�------------------------------------------
---------------------
ge,
lc7�
S �
SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
n
n
n
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 08-00000732 Date 5/29/08
Property Address . . . . . . 571 SAILFISH DR
Application type description FEN( E PERMIT
Property Zoning . . . . . . . TO 1E UPDATED
Application valuation . . . . 0
---------------------------------------- ------------------------------------
Application desc
6FT FENCE
---------------------------------------- ------------------------------------
Owner Contractor
------------------------ ------------------------
JOY, TIM OWNER
ATLANTIC BEACH FL 32233
---------------------------------------- ------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/25/08
----------------------------------------------------------------------------
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY
CONSTRUCTED.
*SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED.
PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL
INSPECTION.
*EMAIL INSPECTION REQUESTS TO BUILDING-DEPT@COAB.US
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach
NUMBER
Building Department (T,6b "d b
,e,:assigpe:, ythe Bui,ldin'
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 . ......
DA E-mail: building-dept@coab.us
D
Cityweb-site: hftp://www.coab.us ate routed,,�
APPLICATION REVIEW ANI) TRACKING FORM
Property Address: P/�7 �4.:54 I(-�Department review required . Yes,,-No
/Building K1-
Applicant: Planning &Zoning
Public Works
,PubIic.Uti.Iities ....-
roject. Public Safety
Fire Services
Other Agency Review or Permit Required Revile N or Receipt Date
of Pern flt 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:
APPUCATION STATUS
Reviewing Department First Review: [!(Approved. E�Denied.
(Circle one.) Comments:
(E EDIN6D
PLANNING &ZONING
PUBLIC WORKS Reviewed by:d U. :L-A� Date: 5 —,2 S`0
PUBLIC UTILITIES Second Review: ElApproved as revised. F�Denied.
PUBLIC SAFETY Comments:
FIRE SERVICES
Reviewed by:_ Date:
Third Review: 7Approved as revised. OlDenied.
Comments:
Reviewed by:_ Date:
CITY OF ATILA:NTIC BEAC H T-71
800 SEMINOLE ROAD,ATLANTIC BEACH FL 32233 08
OFFICE:(904)247-6826 0 FAX NO.:(904)��47-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
BPI'90AN&MON
Atlantic Beach, FL 32233
WWOW kiwi N Qggm��MR
[3 NEW BUILE ING 11 DEMOLITION U RESIDENTIAL
LOT_BLOCK_SUB DIVISION 13 ADDITION [3 CONVERTING USE El COMMERCIAL
ALTERATIC N 11 ACCESSORY BLDG. ...... .....
EIYES El N/A
El MOVE QOTHER 0NO
ft-711 CX, 0 REPAIR 13POOL/SPA
E�%M&�'�- A�
9.NAME: 15.COMPANY NAME: 23.COMPANY NAMF:
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
18.ADDRESS: 26,ADDRESS:
F47
/'11.OFFICE PHONE: 1'2.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
'7 57/-3/30 1 1
13.CELL PHONE: 21.CELL PHONE: 2b.CELL PHONE:
�5r
31 , 2,
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
Is"SIE OUDEM" N 0 MN
am
31.NAME: 33.NAME: 35.NAME-.
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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 t neet 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 a period of six (6) 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,Ta nks, Air Conditioners,etc.
OWNEWS 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. I will not occupy or use the referenced bu Iding or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building oftial,as required by law.
.*** WARNING TO OWNER:
YOUR FAILURE-TO RECORD A NOTICE OF COMMEN EMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO ERTY. A NOTICE OF
I
COMMENCEMENT MUST BE RECORDED AND POSTE ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINA CING, CONSULT WITH YOUR .
LENDER OR AN ATTORNEY BEFORE RECORDING Y UR NOTICE OF COMMENCEMENT.
MEWOW0
]RE-N, 110-��T-
A_
Signed; DateAlft,77 0 9 Signed: Date:
Before me this 2007'In the county of Beforemeth _dayof_ 2007 in the county of
Duval,State of Florida,has personally appeared Duval,7State Florida,has personally appeared
herin by himself herself and affirms that all statements and declarations are herin by hims elf/herself and affirms that all statements and declarations are
true and accu true and aCCL rate.
Notary Public t f SHIR L Notary Public at Large,State of_,County of
ic-'s at f
El Personally lorida 0 Personally<nown
11 Produced 1 rn sion Expir -Fe 14 13 Produced I fentificaff
"1,j.MNIon 1/'MY518533
NuEd�Assn. REVIEMn MR CORE eOMP
Notary Signa re: Notary Signa ure-
CE
U1, OF ATLANT7C BEAC
SEE PERMITS FOR ADDITIONAL
REQUIREMENTS AND CONDITIONS,
CDAB FORM BLDG01:REVISED:11/612007 FILE COPY REVIEWED BY:An 4-
DATE:-�E�(;�-
1 Nj�
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNICWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTIO TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. TEE 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 TV.AY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILE ING. 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 BI JILT 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 OFTHIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRAC TOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES .kND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT P',"OPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW A BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPE-NSATION INSURANCE BE
PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE
OWNER.
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(l). AN"OCCUPATIONAL LICENSE' IS NOT ADEQLATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICE14SED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THA F I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQt)IREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
537 —3o? L97
ADDRB.E�kS PHONE NUMBER
) I(�dt��"A
PRINT NAN
10-11
S!GWAIROE' DATE
Before me this day of 20
Duval,state of Florida,has personally appeared Otin the county of
'HIRLEY L. GRAHAM
herin by himself/herself and affirms that all statements an are
true and accurate. Nota y Public-State of Florida
Notary Public at Large,State ot ri 0 Y Con mission Expires Feb 14,2010
County o
Commission#DID 518533
0
0 Personally Kno Bonded By National Nota ssn.
nt ry Assn.
103 Produ Ide
Notary S;ignatu
COAB FORM BMG07;REVWISED: 8/14/217
7 t
----------
'0I
City of Atlantic Beach
APPLICATION.NUMBER -.
Building Department
ff6bb-a-ssigned b h-- ildinj D60airtm
yt e.Bu
800 Seminole Road ...........
. ... .....
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 -'Fax(904)247-5845
....................
E-mail: building-dept@coab.us
Date routed.:�:
City web-site: hftp:/Atvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
-�Department review required Yes,-No
Property Address: 1:::�" ,/Building r
Applicant: Planning &Zoning
Public Works
I P 7.1, Palic,Utilities
roject: Public Safety
Fire Services
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:
APPLICATIPN STATUS
Reviewing Department First Review: Pro-roved. FIDenied.
(Circle one.) Comments:
BUILDING
Reviewed by:_ Date:
PUBLIC UTILITIES Second Review: FlApproved as revised. FIDenied.
PUBLIC SAFETY Comments:
FIRE SERVICES
Reviewed by:_ Date:
Third Review: FlApproved as revised. ElDenied.
Comments:
Reviewed by:_ Date:
CITY OF ATLANTIC BEA',H T-1 T-F]
800 SEMINOLE ROAD,ATLANTIC BEAC 1,FIL 32233 08-
OFFICE:(904)247-5826 0 FAX NO.:(90,)247-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APP -ICATION DUVAL COUNTY
P 0 M=AQ-Q
Atlantic Beach, FL 32233 17,1 c6
0 NEW BUI DING
11 DEMOLITION RESIDENTIAL
LOT_BLOCK_SUB DIVISION 11 ADDITIOt 0 CONVERTING USE 13 COMMERCIAL
13 ALTERAJ ON 0 ACCESSORY BLDG,
1:3 REPAIR E3 POOL/SPA 11 YES 13
El MOVE QOTHER I Q NO
WR4W off .0MIA' Ark.-TPEN WHOM
OWN"Ma. fflKaffJW1
Q SIT T W AWMW
9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
18.ADDRESS: 26.ADDRESS:
F4
71T OFFICE PHONE: FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
75-1--31,30 r. 4 1 1
13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE:
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
Q QL 'E
Nam -I-W-1-0
31.NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
Application is hereby made to obtain a permit to do the work and installatiots 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 a period of six(6) 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,7anks, Air Conditioners,etc.
OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate an that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced b ilding or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building o icial,as required by law.
WARNING TO OW ER:
YOUR FAILURE-TO RECORD A NOTICE OF COMMEN EMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PR PERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POST D ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FIN NCING, CONSULT WITH YOUR
LENDE-R-OR AN ATTORNEY BEFORE RECORDING Y UR NOTICE OFIC, OMMENCEMENT.
Signed: Datd4%11Z 09 Signed: Date:
Before me this 2007 in the county of Before me Als day of 2007 in the county of
Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared
herin by himself/herself and affirms that all statements and declarations are herin by him 3elf/herself and affirms that all statements and declarations are
true and accu true and accurate.
Notary Public t- f SHIR L Notary Publia at Large,State of_,County of
Ic-Stat f Florida
11 Personally El Personalh,Known
13 Produced 11 m sio E FL- 14 El Produced'Idenfificatlon-
ion 518533
Notary Signa re: ...... Rn rig g pl- Notary Signi iture:
COAB FORM BLDG01:REVISED:11/6/2007
CITY OF ATLANTICBEACH
(OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),1'LORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTflIC) TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERN[IT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OW�ER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DC NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU I&AY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBLTIL ING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST 01 $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAYNOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE E UILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LA W WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION C F THIS EXEWTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRA JOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBIELITY TO MAKE SURE THAT YEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE :OR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED UNDER THE HOMEOWNERS INSURANCE- POLICY TO CLEARLY PROTECT THE
OWNER.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BRCOME 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(l). AN "OCCUPATIONAL LICENSE' IS NOT ADEQ JATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE RECUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
5_7� St/&'54 6A, 537 -3o?o7
ADD PHONE NUMBER
A
PRINT NA
z
DATE
Before me this ��ayof 200ein the county of
Duval,State of Flo as personally appeared
.. SHIRLE L. G,f I'
herin by himself/herself and affirms that all statements anj. RAHAM
c ,kare Not 3ry Public-State of Florida
true and ac urate.
Notary Public at Large,State of Ity 0 fl.-72:
Cour zMYCO'nmission Expires Feb 14,2010
�o gw-,�
11110 .1 101, )mrnission#DD 518533
0 Personally Kno ,I IF" Bonded By National Notary Ass.1n.
0 Produce Iden
Notary Sig<
nat
COAD FORM BLMDGM07;RFVISED: 8/14/217
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road A.&
Atlantic Beach, Florida 32233-5445 7;
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us
Cityweb-site: hftp://www.coab.us Daterouted: -ILI
APPLICATION REVIEW AND TRACKING FORM
Property Address: '�—I/ j7m�4-�SA An /e ,-)Department review required Yes,,-No
/Building
Applicant: 14,A777 i Planning &Zoning
Public Works
Public Utilities
roject: r.-4' '—n . .
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Per nit 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: V�Approved. FIDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
PUBLIC WORKS Reviewed by:'10�� Date:
PUBLIC UTILITIES Second Review: E]Approved as revised OlDenied.
PUBLIC SAFETY Comments:
FIRE SERVICES
Reviewed by:. Date:
Third Review: DApproved as revised FIDenied.
Comments:
Reviewed by:. Date:
CITY OF ATILANTIC,131fACH
800 SEMINOLE ROAD,ATLANTIC B4CH,FIL 32233 08-F
OFFICE:(904)247-5826 0 FAX NO.:()04)247-5845
BUILDING-DEPT@COAB.IS
BUILDING PERMIT AP 3LICATION
DUVAL COUNTY
Ulm
Atlantic Beach, FL 32233
�%a ROM
0 NEW B JILDING 13 DEMOLITION T3 RESIDENTIAL
LOT_BLOCK_SUB DIVISION 13 ADDITI)N 13 CONVERTING USE El COMMERCIAL
11 ALTER�TION 11 ACCESSORY BLDG. Ww"99
13 REPAIF 11 POOL/SPA 11 YES 0 NIA
0 MOVE 130THER EI No
9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
16.NAME: 24.LICENSEE NAME:
11A
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
7f '50t,Xf S 18.ADDRESS: 26.ADDRESS:
�9�. Ffsq-
11.OFFICE PHONE: FAX NO.: 19.OFFICE PHONE: 20.FAX NC,: 27.OFFICE P7�FAX NO.:
13.CELL PHONE: 21.CELL PHONE: 26.CELL PHONE:
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
0.PER
M
31.NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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 i o meet the standards of all laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced wiftin six (6) months, or if construction or work is suspended or
abandoned for a period of six(6) months at any time after work is commenCEd. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Poofs,Furnaces,Boilers,Heaters,Tanks, AJr Conditioners,etc.
OWNER'S AFFID"IT- I certify that all the foregoing information is accurate aid that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced )ullding or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building c ifficial,as required by law.
WARNING TO OWNER:
YOUR FAILURE-TO RECORD A NOTICE OF COMME CEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PR PERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POS D ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FIN NCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING 1COUR NOTICE OF COMMENCEMENT.
,Off
Signed: DateAf-1 7 09 Signed: Date:
Before me this 2007 in the county of Bef6reme is_dayof_ 2007 in the county of
Duval,State of Florida,has personally appeared Duval,Sta of Florida,has personally appeared
herin by himself herself and affirms that all statements and declarations are herin by hir nself/herself and affirms that all statements and declarations are
true and accu true and accurate.
Notary Public t Of SHIR Notary Put ic at Large,State of County of
11 Personally Ic stal afllodWd—a 11 Persona y Known
f 0
f
xpir I
xPir.2 Fe 14
0 Produced I M Sion E tFe 4 201 C1 Produce I Identification-
Notary Signs re- Fi 'I mmk rl 5185
Notary Sigi ature:
.—y—gl Imulary n.
COAB FORM BLDG01:REVISED:11/6/2007
"S1%
CITY OF ATLANT�C BEACH
(OWNER / BUILDE4 AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACK4bWLEDGE 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 PER VHT 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 D NOT HAVE A LICENSE. YOU MUST
SUPERVISE TTjE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A-ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMNERCL&L BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MA Y NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE LTILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE L WILL PRESUNIE THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION DF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTR CTOR. 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 �OUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED UNDER THE HOMEOWNERS INSURANGE POLICY TO CLEARLY PROTECT THE
OWNER.
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BEECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 :ZEQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CA�JNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,00( PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL LICENSE' IS NOT ADEC UATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETEN(Y" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LIC :_NSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE TH�kT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
57,37 -3,?07
ADD�.�S
j 6��'A PHONE NUMBER
PRINT NAN
SIGNATJdl:M DATE
Before me this dayof 20tri the county of
Duval,State of Florida,has personally appeared
herin by himself/herself and affirms that all statements an are SHIRLEY L. GRAHAM
true and accurate. No ary Public-State of Florida
Notary Public at Large,State of I
County o Y Cc mmission Expires Feb 14,20 10
(ommission#DD 518533]
0 Personally Kno Bond Ld By National Notary Ann.
El Produce Ident
Notary Signatu
COA13 FORM BLDG07;REVISED: 8/14/2 7
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road-Atlantic Beach, FL 32233-Tel: 247-6826- Fax: 247-5877
ELECTRICAL iPERMIT
Permit Garess: 101 ZjAIU-181-1 DRIVE
Per ATLANTIC BEACH, FLORIDA 32233
Class Township: 0 Range: 0 Book:
Propos t(s): Block: Section:0
Square Feet: bdivision:
Est. Value: F larcel Number:
Improv. Cost: .............
Date Issued: 7/17/2000 Name: SPILLERS
Total Fees: 25.00 Address: 751 SAILFISH DRIVE
Amount Paid: 25.00 ATLANTIC BEACH, FLORIDA 32233
Date Paid: 7/17/2000 Phone: f?�249�-4308
PAIR/F EP—LACE-METER CAN-I�ag--RNE�D—iAWs-----
BI PE RMIT 25.00
FINAL tLF=GTRIC
NOTICE - INSPECTIONS MUST BE REQUESTED AILEAST 24 HOURS PRIOR TO INSPECT-ION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WO X MUST NOT BE PLACED IN PUBLIC SPACE, AND
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONI RACTOR OR OWNER
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY
OWNER PAYING TWICE FOR BUILDING IMPROVE NTS"
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PAR"OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
$25.08 14
Date: 7/17/00 81 Receipt: &737168
CHECKS 3186
00100003221000
-jL�—TIC B C BUI'L�Dl—GM—PT.
CITY OF ATLANTIC kACH, FLORIDA
by APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE;
RAFORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCif�41TH THE ATTACHED PLANS AND SPECIFICATIONS,
W ICH ARE A PART HEREOF. AND IN ACCORDANCE WITH TrE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC-BEAC!j ORDINANCES.
SON ELUTRIC CO.-,IN
P.0. BOX 330150
ATLANTIC BEACH, FL 32233-0150
ILECTRICAL f IRM: - ER ELECT ICIA
f lli�E JOURNFYM"tA
ADDRE66: RFD--__"X
BLDG.SIZE
-BETWEEN:
APT. ( comm. ( I PUBLIC ( INDUS. I NEW I OLD ( REIN.I I
A001TION TRAILER I TEMP. SIGNS I SO. FT.
SERVICE: NEW INCREASE ( �fi L P A 1 FEE
22NDU2jOR SIZE I AMPS __:OPPER A
INITCH OR BREAKER AMPS --YO—L T-
EXIST.SERV.SIZE 3�5�
'SIZE PS PH . OLT RACEWAY
PS
FEEDERS NO. SIZE NO. SIZE NO.
SIZE
PH ' OLT'-
0
S
___7
LIGHTING OUTLETS CONCEAL-ED OPEN TOTAL
RECEPTACLES L
-S 0 30 AMP,_ CONCEALED OPEN_ TOTAL
SWITCMES
—-----------
INCANDESCENT
FLUORESCENT&M. V.
FIX90 0-100 AMP QVLA
APPLIANCES
8 E L=LT 11 A N S F.
JUR H-P. R AA!,T!IN G p RATING �'Sf: —
HiH MOTO
COkOITIONING COMP.MOTOR OTHER MOTOfi�,'_ AMPS CEIL HEAT: KW-HEAT
OVER
MOTORS H.P. VOLTAGE PHS NO I H.P. VOLTAGE PHS
7is7c7ELLANEO
US 4!Q
I r
TRANSFORMERS: UNDER 600 V. OVER 600 V.
NO. KVA NO. lKVA
1406 NEON TRANSF. NO. VA. MA. MOfOR SIZE SWITCH FL�WF
EACHSIGN I I I
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247-5877
F P IT INFORMATION _T LOCAMNiNFORMA
Permit Number: 21646 AdIdress: 751 SAILFISH DRIVE
Permit Type: BUILDING ATLANTIC BEACH, FLORIDA 32233
Class of Work: ALTERATION To nship: 0 Range: 0 Book:
Proposed Use: L (s): Block: Section:0
Square Feet: S; bdivision:
Est. Value: Pa rcel Number: ----
Improv. Cost: OVOIER INFORMATION
ATLANTIC BEACH, FLORIDA 322
Date Issued: 3/20/2001 Yame: SPILLERS
Total Fees: Ac!dress: 751 SAILFISH DRIVE
Amount Paid: 33
Date Paid: 3/20/2001 Phone: (904)249-4308
Work Desc: CDBG Misc. Repairs
A
-EC
SUNSTATE ENCLOSURES
1"s
In"ections j#r_pA_
FINAL
NOTICE- INSPECTIONS MUST BE REQUESTED AT-LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS W( RK MUST NOT BE PLACED IN PUBLIC SPACE,AND
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CON TRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE CONSTRUCTIOh LIEN LAW CAN RESULT IN THE
PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS01
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
$-1@ 14
ATtANTIC�8EACH BUILDING DEPT. lat" 3/22/81 It Receipt: W44565
DECKS
CITY OF ATLAJ VTTC RF.7A CH
PERMIT APPLICATION P�EM017E-L, AJ)L)-TTIONS, OR ALTERATIONS
MCVZYG,, DEkOLITIONS
Owner(s)
Job Address : Phone:
jr)54 /
Lot # 17 Black or Unit
Contractor: <(
State License
Addzess : E,
-'177 ,4,141 Aeh//11C4 ? one No: 170
city state Zip Code 3.2oZ?
Describe work to be done: Alull aj� 11
2re5ent use of building:.
valuation of Proposed Construction:
propos ed use: . We-17 r
Is this an addition? if yes, what are the dimensions of the added
sp�ace: ft. X ft. will the added area be heated and
cooled? New electrical (or inczaa3e),?
New plumbing fixtures? New fireplace? New Heat/AC?
SUZIaT THREM (CCbad[ERCZ&L) rWO (RESZZENTZX;) COdFLETZ SETS OF PZaNS, ZYC1=MfG
S1= PLAX, SURVEY, ZNERGy Cong ZMR�rS, NCTZCE; OF CCWkzNCzkaavT' A=
cNWXR/C0N=iac7-aR Azyxna7ir, x-- cwNzR zs ccN=vLcTcR.
Signatuxe OWNER: Date*:
Signatuxe CONTRACTOR: oat e:
AS TO OWNER:
Sworn to and subscribed befo..re me this day of 2000.
d6wWmo^wqhft I NOTARY PUBLIC
AS
140tvY PubliC-Stcle of FWc1c d before me this da of Ma,c,/,
MY CO*WAP4n N�,;rLijlAaaSbM
Commission#CC720781 2000.
NOTARY I PUBLIC I
FOR OFFICE USE ONLY
In n ........19
Date........ -------&-�
Permit .....Fee$./k -:�7..
CITY OF ATLANTIC BEACH Valuation ..............
..............
House #...7 _
V111 FLORIDA .......................................................
APPLICATION FOR BUILDING PERMIT ............................................................................
..........................................................................
Application is hereby made for the -approval Of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the City of Atlantic Beach, Florida, and all provisions of the Laws of tl,e State of Florida, all ordinances of the City of Atlantic
Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the City of Atlaniic Beach,Florida. To prevent delay or embarrasment regard-
ing intermediate or final inspections it is suggested that a list of sub-centractors be su itted to this office so that licenses can
be verihed.
D ...... ................
ate...J. y...............
X)-------Telephone No--_-------------------
.-Address-
Owner... ....... - -------------- -------------------------
........................Address,.... ..4......... .................................Telephone No.-_------------------------
Architect.......................... ........................ -;�e/f 2- F,,
..... ----- ----------�7--------
con r Buil _4�------- ........... -1.. ... . .. ............... .........Address---- --- -- -------- el,
6elfoa;e ire,
Lot N I./I------------------ Block No------- ...............S .. ..... .. .. 1_49�75--------------------W_......Zone----------------
----------------------- Side Be e .. . ....................................and------------------------------------------------------Sts'
........Street--_------------ ------_Side Be .... 4
ction...L 'A .............
building b se -------------o�'J......Type of constru ---I................7
Valuation $------- --------------For what purpose will building b ------------------------------------........Size of Footings-4�1/- -wa,(
ing... ----Dimensions of Lot........
Dimensions of Build*
rV ..............Type Roof-------------------------------------
..........Size of Sill -----------Greatest SIII Span in ft.
Size of Pie
now will Building be He ted/? 7�(61C.-I.... ......Will Euilding be on Solid or Filled Ground?........................................
Size of Ceiling Joist--------- ------eo!��..... -------------_........................... Greatest Span--------------_-------------.............
V4 ...... Distance on Centers.
1, 4 f ..................I Greatest Span--------------------------------------------
Size of Floor Joists--------------------------------------------- Distance on Centers_...._ --------------
I I I ' _., Greatest Span.........----------------------------------
Size of Rafters------------------------------------I----------------.,Distance on Centers........ ........................... This rectangle is to represent the lot
Locate the building Or buildings in the
right position. Give distance in feet from
all lot-lines and existing buildings.
REAR LOT LINE
Two copies of plans ane specifications shall
be submitted with application. J
Inspections required. pour footing. W C/C4 . 11, rA
1. When steel is in place and ready to Z o, �0 Z
2. When steel is in place and ready to pour columns and/or lintel.
S. When steel is in place and ready to pour beam.
4. When framing is completed. r--
5. When rough plumbing is completed,-and ready to cover up.
but before it is co0red.
6. When septic tank drain field or sewer is laid
7. Electrical inspection by City of Jacksonville.
S. Final Inspection.
Note: In case of any rejection,re-inspection MUST be called for after
corrections are made. FRONT OF LOT
In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said
work in accordance with tthne"ttached pl 'and specifications, which are a part hereof, and in accordance with the building
regulations of the City 0 antic Beach�
.......... Address---_-------------------.......................... ----------_---_----_-___---------
Signature of B r.- .......................
ddrew----------------------------------------------------------------------------------...............
.............................. .................
Signature of 0 .................
-?(:�) CITY OF
1q'k"iw Bewq4-dq&U-d4
Office of Buildlng Official
q REQUEST FOR NSPE
Date CT
Time
Received A.M. Permit No. Ru Q(V
RM.
Address
Owner,s
BUILDING Contra"tor AC j
CONCRETE ELECTRICA L
Framing Footing PLUMBING MECHANICAL
Re Rooting F) Rough Wir
Ej Slab Temp Pole,ng D Rough
insulation E--j Lintel 0 E] Air Cond. &
El Final L7 Top out
El Sewer Heating
READY FOR INSPECTION Fire Place
Mon, Pre Fab
el r, Tues. Wed. Thurs. Frjda�
inspection Made A.M.
inspector..
Final inspection [-j
Certificate Of Occupancy Ej
Date
CITY OF,
4&4ft4'c
Office Of Buildfirig official
Dat: REQUEST FOR 14SPECTION
Tim
Received Permit No.
0
T
Ra
m
t
ea
a
'ved
J ob Ad
f dress District No.
Owner's
Name
BUILDING
3
Framing CONCRETE
Footing ECT
Re Roofing PLUMBING
Slab Ej Ough Wiring 0 Rough MECHANICAL
Lintel Temp pole U, Top out 0 Air.Cond,& 0
0 Heating
Fire place
Mon. T es. R I N S P I ffl Pre Fab 0
WW---
urs.
Inspection Made Th Friday A.M.
A M P.M.
P.M.---'-,
Inspector
Final Inspection
Certificate Of Occupancy
Date
,�Tr
00
DEPARTMENT OF 8 JILDING
CITY OF ATL
ANTIC BEACH
------ LOCATION x ft"ATXON,
A tor on*i "I xLffi*xSW oftrw9t
Tyl
p*'s fpL*ftxv*, a=aa
All
Work i ft*PA,,Tft Lgm,% -------- -
-CcolMr. Typo t'*^fjjt
L4 M I I
irroposod Poo I sfftaLt J!"AftlLy, -rovuship 2 RIPM,% 0
wo.00
00
020.00
ozz.tm
'9�
Work
zve* Chit
'2$
ATX
X*k",
tvz
Vq
A Ya
ft.U3.
Zx
VON RA000, OAS
- , _-- , 1 11 %* ... I
�4,
00
'typo 2 JL
ACT
NOTES:
-41ALLCO"CRETE FORMSAND FOOTINGS MUSTBE IN
NOTICE
NSPECTiED,BEFORE POURING
A
PERMIT VOID SIX MONTHS FTERDATeOFJSSUE
BU 'DING MATERIAL, RUBBISH AND DEI FROM THIS WORK MUST NOT BE PLACED IN PUBLIC:SPACE,AND MUST BE
BAIS
RED UP AND HAULED AW, AY BY EITHER CONTRACTOR OR-OANER.
ILURE TO COROPLY WITH THE MECH ICs :LIEN LAW CAN RESU IN
T E PROPERTY OWNER PAYING TWICE F R BUILDING I
VE%f lu
MT FRI
I ED'ACCORDING TO APPROVED PLANS WHICH ARE P REVOCA OR
ART.OF THIS PERMIT AND SU
VID, - ION OF APPLICABLE P�OVIMONS OF LAW.
ATLI T
IC BEACH-SU LD-ING DEPARTMENT
CITY OF ATLANTIC 131�:.ACH, FLORIDA
Approwd I APPLICATION FOR ELECTRICAL PERMIT
141
TO THE CHIEF ELECTRICAL INSPECTOR: DATE:
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING TH ' WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE V WH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IWACCORDANCE WITH THI ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
1 � A c -
L� FLjy' �
ELECTRICAL FIRM: MASTER EJECTSJCIAN 9IGNATURE JOURNEXMAfj
DRESS:
NAME AD I I Ajd h4t� RFD-----BOX
SLOG.SIZE TWIEW
RES. APT.( COMM.( PUBLIC( INDUS. NEW OLD
ADDITION ) TRAILER TEMP.( SIGNS ( )— - —SO.FT.
SERVICE: NEW INCREASE( REPAIR FEE
CONDUCTOR SIZE AMPS COPPER ALUM.
SWITCH OR BREAKER AMPS PH w I VOLT RAGEWAY
EXIST.SERV.SIZE AMPS PH W, �YVOLT 4f4j&ACEWAY
NO. SIZE
.FEEDERS NO. SIZE INO. SIZE I - '
LIGHTING OUTLETS CONCEALEDI )PEN I TOTAL
RECEPTACLES CONCEALED )PEN I TOTAL
[__2*30 AMPS. -TI-100AMPS..
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 0.100 AMPS. OVER
APPLIANCES BELL TRANSF.
AIR H.P. RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS ICEIL HEAT: KW-HEAT
c VER
MOTORS H.P. VOLTAGE PHS NO. I H.P. VOLTAGE PHS
MISCELLANEOUS
4
JLv-
VD AlFACC^01LAC CC.
I i Inco ann w mlen ann%I
CITY OF
7-� pq&40d W. AwCA 4f&$
Office of Building O#icial
Date REQUEST FOR INSPECTION
TimeD�
Recejved A.M. Permit No.
R M..
57 t
Owner's
Name Locality
BUILDIN CONCRETE Contractor —
Framing - 1��LCTRICAL -, PLUMBING
0 Slab Ro g J Rough MECHANICAL
Re Rooting
Insulation Footing E]
Lintel e��Pole Air Cond. &
Ell Final Top out
0 Sewer Heating
LJ Fire Place
Mon. READY FOR INSPECTIO11 Pre Fab
Inspection Made Wed. Thurs. Friday P-
__CA��)
).M. P
Inspector F M.
Final lnspectilh�
-4p,e,tlfi are-0—tOccupancy,E7
Date
MON"
CITY OF
4&4094'c &,u4-
Office Of Building 00iciai
REQUEST FOR IN '-
Date SPIXTION
Time Permit No.
Received A.M.
PM.
Job Address PM
�'�ZKL�Ocafity
Owner's
Name
BUILDING CONCRETE Contractor
U Footi ELECTRICAL
f,ng S ng El Rough Wirino PLUM13ING
":n F I MECHANICAL
lnt.�Iatl lab Ej Rough
Lintel Tamp Pole
Final Top out f-' Air Cond. 8,
�J Sewer 0 Heatin
READY FOR INSP f i P gc
Mon. F re la a
Tues. ECTION Pre Fab
Vyed.
Inspectio 77� Thurs. (z
n Made \��,,da
Inspector 4:1�>
P14,
Final Inspection E-�
Certificate Of Occupanc
Date -2-