Permit Demolition 53 Lewis St 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000689 Date 6/06/12
Property Address . . . . . . 53 LEWIS ST
Application type description DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
single family home demo
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Owner Contractor
------------------------ ------------------------
PROGRESS HOME BUYERS SHAYCORE ENTERPRISES INC
2304 ALDERMAN OAKS DR 10169 GENI HILL CIR
JACKSONVILLE FL 322241170 JACKSONVILLE FL 32225
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Permit . . . . . . DEMOLITION PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/03/12
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Special Notes and Comments
Full right-of-way restoration, including sod, is required.
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
(Approved: Advanced Disposal, Realco, Shapelle ' s and Waste
Management)
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834 for Erosion and
Sediment Control Inspection prior to start of construction.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 100 . 00 100 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 104 . 00 104 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
JUN/04/2012/MON 08: 16 AM Progress Home Buyers FAX No, 9047370037 F. 002
.t.heller, 2304 Alderman Oaks Drive
Jacksonville.Florida 37224
F.Lender:
(3,Property: 53&55 Lewis Street
Atlantic Beach,))uval C)Unly,Florida 32233
TT P -1. T -- I . I- I
Place of Settlement: 2187 South Third Street,Jacksonville Beach,Florida 32250 Duval County
1.Settlement Date: - May 24,2012 --- ............. ....
J. Summary of Buyer's T ransaction K. Summary of Seller's Transaction
100.Gross Amount Due From Buyer: 400. ross Amou t Due To Seller:
101. Contract Sales Price 28.000.00 1 40 1. Contract Sales Price 28,000.00
102.. Personal PrODertY 1402. Personal PropeM
103. Settlement Charges to Buyer(line 1400) 18.50 403, -
_Adjustments for Items Paid by Seller in Advance. Adjustments for Items Paid by Seller in Advance:
106. City I Town Taxes 406, City Town Taxes -
107. County/Parish Taxes 407. County/Parish Taxes
109. Assessments 409, Assessments
120. Gross Amount Due from BIWer: 28.018.50 1420. Gross Amount Due to Seller: 28,000.00
1 -
200. Amounts Paid by or in Behalf of Buyer: 1500. Reductions in Amount Due to,�eller-
201. Det)osit/Eamest Money 2.500.00 501. Excess Deposit(see instructions)
202. Priacipal Amount of New Loan 502. Settlement Charges to Seller(Line 1400) 6.098.06
203, Existing Loan(s) 503. Existing Loan(s)
204. 504, Pay ff of First Morwaze
205, 505. Payoff 0 Second Mortgage
206. 506. Purchase Money Mortjzggq___._,._.
Afflustments for Items UniRaid�y Seller: Adiustments-for Items Unpaid by Seller:
210. City/Town Taxes 510, QtX/Town Taxes
211. County/Parish Taxes Jan 1,2012 thra May SI0198 511. County/Parish Taxes Jan 1.2012 thru.May 810,98
23,2012 23,2012
212. Assessments S12, Assessments
220. Total Paid bV/for Buyer: 3,310.98 520. Total Reducti�n-s iW-A--mou`n"-*t,-D,-u-e S-eller-
300. Cash at Settlement from/to Buver-. 600. Cash at Settlement to/from Seller-
301, Gross Amount due from Buyer(line 120) 28,018.50 601. Gross Amount due to Seller(line 420) 28,000.00
Les Reduotions Amount due Seller(line
302. Less Amount Paid by/for Buyer(line 220) 3,310,99 602. 5201_ 6�909.04
303. Cash From Buyer. $24,707.52 603. Cash To Seller: $21,090.96
HUD-1 May 2007 OM$No,2602-0266
M2y 17,2012 1;01 PM RESPA handbook 4305.2
TTTIT/n A.I r)n i r) �vrw n n i (., hu T).. TT n. T'A V V n A r7 r7 n n q 7 T i nni
900. Items Reauired by Lender to be Paid in Advance:
901. Daily interest chargef�oinMav 24.2012
902. Mortgaje Insuranor,Premium
903, Hazard Insurance Premium($2�p�Iied by Buyer P0Q)
904. Flood Insurance Premium
1000. Reserves Deposited with Lender:
1001, HazardInsurance
1002. Mortgage Insurance
1003, Cit,,�Prol
,2erty Taxes
1004. County Property Taxes
1005. Annual Assessments
1100. Title Ch�rges:
1101. Settlement or Closing Fee to The Law Offices of Rod Schloth,P.A, 450.00
1102, Abstract or Title Search
1103. Title Examination
1104. Title Insurance Binder -------
1105. Document
1106. N LtKX Fees
1107. Attomey fees
(includes above item numbers:
1108. Title Insurance to The Law Offices of Rod Schloth,P.A. 161.00
(includes above item numbers:
1109. Lender's 0-00
Qgy&rage
1110. Ownees' 28,000,00 Risk Rate Premium: $161.00
Coveraize
1200. Government Recording and Transfer Charges:
1201, Recording Fees: De�d 18,50 Mortgage 0,00 Releases 0.00 18.50
ILQ2. City/County Tax/Stamps; Deed 0.00 mogglgs_ 0.00
1203- State Tax/Stam2s: Deed 196.00 Mortgage 0,00 196.00
1204. Intangible Tax to Clerk of the Circuit Court
1205. Continue Married Affidavit to Clerk of the Circuit Court 18,50
1300. Addition2l Settlement Charges:
1301. Survey -
1302. Post Inspection
1303. Reimburse Beach Letter to The Law Offices of Rod SchlQth,PA, 20.00
13D4. 2011 Taxes/2009 Taxes to Tax Collector - 2,356.80
1305, 2011 Taxes to Tax Collector 1,215.76
1400. Total Settlement Charges(Enter on line 103,Section J and line$02,Section K) $18.50 $6,098.06
I have carefully reviewed the HTJD-I Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this trmsaction. I lurther certify that I have received a copy of HUD-I Settlement Statement.
ro sWome Buyers LLC
Buyer: a Seller:
A Rigel,Managing Membmr Ella Mae Dillard
The HUD-I Settlement Statement ich I have prepared is a true and accurate account of this transaction. I have ca�ised or will cause the f4nds to be disbursed in
accordance with this statrt. Date, May 24,2012
Settlement Agent: - I
Rod S
n this or any other
WARNING: It is a crime to knowingly m e fal3c stateme ts nited States o s ilarform.Penalties upon conviction can include a fine or
ode Srctio
imprisonment. For details see:Title 18 U.S.C n 1001 and Section 1010.
HUD-1 May 2007 OMS No.2502-0265
May 17,2012 1:01 PM RESPA handbook 4305.2
V ATLANTIC BEACH BUILDING DIEPT.
DEMOLITION PROPERTY OWNER
RELEASE FORM
Date:
To Whom It May Concern:
I /We the current property owners of: Lot 7-z5 2-j f--
%.f �5
Block a
3-s I
Legal 5e—sc—rption of�Property
A KA c 4 f�AA
3 �- 1-�i- 3,ZZ-3 3 have contracted with to have
(Address of Propert
'—Z�VU%A
kt,uinpany Name) !2���.to remove the
taingle Family,Duplex,Commer—cia-1,eitc–�—
Prior to the construction of L'Cwf�. .5t(Ir-Y
As a condition of issuing the permit we agree to the following:
1- All utilities are to be located and clearly marked.
2. Once house is removed, lot is to be graded and leveled.
3. All construction debris is to be removed from the property.
4. Affected area is to have grass or seed in place.
5. Erosion control devices will be put in place and will remain in place until grass I
has covered affected area or new structure is completed and landscaping is
place. in
fa
Signature 61)0
THIS SPACE FOR RECORDER'S USE ONLY
Signed:
Before me this Date:
0 in the Coun of uval,State
Of Florida,has personally app
- ----- tary Public at Large,State of Flori a,County of Duval,
SHIRLEYL RAHAM commission expires:
G
rsonally Known:
COMMISSION#OD 95776
MYC duced Identification: —M
EXPIRES:February 14,2014
';��"0 V- Bonded Thru Notary Public Underwriters
CRY Of Atlantic Beach
Building DOPartrnent APPLICAPON NUMBER
A
,//V P
-PL
800 Seminole Road 4N (To be assigrW by the Buildlng D"fteni.)
Atlantic Beach, Florida 32233.544 4 W"Z2
Phone(904)247-W26 - Fax(9041)21�-
E-mail: building-dePt@coab.us
City vmb-sita- hft'l& EDante routed:
%W-eoab.us
APPLICATION REVIEW AN-D TRACKING FORM
PrOPOrty Address: P �O De rbnent riamw
Buildin Ul Yes No
Applicant: Planning&Zoning
Project: ministrator
ublic Wo
Public Safety
Fire Services
Other Agency Review or Permit Required RevI or Receipt
Florida Dept.of Environmental Protection of Permit Verified B Daft
Florida Dept.of Transportation
St Johns River Water Management District
Y Corps of Engineers
ivision of Hotels and Restaurants
Division of Alcoholic Beverages and
Other.
APP ICATION STATUS
Reviewing Department First Review: pproved. ElDenied.
(Circle one.) Comments:
/v,
BUILDING
PLANNING&ZONING
Reviewed by:
_=A! Date:
TREE ADMIN.
Second Review: [:]Approved as revised. E]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:—
Date:
FIRE SERVICES Third Review: []Approved as revised. E]Denied.
Comments:
IC
Reviewed by: Datei:
Reviud 07127110
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 JUN":
0:4 2012
JobAddress: ZEC-o', FL372_35 Permit Nu
Legal Description k125-24t.-I)�- �o\V�b�k 2 Parcel# 17,)2-1
S Floor Area of' Sq.Ft. _0'V_ ',&K3!;,14--zp-T Sq.1,t
Valuation of Work$ 9-5-0.OG _ProposedWork heated/cooled tV3(_ non-heated/co!oled
Class of Work(circle one): New Addition Alteration Repair M
ove 1;em�ofi�fion , pool/spa lindow/door
Use of exi�ting/proposed structure(�) (circle one): Commercial I-�,. i
�Res�idenlia
is afire in' s
If an existing structure fl, ykIer system installed? (Circle one�) e N/A
Florida Product Approval #
progFor multiple products use ct approval or
Describe in detail the type of work to be performed: 3 6 3�- o,-�s-:_0
Propert
y Owner Information:
Name: f0air-s-t, Address: 7,yo,� (-),i "Ief.5 1,
city LZr Y<.-dAV.1 I/C State/ ip 3ZZ f7 P—hone qvk-07 -X7;17
%_Z
E-Mail or Fax# (Optional qb1Y— 353- 3377
Contractor Information:
CompanyName: 5�,Atc>r- Qualifying Agent: �kcA--_
\,\6 City 7�Ckrf-SOA\J'�k\-E- State Zip 22-zj-1
Address: 1'3(D
Office Phone 9 b4i --T.51 - Zsq 2 Job Site/Contact Number qC?�j-zzq--10Fr-3_Fax# 90q- 2 1 22- .9 10
State Certification/Registration# ylli�o_\I!S to 3 Z'_:�
Architect Name &Phone 4 —
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and 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 pe�jbrmed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or ahandonedfor a period ofsixk)months at any time after
work is commenced. I understand that separate permits must be securedfor Electrical-Work, Plumbing, Sikns, Wells, Pools, urnaces,Boilers,Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICK OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and or inances governing this
��Fwork will be complied with whether specified herein or not. The granting of a permit does not presuitnue to g1i uthomy ltviol te or cancel the
provisions ofany otherfederal,��te, or local la�Vl construction or the pe�formance of construction.
Signature of Owner
Signature of Contractor
Print Name �;rl,c
..........I........... .. ..................... Print Name
__j....................................... ........................................... ..............................
Sworrjto and ibe efore
Sworn to and subscribed before me
this of- this I W -
20 Day of 20 1'�_
Notary Ic M MISSION 4DO 957760 NISE
RTNA DE OU
P III :February 14,2014 "(MARTWA DENISE�UINN
My COMMISSYDN S E
OMM er
80 Notary Public Underwriters EIAM
d 1.26.10
EXPIRES July 25,J2016
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