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992 OCEAN BLVD - WINDOW / DOORS / FLOORS �ij jJ.. .�� ' _� CITY OF ATLANTIC BEACH --,,-, ? 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 .it ;011 >% INSPECTION PHONE LINE 247-5814 RESIDENTIAL -ALTERATION RESIDENTIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RES17-0214 Description: Demo/replace windows, interior doors, floors Estimated Value: 4000 Issue Date: 11/1/2017 Expiration Date: 4/30/2018 PROPERTY ADDRESS: Address: 992 OCEAN BLVD RE Number: 170240 0000 PROPERTY OWNER: Name: Michael Phillips- New Owner Address: GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: PHILLIPS BUILDERS LLC Address: 1250 SELVA MARINA CIR QA BARBARA CAROLINE PHILLIPS ATLANTIC BEACH, FL 32233 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. rTh:••:? • City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) v 800 Seminole Road ��5 C aI y - Atlantic Beach, Florida 32233-5445 —O' Phone(904)247-5826 • Fax(904) 247-5845 ' " aF3ic'' E-mail:K building-dept@coab.us Date routed: 1 of aoj)7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 96/1 oc eI )3 D- •-: 4. • ent review required Ye No \<€14)1, [ 11)C c ( c Building Applicant: M \ ' -■•. • oning Tree Administrator Project: Deam,7)(2e.#61_,Q. (�, J SJi -_(� Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept.of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: %proved. ❑Denied. ❑Not applicable (Circle one.) Comments: :Ui�e1 NO PLANNING &ZONING Reviewed by: Date: a7 7 TREE ADMIN. Second Review: Approved as revised. Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: El Approved as revised. Denied. F INot applicable Comments: I Reviewed by: Date: Revised 05/19/2017 Building Permit Application Updated 5/5/17 �YYl A g City of Atlantic Beach T5 ler OFFICE COPY 800 Seminole Road,Atlantic Beach, FL 32233 `' 91" Phone: (904) 247-5826 Fax: (904) 247-5845 9 � Job Address: Z s1 ' f1' V PeL Number: 1\�5 I��Q � Legal Description RE# Valuation of Work(Replacement Cost)$ 0019 . Heated ooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair i''ve 1-•:,: Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Com -rcial 'esidential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes GiD N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: RitC DGr- o LA) v4304.45, INT, 1)ocrS f=�azsa-s , • Florida Product Approval# for multiple products use product approval form Property Owner Information Name: Ito i c mitt. c)144 LA,PI Address: 91 2- OG I✓A N at City Ps. , State t Zip 3 Z,2 3 Phone E-Mail P iwPJQb, teLts'L CO4 CAST• 1(T Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: PK LLLPS ( A41 V3 LLC Qualifying Agent: Address o Q 2- ac,64sQ U(.� City A (3 , State fi=( , Zip 3i,L 3 ? Office Phone q . 3 44- L 9 a aL Job Site/Contact Number State Certification/Registration# r 12 2_5-7 3 f4 E-Mail 0414,440)1v;id er.S CanAeie 1r: �►<S' Architect Name&Phone# Engineer's Name&Phone# Workers Compensation -t.4 T" Exempt surer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to e work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO R NOTICE OF COMMENCEMENT. //11;G (Signature of Ow r or Agent) y (Signature of Cont tor) (including contractor) igned and sworn to(or affirmed) before me this at(Pday of Signed and sworn to(or affirmed)before me thisillay of OCiv\X , dOr) , by ,A ` Cha e ' ' OS QCi o-t , ;11 , by . �e p - TAPILGRACE MACKEY --- GRACE MACKEY =�:i.VV.= MY COMMISSION#GGA' lirSi Signature GG 042989 ) ,•, 2T.2020 I g �vt'eis ": 1 •nature of Nor EXPIRES:October / i? MY COMMISSION 2020 • ~` EXPIRES'.October 27, —`� Notary Public Underwriters '* 'nP1 Public Underwriters .o o?= Bonded Thru '�'��`! 'Nu Notary .'E `ops Bonded_ ?<I-Personally Known OR [personally Known OR [ ]Produced Identification [ ]Produced Identification Type of Identification: Type of Identification: • OFFICE COPY • PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA Project Name: Pt Z Permit # Re-St?-0, / Project Address: CE-EPA�"!V g t v(2 A �Q► :\ • 3 Z�?J 3 As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide •roduct approval may be obtained at:www.floridabuildin•.or,.. Category/Subcategory - - — Product Description Limitation of Use State# Local# A.EXTERIOR DOORS 1. Swinging I ' { 2. Sliding 3. Sectional 4.Roll up 5.Automatic 6. Other B..WINDOWS - _ 4TA. 1416. .; ) 1. Single hung 2.Horizontal slider 3. Casement 4.Double hung 5.Fixed 6.Awning 7.Pass-through 8. Projected r i 9.Mullion 10.Wind breaker 11.Dual action 12. Other Category/Subcategory Manufacturer Product Limitation -of tion - Description of Use . State# C.PANEL WALL i Local# 1. Siding i 2. Soffits i 3.EFS —. _----- �. 4. Storefronts 5.Curtain walls 6. Wall louvers 7.Glass block ,- - 8.Membrane 9. Greenhouse 10. Synthetic stucco 11. Other D.ROOFING PRODUCTS ......., 1.Asphalt shingles 2.Underlayments 3.Roofing fasteners. .. ....... .... .. . 4.Nonstructural metal roof 5.Built-up roofing 6.Modified bitumen 7. Single ply roofing ----.-__.. ___._._..W...---_ 8.Roofing tiles _ .. 9.Roofing insulation 10.Waterproofing 11. Wood shingles/shakes 12.Roofing slate ' 13.Liquid applied roofing f 14. Cement-adhesive coats 15.Roof tile adhesive - _ .16. Spray applied polyurethane roof 17. Other Category/Subcategory Manufacturer Product Description imitation of Use State# Local# E SHUTTERS 1.Accordion 2.Bahama 3. Storm panels 4. Colonial 5.Roll-up 6.Equipment I 7. Other F.STRUCTURAL >- _- --.._---___ - -- COMPONENTS 1. Wood connector/anchor 2.Truss plates f 3.Engineered lumber 4.RailingC o ers- eezers 6. Concrete admixtures i 7.Material 11 8.Insulation forms ---- 9.Plastics 10.Deck-roof I I 1 11. Wall I 12. Sheds 13. Other I G. SKYLIGHTS ( j 1. Skylight 2. Other s! Category/Subcategory ---T - Manufacturer Product Description ,Limitation of Use State# Local# H.NEW EXTERIOR '_ ENVELOPE PRODUCTS 1. I 2. In addition to completing the above list of manufacturers, product description and State approval number for the products used on thisro'ect the Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and instructions along with this Product Approval Sheet. n I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones listed in this document must be approved by the Building Official. (Contractor Name) (Print Name) (Si:. afore) ' t/ Company Name: V �� PI L l . ' Mailing Address: 9/a C o f\l '1 j( r City: 70 r L7, F t . State: rk , Zip Code: 3z 5 Telephone Number: ( ) Q ? / Fax Number: ( ) Cell Phone Number: ( ) ` d Jar ti ,,��— -.- E-mail Address:Pt-�t( / �J`3�/' �s(�C�!� ry�—' j-1 --- mail °t-.�' `� CITY OF ATLANTIC BEACH OFFICE COPY sl 10 WNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. 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 REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. qAl—. OC- N (?IUD, ARPi , 3-0 -2Z 964 349 - z/9 7 ADDRESS PHONE NUMBER MA U 1.- 4UivPs PRINT M i pificatt J O 2 a Li SI ATURE DATE Before me this?h'Thriday of c�C W ,r 20]1 in the county of Duval,State of lorida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of 1�' 11.,M;SO\ ,County of OW cit l .1". - eersonally Known :St1....&:c. GRACE MACKEY [b]Produced(dent cation- : ,a, •k_ MY COMMISSION#GG 042989 ;.:..L 4 EXPIRES:October 27,2020 M I %of fAss Bonded Thru Notary Public Underwriters Notary Signature: f VId F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009 .. 1 A. U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT B. TYPE OF LOAN SETTLEMENT STATEMENT Richard T. Morehead Title& Escrow, Inc. I. I I FHA 2. FMHA 3. n CONV.LNINS. 444 Third Street 1 Neptune Beach,Florida 32266 4. n VA s. I CONV.INS. 904-247-5147 fax:904-247-6087 6.File Number: 7.Loan Number 17B2253 8.Mortgage Ins.Case No.: C.NOTE: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked (poc)were paid outside the closing. They are shown here for informational purposes and are not included in the totals. Michael D.Phillips and Barbara C.Phillips D.Borrower: 992 Ocean Boulevard Atlantic Beach,Florida 32233 Diana Berry Drossel,as Trustee of the Diana Berry Drossel Revocable Trust UAD 10/19/09 and Diana Berry Drossel,as Trustee of the OFFICE COPY E. Seller: 2900 Magnolia Road Craig Drossel Residuary Trust FBO Orange Park,Florida 32065 Diana Berry Drossel 2900 Magnolia Road Orange Park,Florida 32065 Diana Berry Drossel,as Trustee of The Diana Berry Drossel Revocable Trust UAD 10/19/09 F.Lender: 2900 Magnolia Road Orange Park,Florida 32065 992 Ocean Boulevard G.Property: Atlantic Beach,Duval County,Florida 32233 • Duval County,Florida H.Settlement Agent: Richard T.Morehead Title&Escrow,Inc. Place of Settlement: 444 Third Street,Neptune Beach,Florida 32266 Duval County I. Settlement Date: August 15,2017 J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100.Gross Amount Due From Borrower: 400.Gross Amount Due To Seller: 101. Contract Sales Price 750,000.00 401. Contract Sales Price 750,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower(line 1400) 2,546.50 403. Adjustments for Items Paid by Seller in Advance: Adjustments for Items Paid by Seller in Advance: 106. City/Town Taxes 406. City/Town Taxes 107. County/Parish Taxes 407. County/Parish Taxes 108. Assessments 408. Assessments 120. Gross Amount Due from Borrower: 752,546.50 420. Gross Amount Due to Seller: 750,000.00 200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seller: 201. Deposit/Earnest Money 501. Excess Deposit(see instructions) 202. Principal Amount of New Loan 450,000.00 502. Settlement Charges to Seller(Line 1400) 9,287.50 203. Existing Loan(s) 503. Existing Loan(s) 204. 504. Payoff of First Mortgage to Nationstar 155,518.50 Mortgage 205. 505. Payoff of Second Mortgage 206. 506. Purchase Money Mortgage 450,000.00 Adjustments for Items Unpaid by Seller: Adjustments for Items Unpaid by Seller: 210. City/Town Taxes 510. City/Town Taxes 211 County/Parish Taxes Jan 1,2017 thru Aug 7 384.46 511. County/Parish Taxes Jan 1,2017 thru Aug 7384.46 14,2017 14,2017 ' 212. Assessments 512. Assessments 220. Total Paid by/for Borrower: 457,384.46 520. Total Reductions in Amount Due Seller: 622,190.46 300. Cash at Settlement from/to Borrower: 600. Cash at Settlement to/from Seller: 301. Gross Amount due from Borrower(line 120) 752,546.50 601. Gross Amount due to Seller(line 420) 750,000.00 s 302. Less Amount Paid by/for Borrower(line 220) 457,384.46 602. 520 Reductions Amount due Seller(line 622,190.46 303. Cash From Borrower: $295,162.04 603. Cash To Seller: $127,809.54 HUD-1 May 2007 August 14, 2017 3:41 PM r 1 Settlement Date:August 15,2017 File Number: 17B2253 L. Settlement Charges 700. Total Sales/Broker's Commission: Paid from Paid from Based on Price $750,000.00 Borrower's Seller's Division of Commission as follows OFFICE C O P Funds at Funds at 701. Settlement Settlement 702. 703. Commission Paid at Settlement 800. Items Payable in Connection with Loan: 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee 900. Items Required by Lender to be Paid in Advance: 901. Daily interest charge @ 61.6438 /day 902. Mortgage Insurance Premium 903. Hazard Insurance Premium 904. Flood Insurance Premium 1000. Reserves Deposited with Lender: 1001. Hazard Insurance 1002. Mortgage Insurance 1003. City Property Taxes 1004. County Property Taxes 1005. Annual Assessments 1100. Title Charges: 1101. Settlement or Closing Fee to Richard T.Morehead Title&Escrow,Inc.(poc$350.00 by Borrower) 1102. Abstract or Title Search to Old Republic National Title Insurance Company 125.00 1103. Title Examination 1104. Title Insurance Binder 1105. Document Preparation 1106. Notary Fees 1107. Attorney Fees (includes above item numbers: 1108. Title Insurance to Richard T.Morehead Title&Escrow,Inc. 3,825.00 (includes above item numbers: 1109. Lender's Coverage 0.00 1110. Owner's Coverage 750,000.00 Risk Rate $3,825.00 Premium: 1200. Government Recording and Transfer Charges: 1201. Recording Fees: Deed 18.50 Mortgage 44.00 Releases 0.00 62.50 1202. City/County Tax/Stamps: Deed 0.00 Mortgage 0.00 1203. State Tax/Stamps: Deed 5,250.00 Mortgage 1,575.00 1,575.00 5,250.00 1204. Intangible Tax to Clerk of the Circuit Court 900.00 1205. Recording Affidavits and D/C to Clerk of the Circuit Court 64.00 1206. E-Filing Fees to Old Republic National Title Insurance Company 9.00 13.50 1300. Additional Settlement Charges: 1301. Survey 1302. Pest Inspection 1303. Beach Lien Letter to City of Atlantic Beach 10.00 1400. Total Settlement Charges(Enter on line 103,Section J and line 502,Section K) $2,546.50 $9,287.50 I have carefully reviewed the HUD-1 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 transaction. I further certify that I have received a copy of HUD-1 Settlement Statement. Borrower: y !2 Seller: Diana Berry Drossel,as Trustee of the Diana Berry Drossel ichael I.Phillips Revocable Trust UAD 10/19/09 tta---- J Trig_ Borrower: / �%� Seller: Diana Berry Drossel,as Trustee t Cralg rosQesiduary .ara C.Phillips Trust FBO Diana Berry Drossel The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with the instructions of 's s hereto. Settlement Agent: _ L I Date: August 15,2017 Be • urphy 1 WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form.Penalties upon conviction can,include a fine and imprisonment. For details see Title 18 U.S.Code Section 1001 and Section 1010. HUD-1 May 2007 August 14, 2017 3:41 PM