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1496 Camelia Street WELL-SEPTIC CONVERSION App 05.12.2011 ! ' Xi ' stl :-• .- 5 „r City of Atlantic Beach • 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax (904)247-5805 • http://www.coab.us APPLICATION FOR ASSISTANCE WITH CONVERSION FROM WELL AND SEPTIC TANK TO CITY WATER AND SEWER FY 2011-20-12 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM The information requested on this form is required in order to determine your eligibility to participate in this program. (These funds may be available to homeowners whose incomes are within low and moderate levels based upon family size and as established by HUD Section 8 Income Limits.) Please answer all questions, and provide copies of all required documents. (Your information is considered confidential.) Funds for this program are available only to owner-occupied homes. In the case of a duplex or two-family dwelling, the property owner must live full-time in one of the two units as documented by a valid homestead exemption.) Grant funds are limited, and applicants are selected based upon most urgent and serious need and availability of funds. DATE: _ _./1L. 1. Homeowner Name(s): C k Ct r k a- 6 f eli) ce C re., C 2. Address of Home: / ` 6 C a /n e i / /o, S i 3. Telephone Number: ? / _02 y7.3 V9-3 (day) � 1. (night) 4. Is the person completing this application the Head of Household? yes ❑ no i -female ❑ male 5. How many family members live in this house? f et -F i`m e f te/(v,`L 4',Y 6. Are there people living in this house with disabilities or special needs? yes ❑ no If yes, please explain C \t'irlff otSfeidol Ate di`sal/PI Chales '/".,in lz/ t?Jtiei,-4 ,t314c,il/1ar orri ,`c Cor` C,t)#41-e (-1 _ 7. umber and age of persons living in the household in addition to Head of Household. Ages 0—5 years old Male 3 Female Ages 6—17 years old Male Female Ages 18—39 years old Male Female Ages 40—64 years old Male S.eR Female Ages 65 and older Male Female 8. Water supply is provided by: ❑City Waterrivate Well Other 9. Does septic system work properly? es ❑No If no,please explain. Page 1 of 3 4 • 10. Does your plumbing work properly? Yes ❑No If no,please explain. 11. Is there hot and cold running water in your house? 'us ❑ No 12. Do you have a complete kitchen with running water,a refrigerator and cookin: facilities? y e S 13. How many persons are in your family and living at this address? - .`+_0.16: •I W 14. Federal regulations require that we keep track of certain demographic information and the type of households being served. Please check the appropriate box below. dWhite,Not Hispanic ❑ African-American,Not Hispanic ❑ American Indian or Native Alaskan ❑ Hispanic ❑ Asian or Pacific Islander ❑ Female Head of Household ❑ Other 15. What is the total annual income(before taxes)of your household? to g LI 0 0 16. Are you on a fixed income such as Social Security,(rSSI or retirement? Yes ❑No 17. What are your sources of inc e? Ci jk�i1A.Q ) 1. $' *4° 5c7i �? ('t I vA -4r' I i' 18. Do you own this home? Yes ❑ No � ; ' o 0 tN S` r If you ownyour home, pleaseprovide a copyof your deed and a recent water or electric bill which shows that you live at this address. If you rent your home,please provide a copy of the lease. Si nature of Owner �� g Date If you have any questions about this application or need any assistance preparing the application, please contact the City of Atlantic Beach at (904) 247-5817. The following Income Verification Form must also be completed and mailed or delivered to: Community Development Department City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233 Please provide the time of day and day of the week (Monday through Friday) when it would be most convenient to make arrangements for a City Inspector to meet with you, and the phone number where you wish to be called. t,„, �`i r e, o� L —3y t� Page 2 of 3 u`' * CITY OF ATLANTIC BEACH .,,, 1 . ,) PUBLIC UTILITIES ' _fr: 1200 Sandpiper Lane ATLANTIC BEACH,FL 32233 -,___,°.219r" (904)270-2535 or(904)247-5874 NEW WATER/SEWER TAP REQUEST Date: 2/15/12_ Project Address: 1496 Camelia St. No. of Units: 1 Commercial Residential X _Multi-Family New Water Tap(s) &Meter(s) 1 Meter Size(s) 3/4" New Irrigation Meter Upgrade Existing Meter from to (size) New Connection to City Sewer 1 Name: Charles and Brenda Cregar Applicant Address: 1496 Camelia St. City: Atlantic Beach State: FL Zip: 32233 Phone Number: 247-3443 Cell Number: Email Address Fax: Signature: (Applicant) CITY STAFF USE ONLY Application# Water System Development Charge $_ 1,140 _ Sewer System Development Charge $ 4,050 Water Meter Only $ Water Meter Tap $ 800 (notes) Sewer Tap $ Cross Connection $ 50 Other $ 2,600 TOTAL $ 8,640 APPROVED: Donna Kaluzniak (Utility Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED 1 INCOME VERIFICATION FORM PART I. (To be filled out by the person (employee) completing this application.) Applicant/ Employee name: C Address: ) . /6/ y' G�n� o / 7 Z 1 .�' � Social Security Number: ,2 G 7 —73 — ?L.? � 5oV 7 pr y I hereby authorize release of my income information to the City of Atlantic Beach for the purpose of applying for participation in the septic to sewer conversion funding assistance Program, which is funded by a Community Development Block Grant. ignature of Owner Date PART II. (To be filled out by employer, Social Security Administration or HRS.) Please provide the following information and return to: Community Development Department City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233 Applicant /Employees Name: Gross Monthly Income: $ r �� Q Is employment: n permanent part-time temporary Employer Name: Address: Telephone: N1 ./1/2 .6„/Itino4) e and title of person providing this formation. ate Page 3 of 3 Property Appraiser - Property Details Page 1 of 2 CREGAR CHARLES 3 Primary Site Address Official Record Book/Page Tile# 1496 CAMELIA ST 1496 CAMELIA ST 09613-00501 9418 ATLANTIC BEACH, FL 32233-1849 Atlantic Beach FL 32233 CREGAR BRENDA E 1496 CAMELIA ST Property Detail Value Summary RE# 171078-0100 2010 Certified 2011 In Proaress Tax District USD3 Value Method CAMA CAMA Property Us@ 0100 SINGLE FAMILY Total Building Value $94,548.00 $75,766.00 #of Buildings 1 Extra Feature Value $1,814.00 $938.00 18-34 38-2S-29E Land Value(Market) $33,375.00 $33,375.00 Legal Desc. SEC H ATLANTIC BEACH )and Value(Aaric.l $0.00 $0.00 Subdivision 03119 ATLANTIC BEACH SEC H Just(Market)Value $129,737.00 $110,079.00 The sale of this property may result in higher property taxes.For more information go Assessed Value $74,657.00 $75,385.00 to Save Our Homes and our Property Tax Estimator.Property values,exemptions and Cap Diff/Portability Amt $55,080.00/$0.00 $34,694.00/$0.00 other information listed as'In Progress'are subject to change.These numbers are part of the 2011 working tax roll and will not be certified until October.Learn how the &emotions $49,657.00 See below Property Aooraiser's Office values property. Taxable Value $25,000.00 See below Taxable Values and Exemptions—In Progress If there are no exemptions applicable to a taxing authority,the • ..e Value is .•same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value �&VVMD/FIND T.xable Value School Taxable Value Assessed Value $75,385.00 ssed Value $75,385.00 Assessed Value $75,385.00 Homestead Exemption(HX) -$25,000. Homestead Exemption(HX) -$25,000.00 Homestead Exemption(HX) -$25,000.00 Amend 1 Homestead(I-1B) -$25,000. Amend 1 Homestead(HB) -$25,000.00 Taxable Value $50,385.00 Taxable Value $25,385.0 Taxable Value $25,385.00 Sales History Book/Page Sale Date Sale Price (Peed Instrument Type Code Oualified/Unaualified Vacant/Improved 09613-00501 4/28/2000 $55,000.00 I WD-Warranty Deed Unqualified Improved 07774-00612 2/7/1994 $100.00 AG-Agreement for Deed Unqualified Improved 06686-02349 4/10/1989 $55,500.00 WD-Warranty Deed Unqualified Improved 06383-00730 8/11/1987 $49,100.00 WD-Warranty Deed Unqualified Improved Land&Legal Land Lesal LN Code I Use Description I 2oninq I Front Depth Category Land Units I Land Value I LN Legal Description 1 0100 I RES LD 3-7 UNITS PER AC I ARS-2 150.00 102.00 I Common 50.00 I $33,375.00 I 1 18-34 38-2S-29E 2 SEC H ATLANTIC BEACH 3 LOT 1 BLK 248 Buildings Building 1 Building 1 Site Address Element Code Detail 1496 CAMELIA ST 1-4-1 Atlantic Beach FL 32233 Exterior Wall 16 16 Tile/Frame Stucco Roofing Structure 3 3 Gable or Hip I Building Type 0103 SFR SPLIT-LEVEL SOH Roofing Cover 3 3 Asph/Comp Shingle BAS UGR Year Built 1987 Interior Wall 5 5 Drywall r FuaBAS Int Flooring 11 11Ceramic Clay Tile IIns I Gross Area Heated Area Int Flooring 14 14 Carpet I Finished upper story 1 496 496 Heating Fuel 4 4 Electric ,. , -,...1 Base Area 496 496 Heating Type 14 4 Forced-Ducted Base Area 1324 324 Air Conditioning 13 3 Central Unfinished Garage 1324 0 Finished Open Porch 18 0 Element I Code I Finished Open Porch 12 0 I Stories 2.000 I Total 1660 1316 Bedrooms 2.000 http://apps.coj.net/pao_propertySearch/Basic/Detail.aspx?RE=171 ... 9/9/2011 Property Appraiser - Property Details Page 2 of 2 Baths 1.500 Rooms/Units 1.000 http://apps.coj.net/pao_propertySearch/Basic/Detail.aspx?RE=1 71 ... 9/9/2011 TT ;o Z abed H3'! S DIINY'IIV )NVB: VIAOHOYM ZT'0$ sear( stgl pied lsazalul ZO'0$ po?sad luawalels stgl pied lsazalul Zo'0$ poTaad luawalels stgl pauzea lsazaluI 88'S'B$ aoueTeq lsazalut abezany % 50'0 pauzea pTaTA abeluaozad Tenuuy Z£ potzad luawalels sTgl sAep ;o zagwnN Isazalul OT'4SZ'ZS TelOI Z o0OOIO0OSZt000 TTOZ/TE/SO HOf1O2IHI TTOZ/oE/DO NOXd ISaaaINI zo'o TE/s ^ laOdd SZSOTT 0E09EOTEOE 'QI 'OJ LZVZZ65o6TTTOZ !V�/` flk-D JHS JOSXX EOE AZlI1SFi= SO =MUD OHIyw0Inv 00'065 5Z/5 888T0065L000000 LE89s•..:. 6Z/5 LE89t6650000E 000000000000000 N £Z/5 LE8966650000E 000000000000000 OZ/S LEB9I'66S0000£ disrailoimmidiert 000000000000000 LT/S E6T9ZE'9T000E 000000000000000 LT/5 00689Tf'STT00000 04 41111111111111111111111111.111.. Odd E05011 0£09EOTE0£ 'al 'OJ TZOT59t6TTTTOZt 'Ill) ' JaS OOSXX 101%1/1 SA IIOa2I0 OHIvwOIOY 00'161 £0/S I uotldTaosac lunowy ales sltpazp zaglO pue sltsodaa TZ'6ZEt TE/S aoueTeq 6utsoTO - ST�'89t''T eaa; aotnzas pue BTeMezpglTM zaglo 7� _. s)oag3 palewolny sxosto + ZO'0 pied lsazalul sltpazo zaglo pue sltsodso LE'LTS$ 0£/t aoueTeq 6utuadO Azewwns lun000y INDSMO L SaZ2IYHO tIO 1HIOMXO a YONWHS :(s)zaumo lun000y OETTT800T000T :zagwnu lun000y 6utxues JTsseT3 uMOZJ TTOZ/TE/s nagl TTOz/0E/6 E00 luawalelS luawaaeTdag IdaxadYS T 0 OE 4£O 0£TTTBOOTOOOT ZO luawalels peleptiosuoO V 1111 Consolidated Statement 08 1000100811130 034 30 0 1 SAFEKEPT Replacement Statement 003 4/01/2011 thru 4/29/2011 Premium Savings Account number: 3000059946837 Account owner(s): BRENDA E CREGAR CHARLES J CREGAR JR Account Summary 101111111111111111111111111111111/11.1111111. 0111111111111/111111111.1111.11111.111111. Interest paid 0.10 + 411111111.111111111111.11111111111111111.11111111. Deposits and Other Credits Date Amount Description 'A 01%M:07160312 A��(�/�/r^' 4/01 1,064.00 AUTOMATED CREDIT US TREASURY 220 XXVA BENEF L� 1 �47101T0887160312 CO. ID. 3111036002 110401 PPD d 4/29 0.10 INTEREST FROM 04/01/2011 THROUGH 04/29/2011 000425000600001 4/29 1,064.00 AUTOMATED CREDIT US TREASURY 220 XXVA BENEF 420111159578641 CO. ID. 3111036002 110429 PPD Total $2,128.10 Interest Number of days this statement period 29 Annual percentage yield earned 0.05 % Average interest balance $2,498.41 Interest earned this statement period $0.10 Interest paid this statement period $0.10 Interest paid this year $0.41 Interest Rate Summary Dates Rate % Dates Rate % Dates Rate % 4/01 - 4/29 0.05 Other Withdrawals and Service Fees Date Amount Description 4/12 1130 000000525260003 4/15000000000000000 1000100811130 4/15 .11.111111111111111111111 000006632952264 4/18 000000000000000 41111111111111111111111.. 1000100811130 4/19 000007238804128 Other Withdrawals and Service Fees continued on next page. WACHOVIA BANK , ATLANTIC BEACH page 8 of 12 9,,t3 z vbiti2n--) f7_,./z) .-'6"- /L4' 7--/-ve' L72-4v"4-1/., 0-ce-e) Cavz7 Gid �u� e -'Zno s: � �.:� .iter ;�Y..c, �/j/ G 2-/f/ //(�/ ✓' _-_ ate.,. ,, ., t.. r, J r L/7 LL yeztA4-).4,4 lif„/ if /db. , --?r-dr/ fej-,),/,/jr÷n„, - 0,4-"r1=iti r e- -j// — /' cAN ' .: . gyp' Imo` ti f't) 04/4) cam- --cteKe)k �, � ti) '(-o -e19-e -Lo* 7 -09 c' i ,- . 4-42,7 -(#r/d (1-0 D-VIIPPyz- ) `l er+oJ r,u l' �v /�� a' ,�`� fi J ,44.77, ' , --6 i *)7 --277 :2y :41-. .-brL,417/77-:-/P(444-p7-(7/.4 ri-r2" I r i i7xx44,77e- c-rf,„ „a_42/ev e7,2-7r7'rmf y n 747--/13 /57e v "zA.cf6,-ty frpr--,7 .77--ri27r,k( f,(74=12 (orivv rqi (4/,-/ wrt-e-2 /-4,-/(ra77 ,,� 5-17 c?'v /7 (-e-v "*) r„,„ cvri, 1e - C`(-7g a2:3 may 1(77(;7- 77-7A---Or ,77 / ,z -oma - .•\\.. . ti . t VIII Mr&Mrs Charles Cregar Jr _ i 4 1496 Camelia St. S Irilltilt 1.1 Atlantk Beach,FL 32233-1849 7. AL L 7. 3 O n ar e 4 , ada„id., Ain __t___00-) C4, Idcdk, 4141r‘i j6eruti e44AY1,1/;tvi (foy ait/ l .14 el, 33 3-2.=�33s 4 :i -1i II 1 ,II,J5I,1II,,,11„I,I„I,11,11 ii,J I1I,,,,ILI 4 'S , , CITY OF ATLANTIC BEACH 1 j 800 SEMINOLE ROAD ,._ ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 -0.1119 Application Number 12-00000236 Date 2/29/12 Property Address 1496 CAMELIA ST Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc SEPTIC TO SEWER CHARGES Owner Contractor CHARLES JESSE CREGAR OWNER 1496 CAMELIA STREET ATLANTIC BEACH FL 32233 Permit UTILITIES PERMIT Additional desc . Permit Fee . . . . 00 Plan Check Fee . . . 00 Issue Date . . . 2/29/12 Valuation . . . . 0 Expiration Date . 2/29/12 Other Fees SEWER SDC-SYSTEM DEV CHG 4050 . 00 WATER CONNECT/TAP & METER 800 . 00 WATER CROSS CONNECTION 50 . 00 WATER SDC-SYSTEM DEV CHG 1140 . 00 Fee summary Charged Paid Credited Due Permit Fee Total . 00 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 6040 . 00 6040 . 00 . 00 . 00 Grand Total 6040 . 00 6040 . 00 . 00 . 00 SOSO PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. • E CHECK REQUEST DATE 02/27/12 J 7 'S \iso VENDOR NO. 2948 \L") PAYEE City of Atlantic Beach 01;� ADDRESS 800 Seminole Road POSTED CITY Atlantic Beach STATE FL ZIP CODE 32233 ACCOUNT DESCRIPTION ACCOUNT NUMBER PROJECT NO. AMOUNT Sewer Other Contractual Services 110-5506-535.83-00 $6,040.00 Subtotal from Page 2 TOTAL $6,040.00 DESCRIPTION OF ITEM OR SERVICE: Fees for 1496 Camelia St., RE No. 171078-0100. (CDBG Septic to Sewer, includes connection to City water): Sewer impact fee= $4,050. Water impact fee = $1,140. Water to _&.meter= $800. Cross-connection fee= $50. SPECIAL INSTRUCTIONS: Please forward check to the Building Department for processing To expedite processing,please attach adequate documentation to support payment. ADDITIONAL APPROVALS ONLY REQUIRED WHEN CHECK REQUEST IS OVER$500 Z dC-4 )11° 2-/Z457/2 REQUESTED BY/DATE DEPT HEAD/DATE FINANCE DIR DATE Cly MGR/DATE O:\Finance\finance forms\Check& ACH Request Forms\[sewer impact fee check request.xls]Form Pg. 1 REORDER 905.5 .PATENT NO.5538290,5575508,5641183,5785353,5984364,603001 �lf.� j, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J"r ^ ATLANTIC BEACH.FLORIDA 32233-4445 ! CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH FL 32233 CITY OF ATLANTIC BEACH 800 SE MIINOl E ROAD NO. 104143 ,'1'I'LANTIC BEACH.FLORIDA 32233-4445 INVOICE INVOICE PURCHASE PROJECT ACCOUNT AMOUNT NUMBER DATE ORDER NO. NUMBER NUMBER RE#171078-0100 02/27/2012 110-5506-535.83-00 6,040.00 e<, ' %C6°4\‘‘ liD, GROSS RETAINAGE DISCOUNT NET $******6, 040 . 00 ****** $ 6,040.00 : %'„, CITY OF ATLANTIC BEACH � J� sSr800 SEMINOLE ROAD 1-4 j ATLANTIC BEACH, FLORIDA 32233-5445 7.5' "'' ZeTELEPHONE: (904)247-5800 FAX: (904) 247-5805 'V�J;31�`� www.coab.us June 27,2011 Charles and Brenda Cregar 1496 Camelia Street Atlantic Beach, FL 32233 Dear Owners; The purpose of this letter is to confirm that the City of Atlantic Beach has received your APPLICATION FOR ASSISTANCE WITH CONVERSION FROM WELL AND SEPTIC TANK TO CITY WATER AND SEWER. At the present time,the City is compiling the applications and information so that we can schedule these projects in the coming year. The funding should be available starting in October 2011. City staff will contact you to review your application to assure that you qualify for the financial assistance. Additionally, staff will provide you with direction and guidance so that you can obtain qualified help to perform the services. This will be explained to you in more detail within the next few months. In the meantime, if you any have questions,then you are welcome to contact me for further discussion. Thank you for expressing your interest in this program. Sincerely yours, David E. Thompson Asst. City Manager Prepared by and return to: Michael Griffm, CBO, CFM Interim Community Development Director/Building Official City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 WELL AND SEPTIC TO WATER/SEWER CONNECTION AGREEMENT CITY OF ATLANTIC BEACH, COUNTY OF DUVAL, STATE OF FLORIDA For the value of services received, which may include, abandonment and removal of existing septic tank, construction of the connection, the sewer tap fee and any impact fees related to connection of this property to centralized sewer and/or water services, the undersigned promises to pay, in accordance with the following terms of this Agreement, to the City of Atlantic Beach, hereinafter known as the Holder of this Agreement, which is a municipality of the State of Florida, located at 800 Seminole Road,Atlantic Beach, Florida 32233,the principal sum of: $ 8,640 being payable in lawful currency of the United States of America to the Holder at 800 Seminole Road, Atlantic Beach, Florida 32233, or at other such address as the Holder may specify by written notice to the Maker. Said sum shall bear no interest and shall be reduced in amount at the rate of one/fifth (1/5th) per year, on each year anniversary of this Connection Agreement, until reduced to a balance of zero (0) dollars at the end of five years. Any unforgiven balance shall become immediately due and payable in the event that the Maker transfers title of ownership or moves from the premises, which secures this Connection Agreement within the five (5) year period of time. In the event of the death of the Maker of this Agreement, said Agreement shall remain in effect and the principal sum that is due shall be reduced as described above only in the case that an immediate family member, with qualifying income eligibility,takes residence upon the premises,which secures this Agreement. In all other cases, and under any other circumstance, any unforgiven balance shall become immediately due and payable to the Holder. This Connection Agreement is to be construed and enforced in accordance with the laws of the State of Florida, and is secured by the real property, located at: 1496 Camelia Street,Atlantic Beach,FL 32233 Legal Description: 18-34 38-2S-29E SEC H Atlantic Beach, lot 1 blk 248 RE# 171078-0100 In the event that default is made in the payment of any of the sums as described and required herein, or in the performance of any agreements contained herein, then at the option of the Holder of this Connection Agreement,the remaining principal balance shall immediately become due to the Holder and collectable without notice, time being of the essence of this Connection Agreement contract, and said remaining principal balance shall bear interest at the highest rate allowed by applicable law, from such time until paid in full. Each Maker and Endorser waives presentment, protest, notice of protest and notice of dishonor and agrees to pay all costs, including reasonable attorney's fees, whether suit be brought or not, Connection Agreement-Page 1 of 2 if counsel shall be required after maturity of this Agreement, and if counsel shall be employed to collect said Agreement or to protect the security thereof. MAKERS: By: L ? , \ A.A A Date:' :i C les ar , Nu STATE OF FLORIDA COUNTY OF DUVAL Sworn and Subscribed before me this 2 ( day of E7n,k&�c ,20 fes,by CJI. -les `). 0 rec t ' who is personally known to me or produce FL rp C 6 4, 15o +3`-Fz6 0 as identification,and who did not take an oath. oyn•Qs, Notary Public State of Florida - / L- 1 ? Nancy E Bailey l Aty Commission EE 156116 Notary Publi tate of Florida at arge ?of Dor Expires 02/08/2016 �l if Az,,,, ,,,,---„,,,,z., , c",) Date ,2/ /, Brenda E Cregar STATE OF FLORIDA COUNTY OF DUVAL Sworn and Subscribed before me this 21 day of Fe h1Lc4cL. ,201 ,by 3re rk-,A E O re y C who is personally known to me or produced pi._DL c 42 D46 5-5 R 69 0 as identification, and who did not take an oath. et'ht._ Notary Public State of Florida 51 C A , .,_ ` , Nancy E Bailey � G Aly Commission EE 156116 )) � o Expires 02/08/2016 Notary Public, State of Florida at rge CITY OF ATLANTIC BEACH By: / Date: 4/-7/r a Jim Han on, City Manager / Connection Agreement-Page 2 of 2 Flint Construction Services ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1419 Linkside Drive Atlantic Beach, FL 32233 License# CGC1508003 & CCC1327402 # CAC 1816283 & CFC 1428077 Phone: 904.994.9626 Fax: 904.372.9011 Email: flintr@comcast.net February 13, 2012 1496 Camilla St. Atlantic Beach, FL 32233 Proposal We hereby propose to furnish all the materials and perform all the labor necessary for the completion of Scope of Work: • Pull permit and pass required inspections with the City of Atlantic Beach and the Health Department. • Labor,Materials and permits to disconnect,pump and abandon existing septic system. • Install new sewer service connecting house to new,city sewer tap. • Install new water service connecting house to new, city water meter. • Clean area of all related debris. Exclusions, but not limited to: • Sewer tap and meter fees paid by others • Any undisclosed conditions. • Any scope of work not discussed in this proposal. Total Bid: $2,850.00 This proposal was approved on this day of ,2012,by: (Signature) (Print Name) PROPOSAL lug CHRISTY FIRST COAST PLUMBING, INC. 1651 MAYPORT ROAD, ATLANTIC BEACH, FL 32233 247-4419 (Office); 249-4660 (Fax) CFC 1428444 PROPOSAL January 6, 2012 Charles and Brenda Cregar 1496 Camelia Street Atlantic Beach, FL 32233 247-3443 We will provide labor, material and permit to run approximately 75' of 4" Schedule 40 sewer line and tap into 6" city lateral. We will provide labor, material and permit to run approximately 25' of water service from meter located at southeast property line. Backhoe service will be used to facilitate the job. Ditches will be backfilled to grade. We will contact Central Locating to mark utilities. Please allow 3 to 5 days for locating once contract is signed. We will permit through the Duval County Health Department to abandon the septic tank; it will be pumped out and then inspected by Health Department officials and filled with clean fill after the inspection. DWV to be Schedule 40 PVC. Water piping to be CPVC. Water taps, sewer taps and any other city charges to be billed to and paid for by owner/builder. Patchwork and landscaping are not responsibility of plumber. Price does not include permit fee. A signed copy of this contract must be in our possession before the mentioned work commences. Freight charges on special order items to be paid for by owner/builder. Christy First Coast Plumbing, Inc. will warranty our craftsmanship (installation only of products and materials) for one year after completion of job. Products and material provided by Christy First Coast Plumbing, Inc. will carry the manufacturer's own warranty as applicable on defective products. The term "defective" shall not be construed as embracing damage that arises from misuse, negligence, Acts of God, normal wear and tear or failure to follow operating or cleaning instructions. Warranty work will be performed during regular working hours between 8:00 a.m. and 5:00 p.m., Monday through Friday, except on holidays. We propose to furnish material and labor in accordance with the above prices and specifications for the sum of Two Thousand Six Hundred Dollars ($2,600.00). This price is for work performed during normal business hours; no overtime included. DRAWS: $2,600.00 to be paid upon job completion. Draws to be paid when Invoice is presented. If not paid, a service charge of 1.5% of the unpaid balance per month (18% annum) plus all cost of collection, including attorney's fees incurred in the event of legal action will be assessed. No plumbing will be performed unless or until prior billings for this job have been paid. The above prices, specifications and conditions are satisfactory and are hereby accepted. You have authorization to perform the work as specified above. Signature Date Our proposal is subject to any industry standard price increases. ROTO— EXCAVATION PROPOSALRota-RooterServices Company 2028 W 21st St.,Jacksonville FL 32209 (ROOTER. Sera 1-800-SET-ROTO(438-7686) _ Y3 General(904)354-7321•CFC#044139 PLUDRAIAN SERVICE Ticket No. 's"BING & 1 .7- ). & Proposal Submitted To Work To Be Performed At Name ( tel"^ .. . 1."-..('-' (S/ u Name Street i yof ( da 4(ict5Street City A-- t-0---N\'..t, ).-3 c i. t�1 City State ZIP jv -3 State ZIP Telephone Number Telephone Number Roto-Rooter hereby proposes to furnish all the materials and to perform all the labor necessary for the completion of: (Include make and model of materials and necessary labor,and state anticipated contingencies that would materially alter the estimated completion date.) l-' QC4 -1) ,J E i r ._ 0t 5 u p L� '� l_' ' ^ -- I)P 0 c( J/ AO ( -C�. 1� 1 t ( I4- .,, 1 4 ,t.J•Q LA-, t/C-Q a /du Ce A•)-e c-A o,AA L) ak X -a 1-4-o, c, S•f=' a._ -1/2--(1 .-1-1,1).F.7 - -1l 11 Ci /lJ L • - .PVC /K.% ) 1 lit ati- TIi ,� - T` L� (4j +-At- . tit c a a.. /L) P (-[ W Ca +t G,'% t. f n.) C p rV{� • �i1✓ .==Y1 e 1/ I-0 i--A s 'L( k-e c, R) S 3 l / (. i t-eJc -4-ck (.4/tie 5I - 0.I7C i/c/i a oil / 13 a F f S (ii ‘_ ' I ie otu 7- , .1.t / p 1.i>�,A1 ,1 a t IC -� i ti r P9C) (AA 3 ti+ v p. vei4/(.1 --i- 1 , .v , 3,,,,,,,,,\ e 4" 1 S i f ttJ 7""�'; . 1--c1 (:)- t l(/ #.... G/U e i-'. j /"(l 0'Q 17 a (-A_ p� 1. Roto-Rooter will perform the work described above and supply all required materials for the sum of$ /U U" 67 0 Customer will make payment as follows: • %of the cost($ ) upon execution of this Agreement. • %of the cost($ ) upon the start of the work. • Balance of the cost upon completion of the job. 2. The approximate starting date is ,and the approximate substantial completion date is . Neither date is guaranteed. Unexpected conditions or problems could cause delays.A definite completion date is not of the essence. 3. Roto-Rooter guarantees that all materials will be as specified above and that all work will be completed according to standard practice and in a good,workmanlike manner. 4. Customer will provide all necessary easements and rights of way. Unless specifically stated otherwise above, (a) Roto-Rooter is not responsible for the removal of trees, sprinkler systems, underground and above ground fencing, rocks, sidewalks or driveways,or the repair of streets,sidewalks and the like, (b) Roto-Rooter will back fill and grade the excavated area to ground level and mound it to allow for settlement,and(c)Customer is responsible for all landscaping repairs or replacements Customer required following completion of the job.Roto-Rooter is not responsible for damage resulting from poor weather. Initials 5. If we cannot video or inspect the complete sewer line,we will give you a price to repair the section that we believe is causing the restriction.After we have uncovered that area,we will attempt to inspect the rest of the sewer line. If additional work needs to be done, or a complete sewer line replacement is required,we will propose a price to properly complete the work.The price for the additional work may be significantly higher than the original proposal. If you decide not to proceed with additional work we propose, you will permit us to complete our work and back fill any excavation. 6. If deviation from the work described above is required or customer requests additional or different work be performed,the parties will agree on an additional charge and sign a new written work description before Roto-Rooter begins the new work. 7. THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PROPOSAL WILL BE BINDING ON THE PARTIES. 8. This proposal may be withdrawn by Roto-Rooter if not accepted within days.This proposal constitutes the entire agreement between theparties,and no modifications will be valid unless in writing and signed by both parties. ,- I ;>- . Respectfully submitted: 6 �l)/'L' — t ( , -1 i ,fes / —i 1 / 11//a , Technician Signature .. — . Printed Name/Technician Number Date' ff ACCEPTANCE OF PROPOSAL I authorize tt- services indicated and agree to pay the amounts specified. I have read and agree to the terms, including the limits of 4Roto-Rooterst esponsibility specified in those'terms. Customer Signature Printed Name Date PF-031-EXCA(Rev.4/11) PIICTr111AFR r_P1DV ynsgmo3 esoivMee isfoo$-otoA eoSSE J9 ellivnozAosl.,.f2 fats W BSOSRoto-Rooter Services Company taaac-aet4 OTOWT30-008-t eoivioe eetAAotE 313•tsec-me(eoe)'Blanc Terms and Conditions The following terms apply to all work performed by Roto-R*r Services Company or its affiliates("us")for the customer indicated on the front of this proposal("you"). 1. Your Responsibilities. You agree to(a)remove any hazards,obstructions or dangerous conditions around the job site not caused by our work,(b)limit access to the job site so that people not working odour job are not exposed to dangerous conditions relating to our job,(c)place appropriate warnings to warn of dangerous conditions when we are not on the job site,and (d)provide us with adequate access. 2. Exceptions to Our Responsibilities, We are not responsible for(a)personal injury,property damage or other damage or loss to you or others arising out of our work,except to the extent caused by our negligence or failure to perform the work in accordance with the contract between us;(b)defective,damaged,or deteriorated lines,mold,lead piping,or other unexpected or undisclosed conditions,and the consequences of such conditions,including delays,broken fixtures or lines,and lodged equipment (if we encounter such a condition,we may stop work,and you will pay us a reasonable charge for the work performed);(c)the time required to complete our work with reasonable diligence;(d)unless explicitly stated in writing,any damage necessary to complete our work,including damage to landscaping,walls,painting,tile or concrete or similar items;(e)damage caused by the removal of any clean out,drain cover or cap;or(f)tasks we perform in accordance with your specific instructions. 3. Release and Hold Harmless, You release us from(and if you are a commercial customer,you will defend and indemnify us and hold us harmless against)all damages,claims,demands,settlements,judgments,liabilities,costs and expenses, including reasonable attorneys'fees,allegedly arising out of(a)breach of your responsibilities under paragraph 1,or(b)matters for which we disclaim responsibility under paragraph 2. 4. Our Guarantee If we provide a parts or equipment guarantee,as your exclusive remedy,we will give you the benefit we receive,if any,under the manufacturer's warranty.If we provide a service guarantee,it covers only drainage failure in the line serviced,and defective plumbing workmanship,during the guarantee term. As your exclusive remedy under our service guarantee, we will,at our option,either do the work again at no labor cost or refund your payment. Guarantees do not apply to problems arising out of main sewer line backup or improper,abnormal or unanticipated use or conditions. Except as explicitly stated in writing,we are not giving any guarantees or making any warranties. WE DISCLAIM ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. You may transfer a guarantee of plumbing repair or replacement to a person who purchases the property,but you may not transfer a drain cleaning or toilet auger guarantee. Your transferee must present the warranty claim to Roto-Rooter at the time we perform our work. 5. Limitation of Damages, Our liability to you for any claim arising out of our work on any job(other than a claim permitted by these terms for personal or bodily injury)will in no event exceed three times the amount you actually pay us for the work on that job. EXCEPT FOR A CLAIM PERMITTED BY THESE TERMS FOR PERSONAL OR BODILY INJURY OR PROPERTY DAMAGE,YOU WAIVE ANY RIGHT TO RECOVER INCIDENTAL DAMAGES,CONSEQUENTIAL DAMAGES,OR DELAY DAMAGES. 6. Payment Terms When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. If you fail to pay us any amount when due,we will charge you interest on the amount due at the rate of 15%per month(but not exceeding the highest rate legally permissible). You will reimburse us for the reasonable attorneys'fees we incur in all stages of collection. 7. General, These terms are part of our contractual agreement and will prevail over any inconsistent terms in any other agreement between us,including the terms of any purchase order,and may be modified only in a written instrument signed by both of us which specifically refers to the provisions to be modified. If any of these terms is held invalid or unenforceable,the remaining provisions will not be affected and will continue to apply. HOW TO RESOLVE A PROBLEM • Contact the manager at your Roto-Rooter office.Everything will be done to resolve your problem at the local level. • If your problem cannot be resolved locally, please contact Pat Swanson,Customer Service Coordinator, in our national headquarters: Roto-Rooter Services Company or email pswanson@rrsc.com 2500 Chemed Center 255 East Fifth Street Cincinnati,OH 45202 . ROTO- Date I / I i /l r� INVOICE NO. 46 /6 `- 6 6 /'� Customer a.(.Lt.iC-(.2 e> . i (&e . Technician �-��IBJ' £ ROOTER® � - - 3 PLUMBING & Address DRAIN SERVICE Roto-Rooter Services Company Remittance Address:5672 Collections Center Drive,Chicago-II 60693 1-800-GET ROTO ' T;ROTO(' 'r 'General(304)354-7321 Ext.21900 CFC#044139 Residential Site Inspection & Estimate (See Binding Terms On Reverse) Customer Qty/Location/Description Labor Parts Discount Total Accept Decline Sink—Faucet&Water Supplies ❑ Li L1 Sink—Drain Lines ❑ ❑ `_ 1 s Refrigerator—Ice Maker ❑ u Y Disposer CI Dishwasher(Water Hammer) ❑ ❑ Li Water Filter ❑ ..- _ v El Li ClII Cl —Faucet&Water Supplies L) .,`' �\ - / f oLavatory—Drain Lines ❑ �(1 ` / ❑ ❑ P Shower III — 1 ! /� C0 p ---141D—(-?' _ ❑ ❑ i Toilet—Operation ❑ 4 ,/ ❑ CIm Drainage ❑ (1.,--U1: ; Roto-Rooter Services Company P Terms and Conditions The following terms apply to all work performed by Roto-Rooter Services Company or its affiliates("us")for the customer indicated on the front of this form("you"). 1. Your Responsibilities. You agree to(a)remove any hazards,obstructions or dangerous conditions around the job site not caused by our work,(b)limit access to the job site so that people not working on our job are not exposed to dangerous conditions relating to our job,(c) place appropriate warnings to warn of dangerous conditions when we are not on the job site,and(d)provide us with adequate access. 2. Exceptions to Our Responsibilities. We are not responsible for(a)personal injury,property damage or other damage or loss to you or others arising out of our work,except to the extent caused by our negligence or failure to perform the work• accordance with the contract between us;(b)defective,damaged,or deteriorated lines,mold,lead piping,or other unexpected or undisclosed conditions,and the consequences of such conditions,including delays,broken fixtures or lines,and lodged equipment(if we encounter such a condition,we may stop work,and you will pay us a reasonable charge for the work performed);(c)the time required to complete our work with reasonable diligence;(d)unless explicitly stated in writing,any damage necessary to complete our work,including damage to landscaping,walls,painting,tile or concrete or similar items;(e)damage caused by the removal of any clean out,drain cover or cap;or(f)tasks we perform in accordance with your specific instructions. 3.Release and Hold Harmless. You release us from(and if you are a commercial customer,you will defend and indemnify us and hold us harmless against)all damages,claims,demands,settlements,judgments,liabilities,costs and expenses,including reasonable attorneys' fees, allegedly arising out of(a)breach of your responsibilities under paragraph 1,or(b)matters for which we disclaim responsibility under paragraph 2. 4. Our Guarantee. If we provide a parts or equipment guarantee,as your exclusive remedy,we will give you the benefit we receive,if any,under the manufacturer's warranty. If we provide a service guarantee,it covers only drainage failure in the line serviced,and defective plumbing workmanship,during the guarantee term. As your exclusive remedy under our service guarantee,we will,at our option,either do the work again at no labor cost or refund your payment.Guarantees do not apply to problems arising out of main sewer line backup or improper, abnormal or unanticipated use or conditions. Except as explicitly stated in writing,we are not giving any guarantees or making any warranties. WE DISCLAIM ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. You may transfer a guarantee of plumbing repair or replacement to a person who purchases the property,but you may not transfer a drain cleaning or toilet auger guarantee.Your transferee must present the warranty claim to Roto-Rooter at the time we perform our work.We do not guarantee that our site inspection will identify all existing or potential problems.Any damages or necessary repairs arising from plumbing problems, either identified or unidentified,are the sole responsibility of the customer. 5. Limitation of Damages.Our liability to you for any claim arising out of our work on any job(other than a claim permitted by these terms for personal or bodily injury)will in no event exceed three times the amount you actually pay us for the work on that job.EXCEPT FOR A CLAIM PERMITTED BY THESE TERMS FOR PERSONAL OR BODILY INJURY OR PROPERTY DAMAGE,YOU WAIVE ANY RIGHT TO RECOVER INCIDENTAL DAMAGES,CONSEQUENTIAL DAMAGES,OR DELAY DAMAGES. 6. Payment Terms.When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. If you fail to pay us any amount when due, we will charge you interest on the amount due at the rate of 1.5%per month(but not exceeding the highest rate legally permissible). You will reimburse us for the reasonable attorneys' fees we incur in all stages of collection. 7. General. These terms are part of our contractual agreement and will prevail over any inconsistent terms in any other agreement between us,including the terms of any purchase order,and may be modified only in a written instrument signed by both of us which specifically refers to the provisions to be modified. If any of these terms is held invalid or unenforceable,the remaining provisions will not be affected and will continue to apply. HOW TO RESOLVE A PROBLEM • Contact the manager at your Roto-Rooter office. Everything will be done to resolve your problem at the local level. • If your problem cannot be resolved locally,please contact Pat Swanson,Customer Service Coordinator,in our national headquarters: Pat Swanson or email pswanson@rrsc.com Roto-Rooter Services Company 2500 Chemed Center 255 East Fifth Street Cincinnati,OH 45202 ROTO- RICARDO GRANELA ROOTED`: Licensed Plumber PLUMBING a DRAIN SEUVICE 1-800-GET-ROTO Service (438-7686) (904)350-9111 Phone Roto-Rooter Services Company (904)354-9255 Fax 2028 West 21st Street �f / Jacksonville,FL 32209 1( www.rotorooter.com &q; f 0 ROTO (ROOTER® Date 1 f // /1(cZ- INVOICE NO. 1�p `. q Customer `' k_e l c S ' 1(.0(6'ie . Technician 1«--4.. E' PLUMBING & Address DRAIN SERVICE Roto-Rooter Su i vices Company Rc'(Sfttance Address:5672 Collections Center Drive,Chicago 1160693 1 -800-GET ROTO StrvicC 1-6e3-0E7-ROTO(438-7686)•General(904)354.7321 Ext.21900 CFC#044139 Residential Site Inspection & Estimate (See Binding Terms On Reverse) Customer Qty/Location/Description Labor Parts Discount Total Accept Decline Sink-Faucet&Water Supplies ❑ El CI Sink-Drain Lines ❑ Li ❑ z Refrigerator-Ice Maker ❑ / ❑ ❑ w Disposer ❑ !fit t 1 "9 ,.7 0 / ❑ ❑ 2 Dishwasher(Water Hammer) ❑ ❑ ❑ Water Filter ❑ l✓ ' tri 4,' c- / i 0_• ❑ Lay-Faucet&Water Supplies LI __ i `;" s • E Lavatory-Drain Lines ❑ (,1 , ❑ ❑ c Shower ❑ ...— 1-- ; // C1)3 = / I )-1-1 ❑ ❑ m Toilet-Operation ❑ • ❑ ❑ m Drainage ❑ — (1. ' ' c.f --.1--f r,...,) ,(,-C...--: (tel'(a i (.1 ' N e ❑ ❑ Faucets ❑ , . �� _ El ❑ Washer Drains ❑ -�- /O f ° ,,r_l - 0 t-'. ; _) , / . i _ -to ❑ J Washing Machine Hoses ❑ Qi 4-1.1-,,-, `7) '\ / ❑ ❑ Water Hammer Arrester ❑ ,-°,1 s' ''s ❑i Li Relief Valves Li j S::21-,1 l `.. --r 1.,c 0 J ' _.,V G, ❑ 2, Tankless(Water temperature) ❑ a-- ,, AJ s T' /( T. j =-` _. 4 ❑ ,o i Tank ❑ LP d C ❑ . Boiler Drain ❑ ❑ ❑ (3 Ball Valve/Shut-Offs ❑ —� 0/U lk a i rte ` L.�tt ce C'�-?/trf'f i' ❑ Water Supply&Piping �_:ri- ;{: ';r-I i , ; -��- ?-_0 P Water Piping ,C' -t-'A ( .., 2 tiny f2AJ i--i° LI L Shut-Off at Water Service [_'. 0L Drain Lines :-.i ---- 1 14-1c --- ` (I. CA—LI i i-' °( i.t C Te_ Li Pressure Reducing Valve ❑i ( t. p,..:-ti 1-1 ck 'f 0' ' L., Ca I Ir f . ❑ El Water or Sewage on Floor ❑ ; ,, S o Main Sewer Line ❑ 7--0--0 0 j / 2 r i '3 , ( cl,r.t.( 3 VA-' -v\- -- - -ii wHose Bib ❑ Pc.,(.1.,ri: Fite.) f— t rii ;-9() �''r'.�-U f ❑ Downspouts Li �� ❑ P Maintenance Products ❑ � !�a , )'-e r4' cit,0 --`1 t (� -. 1 `'"'F kl I—z=E N Clean and Treat ❑ 0P P dd . L_l ' Whole House Special ❑ / Li Other ❑ (J,4 `,mo .,1:1-7--) I . H r WORK ORDER AUTHORIZATION I authorize the services indicated and agree to pay the amounts specified. I have read and agree to the terms on the reverse side,including the limits on Roto-Rooter's responsibility specified in those terms. Total estimate reflects customer ;Signature) (Print Name) authorization of work as indicated above. ESTIMATE AND DESCRIPTION OF WORK TO BE PERFORMED(The approximate starting date is ,and the Tax not included in estimate. approximate completion date is .Neither date is guaranteed.Unexpected conditions or problems could cause delays. A definite completion date is not of the essence.) Labor $ Parts $ .� ,+.1 (/“...d...142 ,::)2 _ / :.1O 0 . Discount $ Product $ Other $ COMMENTS/ADJUSTMENTSICHANGES IN WORK: TOTAL $ ❑Cash 0 Check 0 Credit Card COMPLETION I acknowledge completion of the above described work which has been done to my complete satisfaction. Auth# (Signature) (Print Name) Control No. (Service Technician's Signature) (Print Service Technician's Name and Number) 46V 2,3 10 s)I_