1448 Camelia Street WELL-SEPTIC CONVERSION App 06.30.2011 %t1'yi
f• lei
'7.1-01319
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: •L , S 20 i i
1. Homeowner Name(s): C(4h A
2. Address of Home: 14-1- , CCA V1(1&L $4ve.e- ► X95-
3. Telephone Number: }ff-{- 113 —7?? 1(' (day) 5,. (night)
4. Is the person completing this application the Head of Household? E T"yes ❑ no ❑ female ❑ male
5. How many family members live in this house? VI Vve
6. Are there people living in this house with disabilities or special needs? ❑ yeso If yes, please
explain
7. Number and age of persons living in the household in addition to Head of Household.
Ages 0—5 years old Male Female
Ages 6— 17 years old Male Female
Ages 18—39 years old Male Female
Ages 40—64 years old Male Female
Ages 65 and older Male Female
8. Water supply is provided by: [ ity Water ❑ Private Well Other
9. Does septic system work properly? Yes ❑No If no,please explain.
Page 1 of 3
10. Does your plumbing work properly? ErYes ❑ No
If no,please explain.
11. Is there hot and cold running water in your house? EaYes ❑ No
12. Do you have a complete kitchen with running water,a refrigerator and cooking facilities? -e5
13. How many persons are in your family and living at this address? O
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.
[White,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? i {V1 ew(On/yd !tip L C900
16. Are you on a fixed income such as Social Security,SSI or retirement? ❑Yes ENo
17. What are your sources of income?
18. Do you own this home? ges ❑No
If you own your home, please provide a copy of 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.
f
/sr, C, /SO
Signatur o w er 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 w'th(you, and the phone
number where you
�� P wish to a called. / I _ fit.V1 I. ` K-('
OV C�` TOWAA 4J 74( 3 (1 �l N (HP0 /) 1 x'10`�� cA 6,41 s
Page 2 of 3
INCOME VERIFICATION FORM
PART I. (To be filled out by the person (employee) completing this application.)
Applicant/ Employee name:
Address:
Social Security Number:
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 Pro ram, which is funded by a Community Development Block Grant.
/4'71 6/ //
Signature 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:
Is employment: n permanent n part-time temporary
Employer Name:
Address: Telephone:
Name and title of person providing this information. Date
Page 3 of 3
C"
Doc#2011142823,OR BK 15642 Page 1919,
Number Pages:1
Recorded 06/29/2011 at 12:02 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
Donna Blakely DEED DOC ST $0.70
11724 Martha's Vineyard Court
Jacksonville,Florida 32225
Parcel ID No: 171079-0030
Quit Claim Deed
Made this Z day of June,2011 A.D.by Donna Blakely,a married woman;11724 Martha's Vineyard Court
Jacksonville,Florida 32225 hereinafter called the grantor,to Matthew Blakely and Donna Blakely as joint tenants with rights of
survivorship whose post office address is: 1448 Camelia Street,Atlantic Beach,Florida 32233 hereinafter called the grantee:
(Whenever used herein the term "grantor" and "grantee" include all the parties to this instrument and the heirs, legal
re-presentatives and assigns of individuals,and the successors and assigns of corporations)
Witnesseth, that the grantor,for and in consideration of the sum of$TEN AND NO/100 DOLLARS($10.00)and other
valuable considerations,receipt whereof is hereby acknowledged,does hereby remise,release,and quit claim unto the grantee forever,
all the right,title,interest,claim and demand which the said grantor has in and to,all that certain land situate in Duval County,Florida,
viz:
Lot 4,Block 248,SECTION"H"ATLANTIC BEACH,as per plat thereof,recorded in Plat Book 18,Page 34,of the
Public Records of Duval County,Florida.
The herein described property is not the Homestead of the Grantor.
This Deed represents a intra-familia conveyance of unencumbered property no consideration has been paid no
Documentary Stamp Tax has been affixed.
Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold, the same together 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 the said grantor,either in law or equity,to the
only proper use,b-nefit .•. .ehoof of the said grantee forever.
In'i Wh•reo ,• said grantor has signed and sealed these presents the day and year first above written.
Signed, # # d deliv•r,• i o r presence:
/",�. (Seal)
:/ - I 1 ,. . . . •, .46 II . I -
Copy 2 To Be Filed With Employee's Copy B To Be Filed With Employee's FEDERAL Tax Return
State,City,or Local Income Tax Return This Information is being furnished to the IRS
a Employee's SSN 1 Wages,tips,other compensation 2 Federal income tax withheld a Employee's SSN 1 Wages,tips,other compensation 2 Federal income tax withheld
589-74-1597 1004.16 589-74-1597 1004.16
d Control number 3 Social security wages 4 Social security tax withheld d Control number 3 Social security wages 4 Social security tax withheld
1004.16 62.26 1004.16 62.26
b Employer ID number 5 Medicare wages and tips 6 Medicare tax withheld b Employer ID number 5 Medicare wages and tips 6 Medicare tax withheld
59-3217850 1004.16 14.56 59-3217850 1004.16 14.56
c Employer's name,address,and ZIP code c Employer's name,address,and ZIP code
9Z009-FRANKCRUM 9,INC. 9Z009-FRANKCRUM 9,INC.
100 SOUTH MISSOURI AVE 100 SOUTH MISSOURI AVE
CLEARWATER FL 33756 CLEARWATER FL 33756
e Employee's name,address,and ZIP code e Employee's name,address,and ZIP code
MATTHEW G BLAKELY MATTHEW G BLAKELY
1448 CAMELIA ST 1448 CAMELIA ST
ATLANTIC BEACH FL 32233-1849 ATLANTIC BEACH FL 32233-1849
7 Social security tips 8 Allocated tips 9 Advance EEC payment 7 Social security tips 8 Allocated lips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans (10 Dependent care benefits 11 Nonqualified plans
12a 13 Stat.Emp. Ret.plan 3rd-party sick pay 12a 13 Stat.Emp. Ret.plan 3rd-party sick pay
12b 14 Other 12b 14 Other
12c 12c
12d 12d
FL I 1004.16 FL I 1004.16
15 State Employer's state I.D.It 16 State wanes,tips.etc. 17 State income tax 15 State Employer's state I.D.6 16 State wales.tips.etc. 17 State income tax
18 Local wages,tips,etc. 19 Local income tax 20 Locality name 18 Local wages,tips,etc. 19 Local income tax 20 Locality name
t
Form W-2 Wage&Tax Statement 2010 Dept.of the Treasury-IRS OMB No.1545-0008 Form W-2 Wage&Tax Statement 2010 Dept.of the Treasury-IRS OMB No.1545-0008
CO C For EMPLOYEE'S RECORDS This inlomiation is being furnished to the Internal Revenue
i� /�
Copy Service.If you are ction d to file a las return,a uegligence
• (See Notice to Employee on the back penalte.I other ranctwn may be imposes on you d Nis
',
of Copy B.) income is taxade and you ran to report it.
/ 4 J a Emplo ee's SSN 1 Wages,bps,other co nsation 2 Federal income tax withheld
J ) ( S 589 74 1597 1004.16
J
` C d Control number 3 Social security wages 4 Social security tax withheld
7 / 1004.16 62.26
b Employer ID number 5 Medicare wages and tips 6 Medicare tax withheld
— 59-3217850 1004.16 14.56
o Employer's name,address,and ZIP code
9Z009-FRANKCRUM 9,INC.
100 SOUTH MISSOURI AVE
CLEARWATER FL 33756
This area intentionally left blank
e Employee's name,address,and ZIP code
MATTHEW G BLAKELY
1448 CAMELIA ST
ATLANTIC BEACH FL 32233-1849
7 Social security tips 8 Allocated tips 9 Advance EIC payment
Page 1 of W-2 10 Dependent care benefits 11 Nonqualitied plans
12a 13 Stat.Emp. Ret.plan 3rd-party sick pay
12b
14 Other
12c
12d
FL I 1004.16
15 State Employer's state I.D.6 16 State waoes.tips.etc. 17 State income tax
18 Local wages,tips,etc. 19 Local income tax 20 Locality name
Form W-2 Wage&Tax Statement 2010 Dept.of the Treasury-IRS OMB No.1545-0008
r,� r
. ..„ s,
CITY OF ATLANTIC BEACH
x_ r PUBLIC UTILITIES
�� 1200 Sandpiper Lane
\. ,_- ATLANTIC BEACH,FL 32233
\O.2>>r (904)270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 11/02/2011 Project Address: 1448 Camelia Street,Atlantic Beach, FL
No. of Units: One Commercial Residential XXX Multi-Family
New Water Tap(s) &Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name: Matthew Blakely
Applicant Address: 1448 Camelia Street
City: Atlantic Beach State: FL Zip: 32233
Phone Number: 904 713-7716 Cell Number: (Mother: Diane Blakely) 904 645-0604
Email Address: Fax:
Signature: Submitted by: David E. Thompson
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $ �f�' +77 et--
Sewer System Development Charge $ 7/ 0,,5 e con ✓ /'J'Orn - CD.3 6-
Water Meter Only $
Water Meter Tap $ rG-
Sewer Tap $
Cross Connection01441113"1/41`3s
, $
Other Cj��i sty �i of&Ad rlL mt hj $ 2,gZ
1 (notes)
TOTAL $_6,-7
2
APPROVED: — - //-Z--?'/
(Utility Director or Auth a�ed Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
.. 1_,..\.„7....
, I:,
iI
• �;�� CITY OF ATLANTIC BEACH
ss\ 800 SEMINOLE ROAD
•
c-h c) ATLANTIC BEACH, FLORIDA 32233-5445
TELEPHONE: (904)247-5800
FAX: (904)247-5805
�J,31:)-e,
www.coab.us
July 6, 2011
Matthew Blakely
1448 Camelia Street
Atlantic Beach,FL 32233
Dear Mr.Blakely;
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 .Thompson
Asst.City Manager
Prepared by and return to:
David Thompson,Asst. City Manager
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:
$ 6,871.00 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:
1448 Camelia Street,Atlantic Beach,FL 32233
Legal Description: SEC H Atlantic Beach, LOT 4 BLK 248
RE# 171079-0030
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.
MAKER:
By: 1 .9• g Cct Date: it /t° A /
Matthew Blakely
CITY OF ATLANTIC BEACH
By: Date: ori
anson ity anager //
STATE OF FLORIDA
COUNTY OF DUVAL
Sworn and Subscribed before me this A1/4//... day of (il .l-t ,20 //, by
/7)4 7T?fes 6 i /1,37who is personally known to me or produced
iN ?q5 7.3-7/y' as identification, and who did not take an oath.
�,��vitie'•Ns, DEppgH
MYBOMMISS AMANDA
Notary Public, State of Florida at Large
1 '° EXPIRES:
} " May 4. 11,. Bonded Nu No 21
Nolan/PublicU2015
ndernriters
Connection Agreement-Page 2 of 2
Thompson, David
From: dickblakely@comcast.net
Sent: Monday, October 31, 2011 3:17 PM
To: Thompson, David
Subject: Fwd: W-2
Attachments: W-2.pdf
Mr. Thompson, please find attached the W-2 form for Matt Blakely who is applying for the grant to
assist in the sewer implementation of the Atlantic Beach sewer connection requirement.
Regards,
Dick H. Blakely CA
Florida, Texas, Georgia, South Carolina
North Carolina, Mississippi, Oklahoma
Independent Insurance Adjuster
11724 Martha's Vineyard Court
Jacksonville, Florida 32225
cellular 904-735-2403
office 904-683-0767
fax 904-683-0767
dickblakely@comcast.net
From: "Front Desk" <frontdesk@bmwcpa.com>
To: dickblakely@comcast.net
Sent: Thursday, October 20, 2011 9:30:54 AM
Subject: W-2
Good Morning Mr. Blakely,
Please find attached the requested W-2 for Matt. For your security I have password protected the attachment with the last
4 digits of your social security number. Please let me know if you have any problems opening the attachment.
Thanks and have a wonderful day.
Marcie Gallagher
Barley I McNamara I Wild I Martin I Jackson
CERTIFIED PUBLIC ACCOUNTANTS &ASSOCIATES
JACKSONVILLE: 5150 Belfort Rd., Building 400 I Jacksonville, FL 32256
Office:904.694.4CPA(4272) I Fax: 904.694.4BMW(4269) I Direct Fax: 904.694.4271
TAMPA: 1300 North Westshore Blvd, Suite 205 I Tampa, FL 33607 I Office: 813.443.5048 ext. 304 I Toll free:888.410.2323 I Fax:
813.443.5053
1
www.bmwcpa.com
CONFIDENTIALITY NOTICE:This message(including any attachments)contains confidential information intended for a specific individual and purpose,and is
protected by law.To ensure compliance with requirements imposed by the IRS(IRS Circular 230),we inform you that,to the extent this communication(or any
attachment)addresses any tax matter,it was not written to be(and may not be)relied upon to(i)avoid tax-related penalties under the Internal Revenue Code,or(ii)
promote,market or recommend to another party any transaction or matter addressed herein(or in any such attachment).In addition,the information contained in this
message may be protected by the accountant-client privilege.Please immediately reply to the sender of this e-mail if you have received it in error,then delete it.In
addition,you are hereby notified that any disclosure,copying,or distribution of this message,or the taking of any action based on it,is strictly prohibited.
2
PROPOSAL
11.41
CHRISTY FIRST COAST PLUMBING, INC.
1651 MAYPORT ROAD, ATLANTIC BEACH, FL 32233
247-4419 (Office); 249-4660 (Fax)
CFC056487
PROPOSAL
July 7, 2011
Dick and Donna Blakely
1448 Camelia Street
Atlantic Beach, FL 32233
645-0604
Dlblakely8585@yahoo.com
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 remove four deck boards to re-route sewer from under deck and
replace existing boards with torx deck screws when finished. Sewer to be run along house under
fence to front yard. 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. Boat must be moved to access backyard. This is the responsibility of homeowner. We
will remove section of fence on south side of house to access back yard with equipment and put
fence back when finished.
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 includes 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 Eight Hundred Twenty One Dollars ($2,821.00). This price is for work
performed during normal business hours; no overtime included.
DRAWS: $2,821.00 to be paid upon job completion.
Draws to be paid upon job completion. 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.
Blakely Sewer christy plumbing.txt
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 includes 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.
r
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 Eight Hundred Twenty One Dollars ($2,821.00) . This price is
for work
performed during normal business hours; no overtime included.
DRAWS: $2 ,821.00 to be paid upon job completion.
Draws to be paid upon job completion. 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.
Page 2
Blakely Sewer christy plumbing.txt
PROPOSAL
CHRISTY FIRST COAST PLUMBING, INC.
1651 MAYPORT ROAD, ATLANTIC BEACH, FL 32233
247-4419 (Office) ; 249-4660 (Fax)
CFC056487
PROPOSAL
July 7, 2011
Dick and Donna Blakely
1448 Camelia Street
Atlantic Beach, FL 32233
645-0604
Dlblakely8585@yahoo.com
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 remove four deck boards to re-route sewer from
under deck and
replace existing boards with torx deck screws when finished. Sewer to be run along
house under
fence to front yard. 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. Boat must be moved to access backyard. This is the responsibility of
homeowner. we
will remove section of fence on south side of house to access back yard with
equipment and put
fence back when finished.
Page 1
Blakely sewer christy plumbing.txt
signature Date •
Our proposal is subject to any industry standard price increases.
0
Page 3
R/1;■J * 1 PO BOX 11303
ti... LU aI /!�
JACKSONVILLE,FLORIDA 32239-1303–f—– -- –– V PHONE(904)724-7211 FAX(904)724-5925
CFCO22586 •
Date: 8/10/2011 • •
Name: Donna Blakely Phone: 710-0461 Fax:
Street: 1448 Camilla St. Job Name: Cell:
CSZ: Atlantic Beach,Fl.32233 Job Location:
Attn: E-mail:
1 SPE(;T k.AT ,D ESTIMATES F')R
Subject:
Procedure:
*** Owner to have Atlantic Beach locate tap before start of any work.Owner to be responsible for any fees
associated with tap location and connection.
1) Reroute(1)sewer line from point where existing line tied into tank to new tap approx 90'
2) Install cleanout on outlet at house per local code.
3) All drain materials will consist of PVC pipe and fittings.
4) We will pump out(1)septic tank,break hole in bottom of tank and fill with clean fill dirt.
5) Have all work permitted and inspected by local county health and plumbing dept.
6) Owner will be responsible for all landscaping including sod. •
7) 1 year warranty parts and labor.
*** No warranty on existing plumbing systems or connection to them.
8) Owner will be responsible for all tap fees,downstream pollution fees and sewer impact fees.
9) Price is based on information given by owner,any additional outlets at house,
additional septic tanks,and piping footage above specified will be at an additional charge.
10) This price does not include removal of drainfield,wood decking or concrete repairs if driveway must be crossed.
Total Contract: $3,395.00
•
r%{1 MEN IS TO UL MADE AS rOLLOWS due upon completion
C7
c f MliditeM4thlt
AccEPTAr,
1,8,1e.ri.4,4ed,Y..o C,SZ(F�.Y/a 1.flusxs.olOwano as,,Hns.L..Yno,'f ,.-s e:f'txu.t
LATE SI3NATURe •.
.S.IGNATLIF.,
Kellow's /111‘
RAPID-7L-‹- RESPONSE
Plumbing
P,edPaS1,G
P.O.Box 50165
Jacksonville Beach,FL 32240-0165
(904)247-6530 FAX(904)564-2352
rapidresponseplumbing(a earthlink.net
PROPOSAL SUBMITTED TO PHONE DATE
Blakey 713-7716 August 10,2011
STREET JOB NAME
1448 Camilla Street 1448 Camilla Street
CITY,STATE AND ZIP CODE JOB LOCATION
Atlantic Beach,FL 32233 1448 Camilla Street
ARCHITECT DATE OF PLANS JOB PHONE
713-7716
wGPra�►vsc hereby to furnish materials and labor—complete in accordance with specifications below,for the sum of:
Three-Thousand Two-Hundred dollars($3,200.00)
Payment to be made as follows: -�
All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from specifications Signature Terry Bailey
below involving extra costs will be executed only upon written orders,and will become an
extra charge over and above the estimate.All agreements contingent upon strikes,accidents, NOTE:This proposal may
or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance. be withdrawn by us if not
Our workers are fully covered by Workmen's Compensation insurance. accepted within days.
We hereby submit specifications and estimates for:
To install new sewer line from rear of house around side and tie into city tap.To use Sch-40 4"PVC pipe and fittings.To abandon
septic tank,have tank pumped out and back-fill with clean fill-dirt as required by Health Department.Price includes parts,labor,
Plumbing Permit and Health Department Tank Abandonment Permit.All work to meet current plumbing codes.
Acceptance of proposal—-The above prices,specifications and conditions
are satisfactory and are hereby accepted.You are authorized to do the Signature
work as specified.Payment will be made as outlined above.
Date of Acceptance Signature
Property Appraiser - Property Details Page 1 of 1
BLAKELY MATTHEW ET AL Primary Site Address Official Record Book/Page Tile#
1448 CAMELIA ST 1448 CAMELIA ST 15642-01919 9418
ATLANTIC BEACH, FL 32233 Atlantic Beach FL 32233
BLAKELY DONNA R/S
1448 CAMELIA ST
Property Detail Value Summary
RE# 171079-0030 3010 Certified 2011 In Progress
Tax District USD3 Value Method CAMA CAMA
property Use 0100 SINGLE FAMILY Total Building Value $71,118.00 $55,271.00
#of Buildings 1 Extra Feature Value $1,056.00 $1,772.00
18-34 38-2S-29E Land Value(Market) $33,375.00 $33,375.00
Legal Desc. SEC H ATLANTIC BEACH Land Value(Aaric.1 $0.00 $0.00
$ubdivisiort 03119 ATLANTIC BEACH SEC H Just(Market)Value $105,549.00 $90,418.00
The sale of this property may result in higher property taxes.For more information go Assessed Value $105,549.00 $90,418.00
to Save Our Homes and our Property Tax Estimator.Property values,exemptions and Cap Diff/Portability Amt $0.00/$0.00 $0.00/$0.00
other information listed as'In Progress'are subject to change.These numbers are Exemotion� $0.00 See below
part of the 2011 working tax roll and will not be certified until October.Learn how the
Property Appraiser's Office values property, Taxable Value $105,549.00 See below
Taxable Values and Exemptions—In Progress
If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box.
County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value
No applicable exemptions No applicable exemptions No applicable exemptions
Land&Legal
Land Legal
LN Code Use Description Zoning Front Depth Category Land Units Land Value LN Legal Description
I 1 10100 1 RES LD 3-7 UNITS PER AC I ARS-2 50.00 102.00 Common 50.00 $33,375.00 1 18-34 38-2S-29E
2 SEC H ATLANTIC BEACH
3 LOT 4 BLK 248
Buildings
Building 1
Building 1 Site Address Element Code Detail ��-
1448 CAMELIA ST
Atlantic Beach FL 32233 Exterior Wall 16 16 Tile/Frame Stucco
Roofing Structure 3 3 Gable or Hip «_
Building Type 0102-SFR 2 STORY SOH Roofing Cover 3 3 Asph/Comp Shingle
— — FUASAs
Year Built 1986 Interior Wall 5 5 Drywall
Int Flooring 14 14 Carpet FGR
IYQ Gross Area I Heated Area Int Flooring 8 8 Sheet Vinyl I
Finished upper story 1 496 1 496 Heating Fuel 4 4 Electric n
Base Area 496 496 Heating Type 14 4 Forced-Ducted i...+
Finished Open Porch 8 0 Air Conditioning 13 3 Central
Finished Garage 240 0
Total 1240 992 Element Code
Stories 2.000
Bedrooms 2.000
Baths 1.500 I
Rooms/Units 1.000
http://apps.coj.net/pao jropertySearch/Basic/Detail.aspx?RE=171 ... 9/9/2011