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340 14th Street West WELL-SEPTIC CONVERSION aa0l rtivveC1 f / . go , ?&449et 5714°./(403. City of Atlantic Beach • 800 Seminole Road •Atlantic Beach,Florida 32233-5445 S<6 Phone: (904)247-5800 • Fax (904)247-5805 • heap://www.coab.us 3 Z 2 APPLICATION FOR ASSISTANCE WITH CONVERSION FROM WELL AND SEPTIC TANK TO CITY WATER AND SEWER 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 for single-family residential houses and for homeowners who live in their home. (Homes cannot be rental houses.) Grant funds are limited, and applicants are selected based upon most urgent and serious need and availability of funds. DATE: `�17 'O 'S 1. Homeowner Name(s): Mats M , Re b bo✓1 2. Address of Home: 3 ctd Go. I LI ST 14+(a or' c j Pic_(.7 3. Telephone Number: q0 c4 - L','4' - .j S'3 (day) q0 q - 2' (o 21 (night) 4. Is the person completing this application the Head of Household? ®ayes ❑no (female 0 male 5. How many family members live in this house? 1 6. Are there people living in this house with disabilities or special needs? ( 'yes ❑ no If yes, please explain UScS c_�G2.fISP d- ramp , A-s in A P/NAr2inS 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: EiCity Water 0 Private Well Other 9. Does septic system work properly?( Yes 0 No If no,please explain. Page 1 of 3 a t , + '. ,'�_ � `�_� t:� •f,�. .rai. t;ir:ltlf i 7r1^A,11 ' f:`.idr.`.t•:ir'r*trresit(I2r;% (f:i1:1r# r�1►tl.t # '7 b �...t 'UAW).w rr+.':q:I ft ' .08;--"! r k-f,:t . 4 r?tf$? S r ddi:1 • f17111T8 . SW'iT'A,'N• T�'I'$':: OT A#Ai' D1Tg3 KA JJT'tt Iit,M t;)g i T'lJ1 U.11().DN130 f. Ttr(.(Y.) • n; 9, 1..4,--. "21"S`'': ;i r'n •t Lori I!(; T22rti1 hI r1`driLltj7'r`f' j .F111 ..14./ICs t!' ,4v ....'r. ,:?!i:;.t t .a:(;:.i�t ;irT2� `l`(t i;5.,,,,#�'_ {� bra:' _r�.r,. ;11171.`;1 Ir3�l.i i,'1tit %rlrt? „!4:? 2`.' :ii`(S! t1iT` r'rt'iJ G2 rf+)Tt'.'r1ti(i i;i1! t; (''r 1 (T1( . /IV I •!C;i bTIG ?,`3121.")x1 f,10.0 !'::;i( nc*.c. I :r',:44 ebrili '•111ieii?:r;vt; itr:,- • :111,(1 • _ _____..- -- -- . "p�nzt✓ tsd)+ rant 1. • :3rroti it• Egli�i�l (tti!O pit 1�wr in r i. C. 1ir.:P t_a 911gtrt'..2 '_, Off°�{ ?9! j ' o!./?Ct4;1 fr' flt,t)r;711'^,0' -tii {+•l111(11:li) <•i';�a 3S{t ?t • :.1141rS ;1tfT 111 M(c •t'ii'.rtl9:rt 't( a':1 j' N)Y f?`a`JS$ 1311.41? 7f) 111:`1i14:pi►r r iiw ttP11,41 Aft t• *3+ ;vii " +;";:,t� mai! 1-ti, ) . .f)iYrr1')v11I11' . f)611i dTi r`,,ttibt;r1 ni 'ar11tT- r,oii hoer 1,:.) • ___ ^ r.ti; _, .._.. iltta "L'f'---0 it:ri1A `-'in!". �.. bk.new r t .� SIAM�. . _._..._ blai 1f V{fit. f+i z`;-) !of anvil lin ( bin rov.-$r At)-011 P941. Ate+191 ►IRi"fi 79tSi1:bon y.a 4:3=!,A •t:1411';._... __ _ _._ __ i1s'1� : :.'ii141 '11h7/ fl".}, ,ai i 3 .Ivtrlltl ei vig(itte rnJ.'M .nit izi/s4 the. 1 1 S r , ! !';i'i►qr'Is1 0-tow tiTJ1#. 3faf{3i 7 s i�! '10. Does your plumbing work properly? l]Yes ❑No If no,please explain. 11. Is there hot and cold running water in your house? ($Yes 0 No 12. Do you have a complete kitchen with running water,a refrigerator and cooking facilities? --63.,e.o 13. How many persons are in your family and living at this address? I 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/ 7, g574 da 16. Are you on a fixed income such as Social Security,SSI or retirement? "Yes 0 No 5 i s-6 t eJ 17. What are your sources of income? A-11 S5 1 18. Do you own this home? 0 Yes ❑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. Signature of Owner 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) 247-5826. The attached Income Verification Form must also be completed and mailed to: Community Development Department City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233 In order to arrange to inspect your home for needed repairs,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 Building Inspector to meet with you,and the phone number where you wish to be called. Page 2 of 3 . . . • i I1.4;1.'qAtlelq A104: • T si bra4 z• g 'ui •••;, 1, e'WW1 001. '14 rit _11111 tti , . . 41..0 1:11.14 io.r4i 5:07p. i.:•„ :1k) .1 .-4;n1.3.) ;46"C.11:.iui-Nr!Dt.-an9i112. • Je-• wekt; la..:,.;Jrti 2j, • • Pit! Li e ‹.) . .„ ;' — • c.r!. • ;1;11fS'il.e.I Lt . 91 t • Midifi. 11.'11( . :tReA; t - - . . ; • ' , "! .( .„ , .14 ..r • it.: `...•,rVe! jjtr.,416;`.1 :.);!.1t 690: i;:::),CUU .."‘. .1!. ?0) 31t 1411;,f)Ef '2.4t 0; h-; til ;),;4c; Cit5i • io • 4108 • • .)f1cf. ,itYtRi.t.A • • • f.•15,10-4frw, oi t4;10" luil t',tVf.t, t41.;(1.!.! ay..t•ar4 tiwc.i.713 A3,44 Ji!, ri•o.rP!' thergt,UO"s: '111 f)i • • 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 Housing Rehabilitation Assistance Program,which is funded by a Community Development Block Grant. i to-1 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: ❑ permanent ❑ part-time ❑ temporary Employer Name: Address: Telephone: Name and title of person providing this information. Date Page 3 of 3 .. r Yi VI OTJ `T A:r 7 L' ori()T) 4 -*+s•.�mmsetrsytiara:.stvo-akwsw<,swvwtrc;ra+M. ..w,:sawY,•-m�w,mnun -«�,rn.°. :ae,a.,,urx .rsaz ��sr� '.' '_'.^�. _. . ._.. / v r{. `P. s-"sbi rf.-•s ,..,+"�.dd '�G vi.+ �&•.r3 411tP .4 lei`.7f FF1 .7 # ` ' t. 10vt,!I-. .i.,*34'3'Y 74147300Sr 1.fCl'"Y'3d I • "fr sal2 A V' }'a„�fi �.Qfk Al*• ''"S'' •LiC• !'„)W r • a 1* ciarrHw _-<r.�?"Y"'p"y. ..s..-.R.s aerY:axweaau..ac:.� se xy;:•y�+.., •�...« sI! .wrcr _w.e !.,""`enerr ' .. �s r€errs 1'tr"i4s.,t +.'Il «AD':if'' i! �sf' ,y" ta' �` wk.'$ 1 .F 1K9t4..erk aSf:ry .-:S)it x4114",' k; fdN.0 c;4 ;) :144 '3l3{'#••.ri !o, .'+ • ;CT:* iiirm3 `ci#,.r • F $ti.114„ ,'i 2.4 '`:7 l4itiftr i ....., £ y ,.. ' YA �._. • • `:�#Fo ial:�ff tlSf i>s. Safi #"t !�F:♦"JAI f7O%':13t • .." ;�i• - H Page 2 of 3 Statement Period MRS DORIS RIBBON 06-25-08 through 07-25-08 JANE D HAMMOCK B 16 9 I P PI 16 ' Account Number: 0000 0415 1769 Senior Economy Checking MRS DORIS RIBBON JANE D HAMMOCK Your Account at a Glance Account Number 0000 0415 1769 Beginning Balance on 06-25-08 $ 952.21 Deposits and Other Additions + 654.50 Checks Posted - 359.14 Other Subtractions - 72.90 Ending Balance on 07-25-08 $ 1,174.67 Senior Economy Checking Additions and Subtractions Date Resulting Posted Amount($) Balances(S) Transactions 07-01 73.00+ 1,025.21 US Treasury 310 Des:Supp Sec ID:xxxxx8914 SSI Indn:Doris M Ribbon Co ID:3101736121 Ppd 07-03 581.50+ 1,606.71 US Treasury 303 Des:Soc Sec ID:xxxxx8914A SSA Indn:Doris M Ribbon Co ID:3031036030 Ppd 07-03 150.00- 1,456.71 Check 4671 07-07 30.98- 1,425.73 AT&T Services Des:Checkpaymt Check #:4669 Indn:981855356190110 Co ID:1742782655 Arc 07-07 19.44- 1,406.29 Check 4670 07-09 28.33- 1,377.96 American Gen L&a Des:Ins Paymt ID:0001288377 13 Indn:Ribbon Doris 080707 Co ID:1620306330 Ppd 07-11 13.59- 1,364.37 Liberty National Des:Ins. Prem ID:00020Axxxxx5841 Indn:Doris M Ribbons Co ID:9630124600 Ppd 07-22 50.00- 1,314.37 Check 4675 07-22 60.44- 1,253.93 Check 4672 07-23 50.00- 1,203.93 Check 4674 07-23 29.26- 1,174.67 Check 4673 Checks Posted in Numerical Order Check # Posting Date Amount($) Check # Posting Date Amount($) Check # Posting Date Amount($) 4670 07-07 19.44 4672 07-22 60A4 4674 07-23 50.00 4671 07-03 150.00 4673 07-23 29.26 4675 07-22 50.00 Total Checks Posted $359.14 Daily Balance Summary Date Balance($) Date Balance($) Date Balance($) Beginning 952.21 07-07 1,406.29 07-22 1,253.93 07-01 1,025.21 07-09 1,377.96 07-23 1,174.67 07-03 1,456.71 07-11 1,364.37 .. . i - . . •:- . • • • • . . • . , •6',-;-•_,•.4•''' 4..1„,tit,-0.9 of,-'•-t,'#:', iriT ;-, i.,'".•-. ,•''.''.,' , 4 ; ;," e . ;i••."1•...,':•,--;I.; (..1 .• •'•I .. k•?'• .:v' •!-,.. 1,".,•'.i.•.:.1 0 i,I.. , . , ••.----t-ttt... ..„,t,.•,'raer•r.'7,-,r•-•--..f:',,'"r"--1,74°In';••••••••=r•••-"ir- ft„, „Itt".171',.r. 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SOCIAL SECURITY 3733 W UNIVERSITY BLVD Social SecurityAdministration SUITE 100 JACKSONVILLE FL 32217 Supplemental Security Income Notice of Change in Payment Date: November 25, 2007 Claim Number: 265-34-8914 AI cn 000033047 01 AT 0.334 8064,M4E,134 655 07S1756B14198 1 DORIS MARIE RIBBON 340 W 14TH STREET ATLANTIC BEACH FL 32233-2602 lllllI�I�I��III��II�I NM We are writing to tell you about changes in your Supplemental Security Income (SSI) payments. The rest of this letter will tell you more about this change. We explain how we figured the monthly payment amounts shown below on the MUNN last page(s) of this letter. The explanation shows how your income, other than any SSI payments, affects your SSI payment. It also shows how we decided how much of your income affects your payment amount. We include explanations only for months where payment amounts change. Information About Your SSI Payments • The amount due you beginning January 2008 will be $73.00. • The amount due you is being raised because the law provides for an increase in Supplemental Security Income payments in January 2008 if there was an increase in the cost-of-living during the past year. Your Payment Is Based On These Facts Our records show that the following income used to figure your payment has also changed-- Your increased Social Security benefits--before any deductions for Medicare premiums- of $584.00. You should receive the increased Social Security benefit about January 3, 2008. We must count the increase in your benefits for January 2008 even though we are counting your other income for November 2007. See Next Page SSA-L8151 Social Security Administration Retirement, Survivors and Disability Insurance ' Important Information Southeastern Program Service Center 2001 Twelfth Avenue, North Birmingham, Alabama 35285-0001 Date: January 10, 2008 Claim Number: 265-34-8914A — 0001 61 862 01 AT 0.334 T475 T2R M04,0103,PC3,N,81, DORIS M RIBBON 340 W 14 ST -� ATLANTIC BEACH FL 32233-2602 lllll1.I,I1.III IIiI As you requested, we will begin deducting your Medicare prescription drug plan costs from your monthly benefit. What We Will Pay And When • You will receive $579.00 for January 2008 around February 1, 2008. • After that you will receive $581.50 on or about the third of each month. Information About Your Medicare Prescription Drug Plan Costs We deducted $5.00 for your Medicare prescription drug plan costs from the check you will receive for January 2008 on or about February 1, 2008. This represents all Medicare prescription drug plan costs due to date. Each month, we will continue to deduct $2.50 for your Medicare prescription drug plan costs. If you have any questions about your Medicare prescription drug plan costs, please contact your Medicare prescription drug plan. If You Have Any Questions We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-904-730-5555. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at: SOCIAL SECURITY SUITE 100 3733 W UNIVERSITY BLVD JACKSONVILLE, FL 32217 C See Next Page City of Atlantic Beach 8/13/08 CDBG Grant FY 2007/08 Contract#: 5629-41 Claims Filed-to-Date Claim# Contract Project Name I# Lighting on Shelter at Basketball Ct. Infrastructure Infrastructure Donner Center Sidewalks Veteran's Park (2006) (2007) 3701 3702 3703 3280 3489 Total 1 12,926.86 1,584.10 14,510.96 2 2,073.14 2,073.14 3 4 Total 15,000.00 1,584.10 16,584.10 Contract 30,000.00 65,690.00 15,000.00 4,883.02 13,905.00 129,478.02 (A) Balance 30,000.00 65,690.00 3,298.92 13,905.00 112,893.92 (A)-Reimbursement received from COJ via ACH 8/14/08 List of Expenditures/Encumbrances by Project/Vendor Project (encumbered/ Vendor paid) 3701 3702 3703 3280 3489 Total Donner Pk-Shelter (enc) Contract Connections 22,500.00 22,500.00 Veteran's Pk-Basketball Lights (pd) Brooks&Limbaugh 5,301.86 5,301.86 Jordan Pk-Irrigate&Sod (pd) Southland Specialties 7,625.00 (pd) American Well&Irrig 2,073.14 1,376.86 (pd) Brooks&Limbaugh 207.24 11,282.24 Jordan Pk-Basketball Lights (pd) Brooks&Limbaugh 6,958.54 6,958.54 22,500.00 15,000.00 1,584.10 6,958.54 46,042.64 C:\Documents and Settings\sdoerr\Local Settings\Temporary Internet Files\Content.Outlook\LDF2J6B0\[5629-41 08-13-08.XLW]summary 5629-41 • Bankof America H Bank of America, NA. Page 1 of 3 P.O. Box 25118 Statement Period Tampa, FL 33622-5118 06-25-08 through 07-25-08 B 16 9 I PPI 16 0440744 Account Number: 0000 0415 1769 luIIIII l.1II111111ii__Re1l11111/11111111IdJulll 1111 28075 901 SCM999 I 34 0 MRS DORIS RIBBON JANE D HAMMOCK 340 W 14TH ST RETURN MAIL 06202008 ATLANTIC BEACH FL 32233-2602 Our free Online Banking service allows you to check balances, track account activity, pay bills and more. With Online Banking you can also view up to 18 months of this statement online and even torn off delivery of your paper statement. Enroll at www.bankofamerica.com. =r x :G:_"GG?::}... ,...•,..,..„..,,,,,,-------------------- -,:: r'�•.-.Y� riY•Y.•n Y.':.!i•Y _ -:Y.r • - r-.:•:.:•:t>:-.YY .r. ...•ea . .:....... ....�-r.�-mow.—.:r.....�..._ ..•.r me... -.• :-.•.:-<•..•. .. . 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M A ik., t.,-,--: :au(zr... 1-a)'ii"?')1 ii:AletT1610A1,:,d ;ieiv eif.-bnirry:31tx.'.: ' lc i:tf,r9 101J,,;171 . I .. , . r ' - • • . . . • . • • • • • • • • . . • • . • • • • • . . • . • • ' • ENVIRONMENTAL REVIEW SCREENING CHECKLIST CITY OF JACKSONVILLE CDBG, HOME HOPWA, ESG HOUSING CONSTRUCTION PROPERT DDRE'S tom a i 4 44 '- COUNTY U U L , STATE Florida ZIP $ '3 PROJECT NAMES) - �QV� -GDt^Vt�+,SipK O �–� y S.es i€IZ. 1. HISTORIC PROPERTIES a. Is the structure in a Historic District of over 50 years old? Yes_Noses b. If yes,indicate consultation and completion of Section 106 process 2. FLOOD PLAIN MANAGEMENT a. Is structure in 100 year Flood Plain'' Yes Nod/ b. FEMA parcel Number c. Date of Map Month 00,0000 Current data was also utilized and attached. d. If yes above,has flood insurance been required? Yes_No e. Is Flood Certification Documentation attached? Yes_No 3. WETLANDS PROTECTION a. Is the structure in a wetland Yes_No b. If yes,indicate compliance with EO 11990(an 8 step process) Yes_No c. If yes,has the Corps of Engineers been consulted Yes No d. If consulted,has the Corps of Engineers been satisfied? Yes_No 4. NOISE a. Is the structure within 3000 feet of a railway, 1000 feet of a major thoroughfare,or within 5 miles of an airport? Yes No IV b. If yes,indicate maps consulted(Hartsfield International Airport)or mitigation measures to reduce noise: 5. RUNWAY CLEAR ZONES.CLEAR ZONES.AND ACCIDENT POTENTIAL ZONE(APZ) a. Is structure located within runaway clear zones or clear zones and APZ of Jacksonville International Airport? Ycs No b. If yes,please describe: 6. THERMAL AND EXPLOSIVE HAZARDS a. Based on maps,studies and on-site visits,are there storage tanks and other facilities(within one mile)that pose danger to the property? Yes No 1.7"- b. If yes,explain,including any mitigation measures needed: 7. TOXIC AND HAZARDOUS CHEMICALS a. Is project on or within one mile of area,which contains or may contain hazard waste? Yes No ENVIRONMENTAL JUSTICE a. Will impact be positive to low/moderate income families? Yes 1,/No_ I hereby certify that the information on this form is true and complete. What is now being proposed is covered within the scope of the FY 2005-2010 Consolidated Plan and the Format II Environmental Assessment for FY 2 5.12 J,0 Funding. Please see attached documentation. Q I Z5 I h q — Signed: /1 _ Date: D V t i'S \1-1-r1r, CITY OF ATLANTIC BEACH _ OFFICE OF THE CITY CLERK i; i 800 SEMINOLE ROAD J ATLANTIC BEACH,FLORIDA 32233-5445 I' lc, „--,.9 "�r TELEPHONE:(904)247-5810 SUNCOM:852-5810 FAX:(904)247-5846 01319` www.coab.us March 26, 2009 CO f ILE Doris Ribbon do Jane Hammock,her daughter 340 West 14th Street Atlantic Beach,Florida 32233 Re: Abandonment of septic tank and connection to sewer service Dear Mrs. Ribbon: Based upon the information you have provided, you are eligible to receive financial assistance to convert from the existing septic tank on your property to City sewer service. The City will use a portion of its Community Development Block Grant funds to fund the connection to your home and the proper abandonment of the septic tank. We have forwarded the enclosed work authorization to F.W. Fair Plumbing Company. The plumber will be reimbursed directly from the City once the work is completed and inspected by the City. Please be sure that your plumber has obtained the required permits prior to commencing any work. Once the work is completed and inspected,the Connection Agreement with the City will be completed, and I will provide a copy to you. (I have enclosed a copy of the Agreement you signed last year.) I want to be sure you understand the terms of the funds that will be used to do the work. The funds are a combination interest-free loan and grant. Once the work is completed, the Agreement form will be finalized and recorded for the dollar amount of the work plus any tap fee or impact fee that may be due. (Although, I believe these fees have been previously paid in your case, and will verify this with the Utility Department.) The amount of this "loan” will be reduced by ten percent every year. In other words, at the end of ten years, you will owe nothing back to the City. But, if for any reason during that ten years, you should have to sell or rent your house, the balance of any money due at that time would have to be re-paid to the City. Also, in the event of your passing during the next ten years, likewise, the balance of any money due at that time would have to be re-paid to the City if the house was sold, or if the house goes to your family and they wish to keep living in the house, they would have to meet the low or moderate income requirements and sign a agreement for any remaining balance. I will be glad to answer any questions you may have, and may be reached at 247-5826. Sincerely, OFA'/ Sonya Doerr,AICP Community Development Director WELL AND SEPTIC TO WATER / SEWER CONNECTION AGREEMENT CITY OF ATLANTIC BEACH, COUNTY OF DUVAL, STATE OF FLORIDA ADDRESS AND LEGAL DESCRIPTION OF PROPERTY: 340 West 14th Street (Lot 1, Block 232, Section "H" Subdivision) For the value of services received, which may include, abandonment 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 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: $2,988.00 (Two thousand, nine hundred and eighty-eight dollars) 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/tenth (1/10th) per year, on each year anniversary of this Connection Agreement, until reduced to a balance of zero (0) dollars at the end of ten 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 ten (10) 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. Page 1 of 2 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: 390 co . ) Sr- ,ATL R 1-1 L 7-ectcI 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 Rehabilitation Agreement, the remaining principal balance shall immediately become due to the Holder and collectable without notice, time being of the essence of this Rehabilitation 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, 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. Printed Name of Maker: D6 i" 6 b 0 Date: gd l 0-•( Signature of Maker: b(91,,,- ARA, SWORN AND SUBSCRIBED BEFORE ME THIS 7 DAY OF .0 71 NOTARY PUBLIC-STATE OF FLORIDA 'IX Winston Maclntyre STATE OF FLORIDA,COUNTY OF DUVAL ` =Commission#DD6659S8 Expires: JUNE 06,20;.3. BONDED TIMRU ATLANTIC BONDING CO.,INC. NOTARY'S SIGNATURE Page 2 of 2 Mar 20 09 10:18a Brian D. Christy `Ju4L4 '+OOu �.� I PROPOSAL CHRISTY FIRST COAST PLUMBING, INC. \. ,• P.O. BOX 50446 • JACKSONVILLE BEACH, FL 32240 247-4419 (Office); 249-4660 (Fax) CFC056487 PROPOSAL 8/11/2008 Jane Hammock , 340 West 14th St Atlantic Beach, FL 32233 994-8689 •• janehammock@juno.com Re: Septic Abandonment and Sewer Tie In Run 72' of 4" Schedule 40 PVC sewer line; cleanouts as needed per code; abandon one (1) septic tank. Plumber is not responsible for sod or landscape work needed. Bid price of job includes pump out fee and fill dirt for 1 septic tank abandonment. No downstream pollution or impact fees are included. Removal of drain field is not included. Plumbing permit fee is included in bid price of job, DWV to be Schedule 40 4" PVC. Water taps, sewer taps and any other city charges, other than plumbing permit, to be billed to and paid for by owner/builder. A signed copy of this contract must be in our possession before the mentioned work commences. Draws to be paid within 5 days of invoice date. 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. 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. Page 1 of 2 Mar 20 09 10:18a Brian D. Christy VU4Z4V4DOU P. PROPOSAL ifQ CHRISTY FIRST COAST PLUMBING, INC. P.O. BOX 50446 JACKSONVILLE BEACH, FL 32240 247-4419 (Office); 249-4660 (Fax) CFC056487 PROPOSAL ADDENDUM March 19, 2009 Jane Hammock 340 West 14th St Atlantic Beach, FL 32233 994-8689 janehammockayahoo.com RE: SEPTIC ABANDONMENT AND SEWER TIE IN This is an addendum to the proposal dated 08/11/08. There is a Thirty Five Dollars --- ($35.00) increase for the abandonment permit due to a price increase from 2008-2009. This results in an adjusted total cost of Three Thousand. Seven Hundred & Eighty Five Dollars ----- ($3.785.00). Brian D. Christy, President/Owner Date Jane Hammock Date Mar 20 09 10:18a Brian D. Christy 9042494bbU 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 pipe and labor in accordance with the above prices and specifications for the sum of Three Thousand Seven Hundred & Fifty Dollars ----------------- ($3,750.00). DRAWS: Total to be paid upon completion of job. Brian D. Christy, President/Owner Date 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. Page 2 of 2 . Juno Email on the Web Page 1 of 4 EJUNO Email on the Web Print Message I Close From : "Christy First Coast Plumbing,Inc."<christyinc(gbellsouth.net> To : <janehammock@juno.com> Subject : Sewer and Septic Abandonment Proposal Date : Tue,Aug 12,2008 09:07 AM PROPOSAL 1V4 CHRISTY FIRST COAST PLUMBING, INC. P.O. BOX 50446 JACKSONVILLE BEACH, FL 32240 247-4419 (Office); 249-4660 (Fax) CFC056487 PROPOSAL 8/11/2008 Jane Hammock 340 West 14th St Atlantic Beach, FL 32233 994-8689 http://webmailab.j uno.com/webmail/new/8?block=1&msgList=00005Z00:0018cOgB0000... 8/12/2008 . Juno Email on the Web Page 2 of 4 janehammock@juno.com Re: Septic Abandonment and Sewer Tie_In Run 72' of 4" Schedule 40 PVC sewer line; cleanouts as needed per code; abandon one (1) septic tank. Plumber is not responsible for sod or landscape work needed. Bid price of job includes pump out fee and fill dirt for 1 septic tank abandonment. No downstream pollution or impact fees are included. Removal of drain field is not included. Plumbing permit fee is included in bid price of job. DWV to be Schedule 40 4" PVC. Water taps, sewer taps and any other city charges, other than plumbing permit, to be billed to and paid for by owner/builder. A signed copy of this contract must be in our possession before the mentioned work commences. Draws to be paid within 5 days of invoice date. 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. 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. Page 1 of 2 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. ,� ,,^ pp 03115/P1 We propose to furnish pipe and labor in accordance with the above prices and specifications for the 5 sum of Three Thousand Seven Hundred& Fifty Dollars ($3,750.00). -t add/4;4 #' 3S"• http://webmailab.juno.com/webmai lnew/8?block=1&msgList=00005Z00:CV18cOgB0000... 8/12/2008 ij A.. S,��-1� bW Rpt • • I • • ;• • '.' f )1; v •• •'J I • • • et • 7 t! 07 ,. . X • • • •r3 "• .:':•. •. . . .•• . Juno Email on the Web Page 3 of 4 • DRAWS: Total to be paid upon completion of job. Brian D. Christy, President/Owner Date The above prices, specifications and conditions are satisfactory and are hereby accepted. You have authorization to perform the work as specified above. Signature Date Our proposal is subject to any industry standard price increases. http: • .s;, t; y .com/webmail/new/8?block=1&msgList=00005Z00:0018cOgB0000... 8/12/2008 ,): ;JOY `s; .Fra ,•:t;r.. .> c � °�: g''. � e'• w f �frA:y t " . ;t Clls��.,« }e4z 7- ,R�3` iso ",'.'ira z•.•'j r� • • • • • .?'{ ?�t$c•..`.v I!Sti . . ',117/0.:,),c^)/1, x73,;,f{1; s' . Juno Email on the Web Page 4 of 4 • Page 2 of 2 http://webmailab juno.com/webmaillnew/8?block=1&msgList 00005Z00:0018cOgB0000... 8/12/2008 7/31/2008 Job Cost Details Gruhn May , Inc. Job Name: 340 W. 14th Street Septic to Sewer 6897 Philips Parkway Dr. North Customer Doris Ribbon Jacksonville, Florida 32256 PO# Pendinge (904) 262-9544 Fax 268-0679 G.M. Job# Estimate Attention Jane Hammock Item Description Qty. UM Unit Cost Material Equipment Hours Rate Total 4" pipe 80 If $1.95 $156.00 backhoe 8 $45.00 $360.00 4"coupling 2 ea $14.30 $28.60 welipoints $0.00 $0.00 4"cleanout 2 ea $66.30 $132.60 $0.00 4" bends 5 ea $18.20 $91.00 $0.00 fill dirt 12 cy $9.10 $109.20 $0.00 sod 0 sf $0.44 $0.00 $0.00 .tank pumpout 1 ea $325.00 $325.00 $0.00 tank abandon permit 1 ea $214.50 -214.50 Equip. Total $360.00 misc. 1 Is $130.00 $130.00 plumbing permit 1 ea $52.00 $52.00 Labor 6" x 4" reducer 1 ea $18.20 $18.20 Regular 9.5 $120.00 $1,140.00 2" pipe 40 If $1.30 $52.00 Overtime $0.00 2" fittings 4 ea $3.90 $15.60 Labor Total $1,140.00 4" x 2"wye 1 ea $19.50 $19.50 6"cleanout& box 1 ea $94.90 $94.90 Subcontractor $0.00, Material Total $1,439.10 Sub total $1,500.00 Category Totals Material $1,439.10 Labor $1,140.00 Equipment $360.00 Sub. $0.00 Overhead 20%*L&E $300.00 Mobilization $0.00 Grand Total $3,239.10 State License CUCO43134 3 -7 c-.07' ...), •• Ne ' ..-, . 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Ft :i .4.'; - ,..::. '- ' 7' .• ,,,, v :.:, ,4 :'-• q ' ':4 f ."• . . :.• ' ' • ;,;.. >c ..... "72 ;...-• ...... ..---' 7..., ... _-. - .4. • ' '.., — ..:.• t.•,- ,•,,, t,:f) ',.'" 4_ "It i ts .`.... +" '' '" '"...; .1,' :...1 '.. '.:?... 6.1i ....,.. '-''. ''',"" ;" t. ,......... 1- • ''... (...o, C." ) . ' 0 • • .o. 7/31/2008 Job Cost Details Gruhn May , Inc. Job Name: 342 W. 14th Street Septic to Sewer 6897 Philips Parkway Dr. North Customer Doris Ribbon Jacksonville, Florida 32256 PO# Pendinge (904)262-9544 Fax 268-0679 G.M. Job# Estimate Attention Jane Hammock Item Description Qty. UM Unit Cost Material Equipment Hours Rate Total 4" pipe 80 If $1.95 $156.00 backhoe 8 $45.00 $360.00 4"coupling 2 ea $14.30 $28.60 welipoints $0.00 $0.00 4"cleanout 2 ea $66.30 $132.60 $0.00 4" bends 5 ea $18.20 $91.00 $0.00 fill dirt 12 cy $9.10 $109.20 $0.00 sod 0 sf $0.44 $0.00 $0.00 tank pumpout 1 ea $325.00 $325.00 $0.00 tank abandon permit 1 ea $214.50 $214.50 Equip. Total $360.00 misc. 1 Is $130.00 $130.00 plumbing permit 1 ea $52.00 $52.00 Labor 6"x 4" reducer 1 ea $18.20 $18.20 Regular 12 $120.00 $1,440.00 2" pipe 40 If $1.30 $52.00 Overtime $0.00 2"fittings 4 ea $3.90 $15.60 Labor Total $1,440.00 4" x 2"wye 1 ea $19.50 $19.50 6"cleanout& box 1 ea $94.90 $94.90 Subcontractor $0.00 Material Total $1,439.10 Sub total $1,800.00, Category Totals Material $1,439.10 Labor $1,440.00 Equipment $360.00 Sub. $0.00 Overhead 20%*L&E $360.00 Mobilization $0.00 Grand Total $3,599.10 State License CUCO43134 , . . , . . - - • . ,. . • 0 . '.:ii .19''.! - ') .' ,..,',... `P'..;,:--.:.'••• - '7 '''N. . • . . • • . • 4 .1:•-,; •,,,,,..,-AirpliG":•:. : ..!q;i"i'.4 1,z.[?.::.:'; 19'--4.48k; Ot‘ZT3';'.,••-',-?0112: :ilt::.-,` i .. c't:7 ...,-,.-3!-.:.:-.;""i ,t i ‘,.: •." 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