916 Hibiscus St DWAY21-0006 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
TYLER KESTHELY 916 HIBISCUS ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
QUALITY CONSTRUCTION
PROS LLC
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170948 0660 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
916 HIBISCUS ST DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY PAVER DRIVEWAY $5700.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 1/25/2021
PERMIT NUMBER
DWAY21-0006
ISSUED: 1/25/2021
EXPIRES: 7/24/2021
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $125.00
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS CIRCULAR DRIVEWAY INFORMATIONAL
Notes:
Maximum circular driveway width within the City right-of-way is 12 feet.
6 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
7 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 1/25/2021
PERMIT NUMBER
DWAY21-0006
ISSUED: 1/25/2021
EXPIRES: 7/24/2021
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $125.00
DWAY21-0006 Address: 916 HIBISCUS ST APN: 170948 0660 $125.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R14690 $125.00
Printed: Monday, January 25, 2021 3:26 PM
Date Paid: Monday, January 25, 2021
Paid By: QUALITY CONSTRUCTION PROS LLC
Pay Method: CREDIT CARD 416867487
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14690
I I I
I I I
I I I
~+; CENTRALSQUARE
DWAY21-0006
Building Permit Application
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
. IS REQUIRED.
Job Address: Qu, Hir,is:cvs S::b A+1oot 1c. 8cach, Fl. $2233 Permit Number: __________ _
Legal Description La~ (L , Sloe..-., 15:ii', .S:ec+ioa 1 'H'' A-\-\a(l:\-'< Brcv:.b RE# £Lao1J,. 3 353
Valuation of Work (Replacement Cost) $ 5 1 700 Heated/Cooled SF ____ Non-Heated/Cooled ____ _
• Class of Work: □New □Addition □Alteration □Repair □Move □Demo □Pool □Window/Door
• Use of existing/proposed structure(s): □Commercial □Residential
• If an existing structure, is a fire sprinkler system installed?: □Yes □No
• Will tree s be removed in association with must submit se arate Tree Removal Permit □No
Describe in detail the type of work to be performed
Florida Product Approval # __________________ for multiple products use product approval form
Property Owner Information
Name ::1¥.kl: \bes-~ Address --"9,_,J,.,.t.,.e....___._,l..\L.!.i b...,..,,s._,,c..._u'"'s.___.,,.S«-1::~-________ _
City A4-\a;;-\-i(,. gro...c.X-; State fL. Zip ~,;);).33 Phone 9H.e-;).lU-'iltld:
E-Mail :r'.\both<\~ ea.ol, c;.o.,....
Owner or Agent (If Agent, Jfower of Attorney or Agency Letter Required) ___________________ _
Contractor Information
NameofCompany Jl\lQ.14:1-~ CJ>ind:t'\lc+•oo fros'"'-QualifyingAgent \(i(,+c .. r·,o,. Lo.Wee\-~
Address ,ooi l2L3tM. Oc 5.. City A -k\aabc: 6ra.ci, State Fl... Zip 3.}.;;,.33
Office Phone qo 'i -g I> 3 -~ S'-' S::: Job Site Contact Number Cf 044 · 'f Q 3 ◄ LJ (j' S:'1
State Certification/Registration# j"(-'41£41'-l J';. \ E-Mail Cl-nd,:e,,w@ ~'f~'/,,,c, bi&)
Architect Name & Phone# __________________________________ _
Engineer's Name & Phone# _________________________________ _
Workers Compensation Insurer _______________ OR Exempt;~:~lxpiration Date f/~,> J 2 ;;J...
A pplication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and
there may be additional permits required from other governmental entities such as water management districts, state agencies, or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
RECOR¥?.OUR NOTICE OF COMMENCEMENT.
-. ({<'Sl\-l Elj
(Signature of Owner or Agent)
[ ] Personally Known OR
[ I Produced Identification:;:---..,_ L.
Type of Identification: U .,
[ I Produced Identification
Type of Identification: _____________ _
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY" and
-X:{ I tr \hest\oe hi of Atlantic Beach, Florida, hereinafter
referred o as "USER". I
WITNESSETH :
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach .
This work is generally described as _ ___,t;4AtM!tl'.~~l-~~~.£M~~...U.Mi.t2l.-"';.a:;A.1.~~.&.!:u.._ _______ _
Any facility maintained, repaired, erected, and/or i the exercise of the privilege granted remains subject to
relocation or removal on thirty {30) days' notice by CITY to USER, said notice to USER shall be given by certified mail, return
receipt requested, to the following address quo H it,iSC lA,D s+-. A±lao±>< t$<:4rh , PL 3d,;}33
• In the event it is necessary for the CITY or the City's approved representative or other franchised utilitv to ent er
upon the above described easement o r property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks.''
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Wor ks Department, for said change within 30 days after the day of
completion.
• This permit shall i nure to the benefit of, and be binding upon, the USER and their respective success ors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public l and. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by the USER.
Ji"?<' 1(~~1Hf:lf Date 1qJArvz(Jzl
Property Owner/Agent (sign ed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this } [:') day of-""'.....,_-=~cJ->-Q......,C\.___.,,,_ __ ___,, 20 2J
by --r-i1.-fll y(Gs1 1rfl1 who personally appeared before me and
ted name of Signer)
acknow ed th e/ e signed the instrument voluntarily for the purpose expressed in it.
Signature of Notary Public, S
[ ] Personally Known
I ] Produced Identification (Type) _I) _____ L-=--
'-_-J:;f-.~~,:;;:;,, T0:-.11 G:NDLESPERGER Department Approval: t,.· -~ -,~ ~\ MY COi,IM\SSION # GG 3531 78
= . .,;. ~-ii EXPIRES: Oct'Jber 6, 2023
\~:r,~·::i~t---Bonded Thru Notary Pcb!ic Underwriters
Scott Williams, Public Works Dire ctor
H:\Applications & Form s\Word Documents\2018083 1 Revocable Encroachment Agreem ent.docx Revision Date: 8/31/18 --------------------------=---..
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
**ALL INFORMATION
HIGHLIGHTED IN GRAY IS
REQUIRED.
Job Address 9/u }Ji bi K Y4 s+. Altao+i., Beac,L... A. Permit Number _________ _
' 3:,;;,33
Contractor Information
Company Q'Jd \i.\.-; Coiotl<vc+•4.,..
Address J Ob S 12.e:j<M Dr . S .
Phone Cf0'-1-qo1 -(Ji'S'-1
Pros LI.. C Qualifying Agent V'i<;.+oric.. L~ffir::b-:t
City A:t lao ±ic.. d r:a,.,:-k State fL Zip V ::;J. 3 3
Email oodcw@ iceyl..,, C: OC::"
State Certification/Registration #--.v.8 _'i._-_4..!.,4J.8'.....1L1L.::Y:a...1...L.4.L.l.\ ______________________ _
Architect __________________ Phone __________ Email __________ _
Engineer Arocu.2 la£f'-cr '!1 Phone qO<i::903-(;I!:SY Email arx,l re.vJ @'6 t fjai--<-o-.
Workers Compensation lnsurer._F] _________________ OR Exempt~xpiration Date l:}2:J Ja-;;,..
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial
and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or
relocation of all, or any portion of said street or easement as determined by the Public Works Director, any or all said poles,
wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said
street or easement or reset or re located hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of Ard cw L GI Pfec:i--, (Project Superintendent)
with(CompanyName) Gh>oh±'f Cc,cs:+c,,c+,00 Pros LL C Phone qo"J-Cfo3 -u~S'-:J
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical, in keeping with City specifications and t he
manner satisfactory to the City.
• A sketch of plans covering details of this installation, as well as a copy of a recent survey shall be made a part of this permit.
calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
• The permittee shall commence actual construction in good faith within I O days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder, and the holder will, at all times, assume all risk of
and indemnify, defend and save harmless the City of Atlantic Beach from and against any and all loss, damage and cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The Public Works Director shall be notified 24 hours prior to starting work and again immediately upon completion.
-----,""»-<.......,-,-'--.:..:X...;:i >:::__--r:._:lt.:..:f:..:L..!.t _______________________ Date r\ Jf\N z.pi,
Permittee ( · n in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this
by __ -r_-._1-_c_R._K_f_>T_tt_C:_-1,~'( _____________________ _, who personally appeared before me and
(printed name of Permittee)
acknowl dg d that he/she signed the instrument voluntarily for the purpose expressed in it.
H:\Applications & Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date: 10/1/18
•
fidelity National Title
of Florida Inc.
PROP ERTY ADDRESS: 916 HIBISCU S STREET. ATLANTIC BEACH, FLORIDA 32233
•
•
SURVEY NUMBER : Fl.2012.335;3
9
9
9 Q
9 0 --I) !
Fl2012.3353
BOUNDARY SURVEY
DUVAL COUNTY t/-Z-flRC
W,1941;
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:lcK 58 ~ I S1Y.
1<£519 G
LO-G
'3l\ I 53 ~8 39.ll' 32.1' ONt.,.. __ ...::.:::::...---\---.....:a"----1
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G'V _,., O.l'ON
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;,f ......,,.,..__( ./. ..se,l,...,R--
RAYM ON D J . SCHAEFE R
Stile of F1ondo Prot.s.soon.l 5urYeYO< and .. _
l.JCMSe Numt,., 6112
DATE OF SURVEY: 12/23/20
FIELD WORK DATE; 12/21/2020
REVISION OATE(S ): (REV.0 12/23/2020)
SURVEYORS CERTIFICATION:
I hereby certify that th;s Suivey of the lands
described hereon was made under my direct
supervision, and t o the best of my knowledge
and belief is a true and a ccurate representation
of said la nds ~nd meets the Standa rds of
15 ,
CRAPHIC SCALE (In Feet.)
1 inch = 30' ft.
POINTS OF INTEREST:
NONE VISIBLE
AFFILIATE
MEMBERS
Practice set forth in Chapter SJ-15.050 through
SJ -15.053, Florida Adm;nistrative Code,
pursuant to section 472.027, Flo rida Statutes.
This survey i s not valid without the signature and
original raised seal of a Florida licensed surveyor
and mapper, e xcept when the electronic
signature and s eal of a Florida li censed surveyor
and mapper is affixed hereto. 1--.. ----------------------
◄EXACTA ... LS#8291
omc:e 666 73S t916 I FblC 966 744.2882
11940 l=bifWlliY La~ Of',vo S u lto 11 Fort MVC<"S. F L 3 3 9 13
SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION
PAGE 1 OF 2 • NOT VALID WITHOUT ALL PAGES
PROPERTY ADDRESS: 916 HIBISCUS STREET, ATLANTIC BEACH, FLORIDA 32233 SURVEY NUMBER: FL2012.33S3
JOB SPECIFIC SURVEYOR NOTES:
THE ASSUMED BEARING REFERENCE OF SOUTH 1 DEGREES 22 MINUTES 00 SECONDS EAST IS BASED ON THE WESTERLY RIGHT-OF-WAY LINE OF
HIBISCUS STREET, LOCATED WITHIN SECTION ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 18, PAGE 34 OF THE PUBLIC
RECORDS OF DUVAL COUNTY, FLORIDA.
LEGAL DESCRIPTION:
LOT 6, BLOCK 158, SECTION "H" ATLANTIC BEACH, ACCORDING TO THE MAP OR PLAT THEREOF, AS RECORDED IN PLAT BOOK 18, PAGE(S) 34, OF
THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
GENERAL SURVEYOR NOTES:
' 1. TM legal Descrtptlon used to pedorm thlJ survey was 6. Otmensions ar• In feet a nd dedmafs ~-11. Points of Interest (POi's) are .selt<ted abow--gtound
suppll.cf by othtrs. This Survty dMS not Mttrmlne nor 7, Any FEMA food ZOM data con~ned on this survey Is for
lmprowments, whJch m.y appear In confflct with boundary,
Imply OWMrshlp. Unless otherwise noted, an examtnatlon bulk:Ung s.t~ck or ease~nt llnts, H defined by the
of the abstract of title WH NOT performed by the signing lnforTn1tlo~I purposes only. Research to obtain uld dat.a para.meters of this surwy. There maybeaddlt\oMl POi's
surveyor to determine which Instruments, If any, are was performed at www.ftm1.gov and may not "11ect the whkh are not shown or called-out as POi's, or which are
affecting this property. most rKtnt Information. otherwise unknown to the surveyor. These POi's may not
2. The purpose of this survty Is to est:lbRsh the bofJnclary of 8. Unlmotherwtse noted SI RC Indicates a minimum w· represent all ttemsoflnteresttothevlewer.
tho lands d<salbed m tho log>I desalptlon pnwlded and to dlamettJ. 1r Song Iron rebarwlth I cap stamped Ul8291. 12. Utilities shown on the subject proptrty rn,y or may not
~plct the vlsZble Improvements ~n. This survty only 9. If you are reading this survey In 1n electronk fonnat, the lndJQte the existence of recorded or unrecorde<f
shows lmprowments found a boveground. Underground Information contained on thls document Is onty VJ lid tfthls utllfty euements.
f~ngs. utilities and encroachments where not located on do(ument ls.iectronlalty sl9ned as spreclfted ln O.apter 13. The lnformatk>n contalned on th IS survey ha! been tMssu~rN:p. SJ17,062 (3) of the Aot~ Mmlnlsttattve Code 1nd Aortda performed mlus!wly by and Is the sole responslbllltyof
3 . tfthere ls1sepdctankordraln ftekl shown onth1s surwy, Statute 4n..o2S. The EJectronk Signature FIie related to this EXICU: Und Surwyors, llC. Additional ktgo's or references
the k>caUon depicted hereon was either shown to b:acu document Is promtnentty dlspfl)'td on the lrwoke for this to third party firms ire for lnformatSonal purposes only.
Lind SUrw)'ors, UC. by a thlrd party or It was Htlmated by survey which IS sent under HP1rJte covet', Manu,lly signed
v1su,l 1bove ground Inspection only. No excavation was Ind RIied logs of all survty signature files ire Qpt In the 14. Pursuant to F.S. 5S8.003S, an lndlvklual empl~ or 1gent
performed to detemilne the loca:t.Jon. ofti~ of the performing surveyor. may not be held lndlvldualty liable for negllgenc,.
•· Thlssun,,y lsexdus1,,.1y1orthouse of the p¥tlestowhom to, Th• symbols r<ftected m tho legond one! on this sun,ey moy 15. Due to vi,rytng construct\on standards. house dlm,nslons
ltiscertffitd. haw been enlarged or re<tuc:ed for cllrtty. The symbols areapprOXlmate a nd should not be used for new
haw~ plotted at the approxlm1nt center of the field constructJon or plannlng. All fflffSUrements should be
s. Additions or delet1ons to this Surwy MJp and Report by locatlon and may not repre1ent the actval sha~ or slze of vtrtfi~ prlorto suchacttvlty.
othef than the signing su~r Is prohibited w'thout thefu,ture.
wrtnen consent of the sl;nlng surwyc,.
SURVEYOR'S LEGEND ~':=~ l I ,-~ C/5-Conaete Sl1b FIR· Found Iron Rod ORI· Officlll Records Boot S/W·Sld~1lk
"O' -t;;;...:: CATV-Ca~TVRher FIRC· Found Iron Rod &Cap ORV· Offid1I AK.Ord Vohsme Sll·Se~Une
• I Ando,S<t ca-Concrew 8lod FPt • Found Nall OIA·OverlD sa-~oosu,-u~ r·-·-1 ......... I CH•Cho<d-..g FNAO-Found Nal. Oise 0/$-0lls,t SCll ·Soetn
--0-,lklt.c,M<e -=i -~ CHIM·CNrnney FIUISPlt ·follndRdRoad OFF ·OutsldeSLl>]<Ct Prooerty SEC · Soction EJ ~ j E-~7 I (a 1"'-Q.F-Ch1ln link~ -OH · Ovt-rhang SE.P•Septk:Tlnk
CME-CanaJMalnt.ea1n~ GAit-Garage OHL -~UtJfftyUne, SlW•Sewff 1-ot-~:'"' J Easement GM•GasMetlr ON· Inside Subject Property SIRC-Setl1on Aod&Clp g =-' I ,:X I Ullltyo,~-CO·OonOut 10 -ldenUfiatlon ,t£•Poo1Eq-$Miff· Storm Wltc,
I @ I ------; CONC • Conc:reu IE/EE-lngms/£:gress E&sement Pt•PbtBoolt IMnagementf.lterntnt
COA •Comff" IU •mtglblt PC· Point ofCUMtute SNaD -Set NIii Ind Oise AUHVtATIONS ~=Un< I ICJ • C.laAa1'd
CS/W • Concrett Sl<ftw.Jk INST-lnstrumrnl PCC·PolntofCOfflpound SQFT • Square Fett
CUE· t.ontrol Utllty bsement INT· lntersectlOn Curvature Sll • Survey T1e Un<
~Vlr,yl--(OH>ted CYG •Concrete ValeyGune, llltllE • lmg,IUon El.senwnt PCP-~tControl Point SlY•Sto,y lfl·Add ---W.slOfPartyWII DIW ·°"""'y L·ltnglh Pl • Point ol lnttrs«tion SV•S.W..Va!Yo ~--(ll)•Musu,ed
DE•Dnlna.Q4!!:E&sement LAE • l..Jrnh:ed Acmu USl!'fflolent PU· Protes.slonal Und SWE-Sidrw.a.Ac Ea1emrnt I SUOFACliTfPU I (fl)-~ Of -0..alnFleld Lit-ucense No. (8ustne»)
,.,,.,..
TIM• Temporary 8encti Marte
:(2;.1...-I IS)·S.My
OH-DrillHole l9E • Umitecl tlufftr Enement PLT·Ptintet TEL• Telephone Fldlldes
~i llrld<o,Tle
A/C • AJr CondttfONng OUE · Ora!Ngo& Ut111ty LE• Llndsape Elseftwnt POl·PolntofBe,glMlng TO.· Top of Bank
~:~:.=:·~~!=;;-Al•AccHsbsement Euement LMIE•Utt-/undscipe POC·PolntofCOfNl"lefl~t TUE· Technologlal Utllty
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CERTIFIED TO: FLOOD ZONE INFORMATION:
TYLER KESTHELY; FIDELITY NATION AL TITLE; FIDELITY NATIONAL TITLE BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING
INSURANCE COMPANY; NAVY FEDERAL C REDIT UNION MUNICIPALITY OR WWW.FEMA.GOV, THE PROPERTY APPEARS TO BE
LOCATED IN ZONE X. THIS PROPERTY WAS FOUND IN THE CITY OF
ATLANTIC BEACH, COMMUNITY NUMBER 120075, PAN EL NUMBER 0400
DATED 11/02/2018.
DATE OF SURVEY: 12/23/'2!.J
BUYER: TYLER KESTHELY
SELLER: DANA EDWARD GRANT AND ELLEN M. GRANT
CLIENT FILE NO: 52-20-0032
TITLE COMMITMENT: ...
◄EXACTA
T L B# B291
SEE PAGE 1 OF 2 FOR MAP OF PROPERTY Offk:e: 866.735.1916 I Fa>e: 866.744.2882
PAGE 2 OF 2 • NOT VALID WITHOUT All PAGES 11940 Fairway Lakes Dr-lve. SUlte l I Fort Myel"'$. FL 33913
Closing Disclosure
Closing Information
Date Issued 01/05/2021
01/07/2021
01/07/2021
Closing Date
Disbursement Date
Settlement Agent
File#
Fidelity National Title of Florida, Inc .
52-20-0832
Property 916 Hibiscus Street
Atlantic Beach, FL 32233
Sale Price $279,900
f,lj,,\,,@jjt4J.Ji 1t\,ttfof.i,tJ
SELLER'S TRANSACTION
M. Due to Seller at Closing
01 Sale Price of Property
02 Sale Price of Any Personal Property Included in Sale
03
04
05
06
07
08
Adjustments for Items Paid by Seller in Advance
09 City/Town Taxes
10 County Taxes
11 Non-Ad Valorem
12
13
14
15
16
N. Due from Seller at Closing
O 1 Excess Deposit
02 Closing Costs Paid at Closing (J)
03 Existing Loan(s) Assumed or Taken Subject to
04 Payoff of First Mortgage Loan
05 Payoff of Second Mortgage Loan
06 Title Insurance Premium Adjustment
07
08 Seller Cred it
09
10
11
12
13
Adjustments for Items Unpaid by Seller
14 Garbage
15 County Taxes 01/01/21 to 01/07/21
16 Assessments
17
18
19
CALCULATION
Total Due to Seller at Closing (M)
Total Due from Seller at Closing (N)
Cash D From ~ To Seller
CLOSING DISCLOSURE
$279,900.00
$279,900.00
$25,936.96
$16,042 .80
$1,099 .50
$8,750 .00
$44.66
$279,900.00
-$25,936.96
$253,963.04
Transaction Information
Borrower Tyler Kesthely
904 Hyannis Port Dr
Jacksonville, FL 32225
Seller Dana Edward Grant and Ellen M. Grant
616 Pine Street
Neptune Beach, FL 32266
if&fili ffif.ii,M!t-ii ___________ _
REAL ESTATE BROKER (B)
Name
Address
FL License ID
Contact
Contact FL License ID
Email
The DJ & Lindsey Team
1009 AlA Beach Blvd
Saint Augustine, FL 32080
BK3464386
Kristen Magu i re
BK3464386
kristen@moveto904.com
Phone 904-315-5400
REAL ESTATE BROKER (S)
Name
Address
FL License ID
Contact
Contact FL License ID
Email
Phone
SETTLEMENT AGENT
Name
Address
FL License ID
Contact
Contact FL License ID
Email
Phone
Ellen M. Grant
Keller Williams Atlantic Partners
4116 3rd Street South
Jacksonville Beach, FL 32250
BK3144162
Summer Grant
SL3404055
su mmersel lsjax@kw.com
(904) 525-4134
Fidelity National Title of Florida, Inc.
601 Riverside Avenue
Bldg V -5th Floor
Jacksonville, FL 32204
A090982
Erica Lawrence
Erica. Lawrence@fnf.com
(904) 854-8508
PAGE 1 OF 2 01 /0 5/21 09 :54 AM E
Closing Cost Details
Loan Costs
A. Origination Charges .
01 % of Loan Amount (Points)
02 App li cat ion
03
B. Services Borrower Did Not Shop For
01 Appraisal to Navy Federal Credit Union
02 Credit Report to Navy Federal Credit Union
03 Flood Certification to Navy Federal Credit Union
04 MIP to Navy Federal Credit Union
05 Tax Service to Navy Federal Credit Union
06
C. Services Borrower Did Shop For
01 Survey to Exacta Land Surveyors, Inc.
02
03
04
05
06 Title -Lien Search to Black Knight Financial Services
07 Title -Search Fee to Fidelity National Title of Florida, Inc .
Other Costs
E. Taxes and Other Government Fees
01
02 Transfer Taxes to Duval County Clerk of Court
F. Prepaids
01 Homeowner's Insurance Premium ( mo.)
02 Mortgage Insurance Premium ( mo.)
03 Prepaid Interest ( per day from to )
04 Property Taxes ( mo.)
05
06
G. Initial Escrow Payment at Closing
01 Homeowner's Insurance
02 Mortgage Insurance
03 Property Taxes
04
05
06
H. Other
01 Home Warranty to American Home Shield
02 Listing commission to Keller Williams Atlantic Partners
03 Se lling commission to The DJ & Lindsey Team
04 Title -Owner 's Title Insurance to Fidelity National Title of Florida, Inc .
05 Transaction Fee to Kelle r WIiiiams Atlantic Partners
06
07
08
09
10
11
12
J. TOTAL CLOSING COSTS
CLOSING DISCLOSURE
Seller-Paid
At Closing Before Closing
$295.00
$103.0 0
$115 .00
$1,959.30
$600.00
$5,598.00
$6,997.50
$375.00
$16,042.80
PAGE 2 OF 2 01/05/21 09 :54 AM E
Closing Disclosure -Attachment
Borrower: Tyler Kesthely
904 Hyannis Port Dr
Jacksonville, FL 32225
Settlement Agent: Fidelity National Title of Florida, Inc .
601 Riverside Avenue
Bldg V -5th Floor
Jacksonville, FL 32204
(904 )854-8708
Closing Date: January 7, 2021
Disbursement Date: January 7, 2021
Property Location: 916 Hibiscus Street
Atlantic Beach, FL 32233
Confirm Receipt
By signing, you are only confirming. t tnnhat u ~ave receiv~his form.
µ,£4/~~
CLOSING DISCLOSURE -ATTACHMENT
Seller: Dana Edward Grant
Ellen M. Grant
616 Pine Street
Neptune Beach, FL 32266
PAG E 1 OF 1 01/0 5/21 09:54 AM E