HomeMy WebLinkAbout15-16645 CITY OF ZEPHYRHILLS -
5335-8TH STREET /f�
(sis)�so-oozo 166
� � BUILDING PERMIT
PERMIT INFORMATION - LOCATION INFORMATION '
f�ermit Number: 16645 Address: 38027 10TH AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CI�(Q ZEPHYRHILLS
Est. Value: Parcel Number: 1���� �����oo ^��
I Improv. Cost: 2,400.00 OWNER INFORMATION
Date Issued: 10/01/2015 Name: ZAVISZA, ROBERT
Total Fees: 195.00 Address: 6 3 S o z� ���`
� Amount Paid: 195.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/01/2015 Phone: 813-428-4365
Work Desc: BATHROOM ADDED TO EXISTING SPACE
CONTRACTOR S APPLICATION FEES �
HOMEOWNER BUILDING FEE 75.00 ELECTR L FEE 60.00
HOMEOWNER PLUMBING FEE 60.00
, HOMEOWNER
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Ins ections Re uired �
FO ER 2ND ROUGH PL MB N LATION CEILIN
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or ',
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe 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, 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. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONT CT R SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION ,
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED �,
PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDING PLAN REVIEW COIVIMENTS
Contractar/Homeowner: �(����C�!/J�S Z�..
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Date Received: ( � 2�/�
sxte: �.3'c�02 7 I��'- 7��%�
Perrnit Type: �a��`�y'd"�'�l �(�it'�� Sf.�'CC 'E.—
Approved wina comments:❑ 1�ppraved wlthe below comxnents: I7enied w/the below comments:
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This comment sheet shall be kept with the perrnit and/ar plans. �
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Kal ' S ' zer Exatniner Date Contractor an o Horneowner
(Required w comments are present}
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DISCLOSIIRE STATffi�N'P FOR OWNF�R
' CITY OF ZLPHYRHILLS BIIILDING DEPARTMENT
I� �� �,V� have read aad fully understand aad
agree to the provisioas of this iastrumeat.
The uadersigaed states and affirms that he or she is desirous of coastructiag,
reaovatiag, addiag to or reroofing his o r own domicile, that he or she
, actually occupies, or will occupy by ,Z S said domicile, aad same is not for
rent, lease or sale. That he or she shall comply with the following conditions:
1. That the owner and he or she aloae shall act as the builder for all phases of
conatruction.
2. That the owaer will comply with all proviaioas of the City of Zephyrhills
ordinaaces aad codes pertinent to the buildiag.
3. That ia the event various phases of construction are subcontracted, he will
engage only properly licensed subcontractors. and will personally aupervise
such work.
4. That in the eveat the Buildiag Iaspector shall require correctiona to be made,
the owaer will assume full responsibility to iasure they are made, and upon
completion will call for a reinspection before proceediag with the buildiag.
� 5. That the owner ahall assume full responsibility for the construction and will
not expect supervisioa of his work from the City of Zephyrhills Building
Department.
6. That prior to fiaal iaspection aay additioaal fees, including reinspection
fees, must be paid in full. A written request from this office shall
coastitute an official notice to pay additioaal fees.
7. That the owaer shall comply with all City, State and Federal laws in regard to
social security, workman's compensation, lien laws, etc. , where applicable.
8. That the owaer shall comply with all the safety codes issued by the Florida
Iadustrial Commission.
9. State law requires conatruction to be doae by licensed coatractors. You have
applied for a permit under aa exemptioa to that law. The exemptioa allows
you, as the owaer of your property, to act as your own contractor with certain
restrictioas evea though you� do aot have a licease. You must provide direct
onsite supervision of the construction yourself. You may build or improve a
, oae-family or two-family resideace or a farm outbuildiag. You may also build
or improve a commercial building, provided your costs do aot exceed $75,000.
The building or residence muat be for your owa use or occupaacy. It may aot
be built or substantially improved for sale or lease. If you sell or lease a
buildiag you have built or substantially improved yourself within 1 year after
the construction is complete, the law will presume that you built or
substaatially improved if for sale or lease, which is a violatioa of this
exemption. You may aot hire aa unTicensed person to act as your contractor or
to supervise people working on your building. It is your respoasibility to
make sure that people employed by you have licenses required by state law and
by county or municipal liceasing ordinaaces. You may aot delegate the
responaibility for supervisiag work to a licensed contractor who is aot
licenaed to perform the work beiag done. Aay persoa working on your building
who is aot licensed must work under your direct aupervision and must be
employed by you, which meaas that you must deduct F.I.C.A. and withholdiag tax
and provide workers' compensation for that employee, all as prescribed by law.
Your constructioa must comply with all applicable laws, ordinaacea, building
codes, aad zoniag re a ' s. � �
OWNER'S SIGNATURE , Dp.TE 9 a� �5 � .
ADDRESS S�OZ
PxorrE !3�2A�.?G 5 �
WITNSSS PERMIT #
s��-7ao-oo2a City of Zephyrhills Permit Application Fax 813-780-0021
Butlding Qepattment
Date Recetved —� � Phone Cootact far Pe�ntttln —
�
Ctwrser's Name fJl�+�- Owner Phone Nu ber ���~�� �
Owner's Address J �Q�� GJ L �G t le �� Owner Phone Nu
.Feer3lmple Tltleholder.Name � Owner Phone Number � I
F�e_Sinrple Titleholder Address
!�JOB ADDRESS d��� �� � �f � LOT# �� I
SUBDIVISION �� � PARCEL ID# I
(OBTAINED FROM PROPERTY TAX NOTICE)
WORiC PROPOSED y NEW CONSTR ADD/AlT � SIGN Q Q DEMOLISH ,
e INSTALL � REPAIR _
PRQPOSED USE � SFR � CO{VIM [� LITHER
TYPE OF CON3TRUCTION Q BI.00K ° Q FRAME � STEEL Q
DESCRIPTION OF WORK � � �v
BUILDING S1ZE � � SQ FOOTAGE�� MEIGHT ��
' �C������i��' � `� G'fQ��'""" VALUATION OF TOTAI CONSTRUCTION
�•QELEGTRiCA� �� AMP SERt/ICE Q PROGRESS ENERGY Q W.R.E.C.
�P�UMg►�!G �_� .�l`Y��� �
Q MECHANfCAI $ '� VA�UATION OF MECHANICAL INSTA�IATIQN � � �r�`
GAS Rt?OFING , SPECIALTY OTFiEFt � �W����4 ��
0 o a o �
FINISH�D FLOOR ELEVATIONS �� FLOOD ZQNE AREA [�YES NO �/��,/
L..'
BtJ1�DElt i r���` COMPANY
NATURE � REGISTERED Y/ N FEE CURRE� Y/N
� ._. _
�I Address License# _ �
� .�LECTRICFAN �` COMPANY ��'c2�
SIGNATURE Y REGIS7ERED Y/ N FEE CURRE� Y/N
Address License# �� �
; ��tlMBEl2 COMpANY �''����
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
, Address License# � �
MECNAP!}GAt, COMPAR+lY
SIGNA7URE REGIS7ERED Y/ N FEE CURRE� Y/N
Address License# � �
OfiHER COMPANY
�i SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N i
� Address - License# �� � �
RESlD�NTIAL: Attach{2)Plot Rlans;_{2}sets af Bulldtog'Plans;(1}set af Energy Forms;R-O-W Permit fior new canstrucHon,
Minimum ten(1.0)working days after submittal date. Required onstfe,ConstrucUon Plans;Stormwater Plans w/Silt Fence instalied,
Sanitary Facilities&1 dumpster,Site Work•Rertnit for subdivisionsAarge proJects
CONIMERCIl�t. Attach{3}complete sefs of_Builditig Flar�s.plas.a�tfe Safety Pags;(i}��t o#�nsrgy Forms.R-0 W Petmit for new construction.
MiNmum ten(10)working days after submittal date. Requlred onsite,Construcdan Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Faailides&1 dumpster.Site Work_Permit for all'new proJects.All commercial requlrements must meet aomptlance
StGN PERMIT Attach{2)sets af Engineered Plans. �� � . .
""PROPERTY SURVEY required for,all NEW,canstructian. � ' - ' "
Dlrections: ° _ �
FIII out applicatlan completely.
Owner&ContracMr sign back of applica8on,notadzed
If ovsr 52500,a Nottce af Commencement is required, {A/C cipgrades ovar ST500}
" Agent(for the contractor)or Power of Attomey(for.the.owner)wauld:be someone with notarized letter f�rti owner-authorizing same , , ,
��i�•�;}:,� ij; " :;t� -
t}VERTHE CCtUId7ER PERMITfiNG��,= .,- tFrontof�l°�APlicatiqn.Only}`;?" �' �: �. : , • � : ' ,� _ .
Reroofs if shingles Sewers `.Service Up'grades;NC'� Fence§(PIoUSurvey/Faotage) '�; , . , ` .
Drivewaya-Not aver Counter if on.public"roadways,.needs ROW-_=� ' '` ' + �- - rt =� -� -- i _
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NQTICE OF DEED RESTRICTIUNS. The underslgned under�taruSs°t1t�E thl�:p�rmlt,may.be.subject to.°deed"restric�ions" {
which may be�more'�rest�ictive-than �ounty.regulatlons. �THe undersigned assume� responsiblltty�for�compliance wltfi any
appllcable desd restrictions: � �
UNCICENSED CONTRACTORS .AND C�NTR�►CTOR RESPANSiBILITtES: if the owner-,has:�hfired. a cantractor or
contractors ta under�ake wark, #hey may.be:re�quired to�be;ltcensed In-�csordance.w(th state.and•local regulations. If�the
contcactot ts not Itcensed as r$qulred=6y Iaw� batE� the owner an�--ccintiactoT may be-clted�fw a-misdemeanor viola#ion
under state law. If the owner or Intended contracta��are uncertain as to what Itcensing.requiremen#s may apply:�or,the
inkended work,they are advfsed to cont�ct the Pasco County Bulldtng(nspect#on D!v!slon—ltcensfng Section at 727-847-
8009. Furthermore, if the owner�has hired a conhactor oT cantractors, he is advisad to have the contractar(s) sign
pnrtions of the "contractor Block° of this applicatlon for which they wUl be .responsible. If you�-as.fhe owner stgn as the
contractor, thaE may be an Ind�cation #hat�tie is no#.properly�13censed and 1s not enfltled to perniitting privlteges [n Pasco
County. � , . � . . . .
TRANSPQRTATIQN:IMPAGTlU1"1lITIES=IMPACT ANb-RESO!l�tGE RECCIYERY�FEES; The under��gned understands ,
that Trenspo�tation Impact Fees and.Reco.urse Recove.ry.Fees may�-appiy to�the construction of new buildings� change af �,
use in existing buildings, or.expansion�of�exlstiriy.�6uildings, as spec(fled in Pasco County Ordinance number 89-07 and 'i
90-07. as amended. The undersigned aiso:unders#ands� fhat stach fees,:.as<may��ie�due; wlll�.be identiffed at the�tirrie of
permitting. It Is furtFier understaod that Transportation Impact Fees and Resource Recovery'Fees must be pafd prlor ta
reae�v�ng a°cec�lficate of occupancy" or finai�powec-.release. :1��#he pra#ect does nat Invotve:a cert�icate of ac�upancy ai�
final power release;the fees must be patd prlor to permi# Issuance. Fu�thermore;ff Pasco Caunty INater/Sewerr lmpact
fees are due,they�musk be-pald prior to permil�Issuance�ln accordance witti appltcable Pasco�County ardinances.
CONSTRUCTION LIEN�l..AW(Chaptar 713� EloNda$tatutes�as amend�d): •1fi vatuatian of work is$2,500.00-or more, i
certify that I, the applicant,. have-been provi.ded with- a-copy of the "Flarida Construction� Lien..L'aw .Homeawner's
Protecttan Guide° prepared by�the Flotlda Deparfinent af Agrlculture and ConsumerAffalrs, 1#the appt[cant ts someone
other than the"owner", I certify that I h�ve,obtained�a copy.of the.above..described document�and pramise in,good faith.ta
deliver!t to the"owner"p�ior to�commeneement:�
Ct3NTRACTCIR'S/OWNER'S AFFIDAViT: i ce�tify.:that al)the,information In�this application is accurate and that all wark
will'be done in compliance with all applicable laws regulating co�stn�ction� zontng and land development. Applicatlon is
hereby made to obtaln .a perm�t to do. warl�.and instailatlan as tndt�afed� °I certtfy #hat no vuortc or tnstalla#ion has ,
cammenced prior to issuance of a permit and that.all work will be pertormed to meet standarrds of all laws �egulaking�
constructlon, Caunty and City codes, zoning regulations, and land development regutat{ons�in the 3urisdictlon. ( ai'so
certify that 1 unders#and that the regulattons of other government agencies may appiy�ta the intended work, and that it is
my respansibility to identlfy�whak.act[ons I musk take to be�ln:.cotr�pllance: S.uch agenctes.!nclude but are,nQt limited to:
- Department af Erlvtronmental�Pratectiori�Cjrpress.Bayheads, Wetiand Areas and Environmentalty Sensitive
Lands,WaterNUastewater Treatment., �
- Southwest Ftorida Water Management� .C�isUict Wetis, Cyptess. Bayheads; We#land Areas, Attering
Watercourses.
- Army Carps of Englneers�Seawalls, Dacks, Nav(gatite Waterways.
- Department of Health 8 ReY�abilitative Servtces/Ernironmentat Health Unit Well.s, Wastewater�Treatmen#,
Septtc Tanks. � ' � _
- US Environmentai Pro#ec#io�n Agency Asbes#as abatement. ` ,, ,
- ' Federal Avlatton:Authority=Runways. � ° •
I understar�d that the following res#ri�tions apply to the use of flik� '
- Use of filt is no#ailowed in Fload 2one�`"V"unless eicpressty permitted.
- If the flll material is to be used:.�in �Flood Zane. °A", it. (s understood that a drainage plan addressing a
"compensating volume"wi11 be submitted a#time of permitting wl�lch is ptepared by a professlartal englneer �
Iicensed by the.State�of Florlda: �
- !F th� fill materla#.ts ta be used In Fioad �ana °A� in�cannec�fan�vulth.a���ermifted building using stem waff
� canstruction., I certify that fi1l�:wlll:b.e used only.to.fill the area withln the stem wail. .
- !f fill material is to be used !n any area, i aertiiy Htat use- of such .f!{I wil! not adversely a#feat adJacent
properties. if use of fiN 3s#p�nd ta adversety:�ffect adjacent��properties,.the owner may be cited for uioiating
the condliions of the buildtng:permit issued.under the attached�aermit application, for lats less than.one (1�
acr$whtch ar�elevated by i31t�an engineer�d dralnage pEan Is required. .
If I am the AGENT FOR THE OWNER, I;:promise In good fatth#o inform the awner af the permitting conditlans set forth In
this aifidavlt prlor to commencing aonstruetian. "f understand that a=separate permlt may be tequfred #or electrical work,
plumbEng, signs, welis, paats, air candi#ioning, .gas, ar other. Install�tlons nat.spec�ficalEy inctuded in the appiication. .A
permft Issued shall be constcued to be a Iicense to;proceed wfth t6ie work and not as.authority to.vialate,cancel. alter, ar , �
seE aslde any prov�sions of the techntcal codes; nor shall lssua�ce�af a permlt.prevent fhe Bulldlrig Of�icl�l from therea�ter =
requiring a correction af errors in�plans,�constnictlon orviolations of any codes. Every permit Issued shall become invalid
�nless the work authorized.by such permft.�is.commencecl�witl�in sfx months of permlt tssuance, or!f work aathorized by
the permit is suspended or.abandoned for a_period of�six f8}mantFis:after the time#he�work�s commenced.. An extenslon
may be requested, tn writing, fram the Suilding.Offlcial for a perlod.nnt to.exceed ninety�(90) days and will demonstrate �
�ustlfiable cause for.the extension: If wo�k ceases far nine#y�90)consecutive days;.#he�ab is aonstdered aba�doned.
WARNENG TO OWNER: YQUi�.FA1L.URE�70.,RECQRD.A Nt�TIGE:OF�GOMM�NGEMENT NfAY�RESULT 1N YOUR �
PAYING TWICE.FOR IMPROVEMENTS TO YOUR<.PROPERTY.��:IF�YOU-INTEND':'TQ OBTAIPI�FINANCING;�CONSULT
W17H UR �!D �O AN TTOR EY- FORE� ECORD G�YOU � rD �� �°O ' •' E E
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Page 1 of 1
, Mike Wells Pasco County Property Appraiser
Data Current as Of: Weekly Archive - Saturday, September 26, 2015
Parcel ID 11-26-21-0010-06200-0080 (Card: 001 of 001)
- Classification O1 - Single Family
Mailing Address Property Value
LSF9 MASTER PARTICPATION TRUST Ag Land $0
US BANK TRUST NA TRUSTEE Land $18,270
C/0 CALIBER HOME LOANS INC
2711 N HASKELL AVE STE 2150 Building $27,396
DALLAS TX 75204-2912 Extra Features $2,007
Physical Address � t
38027 lOTH AVE
ZEPHYRHILLS FL 33542-3920 7ust Value $47,673
Leqal Description (First 4 Lines) Assessed (Non-School Amendment 1) $47,673
See Plat for this Subdivision
CITY OF ZEPHYRHILLS Taxable Value $47,673
PB 1 PG 54 LOTS 8-10 INCL
BLOCK 62
OR 9184 PG 2575
7urisdiction
City of Zephvrhills
_ l Land Detail (Card: 001 of 001)�__
_Line � Use �Description� Zoning Units� Type � Price TCondition f Value
1 _! _ 0100 SFR OOR3 � 8 400.00 SF i $2.00 � 1.00 � $16 800
--_ �- ' _---t '--- - - � �
--- -----__----- -
2 � 0100 SFR OOR3 1 4,200.00 � SF � $0.35 � 1.00 j $1,470
Additional Land Information
---- �� FEMA �-----r---- _—__T--_ —
Acres � 0.29 Tax Area 30ZH � Code ! -- �Residential Code� ZHLHLP2
I _r_�__.�__ - !
I
Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1955 Stories 1.0
Exterior Wall 1 Above Average Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Plastered Interior Wall 2 None
Flooring 1 Asphalt Tile Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line � Description � � _ _ Sq. Feet i Repl. Cost New YR`
--------._._...__.---________._.___-._. ..,_. .-------- ------.____�----_.___�.
-�--__--1 �_��---_--- BAS I 895 ; $46,236---
2 !-- � FST ----- � 104 ^-�^ i -�-- $2,686
____�.__.___W________ .___�__.___.. _ Extra Features (Card: 001 of 001)___,_ __
_ — ------ ----- --,--- ---:---.___—.�_r_—____
Line Description I Year ! Units I Value
------_---_.._ .._�__.__---- - -----------�-------- ----.,�,.�--.—.—�__—
-------1-----__,.1.__.__ ._CLFENCE � f 1994 _.__.---!_-------680 ----_1_._-- $281
2 UDU-M �-�--^�� 1994— -4i --T-- 1------ 1-- 1,028
------__ --�__---_-_--_ �
-----. ___, __. ____.__
3 ; CON PTO � � � 2008 � 100 j $239
------_--_----_----- ----_----___.____-----_._�__------------
4 � DWSWC j 2006 - �---- -200�------�-------- $459 A---
Sales Historv- See All 6 sales
Previous Owner: ELLISON ]ESSIE
___-------- -------------
T__'_'_ _'.��-___'_�--_T'_,�-__'__
__ Month/Year� Book/Page___i___ ^_ Type _ _ � DOR Code ( Condition � Amount
� _�-_�� --;--------�---
--- .
04/2015 ; 9184 / 2575 ; Certificate of Title � 12 ; Improved � $10,200
--_-_-_-_-�___.___ _._, _. ..._�_-------_���. ----------;------------�--------____-.---_____..______
10/2008 i 7963 / 1384 ! Warran Deed j Im r
-- -- i---------tY i P oved � $53,000
--;---- ----- __-
12/1996 3668 / 1641 ; Quit Claim Deed `�` ; Improved E $0 �
,
, http://appraiser.pascogov.com/search/parcel.aspx?parce1=2126110010062000080 9/29/2015
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p, $ett�em@�t$tateme�t U.S.Department of Housing and OMB ApD�ovai No.2502-0265
, ' Urban Deveiopment
B.T ot Loan
1. QFHA 2.�FmHA 3.�CAnV.UninS. B.FdeNumber. 7.loanNmnber. B.hloRgagelnsuranceCaseNumher.
4. �VA 5.❑Conv.lns. GRG34764
C.No�e: 7ry's form is tumished to gNe you e statemenl of ecWal seHlement cosLa.Nnounte paW to and hy Ne setllemenl ageM ere shovm.Ilems marked'(p.o.c.)'vrera paid ou5ide ihe dasing;Ney are
shaxn here for Infortnational puryoses entl are not IncWded'm Bre fntals.
D.Name B PdGess of Bamrer: E Nane 8 Address of SeEer. F.Narre 8 Address d LeMa
CAPNISA ENTERPRISES,LLC U.S.BANK TRUST,NA.,AS TRUSTEE FOR LSF9 CASH
5520 BRADDOCK DRNE MASTER PARTICIPATION 1RUST
ZEPHYRHILLS,FL 33541 6031 CONNECTION DRNE
IRVING,TX 75039
G.Pmpttly Laa6on: H.Settlement Agent
3802710iH AVENUE BAY NATIONAL TITLE COMPANY
ZEPHYRHILLS,FL 33542(PASCO) 13577 FEATHER SOUND DRNE,SUfTE 250,CLEARWATER,R 33762(/2�443
(»-zs-z�-��aos2oo-ooeo) -
Place OI SeWement I.Settleirent Date I Dishivsert�ent Date
13577 FEA7HER SOUND DRNE,SUfTE 250,
CLEAf2WATER,FL 33762 9/162015 / 9118l2015
J.Summary of Bortower's Transacdon K Summary af Sellers Transaction
700.Gross Amount Due From Bortower 400.Gross Amount Due To Seller
101.CanVad sales price $30,200.00 401.ConGact sales price $30,200.00
102.Personal Pro 402.Personal Property
103.Settlement Cha es to Borrmver line 1400 $523.00 403.
104. 404.
1 O5. 405.
Ad ustment5 for(tems pald by seller in advance Adjustrnents for Items pald by seller In advance
106.Ci Rown haxes 406.Ci Rown taxes
107.Coun [axes 9l182015 to 12f31l2015 $17.71 407.County tazes 9/182015 to 1?/31/2015 517.71
108.Assessments 408.AssessmenLs
109. 4�.
110. 410.
111. 411.
112. 412
120.Gross Amount Due Fram Bortower f30 740.71 420.Gross Amount Due To Seller S30 217.71
200.Amounts Paid By Or In Behalf Of Bortower SOU.Reductlons In Amount Due To Seller
201.De osit or Eamest Mone 530,200.00 501.Encess de osit see insWCtlons
202.Prindpal amowt o1 new loan 502.Settlement Char s to Seller 6ne 1400) 54,498.33
� 203.Existing loan laken su6jed to 503.6dsting loan(s)faken wbjed to
204. 504.PayoBoTfirst moAgage loan
205. 505.Pa R of second mort a e ban
206. 506.Famest rtwne refained b
, 207 507 Disbursed as proceeds(530200.00)
208. 508.
209. 509.
Ad ustrnenls for items un aid b seller Ad'us6nents for Items un aid b seller
210.Ci ltavm taxes 510.Ci Rown taxes
211.Caunty taxes 1/12015 to 9118l2015 @$299.40lYear $213.27 511.County faues 1l1P1015 to 91162015 @$299.40/Year 521327
212.Assessments 512.Assessments
213. 513.
214 514
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.Tatal Pald Byffar Borrower $30,47327 520.Tolal Reduction Amount Due Seller $4,711.60
300.Cash At Settlem¢nt FromlTo Borrotver 600.Cash At Se@lement TolFrom Seller
301.G�oss Amount Due From Bortawer line 120) $30,740.71 601.Gross Amount Due To Seller fne 420 530,217.71
302.Less Amounls Paid 8/For Bortower line 220 $30,41327 fi02.Less Deduction in Amt.Due To Seller line 520) 54,711.60
303.Cash �✓From ❑To Borrower $327,44 603.Cash ❑✓To ❑From Sellar 525,506.11
(W
Loan Number. File Number: GRC-34764 Page 1 oi 2
' ; L Se�lemant Charges
' 700.Tohal SaleslBrokefs Commission
Division of Commission(Iine 700 as folbws: Paid From Paid From
701.8925.00 to Keller Williams Realty Borrowers Fu�s Sellers Furds
at SeWement at Settlement
702.$1,OW.00 to McBride,Kell,and Associates
703.Commission aid at SeHlement 51,925.00
704.
800.Items P able In Connection wth Loan
801.Loan Origination Fee
802.Loan Disoount
803. raisal Fee
804.Credit Re rt
BOS.LenderslnspeGion Fee
806.Mo�tgage Insurance plicatlon Fee
607 hssumption Fee
900.Items Re uired LenderTo Be Paid In Advance
901.Interest
902.Mort age Insurance Premium
903.Hazard Insurance Premium
1000.Reserves De sited With Lender
1001.Hazard insurance
1002.Mort e insurance
1003.City prope taxes
1004.County pmperty taxes
1005.Mnual assessmen[s
1008.Agg ate accaun6ng ad'uslment
1100.Title Cha es
1101.SeWement or closin fee to Ba Na6onal TiOe Compa 5500.00 5550.00
1102.Abstract or title search to Clear Search Solu6ons S350.00
1103.Title examination
1104.Title insurance binder
1105.Document re ara6on
1106.Nota fees
1107.Attome s fees
includes above item numbers:
1108.Title Insurance to Ba Natlonal TiUe Company 5173.65
mcludes above item numbers:
1109.Lenders covera e Premium 50.00 to Ba Natlonal Title Com an
1110.Owners coverage$30200.00 Premium$173.65[o Ba National Title Company
1113.Florida Poli�y Surcharge to Fidelity Na6onal Title Insurance Comparry 5328
1200.Govemment Recotdin and Transfer Char es
1201.Rearding fees:Deed 518.50;MoAgage;Release, 518.50
1202.County faxlstamps:Deed;Mortgage,
1203.Slate faxlstam s:�eed$217.40;Mo a e, 8211.40
1204.G taxfstam s:Deed;Mort a ,
1205.Simptfile R-Recarding to Simp�I'ile 54.50
1300.Additlonal Settlement Char es
1301.Survey
1302.Pestlnspectlon
1304.Munidpal Search to NTIS 5185.00 5165.00
1305.Management Fee to GR Finanaal LLC$1,100.00 57,100.00
1400.Total Settlement Charges(enter on line 103,Secdon J and 502,Sectlon K) $523.00 54,498.33
I have care(uEy reviexad Ihe HUD-1 SetOement SlaMienl and ta the best of rtry Imawledge and befief it is true aM aau2te statemenl of all receipls arid daWusemenla m�e on my eanurd or by me in tlis transactiwi.
I furlherrertiFl Nat 1 have mceNed a aoYaf the HU41 Settlement SFatemenl.
BORROWERS SELLERS � ��
��
Caplvisa Enterprises,LLC U.S.Bank TNSt,NA.,as Trustee for LSF9 Masler Pa�idpation TNSt by Caliber Home
Loans,Inc.as Atlomey in Facl
The HU0.1 Setllertrenl Stafemenlwhich I have pepered ic e We and aau�ate amwmt of this transec6on.I have raused or I wi9 quse the furWS lo be disbursed in accordance with Nis sfalement.
SetUementAgent���� Date
9/1 612 01 5
CHRISTINN SHACKTON
WARNING:It is a vena lo Wro»irigly�ke 61se s6teme�rts b the I1Mted Slates on Ifris a any otAer s¢Nlarfam.Penaltirs upm mmridbn cari ndude e fine mid inprisonment Fw deta3s see;Title 18 U.S.Code
seeion�oo�ana secnon�o�o
,
Loan Num6er: Fite Number: GRG34764 Page 2 oi 2
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