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Home My WebLink About14-14937 CITY OF ZEPHYRHILLS . 5335-8TH STREET �si3)�so-oo20 14937 BUILDING PERMIT ` Permit Number: 14937 Address: 5751 YORKSHIRE DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: WEDGEWOOD MANOR Est. Value: Parcel Number: 10-26-21-0120-00000-0810 Improv. Cost: 5,015.00 Date Issued: 1/30/2014 Name: MASTIN, EMILIE Total Fees: 65.00 Address: 5751 YORKSHIRE DR Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/30/2014 Phone: 352-567-5143 Work Desc: REROOF SHINGLE I AL 5. �� C(��i��< � C�� ` - TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c)when extra inspection trips are necessary due to any one of the following reasons: a) wrong address b)condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site� plans not at job site g)work not accessible. 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, 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 properly. 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 Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. . ' CONTRAC OR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ,,_�iiiiiiiiiii�uiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�iiiioiiiiiiiii�. 2014015608 ' __.------------�--�--- - ------ J Pertntt No. ,f�� / Parcel ID No �0��-O(7�0--QQ[�7�-Og1O NOTICE OF COMMENCEMENT s�ece or F1,oRa Dk cow,�r a �hSc.o THE UNDERSIGNED hereby gNes notice that Improvemant wIA be mede lo certaln real property,and tn exortlance wlth Chaplx 713,FIaMa Sletulea, the foUOVAng Infortnallon la provided In thls Notice oi Cammencement: 1. Desalptlon of Property: Pmcel IdendflcaUon No. (O?lo-Z��OIZL�-OC�DO-Ogl O S'.reetAddress: ��75� Y�KS1'FIR�D2�VE�ZEPHYRFFILC.S�� 33542-Ta170 2. GeneralDeacrlptlonotlmprovement !ZE-Re�oFS1N6�.E �MtLY It�StDE�dGE CWtTF! SFl�W(�..65� 3. Owner In(ortnatlon or Lesaea Infortnetlon If the Lessee contracled tor the ImprovemeM: EMILY 3: MAbTw1 C..7�7 1-�c)h►T1�wSGTf�1.l DRI VE ZEPl�FYP�HCLS F�. 3��1 Z Address . CHy Slate Interest In Property: BUTAIEQ Name oi Fee Slmple Tltlehdder. Qi d(flerent irom Owner Ilsted above) Addresa Ctty State 4. CoMractor: 'E*l�R L_AQKI►.1 CfJr�LSTQI�1�1 Name � 'P.a 8ox�u�4 a+��c.�rl. �� 335w-�47�_ Addresa CIty State Contractora Te�ephone No.: ?552-56?-5 t 4 T� 5. Surety: Name Addreas CRy State Amount ot Bond: 3 Telephone No.: _ 8. lentler. Name Addreas Cfty State Lendafs Telephone No.: �GV�T * * 7. Persons wlthln the State of flalCa dealgnated by lhe owner upon whom notices or otl�doamenb may be aerved es provlded by �� • �� ' � Sectlon 713.13(1)(a)(�,FIOrIGa Stalules: , Name �, s' �� 0 � v �'•. � AGdresa Clty State � � � �►� � � Telephone Number oi Deaigneted Penon: � �� • O r 8. In addfllon ta himaelf,the owner daslgnates of_ �r �(/ to recetve a copy of tt�e Llenora NoUce aa provlded In Sectlon 713.13(1)(b),FloAda Statutea. �i ' � �,.'` r� � •� Telephone Number oi Peroon or EMlty Deslgnated by Owner. � 9. Explratlon date of Notice of Cortqner�ernent(the explratlon date may not be before the completlon oi wnsVUetlon arW flnal payment to the � •* * contredor,but wNl be one year from fhe date of recordhg urdeaa a dltferent date b spedll�: WARNINC�TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFfER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SEC170N 713.13, FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING T1MCE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTtCE OF COMMENCEMENt MUST BE RECORDED AND POSTED ON THE J08 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATfORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalry of perjury,I declare that I heve read the foregofnp notice oi commencement and that the facls ateled thereln are true to the best Q ~ w `� Y of my knowledge end beNef. � W ly J � W STATE OF FLORIDA • O � � LL'_ '� J U COUNTY OF PASCO • f� ? � �F- J � Slgnelure of Owne 9 Le ,or Owne/a or Leasae'a Autho�tzed V� � � � O/ficedDlradorlP��fner/Manaper a �G=Q N � � Rept:1579007 Rsc: 10.00 O � 'p z � a a D5: 0.00 IT: 0.00 dw�� 11 w 0 = - -� � � 01/31/14 K. Gareia, Dply Clerk _r% Slgnato�ysTltlelOt�ce }, � � � Q __ J� r ,,n_ O The forogoing Instnment was ackrw�Medged beTOre me 1Na�day of�20�by C cni�i C. 7• f 1 �45�l� Z =�� U ea h l Jr`P.r (type of authorlty,e.g.,oMlcer,Vustae,ariomey In faq)for � ►-y. U ti �tS Oi- a � 0 Y (name ot party on behalf M wfiom Instnxnent was auecute�. U Q O �� Personaliy Known Q$Produced IdenUllcatlon❑ Notary Slgnature va"^w�"o- � """'-�""" Q 1- �J Q J Type of Itlentlficatlon Producetl Name(PAnq I��'-r�Oo.Te� A-��r"-'� �� tL V @:� � aZ OJ Q� � � Q � W PqULR S.0'NEIL,Ph.D.PR5C0 CLERK 5 COMPTROIIER� lL �� ? 01oR1BK �985 P�o 39 � �`�Z � � O --- ------. . _ _ .. .� e��b�9�� ' w�cc�n� � C,�ornm��8362ot�4 ��--�w� Z � Q— � wpdalalbcs/noticecommencement�c053048 '�h-=- � O S�' a m 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received _ 3 f•� Phone Contact for Permitti� - Owner's Name � STl (� t Owner Phone Number �SZ�5�7-5�4 3 3354 Owner's Address �v�� I-}t?1STf tJC�T�IJ ��. �.-f-�1LL Owne�Phone Number Fee Simple Titleholder Name � � Owner Phone Number Fee Simple Titleholder Address JOBADDRESS -] �KSi�}I PJ V � Z-F�iLLS F1-- �S Z.-'7�(7 LOT# �) SUBDIVISION W�w�� !")/�tSD� PARCEL ID# i C7--7_.1o�--Z I—O 1 ZC)--�C�OUC'>-- C��i O � (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR e ADD/ALT Q SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE � SFR Q COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WQRK 2E �F 1nJ�TN S NI4�G1_ES BUILDING SIZE �9`X � � / SQ FOOTAGE ��'�'� HEIGHT � 5�� ' BUILDING $ �O VALUATION OF TOTAL CONSTRUCTION 5o�i5-- ELECTRiCAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. OPLUMBING $ ( � �� MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS � ROOFIIdG � SPECIALTY 0 OTHER FINISHED FLOOR ELEVATION FLOOD ZONE AREA �YES NO � BUILDE _______ COMPANY �� '^'4��N C01�1 ST1eU�--I�� SIGNAT RE REGISTERED Y/ N FEE CURRE� Y/N Address �O� $ox i 4?t-i �r�1>E e�`r`f 335z-� ►47y �icense# e-�-� ��-�� ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# PLUMBER COMPANY SIGNATURE REGISTERED Y I N FEE CURRE� Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# � RESID�NTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facil[ties 8�1 dumpster;Site Worfc Permit for subdivisionsAarge projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Pemiit for new consWcUon. Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities 8�1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SiGN PERMIT Attach(2)sets of Engineered Plans. ""PROPERTY SURVEY required for all NEW construction. Directtons: Fill out application completely. Owner&Coniractor sign back of applicatlon,notarized If over E2500,a Notice of Commencement is required. (AIC upgrades over s7500) '" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Appiication Only) Reroofs if shingles Sewers Service Upgrades A!C Fences(PIotJSurvey/Footage) -;.,�..c.t.�.,,q AfiAY�ia� Driveways-Not over Counter if on p��.lneeds ROW .+s;��.1a:a.A'1�fiAtA4��+ ;.c �S E3S. �itduq tnslt>i� -,:�� Al .qt� .r+++r�a� viuE ;'��cat��n tit�r. "�'!1i!1R �nr•�" -,, NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compiiance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be Iicensed in accordance with state and local regulations. if the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application fo� which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in exist{ng buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is fu�ther understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a cerfificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, i certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner" prior to commencement. CONTRACTOR'SlOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be dane in compliance with ail applicabie laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work wili be performed to meet standards of ali laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also ce�tify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Departrnent of Environmental Protection-Cypress Bayheads, Wetland A�eas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Weils, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone"V"unless expressly permitted. - if the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submltted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connec#ion with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for Iots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not speci�cally included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to.violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned fo�a period of six(6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justiiiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR F LURE TO RECORD A NOTI OF COMMENCEM T MAY RESULT IN YOUR PAYING TWICE FO MP NTS TO R PROPERTY F YOU INTEND T OB IN FINANCING, CONSULT WITH YOUR L ER OR A TTOR EFORE RECOR NG YO - FLORIbA JU (F . 117. OWNER OR A CONT CT Subscrfbed and swo e e orf me this Subscrlbe or aifirmed)before me thls , �•� _( by—��'�"�°--an �. �--G�'kv� 1-.�'1'.t by e�..�'�.�.� U�-• l.-ess(u�„ _ Who islare personally known to me or has/have produced Who islare personally known to me or ha�S�dentificallon. as IdenUflcaBon. ��Q� �� r��t�r'_, � f� r " — "Notary Public ��"'��"r � "— °�'' Notary Public Commission No. Commission No. �° , "�. :� ��`JL�-' � � r�Y��l�A i—T. ��,�S�'�-� Name o Notary typed,printe�pr��stam ed Name of Notary typed, B11�1i��,U$+pN Stabs ot'I�loti�ia Mf►�8��01�4 My Comm. Exp. Mar. 28, 2014 �• Comm. #DD 967656 � � Bob La rki n Construction, �nc. P. 0. Box 1474 � Dade Citr, FI. 33526-1474 ^� (35Z)567-5143 ^r Fax 567-2716 CONTRACT Contractor Liceose No. CB CO 36549 Roofina License No. CC CO 42866 CLIENT: Emilie J. Mastin DATE: January 13, 2014 ADDRESS: 6227 Huntington Drive CONTRACT#:201�003 CITY/STATE:Zephyrhills, FL 33542 JOB NAME: Mastin PHONE: 813-779-0039 LOCATION: 5751 Yorkshir+e Dr Zenhvrhills We hereby propose to p�ovide the materials and perform the /abor necessary for the comp/etion of See Attachment "A':• 1. Bob Larkin Construction to provide General Liabitity and Worker's Compensation Insurance. 2. Contract to include all material, labor, clear�-up, and waste dispos�i. The above work will be for the sum of $5.015.00 A//materia/ to be as spec�eal. A// wo�to be comp/eted in a won�rman/ike manner acconding to standa�d practices A// agreements contingent u,�n strikes, accidents, or de/ays beyond our contro/. Owne�(sJ to carry fire, tomado and other necessary insu�ance. PAYMENT to be made as follows: �, rBob Larkin Construction, Inc. requires deposit at signinq of contract of 50�•` $ TBD. The balance to be paid per attached draa schedule. A monthly 1.5$ will be charged to any unpaid ba�ance af�;er terms, then every 30 days thereafter. � Authorized Signature:_ Date: /�y�,/� (General Contractor) This Proposa/ may be withdrawn by us if not acaepted within Thiity (30) days ^► ACCEPTANCE OF PROPOSAL^� The above prices, sp�cifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: ��J ,��J Date: �- �j v��✓�7� / � Emilie J. Mastin ` BOB LARKIN CONSTRUCTION, INC. ATTACHMENT"A" 1/13/2014 EMILIE J.MASTIN 6227 HUNTINGTON DRIVE,ZEPHYRHILLS,FL 33542 813-779-0039 JOB LOCATION: 5751 YORKSHiRE DRIvE,ZEPHYRHILLS, FL SCOP€OF WORK: k.RE-ROOF HOUSE WITH GAF TII'dSERLINE DIMENSIONAL SHINGLES 1. REMOVE ROOF SHINGLES&UNDERLAYMENT TO EXPOSE ROOF SHEATHING 2. �NSPECT&IVAIL-OFF ROOF SHEATHING TO CODE WITH 8D RING SHANK NAILS 3. INSTALL 30#FELT PAPER ROOF UNDERLAYMENT ON ENTIRE ROOF 4. INSTALL NEW PAINTED EAVES DRIP 5. INSTALL NEW LEAD PLUMBING BOOTS 6. INSTALL GAF T�MBERLINE DIMENSIONAL ROOF SHINGLES(INCLUDES REAR PORCH) 7. INSTALL 40'OF ALUM. RIDGE VENTS S. WASTE DISPOSAL&CLEAN-UP INCLUDED 9. RE-ROOFING PERMIT&NOTICE OF COMMENCEMENT RECORDING INCLUDED 10. 1/2"CDX PLYWOOD REPLACEMENT PER SHEET($40.00) IF REQUIRED 11. SUB-FASCIA REPLACEMENT PER FOOT-$1.50 IF REQUIRED TOTAL CONTRACT PRtCE-$5015.(30 EMILIE J. MASTIN (OWNER) DATE BOB LARKIN(BUILDER) DATE Page 1 HUD-7 U.S.Depardnent of Housing A. Settlement Statement and Urban Deveiopment OMB No.2502-0265 � B. Type of Loan Q T.FHA Q 2• FmHA � 3.Conv. Unins. 6•�ile Number 7.Loan Number 8. Mortg.Ins.Case Num. 13-12-62JL (� 4.V.A. Q 5.Conv.lns. ID: C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked"(p.o.c.)"were paid oufside the closfng;they are shown here for informatlonal purposes and are not included tn the totals. D.NAME OF BORROVYER: Emilia J.Mastin,a single person Address of Borrower. 5751 Yorkshire Drive,Zephyrhills, Flonda 33542 E.NAME OF SELLER: Jeffrey M.Freeman,a single man Address of Selier: 10d7 Bristoi Lake Road Apt. 108,Mt.Dora,Fforida 32727 TIN: F.NAME OF LENDER: Address oE Lender: G.PROPERTY LOCATION: 5751 Yorkshire Drive,Zephyrhills,Florida 33542 H.SE7TLEIIAENTAGENT. Meridian'f'ftie Company, Inc. TlN:59-3597293 Place ot Sattlement: 37837 Meridian Avenue,Sufte 100,Qade City,Flarida 33525 Phone:352-567-1241 I. SETTLEMENT DATE: 1/28/14 DISBURSEi4[ENT DATE: 1/28114 . •. . . . . �� . . . � . ,�� . . . . 101. Contract sales price 95,000.00 401.Contract sales price 95,000.00 102. Personal pr�perty 402.Personal prope 103.Settlement charges to borrower(Line 1400) 503.50 403. 104. 4d4. 105. 405. ' • � . � . 106.City/town taxes 408.City/town taxes 107.2014 S?1N$62tyr from O1/28/14 to 12l31/14 57.43 407.2A14 STW$62lyr from 01128i14 to 12/31/14 57.43 108. HdA$115lmo from 01/28M4 to 01l3i/14 14.84 408.HQA$115/mo from 01l28/14 to 01/31l14 14.84 109. 409. 110. 410. 111. 411. 112. 492. 120.Gross amount due from borrower: 95,575.77 420.Gross amount due to selier: 95,072.27 �� . . . . . i� - . . . � . 201.Deposif or eamest money 1,000.00 5a1.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement ct�arges to selier(line 1400) 7,413.10 203.Existing loan(s)faken subject to 503.Existing loan{s)taken subject to 204.Principal amount of second mo�tgage 504.Payoff First Mor�a e USAA#01393 58,160.t4 205. 505.Payoff of second mortgage loaz 206. 506.Qeposits hekl by seller 207. Principal arnt of mortgage held by sefler 507.Principal amt of mortyage heid by selier 208. �08. 209• 509. ' � • . .. . 210.City/town taxes 510.CityRown taxes 211.Co Taxes$528.34 from 01/01/14 to 01/28/14 33.08 511.Co Taxes$528.34 from Of/01/14 to 01/28/f4 39.08 212.Assessments 512.Assessments 213. 513. 2�4• 514. 215. 515. 216• 516. 217. 517. 2 3 8. 518. 219. 519. 22p.Total paid byJfor borrower: 1,039.08 520.Tota!reductions in amourrt due seiler: 65,612.32 �► . . �. . .�i . 301.Gross amount due frorn borrower g5��75,77 601.Gross amount due to seller 95,072.27 (line 120) (line 420) 302.Less amount pafd by/for the borrower (1,039.08) 802. Less totai reductions in amount due seller (65,612.32) (line 220) (lfne 520) 3�3.Cash( 0 From [] To )Borrower: 94,536.68 603.Cash{ [�✓ To � From )Seller: 29,459.95 SubsUtute Form 1099 5eller Statement: The Inforrnation contained in blocks E,G,H,and i and on line 401 is important iax informatia��and is being furnishE�d to the IRS. If you are required to fi[e e return,a negligence penafty or other sanction will be imposed on you ff this ifem is required to be reported and the IRS detormines that it has not been reported. Seiler Instructions: If this real estate was your principal residertce,fi1e Form 2119, Sate or Exchange of F'rincipal Residence,for any gain,with your tax return;fo�-other transactions,complete the appiicable parts of Form 4797,Form 6262 and/or Schedule D(Form 1040}. DoubleTime� H��CI-1 U.S.Department of Housing and tJrban Development Fage 2 ," Paid from Paid from 700.Totai Sa}eslBrokers Com.based on price $95,000.00 6.0000 a�= 5,700.00 8orrower's Selier's 701. 3,050.00 3.2105��to Century 21 Bill Nye Reatty Settlement Settlement 702. 2,650.00 2.7895 a�to Prudential Tropical Reaity, Inc, 703. Commfssion aid at settlement 5,700.00 ��• to 801, Loan originat#on fee °�to 802. Loan discount °h to 803. Appraisal fee to 804. Credit report to 805. Lender's inspection fee to 8Q6, Mortgage insurance applicatlon fee to 807. Assumption Fee to 808. to 809. to 810. to 819. to . � . 901. Interest from to /da 902.Mortgage insurance premium for months to 903.Hazard insurance premium for years fo 904.Flood'n�urance premium for years to 905. years to 11 .- . . 1001. Hazard insurance months� per month 1002. Mortgage insurance months� per month 1003. Cfty property taxes months� per month 1004. County property taxes months� per month 1005. Annual assessments months(� per month 1006. Floocf Insurance months r month 1007. months� per month 1008. months @ per month 1009. Aggregate accounting adjustment �� . 1101. Settfement or closing fee to Meridlan Title Company,Inc. 250.00 250.00 1102. Abstract or tftle search to Attomeys'TIEIe Fund Services,LLC 75.00 1103. Title examination to 1104. TRIe insurance binder to 1105. Document preparation to 1106. Notary fees to 1107.Attorne}�s Fees to (includes above item numbers: � 1108. Title Insurance to Old Republic NationaUMeridian Tdle 333.10 (includes above item numbers: ) 1109. Le�ider'S cnvara e(Premium : 1110, Owner's covera e Premium): $95,000.00($333.10) 1111. Endorse: 1112. Wire Fee for Payoff to Johnson Awii Pratico&Chane PA 25.Q0 1113. �a � . � . . 1201.Recording fees Deed St8.5Q Mlortgage(s) Releases 18.50 1202.CitylcounFy tax/stamPs Deed Mortgage(s) 1203.State taxlstamps Deed $665.00 Mortgage(s} �5,pp 12D4. to 1205. to � � � 1301, Survey to Surve A�devit 1302.2013 Real Prop Taxes POC-S to Tax Collector 590.34 1303. Feb.20'14 HOA to �edgewood Manor HOA 115.00 1304. Home Warranty to AHS 120.00 365,00 1305. to 1306. to 1307, to 1308. ta 1309. �� . . Enter on lines 103 Section J and 502 Sectlon K 503.50 7,4t3.i0 DoubleTime� � HUD-1 SETTLEMENT STATEMEl`�T ADI)ENDUM File lVumber: 13-12-62JL I have carefully �eviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts ar�d disbursements made on my account or by me�n this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Borrower(s) � Emilie J. st' Seller(s) ., �.� ffr y M. Freaman Settlement Agent The iiU�-1 Settlement Statement which I have prepared is a true and accurate accvunt of this transaction. !have caused or will cause the funds to be disbursed in accordance wlth this statement. Merid.ian Title C any, Inc. By: Date: � �,� 7 !r f F / WARNING: It is a crime to knowingly make false statements to the United States on this o�any other similar form. Per�alties upon convfctfon can lnctude a fine and imprisbnment. For detafis see: Title 18 U.S.Code Section 1001 and Section t010. QoubleTime�