DS-10-1112Inspection Number: INSP - 146400 Permit Number: DS -6 -10 -1112
Scheduled Inspection Date: July 07, 2010
Inspector: Bruhn, Norman
Owner: RUGGIERO, DOREEN
Job Address: 848 NE 91 Terrace
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BRICK PAVER GROUP INC
Building Department Comments
July 06, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Phone Number (786)286 -4039
Parcel Number 1132060050350
INSTALLATION OF PAVERS DRIVEWAY ON TOP OF
SAND BASE.
Passe .
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 13 of 26
NOTICE
A RECORDED COPY MUST BE
PERMIT NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
WITNESS my h
THE UNDERSIGNED hereby gives notice that improvements will be made to Yi r V
property, and In accordance with Chapter 713, Florida Statutes, the following intbrnu lnn D.C.
is provided in this Notice of Commencement. VA 3%
M }Am I Sholre5 FL:
d NE q 1 re( ii. __+
1. Legal description of prop$y and s treet/ ress. LOT "7 J Thle •T V o1- Lor & 8tooK_ 3l
of Caare i nL d t dd 1 ri Orl p.0O52bJOG 10114E OAT Lhar-caf- N5 gem -66d
2. Description of improvement: DR.L tGEJ0 A.
3. Owner(s) and AAad��dress:
1 �
Interest in property:
Name and address of fee simple titleholder.
'SA t_71 e YI) •
ress: MIMMINattrigiril
4. C • ntracto 's
5. Surety: (Payment bond required by owner from contractor, if ny)
0
Amount of bond $
6. Lender's name and address: 1� /
Name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1Xa)7., Florida Statutes,
Name and address:
N
8. In addition to himself, Owners designates the following persons) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address:
/ IL
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different d is spec • ,
Notary Public •-C
Print Notary's Name
My commission expires:
123.01 -52 PAGE 4 8/02
CF• 2010R04r34890
OR Bk 27335 P9 1516; (1P9
OF COMMENCEMENT RECORDED 06/29/21310 09 :11 :09
POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION HARVEY RUVIH r CLERK OF COURT
MIAMI -DADE COUNTY? FLORIDA
�l - 3 f0-a7J•035?) LAST PAGE
TAX FOLIO NO. STATE OF FLORIDA, COUNTY OF DADE
1 HEREBY CE'TIFY that this it4 Fire copy of the
,original fired in i i on vC da of
01114- , AD20 A )
�r� 0601 t-
A
Signat - • f �� wner
Print Ow,�ner's ame L_. I S A• (;C,■-.NL-1 Prepared b
Sworn to and subscribed before me this `Z day of fl\r' ( , 20&.
P e ry dillpi
111111111111111111111111111111111111111111111
n d and omc; Seal.
NI, CLEF Girt i County Courts
NW, Worths D
ry
1
Protect Address
848 NE 91 Terrace
Miami Shores, FL 33138-
1132060050350
Block: Lot:
DOREEN RUGGIERO
1
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
DOREEN RUGGIERO
848 NE 91 Terrace
MIAMI SHIORES FL 33138-
(786)286 -4039
1
Contractor(s)
BRICK PAVER GROUP INC
Phone
Cell Phone
Approved: Yes
Comments: PLEASE NOTE:
Date Approved: 6/21/2010 : Yes
Date Denied:
Type of Work: DRIVEWAY
Bond Retum :
Scanning: 3
Additional Info: PAVERS
Classification: Residential
Fees Due
CCF
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$2.40
$0.80
$150.00
$9.00
$3.20
$165.40
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Address
Parcel Number
Phone
Pay Date Pay Type
Invoice # DS -6 -10 -38215
06/29/2010 Credit Card
06/18/2010 Credit Card
Amt Paid Amt Due
$ 115.40 $ 50.00
$ 50.00 $ 0.00
Date
Applicant
June 29, 2010
Cell
Available Inspections:
Inspection Type:
Final
Sidewalk
Landscaping
Foundation
June 29, 2010 1
IONCIA A 61 Ztio
4C Value of Work For this Permit $ 5e0 .06
11 **** ****
Submittal Fee $"' Permit Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. 1
PERMIT P CATION Master Permit No.
FBC 20
Permit • e: BUILDING ' OOFING C'7$(0) __ 0E50
•....:•.I X450► IA
Owner's Na ii (Fee Simple Titleholder) Qtl • Ida GOtJ( X r'1 Phone ## Z5(P 4059 °DeCO /T`47A
1-
CityN aril, - 0 1/10(e5 State FL, Zip bb I 55
Tenant/Lessee Name Phone # ---
Einail ?I'D f- ru55 1 ea.° jealloo . COrn
Job Address (where the work is being done) ate' we ci 1 1 eir
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO Flood Zone
County Miami -Dade
a)-4-Ape-
zip
i
Zip
Notary $
Scanning $ ° i'00 Radon $
Double Fee $
Structural Review. $ Total Fee Now Due $ J 15 40
See Reverse side -
§DBEIIWIER
JUN 1 8 2010
BY:
)< Contractor's Company Name
Contrac is Address
City �`'. �k State 1Z, Zip
Qualifier Name V _ (' ] ' - Phone #
State Certificate or Re is ation No. CerfitiNcate of Co petenc N
Contact Phone - ,1 I E -mail ' �cMK\a,
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work: P
Q g 11�
Type of Work: Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Describe Work: r pr 1�!
**Fees ********************************************
/.moo ° CCF $ of 40
CO /CC $
Training/Education Fee $ ®•S Technology Fee $
$ Bond $
Violation date:
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application 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 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
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 TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of com encement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is is ed. I the absence of such posted notice, the
inspection will not be approved a reinspection fee will be charged.
Sign:
Print:
Signature Signature
Owner or Agent �/ / 1 Contractor
The foregoumstr�hment was acknowledged before me this The for oing instrument was�acknG` hedged for me thus 1
day of 'YYIA
, 20 lb, by US fh a C3t
(_ (3W day o , 201 C), b
who is personally known to me or w1V as+prt ced t D who is rsonally known me or who has produced
As identifsA�e� take an oath. ' . '2 ��e k ification and who did take an oath.
NOTARY PUBLIC: . , / � ' N I TAR PUBLIC:
• • — 1 lila,
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07XRevised 06/10/2009)
Plans Examiner
Engineer
Sign:
Print:
6(1,4,
- Bu i•; ATE - F,r) A
My Commission Expire' ' < � DD717 23
r : f; El'. 23, 201
%..mP
BONDED'MRU ATL."STiC bGNL
***************** * * * * *** * * * * * * * * * * * * * * * * * ** * * * **
Zoning
Clerk checked
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1132060050350
Owner's Name: DOREEN RUGGIERO
Job Address: 848 91 Terrace
Miami Shores, FL 33138-
Owner's Phone: (786)286 -4039
Total Square Feet: 850
Total Job Valuation: $ 4,000.00
Contractor(s)
Phone
Primary Contractor
1
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 6/21/2010 : Yes
Comments: PLEASE NOTE:
PROPOSED DRIVEWAY LOCATION WILL MEAN THAT IT MUST BE REMOVED IF A VILLAGE SIDEWALK IS
CONSTRUCTED ON NE 91ST TERRACE.
TO AVOID THIS POSSIBILITY DRIVEWAY WOULD HAVE TO BE LOCATED 7 FEET NORTH OF THE FRONT LOT LINE.
THERE IS INSUFFICIENT ROOM FOR A DRIVEWAY IN THAT CASE.
Charlie Crist
Governor
(Brick Paver Group)
848 NE 91 Ter
Miami, FL 33138
RE: Contingency Letter
Application Document No: AP967674
Centrax Permit Number: 13 -SC- 1146506
OSTDS Number:
848 NE 91 Ter
Miami, FL 33138
Lot: 7 Block: 3 Subdivision:
2. -This project entails : "NEW DRIVEWAY "
G/P
Enclosures
cc:
June 11, 2010
If you have any questions on this matter, please call our office at (305) 623 -3500.
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 Fax: (305) 623 -3645
Ana M. Viamonte Ros, M.D., M.P.H.
State Surgeon General
Dear Applicant:
This will acknowledge receipt of an application dated 06/02/2010 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
1. -There is no increase in sewage flow, change in characteristics compromising the integrity or
function of the system installation.
From a review of your completed application, it has been determined that your existing system is
adequate for the proposed use : " APPROVED ".
AP
POW 11:
PAM:
‘,9PG
CY• I
ROVED .
COUNT, HEALTH DEP -
6 g .
v O
9.64'
•:
•
,0
AND MEAS
CONCRETE
DRIVEWAY
(BAD SHAPE)
LOCATION OF
LDRAINFIELDJ
WALKWAY
EN \Y- - •
-
15.15' 21.60' M
° ° 11.45'
ONE STORY
RESIDENCE NO, 848 1,5
15.15'
0
N
3.50
3.50'_
0
O
MIAMI SHOALS Vfi
For Driveways and/or Sidewalks,
before final inspection and bond can e
ot�roved for refund; all sod and yard
must be completed.
METAL FENCE
X 9.
.•
w
t
z
I V
r:
17.15'
13.65'
STEPS
33.05'
' ?CONCRETE: 4 ,
WOOD FENCE
Z
0
Z
0
UTILITY L -
POLE
H: \08- Drawings \08 -0456.dwg
r :4
O
O
EC
ti
0.351
14/ Sr cit.
(50' TOTAL RIGHT —OF — WAY)
NE 91ST TE E i(A • 41 irePvt.e.f A
CENTERLINE
b 21' PAVEMENT
N - `• { •` 15' PAR •
RECORD AND MEASURED 75.00'
O
L()
6
45 jo 1I► L
0
Iri
MEASURED
52.20'
w
w
L
D L . .
O
c0
O
I-0
W CC
z
0
m
I— .
0
J
6 /, /td
LEGAL DESCF
ADDITION, AC
PUBLIC RECC
SURVEY FOR
1 HEREBY CI
was camPiCI
This survey
of Land Sur
472.027. 1I
DELTA SUR'
13052 SW 1
MIAMI. FLOF
CERnFlCAT
LB. NO
STATE 0
305 -253 — +
FAX: 305
PEP 7 0 5 T DS- 10 1112
APPROVE)
ZONING DEPT
BLDG DEPT
N✓ am' S'iores Village
SUBJECT iO CCMPIJANCE WITH ALL FEDERAL
STATE AND CG UN ,Y r1ULES AND REGULATIONS
BY
DAIU
Requests permission to insta,
Asphalt, concret brick paver, Landscaping
Other
Within the public road right of way of
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, »YE& 10'1-0 1 CV i a ter referred to as the Owner
of the following
(owner)
described property: a -63 11,e, q 1 Qrr- f"°t Arm - et-s
Legal description /folio#: 9 t - 520(0 C 3
Lot 1. SASS 'I2 Lvr a Block 3 Subdivision
GouetJ Ci A-i 'PAaic Add 'n u r)
Tax Folio #:
t4 q e TM. I IYI► 50.01 FL
(address)
IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the
dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County
to make repairs or maintain said items within public right of way including restoration of
street by reason of the Owner's failure to do so, such expense shall be paid by the Owner
or shall constitute a lien against the above described property until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County
harmless from any and all liability, which may rise by virtue of permitting the installation of
these items within the public right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
within 60 days notice by the Village to do so. Failure to comply with this notice will result
in the Village causing the item(s) to be removed and a lien being placed on the property
and/or assessed against the Owner for all costs incurred in the removal and disposal of
the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant
running with the land and shall remain in full force and effect and be binding on the
undersigned, their heirs and assigns, until such time as this obligations has been
canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village
Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this
...
SIGNED. SE LED, ar�D Q Bence of:
�. -; uoissi
i�ozi9OIEO
gS day of M'c C t -X'f0
(owner)
ALEX SINK STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that The individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE. DATE:
• PERSON:
FEIN:
BUSINESS NAME AND ADDRESS:
BRICK PAVER GROUP INC
350 W PARK DR APT 101
MIAMI FL 33172 -3942
SCOPES OF BUSINESS OR TRADE
1- PAVING /ASPHALT
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under thls
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of
election tb be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate. the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
QUESTIONS? (850) 413 -16
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
BRICK PAVER GROUP INC
350 W PARK DR APT 101
MIAMI, FL 33172 -3942
SCOPE OF BUSINESS OR TRADE
1- PAVING/ASPHALT
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
03/06/2009 EXPIRATION DATE 03/06/2011
FERNANDEZ JOSE A
263418082
EFFECTIVE 03/09/2009 EXPIRATION DATE: 03/08/2011
PERSON: JOSE A FERNANDEZ'
FEIN: 283418082
BUSINESS NAME AND ADDRESS:
CUT HERE
IMPORTANT
03 -06 -2009
* Carry bottom portion on the job, keep upper portion for your records.
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
O elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt_ apply only within the scope of the business or trade listed on
E the notice of election to be exempt
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
OWNER
BRICK PAVER GROUP INC
Sec. Type of Business
196 SPECIALTY
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CRIES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE
REQUIRED BY LAW. THIS 1S
NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
PAYMENT RECEIVED
MIAMI•DADE COUNTY TAX
COLLECTOR:
07/22/2009
60020000205
000075..00
SEE OTHER SIDE
2009 LOCAL BUSINESS TAX RECEIPT 2010
MIAMI -DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 30, 2010
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10
THIS IS NOT A BILL — DO NOT PAY RENEWAL
640234 - 1
BUSINESS NAME f LOCATION RECEIPT NO. 667043 - 5
BRICK PAVER GROUP INC 101 CC B E0900115
350 W PARK DR
33172 UNIN DADE COUNTY
WORKER /S
ENGINEERING CONTRACT 1
DO NOT FORWARD
BRICK PAVER GROUP INC
JOSE A FERNANDEZ PRES
350 W PARK DR 101
MIAMI FL 33172
i, , JJI,TiiTTTI IIIIIIII ': 1 - 18 '
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
MIAMI -DARE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
30 6670435 TG RIOT cTh PAY
RECEIPT NO. 90 115
BUSINESS NAME LOCATION
350 W PARK DR
OWNER :BRICK PAVER GROUP INC
A LIST OF NON- PARTICIPATING
MUNICIPALITIES
Receipt holder must
register in the city
where work is to be
done.
PAYMINT fil= CEIVED
02230071001
000175.00
2009 MUNICIPAL CONTRACTOR'S 2010
TAX RECEIPT FIRST -CLASS
MIAMI -DARE COUNTY - STATE OF FLORIDA U.S. POSTAGE
PURSUANT TO COUNTY CODE SEC. 10-24 PAID
EXPIRES SEPT. 30, 2010 MIAMI,
PEPERMIT r NO. 231
SPECIALTY ENGINEERING CONTRACT
DO
BRICK PAVER GROUP
JOSE A FERNANDEZ PRES
350 W PARK DR 101
MIAMI FL 33172
I ll 1111. lF 4 ' StlWAjtHl 'AJAlitlt6hi&
4
A
RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
AS SPECIFIED HEREON.
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
E0900115
BRICK PAVER GROUP INC
D.B.A.:
FEF'NANUEZ JOSE A
Is certified under the of Chapter 10 of Miami -Dade County
ALID FOR CONTRACTING UNTIL 09130%201
QUALIFYING TRADE(S)
000$x' CONCREEE ENGINEER
Heminio Gonzalez P.E.
Secretary of the Board .,
M Ids herein.
an rights CourdY retains all property i
J. Summary _ of borrowers transaction sr x i "
100: Gross amount due from borrower. r, � +�`? '?✓
101. Contract sales price
._ "*
rr '" -�' ' 1
315,000.00
K. `Summary of seller's transaction
-400. Gross amount due to seller:
401. Contract sales price
' - I`'
315,000.00
102. Personal property
402. Personal property
103. Settlement charges to borrower (Line 1400)
5,638.00
403.
104.
404.
105.
405.
Adjustments for items paid by seller in advance '.7.;
106. City/town taxes
Adjustments for items paid by seller in advance
406. City/town taxes
107. County taxes
407. County taxes
108. Assessments
408. Assessments
109. Waste from 05/25/10 to 07/01/10
76.29
409. Waste from 05/25/10 to 07/01/10
76.29
110.
410.
111.
411.
112.
412.
120. Gross amount due from borrower.
320,712.29
420. Gross amount due to seller.
315 076.29
200. Amounts paid or in behalf of borrower: _- r. -
201. Deposit or eamest money
_
13,000.00
_ 500. Reductions in amount due to seller:
501. Excess deposit (see Instructions)
202. Principal amount of new loan(s)
252,000.00
502. Settlement charges to seller (line 1400)
18,285.50
203. Existing loan(s) taken subject to
503. Existing loan(s) taken subject to
204. Principal amount of second mortgage
504. Payoff of first mortgage loan
205.
505. Payoff of second mortgage loan
206.
506.
207.
507. Deposit is being disbursed as proceeds
208. Principal amt of mortgage held by seller
508. Principal amt of mortgage held by seller
209.
509. Water escrow
250.00
209a.
Adustments for items unpaid by seller:, <. , '1.
210. City/town taxes
509a.
Adjustments for items unpaid by seller:
510. City/town taxes
211. County taxes from 01/01/10 to 05/25/10
754.46
511. County taxes from 01/01/10 to 05/25/10
754.46
212. Assessments
512. Assessments
213.
513.
214.
514.
215.
515.
216. Closing Costs Contribution
4,200.00
516. Closing Costs Contribution
4,200.00
217.
517.
218.
518.
219.
519.
220. Total paid by/for borrower.
269,954.46
520. Total reductions in amount due seller.
23,489.96
300. Cash at settlement from/to borrower: Y -''r'
301. Gross amount due from borrower (line 120)
320,712.29
1 600. Cash at settlement to /from seller:
601. Gross amount due to seller (line 420)
315,076.29
302. Less amount paid by/for the borrower (line 220)
(269,954.46)
602. Less total reductions in amount due seller (line 520)
(23,489.96)
50,757.83
603. Cash ( 4 To • From ) Seller.
291,586.33
303. Cash ( 4 From • To ) Borrower:
B. Type of Loan
0 1. FHA
04.VA
HUD -1
D. NAME OF BORROWER:
Address of Borrower.
E. NAME OF SELLER:
Address of Seller.
F. NAME OF LENDER:
Address of Lender.
G. PROPERTY LOCATION:
H. SETTLEMENT AGENT:
Place of Settlement:
I. SETTLEMENT DATE:
Borrower's Initial s)):
,/ Y
1
02.RHS
0 5. Conv. Ins.
A. Settlement Statement (HUD -1)
3. Conv. Unins.
Doreen Ruggiero, a single woman and Lisa Goulden, a single woman
848 NE 91 Terrace, Miami Shores, Florida 33138
Mojdeh Naghashpour Shoshtari, a/k/a Mojdeh Naghshpour Shostar, a/k/a Mojdeh Naghsh Pour Shoshstar
10420 N. MciCnley Drive, #11305, Tampa, Florida 33612
Prospect Mortgage, LLC
15301 Ventura Boulevard , #D300, Sherman Oaks, California 91403
848 NE 91 Terrace, Miami Shores, Florida 33138
Christopher P. Kelley, PA
11098 Biscayne Boulevard, Suite No. 205, Miami, Florida 33161
5/25/10 DISBURSEMENT DATE: 5/25/10
OMB Approval No. 2502 -0265
6. File Number
10-46
ID:
7. Loan Number
81078889
8. Mortg. Ins. Case Num.
C. NOTE:ThIs form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not Included in the totals.
Phone: 305-893-6004
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This
agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No
confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the
settlement process
Seller's Initia
D ou b leTi m e®
L. Settlement charges " „ ^. "' wrw <w . .. ''"' .4. ` r Y ^;
700. Total Real Estate Broker Fees $15,540.00
Paid from
Borrowers
Funds at
Settlement
Paid from
Sellers
Funds at
Settlement
Division of Commission (line 700) as follows:
701. $ 6,216.00 to Co!dwell Banker Res. R.E.
702. $ 9,324.00 to Keller Williams Realty
703. Commission paid at settlement
15,540.00
704.
705. to
800. Items Payable in Connection with Loan- ,?
801. Our origination charge $895.00 (from GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen (from GFE #2)
803. Your adjusted origination charges to Prospect Mortgage, LLC (from GFE A)
895.00
804. Appraisal fee to C2C (from GFE #3) 395.00 POC (B)'
805. Credit report to (from GFE #3)
806. Tax service contract to Prospect Mortgage, LLC
62.50
807. Flood certification to (from GFE #3)
808. Underwriting Review fee to
809. Processing fee to
810. to
811. to
812. to
813. to
900: liems Required by Lender to Be Paid in Advance ';<
901. Daily interest charges from 05/25/10 to 06/01/10 A $35.00 /day (from GFE #10)
245.00
902. Mortgage insurance premium for months to (from GFE #3)
903. Homeowner's insurance premium 1 years to Citizens (from GFE #11) 2877.00 POC (B)*
904. Flood insurance premium for years to
905. years to
'1000. Reserve 's Deoosited'wi,h "L'c - - rider '' .. rv '+ra.. ,1 ..-0 ,, n .. ,3 y . .. =. Vri tR'�°� � . 1, ,xia. :: �,�wt�d:'�, • u,, �acGw�
. ,r,«�. ;«,
� ,;:
1001. Initial deposit for your escrow account (from GFE #9)
1002. Homeowner's insurance months (a), per month
1003. Mortgage insurance months C per month
1004. Property taxes months 18) per month
1005. Flood Insurance months (v, per month
1006. months c per month
1007. months A, per month
1008. months a per month
1009. Aggregate accounting adjustment
1100. Title Charges . .... °,,AttrAtt--44.t.-it - «
1101. Title services and lender's title insurance (from GFE #4)
912.50
1102. Settlement or closing fee to Christopher P. Kelley, PA $695.00
1103. Owner's title insurance premium to Old Republic Nat. Title/Christopher P. Kelley (from GFE #5)
OPM- 1650.00
1,650.00
sod
t
d r w:,
250.00
1104. Lender's title insurance to Old Republic Nat. Title/Christopher P. Kelley $217.50
MPF- 25.00;8.1- 25;F9- 167.50
h
y
1105. Lender's title policy limit $252,000.00
1106. Owner's title policy limit $315,000.00
1107. Agent's portion of the total title insurance premium $1,307.25 to Christopher P. Kelley, P.A.
1108. Underwriter's portion of the total title insurance premium $560.25 to Old Republic National Title Insurance Com,
1109. Abstract or title search to Christopher P. Kelley, PA
1110. Document Preparation to Christopher P. Kelley, PA
350.00
1111. to
1112. to
1113. to
1200. Government Recording and Transfer Charges :` k
'
1201. Government recording charges (from GFE #7)
190.00
1202. Deed $18.50 Mortqaqe(s) $171.50 Releases $18.50 $190.00
18.50
1,386.00
1203. Transfer taxes (from GFE #8)
1204. City /County tax/stamps Deed $0.00 Mortgage(s) $504.00
1205. State tax/stamps Deed $1,890.00 Mortgage(s) $882.00
1,890.00
1206. Record Affidavit of Marital Status to Clerk of Court Miami -Dade County
18.50
1207. Record Termination of NOC & Affidavits to Clerk of Court Miami -Dade County
35.50
1208.
1300: Additional Settlement "Charges :: °. "�"�"""n „ "..- , . u . ` � y r " . '
1301. Required services that you can shop for (from GFE #6)
1302. Survey to Nova Surveyors
295.00
1303. to
1304. Fedex/Courier /Copies to Christopher P. Kelley, PA
25.00
1305. Lien Search to Lightning Lien Letters
158.00
1306. to
1307. to
1308. to
1309.
1400. Total Settlement Charges ...:. -. „ • ..F; s w « ,.. ,.,, si' ., ?..., . fir,w g �. .ter - - t
( Enter on lines 103, Section J and 502, Section K)
5,636.00
18,285.50
HUD-1
* POC (B) = Paid outside of dosing by borrower
* POC (5) = Paid outside of dosing by seller
Borrower's In' tal(s):
U.S. Department of Housing and Urban Development
Seller's initial(s
ri 3
Page 2
DoubleTime®
Your initial loan amount is
$ 252,000.00 .
Your loan term is
30.0000 years
Your initial interest rate is
5.0 %
Your initial monthly amount owed for principal, interest,
and any mortgage insurance is
$ 1,352.80 includes
10 Principal RI Interest r Mortgage Insurance
Can your interest rate rise?
• No 0 Yes , it can rise to a maximum of .00 %. The first change will be
on and can change again every after
. Every change date, your interest rate can increase or decrease
by .00 %. Over the life of the loan, you interest rate is guaranteed to never be
lower than .00 % or higher than .00%.
Even if you make payments on time, can your loan
balance rise?
• No 0 Yes , it can rise to a maximum of $ .00 .
Even if you make payments on time, can your monthly
amount owed for principal, interest, and mortgage
Insurance rise?
• No 0 Yes , the first increase can be on and the monthly amount
owed can rise to $ .00
The maximum it can ever rise to is $ .00 .
Does your loan have a prepayment penalty?
• No 0 Yes , your maximum prepayment penalty is $ .00 .
Does your loan have a balloon payment?
• No 0 Yes , you have a balloon payment of $ .00 due in
years on 00/00/0000 .
Total monthly amount owed including escrow
account payments
0 You do not have a monthly escrow payment for items, such as property
taxes and homeowner's Insurance. You must pay these items directly yourself.
• You have an additional monthly escrow payment of $ .00
that results in a total initial monthly amount owed of $ . This includes
principal, interest, any mortgage insurance and any items checked below:
r Property taxes 0 Homeowner's insurance
0 Flood insurance Q
0 0
Settlement Charges
=
Govemment recording charges
# 1201
Appraisal fee
Tax service contract
Underwriting Review fee
Title services and lender's title Insurance
- 4.M5tf
Initial deposit for your escrow account
# 1001
Daily Interest charges from
Homeowner's insurance premium for
Loan Terms
SETTLEMENT CHARGES AND LOAN TERMS
# 804
#806
# 808
# 1101
# 901
# 903
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Borrower's In ' 1(s ): Seller's Initia s):
562.50
562.50
5275.00
$0.00
51,330.00
$912.50
51,650.00
51,650.00
53,945.00
53,210.00
5-735.00
or 0.00%
Page 3
DoubleTime®
Our origination charge
# 801
$895.00
$895.00
Your credit or charge (points) for the specific interest rate chosen
# 802
5.00
50.00
Your adjusted origination charges
# 803
5895.00
5895.00
Transfer taxes
# 1203
53,276.00
51,386.00
Settlement Charges
=
Govemment recording charges
# 1201
Appraisal fee
Tax service contract
Underwriting Review fee
Title services and lender's title Insurance
- 4.M5tf
Initial deposit for your escrow account
# 1001
Daily Interest charges from
Homeowner's insurance premium for
Loan Terms
SETTLEMENT CHARGES AND LOAN TERMS
# 804
#806
# 808
# 1101
# 901
# 903
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Borrower's In ' 1(s ): Seller's Initia s):
562.50
562.50
5275.00
$0.00
51,330.00
$912.50
51,650.00
51,650.00
53,945.00
53,210.00
5-735.00
or 0.00%
Page 3
DoubleTime®
Fl le Number. 10-46
By
HUD-1 SETTLEMENT STATEMENT ADDENDUM
I have carefully reviewed the HUD -1 Settlement Statement and to the best of my knowledge and belief, it is a true
and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I
further certify that ave received a copy of the HUD -1 Settlement Statement.
Borrower(s)
1/U
Teen RuggierAWA
Mo j deh Nag • T hpour • -�• -`
Christopher P. Kelley, P.A.
Seller(s)
Settlement Agent
The HUD -1 Settlement Statement which I have prepared is a true and accurate account of this transaction. 1 have
caused or will cause the funds to be disbursed in accordance with this statement.
Date:
WARNING: WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form.
Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001
and Section 1010.
DoubleTime®