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EL-11-251Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 160876 Permit Number: EL -2 -11 -251 Scheduled Inspection Date: June 13, 2011 Inspector: Devaney, Michael Owner: PACE, BRUCE Job Address: 69 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060131150 Phone: (786)331 -3967 Building Department Comments BURGLAR ALARM SYSTEM AND DEVICES Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 10, 2011 For Inspections please call: (305)762 -4949 Page 16 of 19 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ° °1 Permit No. t-1 I BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electri4a1 Owner's Name (Fee S�m©pI �itt eholder) Owner's Address 1 7 (. r) frt p &Ge 5I Master Permit No. Phone # City VI( RM - Acs r State FL Zip j3) J g Tenant/Lessee Name E -MAIL: Job Address (where the work i being done) �I Phone # City Miami Shores illage County Miami -Dade Zip FOLIO / PARCEL # I I— -b:)°,0() _ 013 - 115 0 Is Building Historically Desigiated YES NO Contractor's Company Name �� Phone # (,s -) ›e16---37// Contractor's Address avili. 4,07 City 4/k-a/L4A° State R2. Zip Qualifier Name La`) me //j Phone# ( 'is) '6 `75 -7 /9 State Certificate or RegistratiP - n No. i x / 2-1 Certificate of Competency No. E -MAIL: ciaLi u T' eel M ° Architect /Engineer's Name (if .pplicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New Describe Work: [ i) .z _ 4i' A (-0 p (-6) ❑ Repair /Replace ❑ Demolition ******* xxxxxagx**** xxxxxxrxxxxx******wiT ees*** xxxxx* xxxxxxx **xxxxxxxxxxxxxx:rrxxxr° Submittal Fee $ Notary $ Scanning $ Permit Fee $ CCF $ CO /CC Training /Education Fee $ Technology Fee $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's N e (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. 1 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: 1 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 commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approves a reinspection fee will be charged. r i - Signature Signature Owner or T3T" Contractor The foregoing instrument was acknowledged before me this S The foregoi instrument was acknowledged before me this / day of f' , 20 / 1 , by brtite f ce , day of , 20 l/ , by who is personally known to me or who has produced o3L' • who ° "t`Y* who is personally known to me or who has produced 496--boy-90, As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Nov cn, Print: ,,4 My Commission expires:. NOTARY PUBLIC: Sign: Print: roTtilv 7c My Commission Expires :xxx***w e**G1WW xxu icxxxxxaYxxxxxaYxxxxxxaYxxxxxxx xx* *rrxxxYxxxxxxxxxxxxxxx xxxx*xxxxxx**wwxxxxxxxxxxx APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning State of Florida ) )SS: County of Miami -Dade ) I certify that the attached copy of the Settlement Statement dated February 4, 2011 is a true, correct and complete copy of the original signed by all the Parties in reference to the Sale and Purchase of the real estate property listed as 69 NE 98th Street, Miami Shores, FL 33138. In witness whereof, I hereunto set my hand anofficial seal. N tary"Publi ,41rik. MAYRA I. ROJAS -MBIDQ ,' :A MY COMMISSION g DD 983769 4. EXPIRES: August 20, 2014 it: ` Bonded Thru Notary Public Underwriters HUD.1 U.S. Department of Housing A. Settlement Statement B. Type of Loan and Urban Development OMB No. 2502-0265 0 1. FHA O 4. V.A. Q 2. FmHA 0 3. Conv. UnIns. o 5. Conv. Ins. 6. File Number Pace PF ID: 7. Loan Number & Mortg. ins. Case Num. C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and-by tWe settlement agent are shown. Items marked "(p.o.c.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME OF BORROWER: Address of Borrower: E. NAME OF SELLER: Address of Seller: P. NAME OF LENDER: Address of Lender: Bruce M Pace, a single man and Lyle J Churchill, a single man, SS; 2638 County Route 27, Hudson, New York 12534 Rosemary Olson, a single woman 10465 SW 52 St, Cooper City, Florida 33328 G. PROPERTY LOCATION: 69 NE 98th St. Miami Shores, Florida 33138 Legal Solutions Group, P.L 18305 Biscayne Blvd. #200, Aventura, Florida 33160 1. SETTLEMENT DATE: 214111 DISBURSEMENT DATE: 214111 H. SETTLEMENT AGENT: Place of Settlement: ottoman with right; of survivorship TIN: TiN: 26- 1750786 Phone: 305- 895 -5699 Si . rn�ary of bor roi.n.r's transaction 100 C ross arrount.due;froni borrower 101. Contract sales price 102. Personal pro 103. Settlement charges to borrower (Line 1400) 104. 105. •Acjustmants, for items paid by' seller -in advance:.;..- 106. City/town taxes 107. County taxes 108. Assessments 225,000.00 2,563.00 109. 110. 111. K.`Sunmrary of seller's t ansactie 400; Gross amount due to seller; 401. Contract sales •rice 402. Personal property 403. 404. 405. Adjustments for iternspeid;by,sellei . in.ai var:ce; . 225,000.00 406. City /town taxes 407. County taxes 112. 120. Gross amount due from borrower. 204:'Amounts paid or in belinircif.bo itwrer 408. Assessments 201. ' = . osit or earnest money 202. Principal amount of new loans) 203. Existing loan(s) taken subject to 204, P •1 205. 227,563.00 224,526.58 409. 410. 412. 420. Gross amount due to seller. 500 Reductions in,E rnour due to seller: 501. Excess deposit (see instructions) 502. Settlement ch : r . es to seller (line 1400) 206. 207. Princlpal amt of mortgage held by seller 208. 209. Seller's Credit towards Repairs Adjustments for itoms,u0 z3 d l y.sell -r....:. 210. City/town taxes 211. County taxes from 01/01/11 to 02/04/11 212. Assessments 213. 214. 215. 216. 217. 2,600.00 21& 219. 220. Total . = id bylfor borrower: 300. Cash:-at:settlenient fromito. borrower, _.., 461.42 301. Gross amount due from borrower (line 120) 503. Exls u • loan(s) taken subject to 504. Payoff of first mortga e e loan 505. Payoff of second mortgage loan 506. Deposits held by seller 507. Prin . al amt of moms,. • : held by seller 225,000.00 15,201.47 508. 509. Seller's Credit towards Repairs Adjustments fur items ' ;unpaid.byselier 510. Clty/town taxes 511. County taxes from 01/01/11 to 02104/11 612. Assessments 513. 514. 2,600.00 461.42 302. Less amount pald by/for the borrower (line 220) 303. Cash ( j From 4 To ) Borrower. 516. 517, 518. 227,588.00 227,563.00 (227.588.00) 25.00 519. 520. Total reductions in amount due seller: GOO. C esftat'seltleinentitoffrom solle 601. Gross amount due to seller (line 420) 802. Less total reductions in amount due seller (line 520) 603. Cash ( To ❑ From ) Se 18,262.89 225,000.00 208,737.11 Substitute Form 1099 Seller Statement: The information contained in blocks E, G, H, and 1 and en fine 401 is Important tax Information and Is being furnished to the IRS. If you are required to file a return. a negligence penalty or other sanction will be Imposed on you if this item is required to be reported and the IRS determines that it has not been reported, Seiler Instructions: 0 this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your tax return; for other transactions, complete the applicable parts of Form 4797, Form 6262 and /or Schedule D (Form 1040). Double-rime® HUD -1 • U.S. Department of Housing and Urban Development Page 2 S it oil °hat: 700. Total Sales/Brokers Com. based on price $225,000.00 (g2 5.0000 `Yo = 11250.00 701. 8,750.00 3.0000 % tD Keyes 702. 4,500.00 2.0000 % to Keller Williams Eagle Realty 703. Commission paid at settlement($11,250.00 less deposit held $8,750.00 = $4,500.00) 704. Administrative Fee to Keyes 801. Loan origination fee 802. Loan discount 803. Appraisal fee %t• DlD to 804. Credit report to 806. Lender's Inspection fee to Paid from Borrower's Funds at Settlement 299.00 ,r POJuSeller;FCi Paid from Seller's Funds at Settlement 11,250.00 806. Mortgage insurance application fee to 807. Assumption Fee 808. to 809. to 810. to 811. �,;90o_ It Lents rr c r da0v Icii 901. Interest from to ,w be paid :. n: advance:::. to 0 /da B r er,f'C ;Se €Ic,rFr 902. Madge • e insurance •remium for 903. Hazard insurance • =mium for months to ears to 904. Flood insurance •remium for ears • 905. 1.000, Reserves deoos,t C .i tlrl idar.. ,Bo_r i w 'f?13C. ellerie0C, : . 1001. Hazard insurance months (e •= rmonth 1002. Mo • = .4 e Insurance mon s • _ month • 1003. City property taxes months al • =r month 1004. .41: 1 • •• er month 1005. Annual assessments months n month 1006. Flood Insurance months •, •er month 1007. months 0 •= rmonth 1008. mon rr • er month 1009. Aggregate amounting adjustment !'o ro,;er ftOCaellci..E,ti+ 1101. Settlement or closing fee to Legal Solutions G •, P.L 1102. Abstract or title search to Legal Solutions Group, P.L 1103. Title examination to 1104, Title insurance binder to 1105. Document preparation to 1106. Notary fees to 1107. Attorney's Fees (includes above item numbers: to Law Offices of Peter M Lopez, P.A 1108. Title insurance to Old Republic National/Legal Solutions (Includes above item numbers: 1109. Lender's cove =e a Premium : 1110. Owner's covers. - -remium : $225.000.00 ($1,200.00) 500.00 1111. Endorse: F9.1- 120.00 1112. Courier, Copies, Fedex, Fax, Fees to ,.• '-t Solutions Group, P.L 200.. Co+iernrr} ent',recordirtcland;trns 1201. Recording fees Deed $44.00 Mort• a • s Releases 1202. City /county tax/stamps Deed Mort• -,= s 225.00 1203. State tax/stamps Deed $1,350.00 Mo • • -. s 1204. to 1205. to 300.. Additional aeitienient!r,iieree %:: iltblortcy,vertllOCSellealf3 1301. Survey 1302. Past Inspection to 1303. Real Estate Taxes-2010 to Miami -Dade County Tax Collector 1304. Lien Search to A -1 Title 1305. Survey to D'Aviia & Associates Services, Inc 1307. to 1308. Escrow -Final Water Bill & Utitfties t• L =•aI Solutions Grow, P.L 1309. 10 {; cneLsetil fr e nt charciesr Enter on lines 1 on J ry n 750.00 120.00 75.00 44.00 25.00 1,350.00 325.00 1,394.47 157.00 50.00 15,201.47 I have carefully rovlewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all rece pts and disbursements made on my account or by me in this ties , ∎ 1 . I further certify the f have received a copy of the HUD -1 Settlement S -A I� Lyle J 111 The HUD-1 Settlement Sta with this statemenL By Legal Solutions Borrower Borrower ve OeoGini Rosemary Olson Seller Seller nt which 1 have prepared Is a true and accurate account of this transaction. l have caused, or will cause, the funds to be disbursed In accordance y l( As Its Authorized Representative iJ Date 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 line and imprisonment For delalis see: Title 18 U.S. Code Section 1001 and Section 1010. DoubieTime®