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MC-09-574 ::: :::::::::::::::::i,:: {ii.:iii�> Y•-? i'::: '::: ^: %'��iy',.,.,ys�y��j.:ya3' +wyti ..::: is Y: 4:: Y i ' YY % i: { :i: ?; •': •i::ryS� ::�::ii: T °. C.I Mi ami Shores Village .. � ''.. 10050 N. E. 2nd Avenue Miami Shores, FL 33138-0000 �.. . z Phone: 795- 305 r } 2204 • a ./ .. ........ w r✓ f Ex `� €� 1 Q9 Project Address Parcel Number Applicant 16 111 Street 1121360030340 Miami Shores, FL Block Lot: FERDO SARSON y� ......... ........e•..... ... J2�•'FJ ...........: ........... •. :.. . :py..www.www..,.•Y SJJ :• <::::•' J:OKKT'.w:.w....•.•..••.•J ..<6•J }JYJ JJ:. OK:.^•.•:"• Ji• :y:•:ti:•:•'•'r•'•..'•'.•'•:•.q. ... Owner Information Address Phone Cell FERDO SARSON 16 NW 111 ST MIAMI SHORES FL 33168 -4322 i:: y ,. ...•.•...•:. ,d J <. d• d•:•: Y:•:•:•: i{: .• }::•Y:fikd <.o »YYT•:•X•:•Y:ti4kv ,<.S•:•:•:•Y:•YY �:•::N.: ...<rop -.,rr< Jq?:d<J• r,••J'.•Y:i•. •. <n :•Y:•: >•: oJ:fi: •.: d;: p},,,:: bYy>:•' •.•nv..•.•.•.:4 }:•.d .... .. ........ .... ..• ... ..... .•'•YY;•q,4:. .qd.Y. . >....:.......... ........... ....'•a�YJF.,,•i .. >: %0e°;°.:✓e....n >F.d.>:.J'� Y Ja•.v..•,•.;<•- .,r.•ry•.•..re. >......•...:•>.:.......>.....,..• n,,.. .uvv.. >:h.xJ.vc..•.c,,.:.....dv .. �` A9>.•>..d h �..,).... J... uvJ. c,. Gswe,.>. �.. e: �: u¢ v. A.. n..•. v.. a.:..:,:..:.>:. d.. v....,: d: b•...:..:.: . :,..c:.>......ryF,;.:dry:.;d:9l: dJ`,:ti!:ti +.::}•: Contractor(s) Phone Cell Phone Valuation $' 3,0 00.00 JOSE C YANE AIR CONDITIONING & /; ...................................................................................................................................... ............................... Total Sq Feet: 0 Tons: 31 /2 Available Inspections: Additional Info: A/C SPLIT SYSTEM Inspection Type: Classification: Residential Ventilation Approved: In Review Final Comments: Date Approved:: In Review Rough Date Denied: Type of Work: Hood Rough Duct Smoke Test Smoke Det Test Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $ 1.80 MC -4-09 -34488 $ 108.04 $ 58.04 Education Surcharge $0.60 Permit Fee - Additions/Alterations $100.00 MC - 0 &34488 $ 108.04 $ 108.04 $ 0.00 Scanning Fee $3.00 Submittal Fee $$0.00 Submittal Reversal Fee ($W.00) Technology Fee $2.64 Total: $108.04 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. April 15, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 16, 2009 -- 1 5111101 Rq. uYo Miami Shores Village ������ MAY 0 4 2009 51°1o� A� Building Department e__ v W� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY - - - - -_ Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING - Permit No. CS q 1 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): Building Electrical Plumbing e chanical Roofing Owner's Name (Fee Si le le Titleholder) �� 1 1ML 1 5 Phone Owner's Address 0 V / + �T.:Q.� t_a ck_"/ City 1 �1'1 I S � 3 State 4:_ LO ("`1 C . 0— Zip '3'3 Tenant/Lessee Name Phone # Job Address (where the work is being done) (0" I City Miami Shores Village County Miami -Dade Zip (O FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # — Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration 'XNew ❑ Repair/Replace ❑ Demolition Describe Work: f I V Y 1 )Ct l,{ ca r �,� �a� ir-. \Yl - Pro n+ o L i-- K _i LM Winau 1 Submittal Fee $ Permit Fee $ Q CCF $ i y CO /CC Notary $ , tp Training/Education Fee $ Technology Fee $ 3 Scanning $ Radon $ DPBR $ Zoning $ Bond $ — (aN`� Code E m Double Fee $ C Structural Review. $ Total Fee Now Due $ 'rb3 35 N n MAY 6 2009 See Reverse side MIAMI SHORES V ILLAGE Bonding Comp . s Name (if applicable) Boh6ing Company' Address State yip 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 IIrT', 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. AZsQ, 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 approved and a reinspection fee will be charged. Signatur Signature Owner or Agent .. The foregoing instrument was acknowledged before me thi The fore oing iris merit was acknowledged ;fore, me.this • -day of lory? 200, by day ofU4 &Z 20 1� by a C who is personally known to' me or who has produced_ w is personally kno me or who has produced- As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC- NOTARY PUBLIC: Sign: �- Sign: Print: l h0 t cO,__a 4 Print: My Comm --- My Commi o r s: ' GWENDO INI . ABEU Ys . NICOLE A BERQERT NaOq►F d Florfdq', MY COMMISSION # OD 444715 Omm E ONJIM 18, 2012 EXPIRES: July 2,+>� Cron # W 744110 Both Thru No" POW Undenmlm . .. tab!dAMa+K�'!NalondNolorY� . �: kkkk�akkkk% kkaeskkkkk ,kkRks&�Sk&kk:k k �� :R h kk k k �k�k�kkk& k�kk3�k�?k: kkksk��&, k? RBkk��= kks8k�������k�����ka�? &�k�� '� Zoning APPLICATIpN APPROVED BY • 7 s Examiner g . Clerk,checked (Revised 07110/07) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL �r Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: IhISP- 110$81 Permit Number: EL -4 - 09 -576 Scheduled Inspection Date: April 16, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SARSON, FERDO Work Classification: Addition /Alteration Job Address: 16 NW 111 Street Miami Shores, FL Phone Number Parcel Number 1121360030340 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758 -2000 Building Department Comments Inspector Comments Passed ffl °— Failed Correction ❑ Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. . . . . . . . . . . Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (306*196-2204 Fax: (305)766-8972 ............................. .... .. . . . .............. . . . . . ..... _.­_.____­ ...... ................... . ........ . .. . ............... . . .... . ...... — ------- - --------- - ------ ....... 1­ .............. Scheduled Inspection Date: April 20, 2009 Permit Type: Mechanical * - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: SARSON,FEIRDO Work Classification: Addition/Alteration Job Address: 16 NW 1 Street Miami Shores, FL Phone Number Parcel Number 1121360030340 Project: <NONE> Contractor: JOSE C YANE AIR CONDITIONING & APPLIANCES SERV IN- Building Department Comments L Inspector Comments Passed LW Correction Needed ❑ 1* - I rtr2c�ar No Additional Inspections can be scheduled until re-inspection fee is paid. April 17, 2009 Page 16 of 30 >> :: ami S ., m hores Villa e :: : :•k'•I��:. » »: t 10050 N.E. i 2nd Avenue t .» ' Miami Shores, = :::::: >:: >:::: >. - . >:3...: ;;;:: ::. .;: :: .;:: 3>: 3;: �: �:;-;: �: �: �;;;:;: �:•;:: � < ;;: < : < ; < ; < ;: : :: < ;: ; ;: es L 33138 - 0000 •:. ;.3:.::. :.::.:�;:. r,,,11 »:: :: >:: >:: ::> ::::< ::: :::: >. ::::::::<:>:>::::>::<:::>:: z;:::::::>.;>::>::<:::::::;::::>:<::::>-:::::•3.>•:::;;:>:::::>:::<:.;-.;•3:.:::::.:: ::;::.3:::3;::.::.::•:;;:;;:;;• .. ;.3 3. 3:.::.3 :.::.:::.::.::.;:-;:;;<.::.3:;.3:. 33:;.3:. 3:.::.::. 3:.3:. 3:;.3:. 3:. 3:.::.3:.::.:;.::. 3:.::. 3:.::. 3:. 3:. 3;;::. 3:.;; 3:.::. 3;;:.;:.:;:. 3;:. 3:.: 5.:::............ ............................... Phone: 30 5- 5 79 . �. 2204 r s s { ) _-- Exp iration: 10112J200 Project Address Parcel Number Applicant 16 Ill Stre 1121360030340 FERDO SARSON Miami Shores, FL Block: Lot: A S w � ^nnra..• •.vip•.FX........ .. . >.... >..vw.•.•e +.•..w.3.ww.i•: - S,Z.•.a.:•....0'. - ...:.. _. ��,;� . — Owner Information Address Phone Cell FERDO SARSON 16 NW 111 ST MIAMI SHORES FL 33168 -4322 Contractor(s) Phone Cell Phone {Valuation $ 1,000.00 w MOODY ELECTRIC INC (305)758 -2000 ...................................................... ............................... Total Sq Feet: 0 u. ;..;.: ??SO: w.•......•........... n...:' f: 4. M ti4: i! ff2 :' } { } {f:<�2:. }5:.:'.:f {IIJ3:k3:�O:AG'O:ff:4:: f:�:!S I Type of Work: ELECTRICAL Available Inspections: Additional Info: A/C HOOK UP Inspection Type: Classification: Residential Underground Rough Final i Meter Box Alteration Relocation Fire Alarm Service Change W.W. Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0 EL- 409 -34545 $ 106.40 $ 56.40 Education Surcharge $0.20 :' 1 ..>• • * :'• ? >? Permit Fee - Additions/Alterations $100,00 EL - 09 - 34545 $ 106.40 $ 106.40 $ 0,00 Scanning Fee $3,00 Submittal Fee $50,00 Submittal Reversal Fee ($50.00) Technology Fee $2,60 Total: $106.40 i 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, f PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. I 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. April 15, 2009 Authorized Signature: Owner 1 Applicant 1 Contractor / Agent Date Building Department Copy April 15, 2009 1 Miami .Shores Village MCMICITM I APR ®8 Zoos Building Department BY ' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. PERMIT APPLICATION Master Permit No. W _ FBC 2004 Permit Type Electrical 7 Owner's Name (Fee Simple Titleholder) fi, %O j Phone # f 7- ® SKg el Owner's Address /9 A l oj City 0 State Zip 9; a 9 Tenant/Lessee Name Phone # 5 75F K 9 R ^/ E -MAIL: Job Address (where the work is being done) �� ���� �✓���� °' i City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name / ��`A %2 Phone # Contractor's Address City zti Zip Qualifier Name Phone # il�� ®d State Certificate or Registration No. - , , o ®� �� Eertificate,o Competency No. B_.ilyIAIL - Arehit�et/Engineer's Name (if applicable) � Phone # Value of Work For this Permit $ S ua e oota a Of Work: Type of Work: ❑Addition.. ❑Alteration ❑New, , "ORL air /Re lace p p ❑ Demolition Describe Work: -� AAK. Submittal Fee $ Permit Fee 0 &0 CCF $ CO /CC Notary $ .. Training /Education Fee.$ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side —> Bonding Com,pany's Name (if applicable) Bonding Company's Address City S Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City tate 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 commencement must be posted at the job site . for the first inspection which occurs seven 0) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged f Signature Sig Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of I PL , 20 , by a day of A 1/ , 20 T, by �./��j a who is personally known to me or who has prod ` who is personally known to me or who has produce =;mod': `'1 As identification and wh i as identification and who did; U , NOTARY PUBLIC: 9. NOTARY PUBLIC: g '' n A 6 Ro Signlud P a t Sign: Print: 00 d W V — ' Print: 4 b Ina- My Commission Expires: w �, My Commission Expires: if ° oc��i xi: ae aYxxx $kx:a:a:xxxxxaYxxeYxx9cx.Y 9cxx4: :Y ie Y YxfYx & J:a"'�x :i:x x,Y,F 4c 9cxxxdexxx$dexxaY aY aY nY$rxuie x4c xae aFx & &ce e.xx9ex$cxxdcxxx�e ' � O J Q APPLICATION APPROVED BY: Plans Examiner Engineer I Zoning (Revised 02 /08/06) ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUSTACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PERMIT # PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE I ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER I LIGHT OUTLETS CENTRAL HEATING DISPOSAL IRECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCTWORK INTERCEPTOR SERVICE REPAIRIMETER CHANGE REFRIGERATION LAVATORY JAPPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY IRANGETOP UNDERGROUND TANKS CLOTHES WASHER JOVEN ABOVE GROUND TANKS SHOWER IWATER HEATER I U.F.'PRESSURE VESSELS SINK. POT /3 COMP. IMOTORS 0 -1 HP ISTEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3-5 HP IMECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-S HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER &10 HP ELEVATORS /ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP IFIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP ICOOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT A/C WINDOW IREINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL IGENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK ISIGN TIME CLOCK RELAY IFIXTURES FAINFIELD, 4" TILE/RES. JANTENNA PUMP & ABANDON SEPTIC TANK ITELEVISION OUTLETS SOAKAGE PIT CU. FT. IVIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING & LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT # PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES A/C (WINO) FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1-3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL R VENTILATION TEMPORARY WATE CLOSET MOTORS OVER S -8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP EL EVATORSIESCACATORS WATER CLOSET MOTORS OVER 10 -25 HP FIRE SPRINKLER.SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOUNG.TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT A/C WINDOW REINSPECTION FIRE SPRINKLER T AIR CONDITIONERS HEATER -NEW INST. STRIP [EATER . HEATER - REPLACE I GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK JSIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSP•ECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING JOSE C. YANES AIR CONDITIONING & APPLIANCES SERVICES, INC. 1021 NE 132nd STREET, NORTH MIAMI, FL 33161. CONTRACT El LICENSED $ INSURED CELL: 786.683.9345 FAX 305.895.3565 PROPOSAL WORK TO BE PERFORMED AT DATE NAME NAME ADDRESS � � � % ADDRESS lrvw CITY, STATE CITY, STATE PHONE PHONE ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED, AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE CONTRACT AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER FOR THE SUM OF: �f1Pe � I � f" g- L"7''1 d/ 4a� J) DOLLARS$ - WITH PAYMENTS TO BE AS FOLLOWS: ANY LTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COST WILL BE EXECUTED ONLY UPON WRITTEN ORDER. AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTMIATE. ALL AGREEMENTS CONTINGENT UPON STRCES. ACCIDENTS. OR DELAYS BEYOND OUR CONTROL. ❑ ACCEPTANCE OF PROPOSAL CUSTOMER'S SIGNATURE ❑ ACCEPTANCE OF CONTRACT CONTRACTOR'S SIGNATURE % oe DATE