MC-09-574 ::: :::::::::::::::::i,:: {ii.:iii�> Y•-? i'::: '::: ^: %'��iy',.,.,ys�y��j.:ya3'
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Mi ami Shores Village
.. �
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10050 N.
E. 2nd Avenue
Miami
Shores, FL
33138-0000
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z
Phone:
795-
305
r
}
2204
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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
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. >....:.......... ........... ....'•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
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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 { )
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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