MC-14-166Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 206352 Permit Number: MC -1 -14 -166
Scheduled Inspection Date: March 03, 2014
Inspector: Perez, JanPierre
Owner: MORA, ALBERT
Job Address: 645 NE 92 Street 14 -D
Miami Shores, FL
Project: <NONE>
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number
1132060430070
Contractor: SUNNY ISLES BEACH AIR CONDITIONING INC Phone: (786)268 -7691
Building Department Comments
CHANGE OUT 2 TON SPLIT SYSTEM Infractio Passed Comments
INSPECTOR COMMENTS False
l
February 28, 2014 For Inspections please call: (305)762 -4949 Page 11 of 36
Inspector Comments
Passed
UNIT 14 B
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 28, 2014 For Inspections please call: (305)762 -4949 Page 11 of 36
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 APPLICATION
Permit Type: MECHANICAL
JAN-1,9 a#
FBC 20
Permit No.
Master Permit No.,_
JOB ADDRESS: 6 Y. � Z22 f�,O- --0 / 11
City: Miami Shores County. Miami Dade Zip: 3313 Y
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO
Zone:
OWNER: Name (Fee Simple Titleholder): Acs :t /ti(? g_.4 Phone #: a S
Address: /I t, )Ut Q;-1 ^n 'q4 -Wl74 -0 l u
City: M) m _S h o 1 r S - State: F I 0 2 g ao Zip:
3�
Tenant/Lessee Name: Phone #(3 �9
Email: & A e) Y AW ee .r y aj.. !' o m
CONTRACTOR: Company Name: �$�i Phone #:�'�'J�
Address: 9P/.2- o
City: Stater g Zip:
Qualifier Name: 67?� Phone #:
State Certification or Registration #: �, �' /X/!Za/qg3 Certificate of Competency #:
Contact Phone#: ' C� �� '' � Email Address: S J/ A ( G C
DESIGNER: Architect/Engineer Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work:, ❑Address DAlteration / ONew Okepair/Replace ODemolition
Description of Work: G
Submittal Fee $ Permit Fee $ �`C CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ �%
Bonding Company's Name (if applicable) AJJ,1
Bonding Company's Address
City
State
Mortgage Lender's Name (if- applicable)
Mortgage Lender's Address
City
State
Zip
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 (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.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged Abe�fore me this
day of 20 if by Al be4/- -- +� �o g- A- ,
who is personally known to me or who has produced t;" O4
DD\PZ �- identificatic }, Id who did take an oath.
.• "•.�P MAFOA LOPEZ
NOTARY PUBLIC: * * bIY�QMMISSION f EE 172018
,� PI ES:Februepr2i,2016
OWN!
The foregoing instrument was acknowledged before me thi�
day of rr 20% , by &h&6�42 ,� �
who is personally known to me or who has produeWgK
identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires: �I _Z1 I' My
etint�trot�Y�zdrdnYa @9esYFrrh &dedE4eoY 3carrksY3r3r�YsYtY�Y3r�ir dn44r4rs 44edroHYsksYaY4r4r9r4cdnt4a�Y9i4eaP�YaYardraYdr4evYaY�Y
APPROVED BY %j ply Examiner
Structural Review
(Revised 3 /12/2012XRevised 07 /10 107XRevised 05 /10/2009)(Revised 3/15/09)
Notary Public State of Florida
emission FF 082753
01/12/2018
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel (305) 795 2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data
sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work is being dens): X 415 P► —P • 'a s
City: Miami Shores Village
County:
ALL CONDENSING UNITS DUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO jg ARHI Sheet Attached: YES 2""NO ❑ Contract Attached: YES
;61
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Ovencurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): 420d
4. Size Disconnecting
Contractor's Company
State Certificate or Registration N. g C= Certificate of Competency N.
Signature Date:
eK signature only)
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
012 AEA
(O
AHU or PKG. UNIT MODEL #
A&
Z/— --IJAI 25V-2
COND. UNIT MODEL #
KW HEAT
NOM TONS
AH
a
KG
1 M.C.A
2 M.O.P
AH.
AH
AH
G
CCU KG
CU ®PKG
AH . 0, CU r-KG
AH �rKG
3 VOLTS
PKG UNIT /
/
PKG UNIT
EER/SEER
YES
0
REPLACING DUCTS
YES
NO
YES
NO
A
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4 °CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Ovencurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): 420d
4. Size Disconnecting
Contractor's Company
State Certificate or Registration N. g C= Certificate of Competency N.
Signature Date:
eK signature only)
OL PAX
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JAN -22 -2014 09:23 PM
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18003748812180034305 P.01
.r
Nil iami �7hores Vill 1g e
Building Department
10050 N.5.2nd Av nue
Miami Shores, Florida 3136
Tel: (306) 7951204
Fax: (365) 756.6972
CONTRACTORS' REGISTRATION CORM
C
il
ONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PORMIT IS
TED OR THE VILLAGE MAY MAINTAIN A FILE IMTH YOUR INFORMATION FOR A $30.00 FEE PER Yl?' P.
!ACTOR IS A FLORIDA MIE CERTIFIED CONTRACTOR:
��'
i
_COPY OF QUALIFIER'S STATE LIC CARD
_ COPY OF LOCAL BUSINESS TAX RECEIPT
_COPY OF LIABILITY INSURANCE ICERTHCATE HQLDER IQ Q1 MIAMI SHORES VILLAGE BLDA DE
COPY OF WORKERS COMPENSATION 1ETTHER CERTIFICATE OR EXEMPTIONj
COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VI, LL6QE jI.IJG D _RT►` t
COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER Al FOLLOW
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33136
•rgMr�rrrr■ ■r.■ ■.■■. ■ ■ ■■ COMPLETE CONTRACTOR` S INFORMATION ■ ■g ■M ■.g ■MrgMrrrr■■■i ■■ ■ ■■� not
ADDRESS: Q %�b 6L() ST C-�- CITY `1�L�
ZIP CODE 333=9P � `
PHONE: j _�(a�- �E, FAX NUMBER
QUALIFIER'S NAME: Cj) t6a_ , j
QUALI IER'S LIC NUMBER:
E-MAII., ADDRESS (IF APPLICABLE):
JAN -22 -2014 09:26 PM
I I
18003748812180034305
03 -13 -2012
ATWATER STATE OF FLORIDA
FINANCIAL OFFICER DEPARTMENT OF FINANCIAL. SERVICES
DIVISION OF WORKERS' COMPENSATION
P.07
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,
,
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION. LAW *I.*
INDUSTRY EXEMPTION
Thislcertifies that the individual listed below has elected to be exempt from Flarida Workers' Compensatlon law.
DATE: 04/14/2012 EXPIRATION DATE: 04114/2014
OTERO ROBERTO J
5511011858
BUI TNE SS NAME AND ADDRESS:
S Y !SEES BEACH AIR CONDITIONING INC
812 SW BS CT.
COD ER CITY FL 33328
SC ES OF BUSINESS OR TRADE:
1- STRUCTION SUPERVISOR (63015) 2- CONTRACTOR - PROJECT MANAGER, CO
3- ERTIFISD AC CONTRACTOR
IMPO ANT. Pursuant to itoptar 440 , 051141, F4, an officer of a corporation who elects exemption Itom this chapter by filing s certill0to or slectloo under tdI
section may not recover pe11eflis or compensation under this chapter. Pursuant to Chapter 440,05112), F,$., Certificates of election to pa ssompt.,, s #ply, only withina
Drape i the business of 11`44* listed as the notice of sleetian to be eae01pt. Pureuent to Chapfor 440.o5031, F.S., mottos, of eisetfos to be exempt aid cartfficetap'af
elaatla to be exempt sha11 00 neglect to revocation If, st any time after the filing of t4a Retie■ or tpe Issuance of the certificate, in pareon named on the aotlep"Of
rariffle to no longer meets the ragoltsmsota of this section for fsaaenae of a earllliaste, The depoginant shall revoke s certificate nt 010 Inge for Iatlure of the arson
11:01#0 a the certificate to meet the requirements of this section,
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 WESTIONS7 501 413 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
DEPART ENT OF FINANCIAL SERVICES
DIVISIO Ole WORKERS' COMPENSATION
CONS UCTION INDUSTRY
CERTIFI re OF 4LECTION TO BE EXEMPT FROM FLORIDA
WORIM S' COMPENSATION LAW 0
EFFECT VE: 04/14/2012 EXPIRATION DATE; 04/14/2014
PERSON: ROBERTO J OTERO
Fraft. 601011838
13USINE S NAME AND ADDRESS:
SUNNY ISLES BEACH AIR CONDITIONING INC
5120 SY, 56 CT.
COOPE CiTY, FL 33338
SCOPE OF EiUSINESS OR TRADE:
I• CONSTRUCTION "ORVIBOR 168061 2- CONTRACTOR - PROJECT MANAGER, CO
3- CERT IEO At CONTRACTOR
IMPORTANT
0 Pursuant to Chapter 440.05(141. F.S., an officer of � a corporaggn wha
elects exemption from this chapter by filing a certificate of, leotion
L under this section may not recover benefits or compensation !tinder this
D chapter,
I
Pursuant to Chapter 440,05(12), F.S., Certificates of election 1`4 be
H exRmpt.. apply only within the scope of the business or trade fisted on
Rthe notice of election to be exempt.
R Pursuant to Chapter 440. 05(13), F.S„ Notices of *fiction to bf exempt
and certificates of election to be exempt shall be subject to, revocation
If. at any time after the fllino of the notice or the Issuance,;of the
certificate, the person named on the notice or eerfffleate no ,Ipnger mail?
the requirements of this section for issuance of a, certificetar, The
department shall revoke a certificate at any time for failure p,1` the
person named on the certificate to meet the requlremil"ts of-this
section.
QUESTIONS? (850i!413 -1809
CUT HERE
t1` Carry bottom portion on the job, keep upper portion for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
JAN -22 -2014 09:25 PM
and V
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18003748812180034305
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1
1940 NORTH MONROE STREET
TALLAHASSEE FL 32398 -0783
OTERO, ROBERTO J
SUNNY ISLES BEACH AIR CONDITIONING, INC.
9120 SW 66TH COURT
COOPER CITY FL 33328
stionsl With this license you become one of the needy
n Floridlans licensed by the Department of Business and
tectss to yacht broke sr from boxers odbarbeq er$ range
c k
seep Florida's economy strong.
WS better. For information about we do business pieese log onto
lorldalioonse,00m, There you can find more information
tdentsooewslettte s and learn more about the Deart e subscribe
the Department Is; License Efficiently, Regulate Fairly.
strive to serve you better so that you can serve your
ank you for doing business in Flodds,
lions an your now licensel
wi
VILA i1111111
P. 05
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STATE OF FLORIDA
DEPARTME T, OF USINES AND
PROFESSIt N,,AL R •G,ULATII N
CAC1817693 • • , .. 11., UB 12/3 /2013
CERTIFIED AIRCAN6 t?N1?.. k
OTERO, ROBkft J ; . ,, • I
SUNNY ISLES BEACHgit: 'NINA
IS CERTIFIED under the provisions or ch,4ee FS.
Exptr doIN : AUQ 31, 2014 L131 006+
The Department of State Is leading the commemoration of Florida's 500th anniversary In 2013,
For mare informa #ion, please go to www.ViveFlorlds.org,
•..• -... ., DETACH HERE
SCOTT, GOVERNOR STATE OF FLORIDA KEN LAWSI
DEPARTMENT OF BUSINESS AND PROFESSIONAL. REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1 _
CACIf 17693
The CL SS B
provisions of C
date: AUG 31,
G
4r 489 FS.
aY I5L95 BEACH AIR CONDITIONING, INC,
SW 55TH COURT..
aER CITY FL 33328
ISSUED: 12/3x/2013
,y�.e.'• .. W .. .,gee'' ;
ISEQ # L1312300000548
VIVA FICRIO T
1 �.
JAN -22 -2014 09:25 PM
18003748812180034305 P.04
CERTIFICATE OF LIABILITY INSURANCE I CAN (MMM " M
THIS ICERTIFICAT E IS I88UE0 AS A MATTER OF INFORMATION ONLY AND CONIFERS NO RIGHTS UPON THE CERT I CATS I{O /201THII
O IFICATE pOEB NOT APFIRAAATIVEt.Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD D BY Thl POLCCEEI
REL 9 THIS VERTI1rICATE OF ,AND THE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU)IER(% p� HORIZEL
REP EBENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
the ANTS Conditions the gliltf�e holder s an, ADDITIONAL INSURED, the Pallcy(I� meet tw ��, H SUBROGAT10N 8 WAIVE I), subject N
the sand in lieu Of the on lay, certain Policies may 1041,111`0 an Endorsement, A statement on this Certificate does pot Confer lrlphts to the
t�rtlt to holder In Ileu of such endorao s
PRCOUC R
CM derwritera Corp. >Eichaet aascia I �
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3220 oath ttaive>rsit+y axfve, .eitce8ewr4nnd.reritars.cama
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Davi S'L 33328 uII,uR +
aaQURIC uva G1` �►da Insurance C as 870
8 IOZAB SZWN AIR CO3MZNWXONZXG INC i
9120 33Tv CT
FL 33328
.+ LF_V yr in3uevuvvt U.5TEp BE4RW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE R THE PO
INDI NOTSMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R�SPECT TO
CERT1 KATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL.
EXCL IONS AND CON...... 9 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R @ OF MURAMOE
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$ MAAERCWL GkTfERAL lIABII ITtH OCCURRENCE &
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SHOULD ANY OF THE ABOVE 09SCRMED POLICIES 04 am
THE EXPIRATION DATE THEREOF, NOTICE VMJ, BE
ACCORDANCE WnN THE POLICY PROVIwONa.
REPRESENTATIVE
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JAN -22 -2014 09:26 PM
18003748812180034305 P.06
"IMKVWARD p -
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL $3301 -1895 — 954. 831 -4000 I i
VALID OCTOBER 1, Z013 THROUGH SEPTEMBER 30, 2014 i
DBA: 183 -1586 i l i
Business T
Businest Name: SUNNY ISLES BEACH AIR CONDITIONING pt e:�'TING AIRCONDITION' COl�
Type, (AIR CONDITIONING CTR1
Owner Name; OTERO, ROBERT .7 Business Opened:o4 /19/2ao6
uslnalsS iLocalion: 9120 Sw 55 CT State /CountylCert/Reg:CAC1817693 I i
COOPER CITY Exemption Code:
Business Phone: 786369 -7691
Rooms Seats Em I
p oN ges Machines Professipnaia
1
For Vending Business my
Number of Machines: Vending T s;
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Colieotion Cost Total Paid '
27.00 3.00 0.00 0.00 0100 0.00 30.0
i
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS i
i �f
THIS BECOMES A TAX RECEIPT This tax Is levied for the privilege of doing business within Browsrd County and
non - regulatory in nature. You must meet all County and /or Municipality plannir
WHEN VAUDATED and zoning requirements. This Business Tax Receipt must be transferred whey
the business is sold, business name has changed or you have moved t .
business location. This receipt does not indicate that the business is Ipgel or tha i
it is in compliance with State or local laws and regulations.
Mauling Address:
SUNNY ISLES BEACH AIR CONDITIONING
9120 SW 55 CT >tacaigt: 030A- 13- p0006989 i
FORT LAUDERDALE, FL 33328 Paid 01/14/207,4 3.00
K-J I
. 20i3 .. _ 2014 i
This combination quallfles for a Federal Energy
Efficiency Tax Credit when placed In serviced
between Feb 17, 2009 and Dec 31, 2013.
.. �_`` >•
•• .• • _k Le
AHRI Certified Reference Number: 5550388 Date: 1/22/2014
Product: Split System: Air - Cooled Condensing Unit, Coll with Blower
Outdoor Unit Model Number:14AJM25
Indoor Unit Model Number: RHLL- HM2417 +RCSL -H *2417
Manufacturer: RHEEM SALES COMPANY, INC.
Trade/Brand name: RHEEM
Series name:
Manufacturer responsible for the rating of this system combination Is RHEEM SALES COMPANY, INC.
Rated as follows In accordance with AHRI Standard 210/240 -2008 for Unitary Air - Conditioning and Alr- Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored, Independent, third
party testing:
Cooling Capacity (Btuh): 24600*
EER Rating (Cooling): 13.00
SEER Rating (Cooling): 16.00
IEER Rating (Cooling):
* Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which Indicates an Invokurtary rerate.
02013 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 130348724169118325
Shores Plaza West Condo, Inc
PO Box 530428
Miami Shores, FI 33153
January 30, 2014
To Village of Miami Shores,
This letter is to confirm that Sunny Isles Air Condition has the permission to replace and install an
air condition unit at 645 NE 92nd Street unit # 14 for owner Albert Mora.
Thank your for your operation.
John Kilpatrick
President b
Cc: Albert Mora
Proposal Submitted Phone ate
Azbw- "44 5 1�1 2- V �
Street Job Name
City, Street and Zip Code Job Location
Architect Date of Plans Job Phone
We here by submit sDecifications and estimates for:
With permit, labor, equipment and supplies. To be hooked up to existing electrical, duct work,
Freon Lines, and drain lines (all work to be done to code). Any additional electrical work, duct
work, Freon Lines, drain lines, mechanical plans, test and balance, wind load calculations, heat
load calculations, curb adapters, and smoke detector installation, or repair, if not up to code will
have additional charges.
We Propose hereby to furnish ppmateria bor — complete in accordance with above specifications, for the sum
w
Dollars
Payment to be made as follows
50% up front Cwhen permit is obtained), 25% at installation and 25% at final inspection.
Note: This proposal may be withdrawn by us if not accepted within.
All material is guaranteed to be as specified. All work to be complete in a workmanlike manner according to standard practices. Any
alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an
extra charge or over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to
carry fire, tornado and other necessary insurance. our workers are fully covered by Workman's Compensation Insurance.
Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified. Payment will be made as outlines above.
Date of Acce tance.
Signature- �'�G /% ��1�