WS-06-2999Miami Shores Village
Building Department
/
10050 N.E.2nd Avenue Mi ( ami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: < es:— M& cw -'
Permit No.
MAR 872014
'20
Master Permit No.1-A) S 66 — e99
ROOFING
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder): V411-0
Address: Aj6r -73 Ir --f
City - Z�n
Tenant/Lessee Name:
Email: 1.3 eo 'G
NO Flood Zone:
a1* /. AIN
State: FL Zip: _33f'? k—
CONTRACTOR: Company Name: Phone#:
Address:
City: State:
Qualifier Name:
State Certification or Registration #:
Contact Phone#: Email Address:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work.
Type of Work: DAddition DAlteration New DRepair/Replace ° pIIemolition
Description of Work: ( jJQ
COZOP thru tele:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
CCF $ CO/CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE 1 ?�,� w e-)
Bonding Company's Name (if applicable)
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
�r
Owner or Agent
The foregoing instrument was acknowledged before me this
day of/6&J0 20 , by -4
who is pe na y cno me or who has produced
n and who did take ah" oath.
NOTARY PUBLIC:
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced
as identification and who did take an oath.
Plans Examiner
Structural Review
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Revised 5/2/2012)(Revised 3/12/2012) XRevised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNINWILDER
Q DISCLOSURE STATEMENT
NAME: LL, DATE: 5 —
ADDRESS: k)&,
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 489.103(7).
And I have read and understood the following disclosure statement, which entities me to work as my own contractor, I further
understand that I as the owner must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The
exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must
supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a
commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and
occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire
an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state
law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your
supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers'
compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances,
buildings codes and zoning regulations.
Please read and initial each paragraph.
1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder
permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may a y own
contractor with certain restrictions even though I do not have a license.
Initial
2. 1 understand that building permits are not required to be signed by a property owner unless he or she is respo ible for the
construction and is not hiring a licensed contractor to assume responsibility.
Initial
3. 1 understand that, as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name inst f my own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licens nu bars on
permits and contracts.
Initial
-4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve
a commercial building the costs do not exceed $75,000. The building or residence must be for my use or occupancy. it may
not be built or substantially improved for sale or lease. If a building or residence that I have built or substanjimproved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I builttantially
improved it for sale or lease, which violates the exemption.
Initial
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial--
I
nitial
I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law an y'r� my or
municipal ordinance. r
Initial
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that
erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held
liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully cling as an
owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
Initial v
I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to
perform the work being done. Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers copensation for
the employee. I understand that my failure to follow these may subject to serious financial risk. ( T
Initial "
I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable
laws and requirement that govem owner -builders as well as employers. I also understand that the
Construction must amply with all applicable laws, ordinances, building odes, and zoning regulations.
Initial
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the
United States Small Business Administration, and the Florida Department of Revenues. I also understand that I mpqontact the
Florida Construction Industry Licensing Board at 850.487.1395 or http:/Mw.mygoNdalicense.com/dbpr/Dro/cilbfinddx.ht?ml
Initial
I am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the parry
legally and financially responsible for the proposed construction activity at the following address:
Initial— 1 V
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informat
have provided on this disclosure. ,ull
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a
license, the Constr4ucfion Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to
understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may
be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for
verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
retumed to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when
the permit is issued.
Was acknowledged before me this _day of �� , 20�_
By who was personally known to me or who has
there
OWNER
identification.
NOTARY
• • • • • • • • • •
M 1� DADE 00 MIAMI-DADE COUNTY, FLORIDA
• • • • • • • • • • � E DADE FLAGLER BUILDING
BUILDING CODE COMPLIANCE • I BCC • • • • • • •
V ( . ; ; ; ; 14� S AGLER STREET, SUITE 1603
PRODUCT CONTROL DIVISION • • • • • • • • • • e • MIAMI, FLORIDA 33130-1563
(3 5 375-2901 FAX (305) 375-2908
NOTICE OF ACCEPTANCE WOAI. ... • •
Jeld-Wen, Inc.
.. .. . . . ... ..
31725 highway 97 North.
Chiloquin, OR 97624
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials.
The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted
by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by
the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control
Division (In Miami Dade County) and/or the AIIJ (in areas other than Miami Dade County) reserve the right to
have this product or material tested for quality assurance purposes. If this product or material fails to perform in
the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately
revoke, modify, or suspend the use of such product or material within their jurisdiction. BORA reserves the right
to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or
material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane
Zone of the Florida Building Code.
DESCRIPTION: Series Jeld-Wen® Steel W/E Outswing Opaque Insulated Steel Doors
APPROVAL DOCUMENT: Drawing No. DC9921, titled "Outswing Opaque Insulated Steel Double Door in
Wood Frame", sheets 1 through 6 of 6, prepared by R.W. Consulting, Inc., dated 9/25/00 with revision No: 1 dated
10/14/02, bearing the Miami -Dade County Product Control Revision stamp with the Notice of Acceptance number
and expiration date by the Miami -Dade County Product Control Division.
MISSILE IMPACT RATING: Large and Small Missile Impact
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any
product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply
with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by
the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall
be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site at the request of the Building Official.
This NOA revises and renews NOA # 00-1003.04 and consists of this page 1 as well as approval document
mentioned above.
The submitted documentation was reviewed by Manuel Perez, P.E.
NOA No 02-1022.14
Expiration Date: December 02, 2007
Approval Date: December 19, 2002
qW Page 1
• ... ...
. . . .
%: . . . .
• • ••• • • • • •••
Jeld-Wen, Inc. 0 0 • 669 . •
. 0.. . . .....
NOTICE (W AtCEPtAXC:E::: &
File ONLY. Not part of NOA)
.... . .. ... ..
A. DRAWINGS
1. Manufacturer's Zid dtawiiag's'and sectio$s.
2. Drawing No. DC9921, titled ` Outswing Opaque Insulated Steel Double Door in
Wood Frame", sheets I through 6 of 6, dated 9/25/00 with revision No. 1 dated
10/14/02, prepared by R.W. Consulting, Inc.
B. TESTS
Submitted under NOA No. 99-0624.05
1. Test reports on 1) Air Infiltration Test, per TAS 202-94
2) Uniform Static Air Pressure Test, Loading per TAS 202-94
3) Water Resistance Test, per TAS 202-94
4) Large Missile Impact Test, per TAS 201-94
5) Cyclic Loading Test, per TAS 203-94
6) Forced Entry Test, per FBC 3603.2 (b) and TAS 202-94
along with manufacturer's parts and section drawings marked up by Certified
Testing Laboratories Inc., Test Report No. CTLA-395W-1 dated 05-07-98,
signed and sealed by Ramesh Patel, P.E.
C. CALCULATIONS
Submitted under NOA No. 99-0624.05
1. Anchor Calculations dated 03-29-99, prepared, signed and sealed by mark
Fetherman, P.E.
D. MATERIAL CERTIFICATIONS
1. Tensile Test report No. CTL99007 dated April. 06, 1999, issued by Certified
Testing Laboratories Inc., for steel samples tested per ASTM E8-96, signed and
sealed by Ramesh Patel, P.E.
2. Test reports No. J9906660-001 for "Surface burning characteristics" per ASTM
E-84 and "Self ignition test" per ASTM 1929 D, for polystyrene core dated April
8, 1999, issued by Intertek Testing Services.
E. STATEMENTS
None
F. OTHER
1. Notice of Acceptance No. 00-1003.04, issued to Jeld-Wen, Inc. for their Series
"DoorCraft® Steel" Outswing Opaque W/E Residential Insulated Steel Double
Doors, approved on 01/11/01 and expiring on 12/02/02.
Manuel P
Product Control er
NOA No 02-1022.14 f
Expiration Date: December 02, 2007
Approval Date: December 19, 2002
E-1
JELD-WEN® STEEL
OUTSWING OPAQUE DOUBLE DOOR
WOOD EDGE INSULATED STEEL DOOR WITH WOOD FRAMES
GENERAL NOTES
1. THIS PRODUCT IS DESIGNED TO MEET THE SOUTH
FLORIDA BUILDING CODE 1994 EDITION FOR
MIAMI—DADE COUNTY.
2. WOOD BUCKS BY OTHERS, MUST BE ANCHORED
PROPERLY TO TRANSFER LOADS TO THE
STRUCTURE.
3. PRODUCT ANCHORS SHALL BE AS LISTED AS
SPACED AS SHOWN ON DETAILS. ANCHOR
EMBEDMENT TO BASE MATERIAL SHALL BE BEYOND
WALL FINISH OR STUCCO.
4. IMPACT RESISTANT SHUTTERS NOT REQUIRED.
5. DESIGN PRESSURE RATING SHALL BE AS FOLLOWS:
— FOR 6'8" WOOD FRAMES; SEE TABLE THIS SHEET
— FOR 8'0' WOOD FRAMES; SEE TABLE THIS SHEET
S. ALL DIMENSIONS ARE GIVEN IN INCHES UNLESS
OTHERWISE SHOWN.
OUTSWING INSULATED STEEL DOOR
(Common to all frame conditions)
Door Leaf Construction:
Face sheets: 24 ga. (0.020') minimum thickness,
Galvanized steel A-525 commercial quality — AKDO
per ASTM 620 with yield strength Fy(min.)=24,600 psi.
Core dawn: Expanded polystyrene with 1.0 to 1.25
lbs. density.
Constructor: steel face sheets glued to expanded
polystyrene (EPS), with wood rails and Laminated
Veneered Lumber stiles and a wood lock black
reinforcement.
OA. MAX. FRAME WIDTH 74-1
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TABLE OF CONTENTS
SHEET #
DESCRIPTION
1
COMMON GENERAL NOTES TYPICAL ELEVATION
2
DOUBLE 6'8' WOOD FRAME ANCHORS ELEVATION
3
DOUBLE 8'0' WOOD FRAME ANCHORS ELEVATION
4
DOUBLE DOOR HORIZONTAL CROSS SECTIONS
5
DOUBLE DOOR VERT. CROSS SECTIONS BILL OF MATERIALS
6
COMMON DOOR MODELS LOCK DETAILS
NV
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REQUIREMENT IS NEEDED REQUIREMENT IS NOT NEEDED
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Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status: APPROVED
Issue Date: 12/14/2006 Expires: 06/12/2007 Permit Number: WS -12-06-2999
Owner's Name: JERRY MOORHEAD
Phone:
Permit Type: Windows/Shutters
Work Classification: Door Replacement
Job Address: 585 93 Street NE
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
BUENO CONSTRUCTION (305)436-1966 Yes
Additional Information
Type of Work: doors
Additional Info:
No of Openings: 3
Classification: Residential
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.
Fees Due
Amount
CCF
$0.60
Education Surcharge
$0.20
Permit Fee
$130.00
Scanning Fee
$6.00
Technology Fee
$3.25
Total:
$140.05
Building Department File
Applicant
Parcel #: 1132060141030
Block: Lot
Section: PB:
Total Square Feet 0
Total Valuation: $ 1,000.00
Invoice Number Amt Due
WS -12-06-27014 $140.05
Total: �-v
DEC 2 8 PAID
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit Number: WS -12-06-2999
Invoice Number: WS -12-06-27014
Applicant: JERRY MOORHEAD
Company Name:
Owner Address:
585 NE 93 ST
MIAMI SHORES, FL 33138
Job Address:
585 93 Street NE
Miami Shores Village, FL
Date Payment Type Check Number Amount Change
Thursday, December 28, 2006
12/28/2006 Check 1326 $140.05 $0.00
Total Payment: $140.05
Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDINGS
PERMIT
PERMIT APPLICATIOlp � DEQ 132006 !J
)2-114%
411�ccb Ulk-
Permit No.LXIL�
Master Permit No.
FSC 2001
By..
Permit Type (circle):Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple �%& g Y S', M&ng etagftone it Lc: CV) 7 V A 5/ 6
Owner's Address 9- 5 1k E s'r d
City 4& M 1 fj-fo&�) State (zv Zip
TenantUssee Name Phone #
Job Address (where the work is being done) �J ,S
City Miami Shores Villaee County Miami -Dade Zip
d
Is Building Historically Designated YES NO
49
Contractor's Company Name or9 ckori Phone # (L ) — lef&a
Contractor's Address cive. -
State L• Zip .4,3q4'�
Qualifier
State Certificate or Registration No. GC(V /50 "5q55 Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Phone #
Square Footage Of Work:
Type of Work: ElAddition .Alteration ONew 91 Repair/Replace
{] Demolition
Describe Work: 3 -0 C) C)
Submittal Fee $ Permit Fee $ t150� CCF $ 0 COICC.
Notary $ Training/Education Fee $ Technology Fee $212-z
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ . 1 ^ U
(Continued on opposite side) C `�
DEC 2 8 PAID
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Zip
Mortgage Lender's Name (if applicable) ,G, 6 m tz ".414; G^ r- �� „Q
Mortgage Lender's Address
City 00f/-4 t 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 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 wild b charged ,
Signature
t' Owner or Agent ` '
The foregoing instrument was acknowledged before me this
day of '�, , 20 qg by A.Iti�p �f;1n •
who isye!svti y:2 to me or who has produced
_ As identification and who did take an oath.
NOT.
Sign: r -�
Print: _Wo
My Commission
$raYaie fYti fYir*irief deilr�l
l
Bonded By Naflonal NotaryAssn.
APPLICATION APPROVED BY:
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 20 9R; by Pt=0641� It ot
who . rsonally kno me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
My
$4{c aY
�F xq
Plans Examiner
Engineer
Che 05/13/03 Zoning
�'` : • •: •: • • • • CONTRACT DATE:
• • • • •
• • •
L ATE : jhNTRACT Nl1MBER:
WINDOWS •DOORS •SHUTTERS SALESMAN:
age ago
: • • i • • i • : ;N ULLER'
g 60
NAME 'F ` ¢ `'�;i • DATE OF INSTALLATION:
a Go go
r` [�• :.: : : : :• •jiOME PHONE• S/— 6-S16
CITY:�� t�-�� �,�=. STATE: Ij- ZIP:`• �S•' ..OFFICE PHONE: SY it-
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