MC-15-914Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-232818
Scheduled Inspection Date: May 04, 2015
Inspector: Perez, JanPierre
Owner: VUL, C/O CYNTHIA
Job Address: 723 NE 91 Street 3-C
Miami Shores, FL
Project: <NONE>
L� IL"', ,
Permit Number: MC -4-15-914
mit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number
1132060440150
Contractor: ERV AIR CONDITIONING INC Phone: (305)975-5943
tsunamg uepariment comments
REPLACEMENT OF EXISTING WALL A/C 12,000 BTU
AND INSTALLATION OF A NEW HEAT AND COOL AIR
CONDITIONING.
INSPECTOR COMMENTS False
May 01, 2015 For Inspections please call: (305)762-4949 Page 14 of 41
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 01, 2015 For Inspections please call: (305)762-4949 Page 14 of 41
1s•,''� y,
Miami Shores Village
CCF
10050 N.E. 2nd Avenue NE
DBPR Fee
Miami Shores, FL 33138-0000
DCA Fee
Phone: (305)795-2204
Project Address Parcel Number Applicant
723 NE 91 Street Number: 3-C 1132060440150
Miami Shores, FL Block: Lot: LINKING DOTS, LLC
Owner Information Address Phone Cell
LINKING DOTS, LLC 723 NE 91 Street
MIAMI SHORES FL 33138-
9180 W BAY HARBOR Drive
BAY HARBOR ISLAND FL 33154-
Contractor(s) Phone Cell Phone
ERV AIR CONDITIONING INC (305)975-5943
Tons:
Additional Info: REPLACEMENT OF EXISTING WALL A/C 12
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$0.60
Total:
$114.60
Valuation: $ 650.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -4-15-55242
04/17/2015 Cash $ 60.00 $ 64.60
04/21/2015 Cash $ 54.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Mechanical
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 thWalho egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constrElding
r! oorize the above-named contractor to do the work stated.
April 21, 2015
lgnature: ner / pplicant / Contractor / Agent Date
Department Copy
April 21, 2015 1
,
Miami Shores Village civ�D
J
' Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ _
BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
.F
BC
BC 26(0
BUILDING Master Permit No. _15e
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION r-1 RENEWAL
❑ PLUMBING (q MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: "72 G%'/ */- /fiW. 3 c-,
City: Miami Shores County Miami Dade Zip
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: _ FFE:
OWNER: Name (Fee Simple Titleholder : Phon :
Address:4-6i&�W/t> -
City: State: �. Zip: 3 1BO/ 54
Tenant/Lessee ame: Phone#:
Email:
CONTRACTOR: Company Name: ���L� .02- 60.0bl l"I Phone#: -_RAT6?7$ =5-1
Address: 10,5569 CPeli (� at Z)r.
City: _Ai C 14-1 1, State: 4L Zip: 53/7_5
Qualifier Name: 1�nC e 7z /�y i Z �� I)A lk Phone#: 3&9 qA-4? 1j0
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
,Value of Work for this Permit: $ 1!5�50,00 Square/Linear Footage of Work:
s
Type of Work: ❑ Addition /❑ Alteration ❑ New
Description of Work:
Specify color of color thru dle, `:'
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Demolition
c,> 6/0
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ �� .
l
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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
OWNER or AGENT
The
for oing instrum nt was acknowledged before me this
/ day of a 20 by
wh is onally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: L I/
Seal:t RAVIONDLDEGUARTO
Notary Pubs, State of Flodda
Owndss" FF 12307
My CaMot. axp = June 2, 201 161
APPROVED BY
(Revised02/24/2014)
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
8 day of 20 , by
Sd`Ea0 l)ILVF_ jLkA who is p/e�rsonally known to
me or who has produced IFL DO �'CN�
identification and who did take an oath.
NOTARY PUBLIC
Sign:
Print:
Seal EjpJWV0&,% Notary Public $tate of Florida iSindia Alvarez My Commission FF 156750
Plans Examiner Zoning
Structural Review 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 done):_ 7 0 ---->C q / 4T -A C_
City: Miami Shores Village County: Miami Dade Zip Code: 'J
ALL CONDENSING UNITS MUST 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
AHRI DATA SHEET REQUIRED
Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: _4� ff&//Z 01MIAUAV 106 TSG Phone: C� q7S =�
State Certificate or Registration No. al 6—(OZ2 Certificate of Competency No.
Signature77 "fes Dater®��2���
(Qualifiers sig lure)
(Revised02/24/2014)
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU
CU
PKG
1) M.C.A
AHU
CU
PKG
AHU
CU
PKG
2) M.O.P
AHU
CU
PKG
AHU
CU
PKG
3) VOLTS
AHU
CU
PKG
PKG UNIT /
/
PKG UNIT
EER/SEER
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
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 Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: _4� ff&//Z 01MIAUAV 106 TSG Phone: C� q7S =�
State Certificate or Registration No. al 6—(OZ2 Certificate of Competency No.
Signature77 "fes Dater®��2���
(Qualifiers sig lure)
(Revised02/24/2014)
RI,CK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD _ 4.-
CAC1815622
The CLASS B AIR CONDITIONING CONTRACTOR
UUQKW
Local Busines Tax Receipt
Miami—Dade Coun State' of Florida
THIS IS NOT BILL DO NOTPAY
i
6124929 LBT
BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES
ERV AIR CONDMONING INC RENEWAL SEPTEMBER 30, 2015
10840 SW 69 DR 1 6887799 Must be displayed at place of busing
MIAMI FL 33173 i' Pursuant to. County Code
Chapter SA — Art. 9 & 10
OWNER SEC. TYPE' OF BUSINESS
ERV AIR CONDITIONING INC 196 SPEC MECHANICAL CONTRACTOR
Worker(s) 1 CAC181"22
PAYMENT RECE11190
BY TAX COLLECTOR
$75.00 08/21/2014
CREDITCARD-14-033421
This Local Basfaess Tax BecMIpt only confirms payment of the Local Business Tax The Receipt is not a license,
Pernik or a ce►tification of the holders qualifications, to do baiiness. Holdar most comply with say governmental
or nongaverm sntBl regulatory laws Rod requirements which apply to the business.
The RECEIPT N0, above ams! IN displayed on all commercial "I icias— Wand—Dade Code Sec Ba -776.
For more information, eish www miamidadAgliftaxcollecmr
2015-04-14 14:57 WESTCOA5TINSURANCE » 1 800 685 7530
P 1/1
CERTIFICATE OF LIABILITY INSURANCE -~UAT 04/1415YYY)
• �r` 04/14/15
THIS CERTIFICATE IS ISSUED A n MATTER 6044ORMATION ONLY AND CONFERS NO RIGrtTs UPON TrtE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the polley(les) must be endorsed, If SUBROGATION (S WAIVED, subject to
the terms and conditions of the policy, certain pollcles may require an endorsement, A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
_....---
PRODUCER • • • _ � CONTAOT —.." •_. • • •
West Coast Insurance Consultants In &..11I . 1. (305)888-1880 _ jac, Not. (3')W&l885
707 East 9 Street IL e199 msn.com
Hialeah, FL 33010
PhOn@ IL 3W188-18SO II�SURERI&I AFFORDING COVERAGE _ NAIOI
, • _ ,•,• , , Fax (305)888-1885 I INSURER A : GRANADA INSURANCE COMPANY
INSURED
ERV AIR CONDITIONING INC. INAVRERC:-
10640 S.W. 69 Drive INSURER 0:
Miami, FL 33173.2008 305 I,}VSURER E;— _ • • „, , , _ _
INSURER F:
C_OV_ERAG_ES CERTIFICATE NUMBER: _ REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL0111% HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS J
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.NSR
LTR TYPE OF INSURANCE T ADDLiSUa POLICY EFFF POLICY EXP —
TI DIYY`lY) MMIDD/YYYYI POLICY NUMBER (MM/DI - LIMITS
GENERAL LIABILITY I j
EACH 2qq. RR6NCs $ 2,000,000.00
1VF1 COMMERCIAL GENERAL REL IAFi1LIN NTED
I QAPR,MAMA =S GE TO IF
acculfeneel _$ 100.000.00
J , J t J CLAIMS -MADE L_J OCCUR 07 85f L00031147 MED EXP (Any Ong per, $ 5,000.00
A I Y 11 /07/2014 11/07/2015
PERSONAL & ADV INJURY s 1,000,000.00
GENERAL AGGREGATE S 2,000,000.00 _
GEN'L AGGREGATE LIMIT APPLIES PER: I I PRODUCTS _ COMPMP AGG S 2,000,000.00
I i U PRO _
. _..
POLICY . ,I T
...,—U Lam:
AUTOMOBILE LIABILITY
J ANY AUTO
N50 1M .1
f I�
AUTOS ASUTOSULED
I HIRED AUTOS AUTOS NON -OWNED I AUTOS
UMBRELLA LIAM n OCCUR
L_J
i. ....
_....
_.
._ .........
EXCE3SLIAB_—L_JGL4IMS-MADE
DED I RCTELIIpt,S
WORKERS COMPENSATION
AND EMPLOYERV LIABILITY YIN
I
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? j
N f A
1
(Mandatory in NN) I 1
Ify¢8 describe under
DrINIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIU0 ACORO 101, Additional Remarks Schaduie, If more spec
license no CAC1815622
CERTIFICATE HOLDER
MIAMI SHORES VILLAGE
BUILDING DEPT
10050 NE 2 AVENUE
MIAMI SHORES FL 3313E
ACORD 23 I2010/MS) QF
_ S
---—.iBBlhl DSINGLE LIMB
il
BODILY INJURY (Per pereon) $
BODILY INJUpRY (Per aecrden S
S-01IRYIRAMAGE ._.. ' S . ..
S
I EACH OCCURRENCE-
AGGREGATE s
I J TO STATlUI MOT
ER" -- -..
E.L. EACH ACCIDENT S-
EL DISEASE -eAEMPLOYE S —_—
E.L. DISEASE - POLICY LIMIT S
B Is required) .. •... .. . — _.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE _
01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
JEFF ATtMATER
CIS FINMCIAI. OFFWER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
' = CERTIFICATE OF ELECTION To BE ExEmPT FROM FLORA WO ' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This oertiftes that the individual listed below has ekKftd to be exempt from Florida WodmW Compensation law.
EFFECTIVE DATE: 3414/2014 EX 11RATION DATE: 341342016
PERSON: RU®EVILLA ERNESTO
FEIN: 260493638
BUSINESS NAME AND ADDRESS:
ERV AIR CONDITIONING INC
10840 SW 69 DR.
MIAMI FL 33173
SCOPES OF BUSINESS OR TRADE:
HEATING, VENTILATION,
AIR-COND
Pmsw dto 1 440A5(14), Fs.. an oi[toef of a ampaadbn WhodedB eft from oft dwoor by ekv a fin tray
=fe,cvsrba►eftoraorttpettWMunderthiscIuVW pwwudto ChaptN4#Aoqj2j F.S, CedlWates ofebKowtobeexempt- applycn�YYAM Oresave
of ft bustness orhade fisted on 0a noffm afeftft to be exempL Pumfin t to Chapfer410Aglah F.S., Naloes of eleedmt to be enempt and,, M' I of
etedion to be II stall besubNdto revordHon ff. at anyffine a2erMeOft of11a MUM arthe Issuance oftheoetM' I Qin person wined on the not W 0r
rw taiger trams Iia requirements of this se lf, forfsswnce ofa aerifficate. The dgwtmod shall ravalmacm at any5aa forfaaae d'the
Person named on Ito oto meatthe requUements of Ods 1et0,11ar
DFS-F2-0VVC 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESMONS7 (OW)4131609
Miami shores V
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
er
State of Florida
County of Miami -Dade
The forego' g was acknowledge
t �
By
AL If.,%
Notary:
me this /577day of 1'� / , 20)C
who is personally known to me or has produced
identification.
RAYMOND A. DEQUARTv
SEAL: + °k Nd" PubUc, State of Florida
Commis** FF 123597
My comm. expires June 2, 20'
ERV AIR CONDITIONING, INC.
oA1/C/2v,s
State of 'r/or; d't
County of P 0.w % ()u de -
Before me this day personally appeared &'Oef- o Kit tie, l'&ho, being duly sworn, deposes
and say:
That he will be the only person working on the project located at 723 NE 91 St. Apt. 3C
Miami Shores, FL 33138.
Sworn to and subscribed before me this /5 -days ofI�Pril 20%3; by
Personally know
Produced Identification
Type of Identification produced
I11�
Detail by Entity Name
Florida Limited Liability Company
LINKING DOTS, LLC
Fllina Information
Document Number
FEI/EIN Number
Date Filed
State
Status
L11000122562
383858156
10/27/2011
FL
ACTIVE
Principal Address
9180 WEST BAY HARBOR DR.
2C
BAY HARBOR, FL 33154
Mailing Address
9180 WEST BAY HARBOR DR.
2C
BAY HARBOR, FL 33154
Realstered Aqent Name & Address
KRUPKIN, ALVARO
9180 W. BAY HARBOR DR
2C
BAY HARBOR, FL 33154
Authorized Person(s) Detail
Name & Address
Title MGR
KRUPKIN, ALVARO
9180 WEST BAY HARBOR DR, 2 C
BAY HARBOR, FL 33154
Title MGR
VUL, CYNTHIA
9180 WEST BAY HARBOR DR, 2 C
BAY HARBOR, �L 33154
Page 1 of 2
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/17/2015
m3m
Air Conditioning & Refrigeration
Installation • Repair & Service Q
PROPOSAL SUBMITTED TO:
NAME
ADDRESS
PHONE NO.
. . 1 ;
PROPOSAL
CAC 1815622
WORK TO BE PERFORMED AT:
SHEET NO.
DATE 7
ADDRESS
72 d
wla-t /
DATE OF PLANS
ARCHITECT
We hereby propose to furrhish the materials and perform the labor necessary for the completion of
OWE r
s
1
}
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications
submitted for above work,, and completed in a substantial workmanlike manner for the sum of
Dollars ($ ?5!Z0, )
with payments to be made as follows:
04(2k)
4 (2k) A 1
6
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and Will become an extra charge Per
over and above the estimate. Al agreements contingent upon strikes, ac-
cidents, or delays beyond our control.
Note -This proposal may be withdrawn
by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be made as outlined above.
Signature
Signature
PROPOSAL
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