HomeMy WebLinkAbout06-5601
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5601
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
5601
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 5540 23RD ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 12-26-21-0070-00009-0050
6,400.00
Name: MONTOYA, B Y A
65.00 Address: 5540 23RD ST
65.00 ZEPHYRHILLS, FL. 33542
4/11/2006 Phone: 813468-1286
RE-ROOF-- TEAR OFF AND APPLY 20S0 1 PLY MOD BIT
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
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, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"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 reco' our notice of commencement."
NO OCCUPANCY BEFORE C.O.
~~
R SIGNATURE PERMIT OFF I
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRE~ - .
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5601
Permit umber:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
5601
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 5540 23RD ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 12-26-21-0070-00009-0050
6,400.00
Name: MONTOYA, BEYA
65.00 Address: 5540 23RD ST
65.00 ZEPHYRHILLS, FL. 33542
3/24/2006 Phone: 813468-1286
RE-ROOF--TEAR OFF AND APPLY 20S0 1 PLY MOD BIT
',',-
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
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, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"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."
NO OCCUPANCY BEFORE C.O.
~~~
CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner's Address
Fee Simple Titleholder NamJ
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Date Rec,ived
Owner's Name
LOT #
I
I
I
~
I
JOB ADDRESS
Fee Simple Titleholder Address I
1.S5f'tJ 2,~,j ell
I"..
B
PROPOSED USE D
TYPE OF CONSTRUCTION D
DESCRIPTION OF WORK I ~r O{.c. /1.1\) A.-pj!j.~ 20 ~ ) ,IJ!c.t
BUILDING SIZE I I SQ FOOTAGE I ;?o I HEIGH:I
..............111....11.11....111..11......11............11.........11.........111...11.......11.......................11...........1.11..........
4JVtO
NEW CONSTR
INSTALL
SFR
BLOCK
I
E3
D
D
PARCEL ID# I /;2 - ;?t; - 2/ - Or) 70 - axx;'1- ex; 50
(OBTAINED FROM PROPERTY TAX NOnCE)
SIGN D MOVE D
D
D
D
DEMOLISH
SUBDIVISION
WORK PROPOSED
ADD/AL T
REPAIR
COMM
FRAME
I
I
I
OTHER
STEEL
I
D
/Y1orJ.
OTHER I
~'j-
ROOFING
I
I
I
I
D
I
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C.
D
D
D
D
D
1$
1$
1$
~
FINISHED FLOOR ELEVATIONS I
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
PLUMBING
VALUATION OF MECHANICAL INSTALLATION
MECHANICAL
GAS
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
11...111.111....'.11.111.11....111.....................11.......11...111111....1111.1111..11......11........l'p"III...III...I.I.IIIII...III......I
BUILDER
SIGNATURE
COMPANY
REGISTERED
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
Y/N
Address
COMPANY
REGISTERED
Y/N
ELECTRICIAN
SIGNATURE
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
Address License # I
OTHER COMPANY 1.t4A1e Lh{t{(j.emen. f Se, IL' ceC
SIGNATURE REGISTERED Y / N FEE CURRENT I Y / N I
Ill" ~'~~:~~~II ~~~ ,if ~ I' ~lll ~r.11 ~ IIIIIIII(~~; I~~IIIIIII! 11111111111' 1111111~i~I~~~~ ~ IIIIII~ ~~~:Zlllllllllll
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance.
SIGN PERMIT Attach (2) sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
I I I j I I I I I I I I I I I I ~ ~ ~ I I . I ~ I I I I I I I I I I I I I I I I I I I I I I . I I I I I I I I I I I I . . I I I . I . I I I I I I . . I I . I I I I I I I I I I I I I I I I . I & I I I I I I I I I I I I I I I I I I I I I I I I I I I . I I I I I I I I I I I I I I I I I I I I i
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A1C upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC Driveways Fences (Plot/Survey/Footage)
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance humber 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees tnust be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does hot. involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/SeWer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and. that aU Work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterlWastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
. acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations.of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time th~ work is commenced: An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90.) days and WIll demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
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.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affinned) before me this
by
Who is/are personally known to me or haslhave produced
as Identification.
CONTRACTOR
Subscribed and sworn to (or afflnned) before me this
by
Who is/are personally known to me or has/have produced
as Identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
-~
..~.
~)I1l: NAVI(JAIION
~ Prod~
~ Approwl
PIlOUIJCT llPPROVllt Product Type Detail
., 1'""
Overview Product Search Organization Product
Search Application
User: Public User - Not Associated with Organization -
Need Help '?
Application #:
Date Submitted:
Code Version:
FL5220
09/02/2005
2004
..
Product Manufacturer:
AddressIPhoneJemail:
Firestone Building Products Co.
525 Congressional Boulevard
Cannel, IN 46032
(317) 575-7000
Category:
Roofing
Subcategory:
Modified Bitumen Roof System
Evaluation Method:
Certification Mark or Listing
Referenced Standards from the Section Standard Ya1:
Florida Building Code: 1507.11 TAS 110 2000
Certification Agency: Miami-Dade BCCO - CER
Quality Assurance Entity:
Validation Entity:
Authorized Signature:
James Buckner
jimmy@cbuckinc.net
Evaluation!Test Reports
Uploaded:
Installation Documents
Uploaded:
PTID 5220 I 1-
APPSBS ModBitOnWoodDecks NOAOI0130QLpdf
P.IJD 5220 I 2:.
APPSBS ModBitOnConcreteDecks NOAOI0l~QfuQf
P11D 5220 I 3:
t\PPSBS ModBitOnCWFDecks_NOAOl01300~df
PTID 5220 I 4-
APPSBS ModBitOnRecoverDecks NOAOI013008.pdf
PTID 5220 I 5-
1. -
APp.s.J3S ModBitOnSteelDecks NOAO 1 042403 . 12M
P-TllL5229_U:
APPSBS."ModBitOnL WICDecks._NOAOl 042404~f
Product Approval Method:
Method 1 Option A
SUPF'ORT
Application Status:
Date Validated:
Date Approved:
Date Certified to the 2004 Code:
Approved
09/02/2005
10/11/2005
.
.
Page:
IGoj
Page 1 11
,",pp/SeQ Product Model # or Model Limits of Use
# Name Descriotion
5220.1 1-APP / SBS Modified Applied to Wood Install the product per
Bitumen Roofinc Decks NOA 01-0130.01
5220.2 ,- APP / SBS Modified Applied to Install the product per
Bitumen Roofinc Concrete Decks NOA 01-0130.03
3- APP / SBS Modified Applied to
~220.3 Icementitious Install the product per
Bitumen Roofing Wood Fiber NOA 01-0130.05 .
Decks .
5220.4 4- APP / SBS Modified Applied to Install the product per
Bitumen Roofinc Recover Decks NOA 01-0130.08
5220.5 5- APP / SBS Modified Applied to Steel Install the product per
Bitumen Roofina Decks NOA 01-0424.03
5- APP I SBS Modified Applied to
5220.6 Lightweight Install the product per
Bitumen Roofing Insulating NOA 01-0424.04
Concrete Decks
Next
QQPyIjJl.t\tlU'.Q.J1i.~~!E!t~L; 02000 The State of Florida. All rights reserved.
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2006056911
Rcpl:980980
DS: 0. 00
03/21/06
Rec: 10.00
IT: 0.00
Dpty Clerk
AN PASCO COUNTY CLERK
~~92n~lM 04': 25f)m 1 Of11349
OR BK 6896 PG
7rj!+Y fL/f-l C{ J
~3S-{2
~ 727-530-0412
fteee:
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COUNTY OF . -rA5C() f I
.......~:!- . !..... 'ldIII.wIedeeWiilftlHdIis ) S;1i--f&2f11 JL1 }(tILer-( .20~
by ':g~ y A- /-1 Dl"),O Y A ' . wile r.) (are) ~~ ..... .. ..e _.......
M 5'3 C1.- 6 IR 0 - ~z - 585 - () _ ~~ ........ wile did 1 did 1I8t mile _ oatIL
(Driver's '~#I)
DAVID L BORING
Notary Public, State of Rorida
My Comm. Expires Nov. 17, 200a
No. 00491909
Ho~ J[MPROVJE:M1E:WJr SlE:~C]E:S
ROOFING DIVISION
14377 U.S. Hwy. 19N. Clearwater, FL 33764
Phone: 727-530-0412. Toll Free 1-877-845-6660. Fax: 727-539-6912
Lie. No. CCC058227
SALES CONTRACT
Home Improvement Services agrees to furnish all materials and labor necessary to do the modernization.worlLat the followIng add~S'
. . ~ Y"f". CQ.{(4L--~'O-~~-( I
Name 1':11'\ ,t..q;gzO * u~y 1'1 ftOJV1'O'lA Phono Phono (w}S'n - _1>-/z.. r"
Address 55'-10 ;;J. 3. ~ 3'T Date ~ f{ / n "
City ::2-& PHY?H I '-'- :5 State y~ ZIp 3::S~ '1--2-
In accordance with the specifications given below:
REROOF:
A. SHINGLE ROOF )) /f1
1. REMOVE OLD ROOF TO SMOOTH WORKABLE SURFACE. j/ I
2. REPLACE ANY ROTTED WOOD WITH STANDARD SHEAT $7.00 PER FOOT AND $90.00 PER SHEET OF PLYWOOD, IF ANY.
3. INSTAll FHA/VA EAVES DRIP. COLOR
4. INSTAllDRY IN FELT OVER ROOE
5. INSTAll NEW VAllEY METAL AND FLAS S AS NECESSARY.
6. INSTAll NEW lEAD BOOTS OVER V PIPES AND RESEAL VENTS.
7. INSTAll YEAR FIBER SS SHINGLES. COLOR
8. INSTAll FEET OF GE VENT AT $6.00 PER FOOl COLOR .
9. CLEAN-UP JOB SITE OF WORK DEBRIS AND HAUL AWAY All RELATED DEBRIS AND lEAVE JOB SITE CLEAN.
10. CONTRACTOR Will RDINATE REMOVAL AND REINSTAllATION OF ROOF RELATED PERIPHERALS SUCH AS (BUT NOT LIMITED TO) SOLAR UNITS, SKYLIGHTS, IV. DISH
AND AIR CONDITI RS, ETC. REMOVE AND REINSTAll EXISTING SOFFIT AND FACIA @ $4.25 PER FOOT IN ADDITION TO CONTRACT PRICE, IF REQUIRED. THE COST FOR
SUCH WORK Will BE IN ADDITION TO CONTRACT PRICE AND HEREIN APPROVED BY HOMEOWNER.
B.1 PLY ROOF SYSTEM
1. REMOVE OLD ROOF TO SMOOTH WORKABLE SURFACE.
2. REPLACE ANY ROTTED WOOD WITH STANDARD SHEATHING @ $7.00 PER FOOT AND $90.00 PER SHEET OF PLYWOOD, IF ANY.
3. INSTAll43 lB. BASE FELT OVER ROOF.
4. INSTAll NEW lEAD BOOTS.
5. INSTAll FHA/VA EAVES DRIP. COLOR
6. INSTAll 1 PLY ROOF SYSTEM. COLOR Wff/ re .
7. ClEAN.UP JOB SITE OF All WORK DEBRIS AND HAUL AWAY All RELATED DEBRIS AND lEAVE JOB SITE CLEAN.
WI-f/ tIE
1. Contract Documents. This contract consists of this document, extra work/wood authorizations, if any, and, if payments
hereunder are to be financed, all financing documents. No promises other than those specifically set forth in the contract
documents shall be recognized by either party. The entire understanding and agreement of the parties is contained in the
contract documents
2. It is understood and agreed that this contract shall not become binding upon Home Improvllment Services until it is duly
approved, accepted, signed and witnessed by an officer or officers of the Seller. ~ J
3. Work on the job described. . the tr ct documents will commence on approximately A b/6.' and be completed
on approximately The recited dates are approximations and are ubjecf{O scheduling difficulties of
Seller, labor and/or m nal s rtag ,acts of God and other events not foreseen by Seller. Seller reserves the right to
employ any sub.contractor for the completion of the work described in the contract documents.
4. Home Improvement Services reserves the right to substitute materials of equal or greater value and kind. My required
material such as fire retardant plywood, tongue and groove board, etc. will be billed on a time and material basis. All other
changes required by New Jurisdictional Code Enforcement laws may result in additional charges.
5. Interest at the rate of eighteen (18%) per cent per annum will be charged on all balances not paid as per the terms specified
above. Reasonable al1omey's fees will be charged to the Purchaser if It is necessary to place this contract in the hands of an
al10mey for collection, and this charge becomes a part of this contract and obligation of the Purchaser to pay.
6. Parties agree that this agreement shall be construed according to the laws of the State of Florida and any action brought
thereon may be brought in the State of Florida. Venue is hereby agreed to be in Pinellas County, Florida.
7. BUYERS RIGHT TO CANCEL. If you do not want the goods or services, you may cancel this agreement by providing wril1en
notice to the seller in person, by telegram, or by mail. This notice must Indicate that you do not want the goods or services and
must be delivered or postmarked before midnight of the third business day after you sign this agreement
8. Both worker's compensation and public liability insurance are carried by the Seller and they are applicable to the work to be
performed.
9. It is understood and agreed that the buyer hold harmless, Home Improvement Services, for any damages that may occur to
the buyer's driveway(s) during the delivery of materials and/or the removal of work related debris that may be required to
perform this home improvement contract. Furthermore, the buyer herein gives permission for typical delivery vehicles and
typical waste removal vehicles to enter said driveway(s) for the purpose of expediting this sales contract.
10. Contractor will coordinate removal and reinstallation of roof related peripherals such as (but not limited to) solar units, skylights
TV dishes, and air conditioners, etc. The cost for such worf< will be in addition to contract price and approved by homeowner.
11. Home Improvement Services shall not be held responsible for damage to eleclricallines, water lines, refrigerant lines or
other mechanicai components that have been improperfy installed near roof decking and may be damaged while performing
installation of roofing materials.
12. Construction Industries Recovery Fund payment may be available from the CRIF if you lose money on a project performed
under contract, where the loss results from specified violations of Fiorida law by a state-licensed contractor. For
information about the recovery fund and filing a claim, contact the Florida Construction Industry Ucensing Board at the
following telephone number and address: 7960 Arlington Expressway, Suite 300, Jacksonville, Fl 32211-7467 or call (904)
727.6530.
13. Chapter 588, Florida Statutes contains important requirements you must follow before you may bring any legal
action for an alleged construction defect in your home. Sixty days before you bring any legal action, you must
deliver to the other party to this contract a written notice referring to chapter 588 of any alleged construction defects
and to consider making an offer to repair or pay for the alleged construction defects. You are not obligated to accept
any offer which may be made. There are strict deadlines under this Florida Law which must be met and followed to
protect your interests.
Contract Price
$--~~_~~Lf[JJ
Permit
$______~_5_0~~____
Total
$____~!t_~~!_~
1/3 Deposit
$----------------
Subtotal
$----------------
BALANCE DUE $ t t.I 0 0, trO
(Plus Total from Item NO.2 above)
UPON COMPLETION
/g+J
Executed in triplicate, one copy of which was delivered to, and receipt is herby acknowledged by Buyer, this
day of kp..t<-CJ-f, 20 ~ Go
Approved and Accepted:
NOTICE TO OWNER
a. Do not sign this home improvement contract In blank.
b. You are entitled to a copy of the contract at the time you sign. Keep It to protect your rights.
(Seal)
(X)
(Dealer-Seller)
BY
(X)
(Seal)
(Seal)
HIS 3 . 10/13105