HomeMy WebLinkAbout10-11070 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 11070
BUILDING PERMIT
Permit Number: 11070 Address: 38507 5T AVE
Permit Type: RE -ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11 -26-21-0010-15200-0170
Improv. Cost: 8,800.00 �� ' a ;
Date Issued: 10/21/2010 Name: "k & M TRAVEL INC
Total Fees: 120.00 Address: 38507 5TH AVE
Amount Paid: 120.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/21/2010 Phone:
Work Desc: REROOF WHITE RUBBER OK PER TODD HAD TYPE ROOF BEFORE
121.0.
av r,
TAPE JOINTS RAD OF SP
FINAL - - I
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one 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."
`i CONTRACTOR SIGNATURE •
PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Jacqueline Boges
To: Todd Vandeberg
Subject: could you check a roof
Hello Todd,
Beverly is not here I have a permit for a reroof located at 38507 5 ave the contractor is reroofing with white rubber he
says it is on an area where not seen. Need to know if we have to have historical review?
Contractor already has started the roof.
Could you let me know today?
Thanks Todd
Jackie Boges
Code Support Specialist
ext. 3513
1
813-780 -0020 City of Zephyrhills Permit Application Fax -813- 780 -0021
�f Building Department
Date Received I
i Q 1 v t 7
Phone Contact for Permittin: ' 13 1 - l
Owner's Name vvk i r ck V - \ -a- L,'( Owner Phone Number
Owner's Address 3 C 6 5 ( 1 g.-t t'` 4 `' C Z- I1 ; / ) ' Owner Phone Number
Fee Simple Titleholder Name . Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 3 S k.; l k , / I . LOT #
SUBDIVISION C ■ 1 t4 Z IA . IS PARCEL ID# I 1 - 7 (E) Z I - OO/ tJ -- / S G1 O• - 0/70
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT I 1 SIGN $ $ I I DEMOLISH
INSTALL REPAIR
PROPOSED USE I I SFR n COMM 1 I OTHER I I
TYPE OF CONSTRUCTION I 1 BLOCK n FRAME I 1 STEEL I I 1 $
DESCRIPTION OF WORK ` ‘ f V i / c.-, i Pc 0 311 , 1-c r Ls e V - 1(30 f
BUILDING SIZE SQ FOOTAGE $• I '`f HEIGHT I
T
ILDING $ �r t U 0 au VALUATION OF TOTAL CONSTRUCTION
1 $ELECTRICAL $ l AMP SERVICE I I PROGRESS ENERGY I W.R.E.C.
I IPLUMBING $
1 'MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
I $GAS 1:p ROOFING n SPECIALTY I I OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 $YES NO
BUILDER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y/ N 1
Address License #
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N J FEE CURREN I Y/ N I
Address License # I
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREN 1 Y/ N I
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y1 N I
Address License #
�% f
OTHER COMPANY ' , �*
7 ��� 4.f vim. Rte.
SIGNATURE REGISTERED I Y/ N ,I FEE CURREN I Y/ N I
Address (26 l 't,1(; I t vi jtt.yk it, ,,., f I 1 License # 1 Cc " 7
CGS
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
* ** *PROPERTY SURVEY required for all NEW construction. /
I.
Directions: i�, //
Fill out application completely.
Owner & Contractor sign back of application, notarized Q
If over $2500, a Notice of Commencement is required. (A/C upgrades over $7500) ���JJJ ( f' I/0
** 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 if shingles Sewers Service Upgrades A/C Fences (Plot/Survey /Footage)
Driveways -Not over Counter if on public roadways..needs ROW
77
.0-/-ff#2
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 number 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 must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not 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'SIOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all 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, Water/Wastewater 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 the 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. 117.0 r`
OWNER OR AGENT
• ,
Subscribed and sworn,te0 affirmed) before me this Subscribed and swom to (or affirmed) before me this
by by
Who is /are personally known to me or has/have produced Who is /are personally known to me or has/have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped
•
STATE OF FLORIDA, COUNTY OF PASCO 1111111111111111111111111111111 IIIIIIIIIIIIIIII
THIS IS TO CERTIFY THAT THE FOREGOING IS A 2010151508
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE Rcpt :1331819 Rae: 10.00
WITNESS MY HAND AND P FIC, L SEAL THIS DS : 0.00 IT: 0.00
02. DAY OF d 2 U/ U 10/20/10 A. Giard, Dpty Clerk
PAULA O'NEIL, CLERK : OM' • • ER
PAULA S.O'NEIL,Ph.D.PASCO CLERK & COMPTROLLER
BY / _,,l_ _ _ // Y CLERK 10/ 1:33 1 of
1
BK 8447 PG 1 1 344
Of 1 NOTICE OF COMMENCEMENT
Permit No.
Property Identification No. /1 Z !o - 2, 1-0010-1 sa oo - 0110
E
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida Statutes, the following information is provided in tl;i NOTICE OF COMMENCEMENT.
G o) 2e vif O 13 / /° G S 9 mac. So co r9
1.Description of property (legal description:) • [,07 / ? 4/43(14 /C,A D/Z, S 32 P 6 /21t
a) Street Address: 3 Ff5 b - 1 L Z
• � --,.ice ,
2.General description of improvements: ME 1.,-) ' a ‘:"..,1 -
3.Owner Information I /
a) Name and address: 1'� �b rv1 ]" R V- V e- L JH ( 3 6" - 7 s' �]" �r 2 Co/ h . fir Pt
b) Name and address of fee simple titleholder (if other than owner) T 7`f r `
lik c) Interest in property
tractor Information r l
a) Name and address: ,S(lj /jL yv
(JLwn �im'( .1q TinC 3 3 to ,C 12. S`.4. 1Q 6!X i lr, -hk. Arkt Ft
b) Telephone No.: 3 c1 -gt -7 (00 3 J Fax No. (Opt.) 3 S 2- Se, —7 7103 3 357,0
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
113.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PASCO
Signature of Owner or Owner's Authorized Officer /Director/Partner/Manager
thi Name
1
t^ • _ . F ' y / t a 4 as wledger b oFe, t n
, e; t . as T ' L y ° f - 20_ IV
in fac for V (,� ' (type of authoty, e.g. officer, trustee, attorney
` / � (name of party on behalf of whom ins i i - i t was execu ed).
Personally KnownL7�Qg_puced Identification Notary Signature � � ( 4444
Type of Identification Produced t/
Name (print) i / , ,n l ./
/
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
. ,
FORMS/NOC.rvsd2007 Signature of Natural Person Signing Above
,pu
�N,v p , � CORE ANN KEOUGH
s Notary Public - State of Florida
ti s My Comm. Expires Aug-22,2014
Vt„ ` Bonded i Commission l
.rlln Notary Attu.
�
City of.Zephyrliills
BUILDING PLANREVIEW COMMENTS
q7C
Contractor/Homeowner: CG � ` 'Yl
an 11;j
Date Received: /0 - Z° (
Site: 3 5..5 7 Q. ` Ae-
Permit Type: Xe v' OsZe 4 , c-
Approved w /no comments:
if
Approved w /the below comments: ❑ Denied w /the below comments: ❑
This comment sh- 'shall ' e kept with the permit and/or plans.
(19:-/
Ka1v',4 Swi v er — 7 ; Examiner Date Contractor and/or Homeowner
(Required when comments are present)
Pasco County Parcel: 11- 26 -21- 0010 - 15200 -0170 001 Page 1 of 1
Data Current as Of: I _ Weekly Archive - Wednesday, October 13, 2010
Parcel SID 11- 26 -21- 0010 - 15200 -0170 (Card: 001 of 002) 1
Classification 17 - 1 Story Office
'Mailing Address Property Value
K & M TRAVEL INC Ag Land $0
38507 5TH AVE Land $6,763
ZEPHYRHILLS FL 33542 -4330
Physical Address Building $34,733
38507 5TH AVE Extra Features $0
ZEPHYRHILLS FL 33542 -4330 Market Value $41,496
Legal Description (First 4 Lines) Assessed (Non School Amendment 1) $41,496
See Plat for this Subdivision ..1
Taxable Value '
CITY OF ZEPHYRHILLS $41,496
PB 1 PG 54 THE SOUTH 50 FT
OF LOT 17 BLOCK 152
OR 5832 PG 1888
•
Land Detail (Card: 001 of 002)
Line IF $6,763 Use Description Zoning Units I Type Price Condition I Value
�
1 11 1700 II1STORY OFFII 00C2 I [ 1,250.00 lI SF $5.41 II Co 1.00 I
II ll
Additional Land Information
Acres 0.03 1 Tax Area 1 30ZH FEMA Code X Commerical Cod M5AV2AB I
I Building Information - Use 17 - Offices (One Story) (Card: 001 of 002) 1
Year Built 1956 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None
Roof Structure Rigid Frame w /Bar Joist Roof Cover Built -Up Tar and Gravel
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Carpet Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 2.0
Line
t Description Sq. Feet Repl. Cost New
1 AOF 724
L 2 CAN $69,294
132 $3,828
I Extra Features (Card: 001 of 002) J
I Line Description I Year Units I Value
No Extra Features I
I Sales History
Previous Owner MATTESON MARVIN
Year Month Book /Page Type Amount
I 2004 II 04 II 5832 / 1888 II QL 11 $0 I
L 1 999 10 I 4250 / 0010 1114/DA $70 000 I 1997 07 �� 3781 / 0688 WD
165,000
http: // appraiser. pascogov.com /search/parceLaspx ?sec =11 &twn= 26 &rng =21 &sbb= 0010 &... 10/20/2010
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Cc mmunity
Affairs Product Approval Menu > Product or Application Search > Application List > Application Detail
FL # FL6943 -R2
► COMMi NITY PLANNING
Application Type Revision
k NOusiNG & CCMMU' W°Y Code Version 2007
DEVELOPMENT
F EMERGENCY
Application Status Approved
MANAGEMENT Comments `
w OFFICE OF THE Archived o Ir \ '
SECRETARY' . -44 D -�' - __--- ..-'_._
KV - _
Product Manu pp ct E �I11NE GenFlex Roofing Systems, 1
Address /Phone/ mail 250 West 96th Street
Suite 150
Indianapolis, IN 46260
(317 , ) 816 -3806
,,, yi, bmc 3 Ilencim @firestonebp.c
Authorized Signature � i 1 1' C, „�, - �� ', C 1 u
C DE, ` � ,,Tm: ` rricquillentim @firestonebp.c
\
Technical Representative Tim McQuillen
Address /Phone /Email 250 West 96th Street
Indianapolis, IN 46240
(800) 443 -4272 Ext 5380E
mcquillentim @firestonebp.c
Quality Assurance Representative David Wally
Address /Phone /Email 393 Denton Circle
Tuscumbia, AL 35674
(256) 386 -8383
david.walley @omnova.com
Category Roofing
Subcategory Single Ply Roof Systems
http : / /www.floridabuilding.org /pr /pr app_ dtl. aspx ?param= wGEVXQwtDqu %2foRM43... 10/20/2010
L 1VL Lb4 L{.LLL&LL1� VV\1v VLUUav tea— — —
Compliance Method Evaluation Report from a FIi
Florida Professional Enginec
Evaluation Report - Hari
Florida Engineer or Architect Name who Robert Nieminen
developed the Evaluation Report
Florida License PE -59166
Quality Assurance Entity Underwriters Laboratories I
Quality Assurance Contract Expiration Date 03/30/2013
Validated By John W. Knezevich, PE
Validation Checklist - Hi
Certificate of Independence FL6943 R2 COI Trinity ERI
Referenced Standard and Year (of Standard) Standard
ASTM D6878
FM 4470
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 06/28/2010
Date Validated 06/28/2010
Date Pending FBC Approval 07/12/2010
Date Approved 08/10/2010
Summary of Products
+FL # IModel, Number or Name Il Description
6943.1 GenFlex TPO Single Ply Roof Thermoplastic pol'
Systems
Limits, of Use Installation Inst
Approved for use in HVHZ: No alp FL6943 R2 II A:
Approved for use outside HVHZ: Yes TPO FL6943 -R2.p
Impact: Resistant: N/A Verified By: Robe
Design Pressure: +N/A/ -292.5 Created by Indep
http: / /www.floridabuilding.org/pr /pr_ app_ dtl. aspx ?param---vGEVXQwtDqu %2foRM43... 10/20/2010
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SCOTT BLACKMAN ROOFING
i
P.O. Box 1188
rf i SAN ANTONIO, FLORIDA 33576
(352) 588 -7663 (813) 782 -1330
PROPO$ SUBMITTED TO ��� ' /` / — % - - -- PHONE DATE A �� /o —
STREE/ /14 V JOB NAME I \YV' --I
3frict 1
CITY. STATE and ZIP CODE JOB LOCATION
ARCHITE ±! T ''� - -� I DATE OF PLANS JOB PHONE
I
— We hereby submit specifications and estimates for:
A rtoiL4t I-14.44 roa tev-c sk,b rc,hi
. e.v . b k4. lyt -D , A �' c A f 00 #11 ++1 6 an /r ft, d ate /cep
9
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3 S kc,.c.. f-, P Di vt d (' c. 1 4 de� I __ i_e ieid
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r ie y 44-10 14 ,,-0,0144.44h.rh e ...
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Oil P propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of
jf0 0,
- - - -- --- -- - -- __ dollars ($ - k! Q D ).
Payment to be made as follows:
— rte _ in,.— i ' &Av.* v ales'" A hi eo fl /G�d$
■
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All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized ..A �► ----_
involving extra costs will be executed only upon written orders, and will become an extra Signature y' i G �— —
charge over and above the estimate. At agreements contingent upon strikes. accidents
!I or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be
Our workers are fully covered by Workman's Compensation Insurance w by us if not accepted within days.
r( Arr. . 4 a , r o roposttl - - - pr s pecifications
and c nditions =re fac . are • s. accept Yo are authorized Si ture — _ —____ ___.._ —____ 1
to do ,e work .. specifies. y �" s s r in, s above.
Date of Acceptance: . Signature _— - -__ .____._ —__ I