HomeMy WebLinkAbout1011-0228OFFICE USE
DATE FILED:
PLAN REVIEW FEE: t . RECEIPT NO.: PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
I.
2.
3.
4.
5.
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS D"IO
2300 Vir&&Avenue
Ft. Pierce, FL 34982-5652 Cq
� M
772-462-1553 „
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION /
LOCATION/SITS ADDRESS: —1 CD t l R oc_k
PROJECT NAME: AW SITE PLAN NAME:
PROPERTY TAX ID #:
LEGAL DESCRIPTION (attach extra sheets if necessary): l Sr f� S ^3qe -' N �t , �r `tl�`] ��
n � r-*-r % _ , aO �' ^) C CT A %at% F 316 or. S Iq OF__ 4 Wl'/� L96S S 69 r 1 AfMI E as F 1
PLAT BOOK 6. PAGE N � �� 3I _ 157- .
A N i\ L"e, 12b�-lL -gb
9. PARCEL SIZE A(a C ES1SQ FT.): 5 4 LOT DMNSIONS:
i0. # COMPLETE DESCRIPTION OF CONSTRUCTION PRO
JE T OR W R]
ACTIVITY: I7 Id4 si �,//('
11. SETBACKS (ACTUAL) FRONT:1y,_ BACK: _h1JPt__ RIGHT SIDE:_ LEFT SIDE: M.4N,'
12. 0 TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] EXPANSION/ADDITION
COMMERCIAL
[VI NEW CONSTRUCTION
[ ] RESIDENTIAL
[ ] OTHER (SPECIFY) _
13. 0 DESCRIPTION OF PROPOSED USE:
[ I INTERIOR RENOVATION
[ ] INDUSTRIAL
14. 0 SQ. FT OF CONSTRUCTION: 700 15. SF. FT Ist FLOOR:
Oo
16. "vALUE OF CONSTRUCTION: $
t to question andlor modify the
The value of truc ion ii it is used n determine the amount d permit � no consistent
t with
Lucie similar County -reserves the � of construction activities- ties- If the value $2500 or moe, indicated
value of construction if it is demonstrated that the submitted figure
RECORDED Notice ofCommencement must be submitted with this apPlication.
SLCCDV Form No.: 001-02
UPDATED 05109
OWNER INFORMATION
NAME:
ADDRESS: Q ;�QQ Q is&-ir3 1 A
CITY: r-Z. R EP_c-r
PHONE (DAYTHAE)! 2) y Io 102t
IF THE FEE SIMPLE TITLEHOLDER (PROPER?
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:Cgc 03 t
BUSINESS NAME: i
QUALIFIERS NAME:
ADDREP-0
SSS:.�� a6
CITY: C_-4- s � I ) Ll C r
PHONE (DAYTIME): g7
ADDRESS:
CITY:
PHONE (DAYTHAE): C___)
BONDING COMPANY:
ADDRESS:
V
STATE: t- L-- ZIP: 5"t" l U r ---
51 Email: MLLAml R sk1�ue.t0. SL>rR
OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
STATE:
IP
l� ST. LUCIE COUNTY ChERT
STATE: F L, ZP: 349 20 7
FAX NO. 22 2- �4, Email��Iif��i�� CJ�CDO,
o LAM,
STATE:
ZIP:
CITY: STATE: gyp;
MORTGAGE LENDER:
ADDRESS:
CITY: STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mil.
/fir -
CERTIFICATION:
This application is hereby made to obtain a permit to do tae work'and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. 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 separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES; BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency. review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR MROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROhME IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST Lvc.irL CoV►rt.t
OWNER OR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrume t was acknowledged before
me
l o1~c�
th�s � da Y
>s.25�222 a � ,
STATE OF FLORIDA y c
COUNTY
s
The foregoing instrument was acknowledged b .6
me this day of�� 20
by SOS
who is personally known ►- or has produced who is personally known (`or has produced
as identification.
S & v _ D s idenfificatio�n. ✓
Signature o Signature of No ry
; S is i. PELTON Commission No. (Seal)
Commission Nat C� _*: emission # EE 024685
a. Expires October 31, 2014
�� Bonded Thru Troy Fain Insurance 800385.7010
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
i
OFFICE USE ONLY
o
SECTION
r I
TOWNSHIP
RANGE
MONO.
A '
ZONING
i
LAND USE
i
LOT CVG %
TAZ NO.'
FLOOD ZONE
FIRM MAP #
PT FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
After 111990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
%ob
HABITABLE
AREA
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
UBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
R AD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC
PLUMBING ^
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING. /
.REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
•O.?• /O
CATE
OMPLETED
�ll
1C�
/.�• O2• / O
]NrrlALS
% v .11 1 � I /
�J \E COG ST. LUCfE COUNTY
BUILDING & ZONING
n 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
�ORIOP 462 1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
) tl\ . �RLve_OC
Ll a3%1-0allo -ot0, 000 —(0
(Tax ID/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In accepting
this Final Development Permit, BP Number , 1 acknowledge that as
owner of the above described property, and in accordance with Section 7.04.01(D), St.
Lucie County Land Development Code, I shall be responsible for assuring adequate
drainage so that the immediate community WILL NOT be adversely affected. I further
acknowledge that in .granting this permit for the development of this property, St. Lucie
County -is neither obliged nor liable to provide for, or maintain in any form, adequate
drainage off my property which will not adversely affect the immediate community.
5 T, Luce Lwu-zy
q to
Property Owner Name
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OFO/
ACK OWLEDGED BEFORE ME THIS DAY OF , 20 lQ
B WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED
AS IDENTIFICATION.
zz It
SIGNATURE OF OTARY TYPE OR PRINT NAME OF NOTARY
�Y'^r DORIS J. PELTON
( aKa Cpmmission # EE 024685
NOTARY PUBLIC TITLE �G D &OMMISSION NUMBER ... ae Expires October 31, 2014
;Fov,..
,,,,, Bonded TfwTroyFain lnwrdneeBD438570f8
Property Appraiser - St.LucieFL
Page 1 of 1
PRCrPEf TY REC6RD CARD
St Lucie County Record: 1 of 3 <<Prev Next» Spec.Assmnt
Taxes Exemptions Permits Home Print
Property Identification
0G2
Site Address: 900 N ROCK RD
ParcellD: 2311-210-0000-000-6
Sec/Town/Range: 11 :35S :39E
Map ID: 23/11N
Account #: 13460
Land Use: COUNTIES
Zoning: I
City/Cnty: St Lucie County
Ownership and Mailing
Legal Description
Owner: St Lucie County
11 35 39 NE 1/4 OF NW 1/4-LESS N80 FT AND E 25 FT- AND E 3/4
Address: 2300 Virginia Ave
OF SE 1/4 OF NW 1/4-LESS S 54 FT AND E
Fort Pierce FL 34982-5632
More...
Sales Information
Assessment 2010 Final
Total Land and Building
Date Price Code Deed
Book/Page 2010 Final: 11755500
Land Value: 1750000 Acres: 69.54
1/1/1984 390000 00 CV
0421 / 2150 Assessed: 11755500
Building Value: 10005500
Ag.Credit: 0
Finished Area: 182947 SgFt
Exempt: 11755500
Taxable: 0
Taxes: 0
BUILDING INFORMATION
Exterior Features
View:
-
RoofCover:
MA - Masonary Shg
RoofStruct:
PC - Precast Conc
ExtType:
MUNI - Municipal
BD YearBlt:
1986
Frame:
Grade:
Y_C+ - Commer C+ EffYrBlt:
1995
PrimeWall:
RC - Reinf Conc
StoryHght:
0010 - 1 Story
No.Units:
100
SecWall:
-
Interior Features
BedRooms:
0
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
0
HeatType:
FHA - FrcdHotAir
AvgHt/Fl:
1/2Bath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CA - A TL/CON
%A/C:
100
%Heated:
100
%Sprinkled:
100
Special Features and Yard Items
Land Information
Type
Y/S Qty.
Units Qual. Cond.
YrBlt.
No. Land Use
Type
Measure Depth
ASP2 - ASP2 LOW
Y 1
58600 AV AV
1986
1 8600-COUNTIES 520 -Acres
53.51
FEN8 - CHAINLINK 8'
Y 1
5200 AV AV
1986
2 8600-COUNTIES 260 -Front Ft
1016
3 8600-COUNTIES 225 -Front Ft
2348.78003
BARB - BARB WIRE
Y 1
5200 AV AV
1986
More...
CNC2 - CONCRETE LOW Y 1
16872 AV AV
1986
FEN6 - CHAINLINK 6'
Y 1
1200 AV AV
1986
THIS INFORMATION
IS BELIEVED TO BE CORRECT AT
THIS TIME
BUT IT IS SUBJECT TO CHANGE AND
IS NOT WARRANTED.
http://www.paslc.org/pre.asp?prclid=231121000000006 11/19/2010
,7
'ccmcx
• 5:3362102
Plant: Begin Loading: To Job: Arrive Jobr Start Unload: Finish Unload: Leave Job: Return Plant:
da12'/ 1 o 9 2
Cusco oCode� Custre-Name:
tl'Pt,j-I.:/;7>_' r�L_ viop aco, i�`�ll'+lw"rRUC T r►JN FC) INC,
Project Code: Project Name:
Ticket Date:1. Deliv Addre ROCK,ft
Delivrriy4' struclotnns'1 L
1
Customer Job Humber: , Oide Code / Date:
Project P.O. Number: Order f,A: u r:
Map Page: Map/Row/Column:
Dispatc'M! 4W j 1 i; i n r{ o T i
Ticket Number:
3 1 4i,1 d"ICr8
Due;On'Uob:f Slump: i" Truc umber:" ,32, Driver Nu tier;,•.'„ DriverN e: 6 � t' End Use: �:) �-.-.W aL,
.. t.` p "� ..�d 1 N..: s. ,, t .T I.: I _.I r C l�l.:> RL�WAY o i._
LOAD
QUANTITY
CUMULATIVE I
QUANTITY
ORDERED
QUANTITY
I MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
1 0. d_,0 1.0 twrt_?
I t':i, t.) l 12136649
::rd.}f. 0 REG iYlClNG —C I BER
d"f YID3
L a :'I{ a
1 24*7 81
FUEL SURCHARGE.
f a -pry
1 '0;R'74 9
ENVIRONMENTAL CFIARGE
Cash Check # / Auth Code: Signature of Driver Receiving. Cash:
Check
Charge
Comments:
Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
WATERADDED:'° GAL YARDS IN DRUM:
' WHEN ADDED.
RECEIVEDSIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
' JAN 13 2011
SIGNATURE
Public Work
St, Lucie County, FL ❑ LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customsown risk.' If water is added on job, concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is,n8longer guaranteed. WARNING: Product'rgay cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to, your safety and -tiealth."Please refer. to the backside of this ticket for iimportant
control after delivery, this Company will not accept any responsibility for the finished results. No credit for' safety handling information, and to the, material safety data,slieets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing •AUTHORIZED SIGNATURE:
within one business day after the receipt of materials.
F`i-iLLV I Ff .6 "r LOAD N[JiYi 1
68UNIVERSAL INVOICE v'r�
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions. Seller's Quotatic any, and Seller's Order Confirmation (it ling limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agrees "). Seller will provide the Standard Tenr d Conditions upon request. iluve�,Agrees
that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees
to pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco.
Concrete products include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand,
gravel, and other siliceous materials. These products may contain more than 0.1% crystalline silica.
Hazards: Freshly mixed wet cement can cause eye irritation, skin and eye burns and allergic skin reactions. Dry concrete
and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust from handling, crushing,
grinding, cutting and/or drilling may,contain crystalline silica, which may cause silicosis and cancer if inhaled.
Health risk depends on duration and level of exposure.
Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate
protective clothing. Rinse hands thoroughly after handling. Avoid breathing dust. If exposed. to dust above
recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact, immediately flush eyes with water. If dust is inhaled, remove to fresh air. If wet cement
contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX
920 Memorial City Way, Ste. 100
Houston, Texas 77024
For further information, please visit www.cemexusa.com.
V4 combined
03/10
Este ticket de entrega asume aquf por referencia, que el cotnprador ha previamente cumplido con la solicitud de credito, de ex.istir,
los tenninos y condiciones estdndar del vendedor, el presupuesto del vendedor, si es que existe, y con la confirmation del ped.ido
del vendedor (incluyendo limitaciones de garantfas),; Como se establece por completo en este ticket de entrega ("el Acuerdo" )..El
vendedor suministrara los terminos y condiciones estandar de asf solicitarse. El comprador esta de acuerdo en que salvo que se
especifique al frente del presente, todas ]as cantidades y artfculos han lido entregados coma se indica, y ademas se acuerda
expresamente abonar conforme al acuerdo.
ARIDOS / CEMENTO / PRODUCTOS DE CONCRETO
Los productos aridos son materiales de ocurrencia natural que incluyen caliza, dolomita, granito, roca volcanica, arena, Brava,
y otros materiales siliceous. Los productos de cemento incluyen cemento portland, mamposterfa, puzolana, (Tipo IP), teja y
estuco. Los productos de concreto incluyen cemento portland y productos aridos incluyendo caliza, dolomita, granito, roca
volcanica, arena, grava y otros materiales vinculados a la siliceous. Estos productos podrfan contener mas del 0.1 % de sflice
cristalina.
Peligros: El cemento fresco humedo mezclado puede provocar irritation en los ojos, quemaduras de piel y gjos, asf como
reacciones alergicas en la piel. El concreto seco y el polvo de materiales aridos podrian provocar irritation en
los ojos, piel y/o tracto respiratorio. El polvo del manejo, triturado, molido, corlado y/o perforado podria
contener silice cristalina, que podria causar silicosis y cancer de ser .inhalada. Los riesgos a la salud dependen
de la duration y del nivel de la exposition.
Seguridad: Evite el contacto con los ojos y el contacto prolongado con la piel. Use guantes, proteccion ocular y ropa
protectors apropiada. Enjuaguese bien ]as manos luego del manipulado. Evite respirar polvo. Si se expone al
polvo por encima de los lfmites recomendados anteriormente (vease MSDS por su sigla en ingles), use la
apropiada proteccion respiratoria aprobada por NIOSH.
Primeros auxilios: En caso de contacto con los ojos, inmediatamente enjuagueselos con agua. Si se ha inhalado polvo.
coloquese al aire libre. Si el cemento humedo entra en contacto con la piel, enjuaguela con abundance agua.
Obtenga la atencion medica apropiada si la irritation persiste.
CEMEX
920 Memorial City Way, Ste. 100
Houston, Texas 77024
V4 combinado Para mayor infonnacion, por favor visite www.cemexusa.com.
03/10
53362116
Plant:
Begin Loading:
To Job:'
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
r3 .
0 mac:: ,� '_l, i=? �:;
Customer Code: Customer Name:
:":;i-1; `:?''*"' HEh.;NIS COi•STRUC;TION CO 11IC'.
Project Code: Project Name:
Ticket t Date: Delivery Address: }} r 1 ROAD
1 �T ,'� C?13 :� i ice} '90C's d,i i Sl_.i 5,�1 e ROAi_,`
Delivery Instructions:
THF1 ,1'111L_
Customer Job Number:
Order Code / Date:
Project P.O. Number:
Order P.O. Number:
VERBAL ...iOE
Map Page: Map/Row/Column:
Dispatcher:
SrlWis I I ialnT.•0rl
Ticket Number:
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
e i 7r;
I ij(X'-:' ,7't:,o
1. i_�192,28
B05 COL_Er=BAN
rr�W(W — S UDEI. AL_
';.
LOAD
QUANTITY
CUMULATIVE
QUANTITY
I ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
:! Ji.i 11.50 1.:%. • 50 'i i:.:`;? G- G 4 w'i 3000 REG MONO —FIBER l.j YD,.:r
'' LiiC�.r 49 F,�•i�J.•�i�
1.,, t�?i..+-L:ei�li'. % �Mre HP) 1 �tOl',jr�iF P�dTi-t iw�"i 1t�l7F»
i
Cash Check #! Aulh Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge
Comments:
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
❑ LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customers own risk. If water is added on job, concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important
control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handjing information, and to the material safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTH0RIZED'SIGNATURE: ,-% /7 'qq
within one business day after the receipt of materials.
68UNIVERSAL j f��FtEV TRK - :L{?1 3i �!•_ .�,� INVOICE L ijiirl� 4`•I�.)I*j i:=
This Delivery Ticket incorporates here.i-, 1— reference Buyer's previously executed C - dit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatio any, and Seller's Order Confirmation (h ling limitations of warrantiq�), as if fully
set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard TenTiN and Conditions upon request. Buye--4—grees
that, unless otherwise noted on the front hefeof, all quantities and items were delivered as indicated and further expressly agrees
to pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco.
Concrete products include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand,
gravel, and other siliceous materials. These products may contain more than 0.1% crystalline silica.
Hazards: Freshly mixed wet cement can cause eye irritation, skin and eye burns and allergic skin reactions. Dry concrete
and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust from handling, crushing,
grinding, cutting and/or drilling may contain crystalline silica, which may cause silicosis and cancer if inhaled.
Health risk depends on duration and level of exposure.
Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate
protective clothing. Rinse hands thoroughly after handling. Avoid breathing dust. If exposed to dust above
recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact, immediately flush eyes with water. If dust is inhaled, remove to fresh air. If wet cement
contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX
920 Memorial City Way, Ste. 100
Houston, Texas 77024
For further information, please visit www.cemexusa.corn.
V4 combined.
03/10
Este ticket de entrega asume aquf por referencia, que el comprador ha previanrente cumplido con la solicitud de crddito, de existir,
los terminos y condic.iones estandar del vendedor, el presupuesto del vendedor, si es que existe, y con la confirmac.i6n del pedido
del vendedor (incluyendo li.mitaciones de garantfas), como se establece por completo en este ticket d.e entrega ("el Acuerdo"). El
vendedor suministrard los t6rminos y condiciones estandar de asf solicitarse. El comprador estd de acuerdo en que salvo que se
especifique al frente del presente, todas las cantidades y articulos han sido entregados como se indica, y ademds se acuerda
expresamente abonar conforme al acuerdo.
ARIDOS / CEMENTO / PRODUCTOS DE CONCRETO
Los productos aridos son materiales de ocurrencia natural que incluyen caliza, dolomita, gran.ito, rota volcanica, arena, grava,
y otros materiales siliceous. Los productos de cemento incluyen cemento p6rtland, rnamposterfa, puzolana, (Tipo IP), teja y
estuco. Los productos de concreto incluyen cemento p6rdand y productos aridos incluyendo caliza, dolomita, granito, roca
volcanica, arena, grava y otros materiales vinculados a la siliceous. Estos productos podrfan contener mas del 0.1 % de silice
cristalina.
Peligros: El cemento fresco humedo mezclado puede provocar irritaci6n en los Ojos, quemaduras de piel y ojos, asf como
reacciones alergicas en la piel. El concreto seco y el polvo de materiales aridos podrfan provocar irritaci6n en
los ojos, pie] y/o tracto respiratorio. El polvo del manejo, triturado, molido, cortado y/o perforado podrfa
contener silice cri:stalina, que podi-fa causar silicosis y cancer de ser inhalada. Los riesgos a la salud dependen
de la duraci6n y del nivel de la exposici6n.
Seguridad: Evite el contacto con los ojos y el contacto prolongado con la piel. Use guantes, protecci6n ocular y ropa
protectooa apropiada. Enjudguese bien las manos luego del manipulado. Evite respirar polvo. Si se expone al
polvo por encima de los lfmites recomendados anteriormente (vease MSDS por su sigla en ingles), use la
apropiada protecci6n respiratoria aprobada por NIOSH.
Primeros auxilios: En caso de contacto con los ojos, imnediatamente enjuagueselos con aqua. Si se ha inhalado polvo,
col6quese at aire libre. Si el cemento humedo entry en contacto con la piel, enjudguela con abundante agua.
Obtenga la atenci6n medica apropiada si la i.rri.taci6n pers.iste.
CEMEX
920 Memorial City Way, Ste. 100
Houston, 'Texas 77024
V4 combinado Para mayor informaci6n, por favor visite www.cemexusa.com.
03/10