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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: DATE FILED:9— I II C� PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: I�� 1 - cc { � CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL. INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT u BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 772462-1553 SCANNLU BY APPhICA, TIONtfor BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: )1�QW osR�6c\ StN Q&-N ' 2. PROJECT NAME:V�2�\P SITE PLAN NAME: 3. PROPERTY TAX ID #:- 4. LEGAL DESCRIPTION (attach extra sheets if necessary): l�S� iye-" _ '��c�acl,t - V, 5. PLAT BOOK`)t-__S` SS 6. PAGE 7. BLOCK NO. 8. LOT NO. � 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORKACTIVITY: e�i<t_7✓r — V onn1/� _ SGis b GAG 15-5*e1,fie bAr ` 4i s m `A 7) qIC— 11. SETBACKS (ACTUAL) FRONT: _� BACK: l RIGHT SIDE: LEFT SIDE: l- 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: Q�d C 1 14. SQ..FT OF CONSTRUCTION: �!, /.�`� 15. SF. FT 1st FLOOR: 16. VALUE OF CONSTRUCTION: $ The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the.value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 OWNER INFORMATION NAME:\C� ADDRESS: ls� CITY: STATE: _ i_ ZIP: >As to PHONE (DAYTIME): �,� C1-� \`� Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): l/ CONTRACTOR INFORMATION f, 11 7 ST. of FL REG.CERT #: �C ����`�`3� ST. LUCIE COUNTY CERT #: V I BUSINESS NAME: '� a�.J ! yak CID QUALIFIERS NAME: 1Z>@_N�, 2_. �A N�7 ADDRESS:-\\C\ <'zlJ ST CITY: STATE: ZIP: PHONE (DAYTIME): 'oQ-:�-\k" 1ci FAX NO. ARCHIT/ENGINEER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): BONDING COMPANY: ADDRESS: CITY: STATE: ZIP: 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 mail. r r1i CERTIFICATION: This application is hereby made to obtain a permit to do the 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 pen -nit 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 IMPROVEMENTS 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 PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OR SIGNATURE STATE OF FLORIDA COUNTY OF M sic -, 4`1 The foregoing instrument was acknowledged before me this � day of �, �. 20 \y , who is personally known has produced identification. Signature of Notary Commission N "6`•,, STELL�(%M)NTER Notary Public - State of Florida �; •c My Comm. Lgires Jan 23. 2015 Commission # EE 31278 C NTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF c-\r • f1 The foregoing instrument was acknowledged before me this _% day of n , 20�, by �cn,%. -e_ NA who is personally known nor has produced as identification. Signature of Notary e• N HUNTEp hA Notary public - State of Florida y Comm. Expires Jan 23, 2015 Commission # Commi EE 31278 NOTE: TWO +T.'ACH SIGNATUEfJSTgBE-1OTAY'ZED.,taiE LYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONAL-'APP AR .TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS. ' For specific instructions see appropriate permit checklist. OFFICE USE ONLY BP #: 10I SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE HABITABLE AREA (RADON) RADON FEE PERMIT F LIBRARY IMPACT FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC B T FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE _ ROAD livi CT - EE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE 0901 South Moan lDAvo Jansen Beach, F L 24957 (772) 229,2830 FAX(.172)229w9901 Jauuaiy 3, 2014 Mr. & Mrs. Hendriclo 484 Nettles Blvd Jensen. Beach, Fl 34957 RE: 484 Nettles Blvd Nettles .Island Inc. has no objection to the .house plans as submitted for lot 484, per the attached. Any subsequent revisions or changes .m.u.st be submitted to Nettles Island for approval. AIM. Nettles Island Contractor Rules and Rogul.ations must be followed. Nettles island must receive tie adjacent owner notice prior to construction commencing. Rpespe William F.iarkins Operations .Manager `P11 16YED ORIGINAL PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, (Parcel Id#/Legal descrip0on/Address) for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , I 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 -thatthe 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 co t . t Property weer ame (Please Print) Property Owner Signature Date STATE OF FLORIDA, COUNTY OF \ ftf� \ C\ ACKNOWLEDGED BEFORE ME THIS 7-JZ) DAY OF Q 20 By �� \\S WHO IS PERSONALLY KNOWN TO ME 4----_0'R WHO HAS PRODUCED AS IDENTIFICATION. ♦�1 PRY AG ii� SIG ATUREE OF NOTARY PUBLIC -'•�• , :P iifr ubiic . HUNTER • ..; M State of Florida COMMISSION NUMBER 9A .oP Y Comm, Expires an '�. ;oF F1.oa; •• Commission EE 1278015 - „��a Bonded Through Nat tart' Assn. SLCPDSD Revised 08/24/2010 Apr 041 F4'04:12(p� ? Angus Termite & a��+ Cont _ 7722239791 p.1 J _ Planning & Development Services - Building & Code Regulation Division i 2300 Virginia Ave 'A.Fort Pierce, FL 34982 772-462-2172 Fax 772-462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERM # �bI {00JOB ADDRESS: 3 i V0 BUILDER/ R: 3 PEST CONTROL CONTRACTOR: No S f PEST CONTROL LICENSE #:,-� 9 aG q We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: Percentage of solution: Date of Treatment: Footing 1st Treatment Re -Treat Driveway 15t Treatment Re -Treat Other 15r Treatment Re -Treat Chemicals used: Total gallons used: Time of Treatment: St � Treatment Re -Treat Pools 1-" Treatment Re -Treat Perimeter for F' nspection n ure of Exterminator Note: Theremust be a completed form for each required treatment or re -treatment and this form must be on Me job site to be picked up by the inspector at time of each inspedion or the scheduled inspection will fail and a re-inspecton fee charged F8C1D4.2.6 Certificate of protective Treatment for prevention of termites A reab'ierresistantjobsite pos[ingboard shall be provided to receive duplicate Treatment Certificates as each required protective &eatmentfs completed; Providing a copy for the person the permit is issued to and another copy for the building permit files The Treatment Certificate shall pro vide the product used identity of the applicator, time and date of the treatment, site location, area &Wled, chemical used, percent concentration and number ofgai/ons used, to establish a verifiable recordof protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on the electrical panel box cover, listing all the treatments and dates of applications. kpR 0 8 r� RECEIVED APR 0'9 ���e ZZCC-mC-x 'q() Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: Project Name: Project P.O. Number: Order P.O. Number: Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: LOAD I CUMULATIVE ORDERED QUANTITY QQUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT UANTITY Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: 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 r 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 sheets 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. O / 68UNIVERSAL INVOICE his Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quotatioi '-any, and Seller's Order Confirmation (in, [ng limitations of warranties), as if fully set forth on this Delivery Ticket ("Agreer "). Seller will provide the Standard Term; I Conditions upon request. Buyer 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 / ELF' ASH 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, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. 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. Wash hands thoroughly with mild soap and water 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 flowing water for 15 minutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX. Memorial. Hermann Tower 929 Gessner. Suite 1900 V7 combined Houston. Texas 77024 02/12 For more information please visit www.cemexusa.com. Este ticket de entreaa incluye como referencia at comprador (ya previamente ejecutada on su aplicaci6n de cr6dito); cualquier t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6rr del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega (" Contrato''). El vendedor proveera los t6rminos estdndares y condiciones detal- laclos en caso de asf ser requericlos. Con este documento, e] comprador acepta Jos mismos ya antes rnencionados y que las cantidades y materiales fueron entregados,como se expresa en el mismo. Acepta pager el monto de acuerdo a] contrato; at mends quo se identi- fique con una rota al'frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluven Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita, granito, rota volcanica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) ]a cunt puede contener mas de 0.025% de silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en pie] y ojos, y reacciones a]6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los n ojos, pie] y/o e la zona respiratoria. Polvo del manejo en el trituramiento, pulido, carte y/o perforaci6n puede contener materiales silicos. Jos cuales pueden causar silicosis pulmonar y caricer si son inhatados. En caso de ser ingeridos, mantenerse en temperature calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contencr amoniaco. Se-uridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritaci6n o b quemaduras on la nariz, garganta y pulmones. ACLldir inmediatamente al medico. El riesgo en la salud depende en la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n on los ojos y ropa Primeros adecuada Para protecci6n. Ldvese las manos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria. 0 Primeros auxilios: En caso de contacto on los ojos, inmediatamente fluya agua en la parte afectacia por 15 minutos. Si se inhala polvo, exp6ngase a wire fresco. Si el ce,nento fresco tiene contacto con sus ojos, lavelos a fordo con agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informati6n visita www.cemcxusa.corn. -- Ccmcx REC.EIVED APB 17 2014 PERMITTING C4_ I ur--tw County. FL _ tr Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: Project Name` Project P.O. Number: Order P.O. Number: Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number. Y. Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: .•�.: - _. ., +. t / !.f i::. _. fit_ LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY .... ..�t.� i:.. s� . i... :I4' r. �.wl.•`„ .1..-j� r rl...,. j P1.'1 ...��1.:. ' Cash Check # / Auth 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: l ' 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 handling 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 AUTHORIZED SIGNATURE: _--- within one business day after the receipt of materials. 6BUNIVERSAL ri INVOICE i III .vri_rvery .i icxet incorporates herei v reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Qu •o. .f any, and Seller's Order, Confirmati ding limitations of warranties), as if fully set forth on this Delivery Ticket (") e5nent'°). Seller will provide the Standard- ..da. id Conditions upon regbest. Buyer 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. 1-1 AGGREGATE / CEMENT / CONf M VTr. PR nnr TPTQ i V r v A Qu 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, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the anunonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. 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. Wash hands thoroughly with mild soap and water 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 flowing water for 15 minutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston. Texas 77024 02/12 For more information please visit www.cemexusa.com. t✓ste ticket de entrega incluye Como referencia al comprador (ya prev.iamente ejecutada en su aplicaci611 de credito); cualquier termino estandar, condiciones del vendedor, propirestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes rnencionados y que las cantidades y materiales fueron entregados como se expresa en el mismo. Acepta pagan el monto de acuerdo at contrato; al menos que se identi- fique con una rota al frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomgra ita, nito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de alban"ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de conereto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita, granito, coca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mas de 0.025% cle silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y reacciones alergicas en ]a piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los Ojos, pie] y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, Corte y/o perforaci6n puede contener materiales silicos. los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperature calida, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. L,a inhalaci6n del amoniaco puede causar toser, irritacion o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en la duraci6n y el nivel de la exposici6n. Seguri.dad::Evite el contacto con Ojos y contacto prolongado con ]a pie]. Use guantes, protecci6n en los Ojos y ropa Primeros adecuada para protecci6n. Ldvcse las manor con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, .inmediatamente fluya agua en la parte afectada por 1.5 minutos. Si se inhala polvo, exp6ngase a wire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fordo con agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/1.2 Para mas informaci6n vis.ita www.cernexusa.com. 4!:lir CEMEX 5637i3MG Plant: Begin Loading: To Job: Arrive Job: Start UnloadT Finish Unload: Leave Job- Return Plant: Customer Code: Customer Name: Projdct�Code:- Project'NAme, Ticket Date: Delivery Address: Delivery Instructions: Customer Job Number: Order Code I Date: Project P,O. Number: Order P.O. Numbe'r:: Map Page: Map/Row/Column: Dispatcher., Ticket Number: Due On Job, Slump: Truck Number: Driver Number: Driver Name: End Use: a 0" L LOAD CUMULATIVE ORDERED PRODUCTION DESCRIPTION QUANTITY QUANTITY QUANTITY MATERIAL CODE P TION % UOM UNIT PRICE AMOUNT % Cash Check,#/ Auth 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 C) 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. Cukomer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material terms of sale and delivery and,acrepts concrete as is. Due to important fact6irs 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 handling 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 AUTHORIZED SIGNATURE: within one business day after the receipt of materials. 68UNIVERSAL CUSTOMER This Delivery Ticket incorporates here:/ reference Buyer's previously exec -- Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Qu d, 0, , if any, and Seller's Order Confirmati i ding limitations of warranties),Ias if fully set forth on this Delivery Ticket -ement"). Seller will provide the Standard i err— -nd Conditions upon request. Buyer 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 / FLY ASH 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, includino fly ash, may contain more than .025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure. I Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective clothing. Wash hands thoroughly with mild soap and water 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 con -,act, immediately flush eyes with flog;viffl- water for 15 Minutes. If dust is inhaled, move to afresh C air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston, Texas 77024 02/12 For more information please visit www.cernexusa.com, Este ticket de entrega include como referencia al comprador (ya previamente ejecutada en SU aplicaci6n de cr6dito); CUalquier t6rmino est6ndar, condiciones, d-1 vendb-der, propuestas del vendedor y orden de confirmaci6n del vendedor (con lirnitaciones y garantfas), corno acuerdo total del tip-ket do entrega ("Contrato"). El vendedor proveerA los t6rminos estdridares y condiciones detal- lad(),,� en caso) de as.f ser requeridos. Con este docuniento, el comprador acepta Jos rnismos ya antes rnencionados y que las cantidades y materiales fueron entre-ados corno so exptesa en el misn-to. Acepta pagar el monto de acuerdo al contacto; al. menos que se identi- fique con una rota al frente de este docunicilto. AGREGADOS / CEMEN.t i PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales natUrales corno piedra caliza, dolomita, rava y otros 1� aranito, rota volcAnica, arena, g C) materiales silicios. 1,os productos de u..,,nento incluyeD Cernento de tipo Portland, de albaAilerfa, pozzolan (tipo IP), azulejo do azotea y estuco. Los productos' de concrew incluyen cernento Portland y productos de agregados corno piedra caliza, dolornita, granito, roca vo1cdnica, arena, grava, 1; o)I ros materiales siticios. Estos productos inCIUyen cenizas volantes (fly ash) la coal puede contener m6s de 0.025% de silicio cristai;no. Peligros: Mezcla de cernento -fresco y/o cenizas volantes pueden causar irritaci6n en Jos ojos, quernaduras en piel y ojos, y reacciones al6rgicas en la peel. Concrete, seco y polvo de agregados, pueden causar irritaci6n en, los ojos, pie] y/o on la zona respiratoria. Polvo del mauejo ' en el. trituramiento, PLIJ.1(10, torte y/o perforaci6n. puede contener materiales silicos, los cuales pueden causar sificosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura cAlida, reposar y tomar grandes cantiolades de agua. Las cenizas volantes pueden contener arnoniaco. Seguridad: La humedad puede causar la liberaci6n del arnoniaco. La i.r1halaci6n del amoniaco puede causar toser, irritaci.6n. o quemaduras en la nariz, garganta y pulmones. Acudir inmooliatamente al medico. El riesgo on ]a salud depende en la duraci6n y el nivel de la exposici6n. Seouridad: Evite el contacto con ojos y contacto prolongado con ]a piel.. Use guantes, protecci6n en los Ojos y ropa Primeros adecuada Para protecci6n. Uvese las manor con jab6n suave v agua despu6s del. manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los lirnites recornendados, use protecci6n respiratoria. Primeros auxillos.: En caso de contacto) on los ojos, inmediatamentefluya agua en la pane afectada por 15 rninutos. Z-' Si se inhala polvo, exp6ngase a aire fresco. Si el cernento fresco tiene contacto con sus ojos, ldvelos a fondo con agua. Acuda a atenci6n m6dica inmediatarnente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para nids informaci6n Visita www.cemexusi.com. L� Ccmcx S" ``�"3 to �� -, t; � �l 2 0 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Project Code: Project Name: Ticket Date: Delivery Address: Delivery Instructions: Customer Job Number: Order Code / Date: Project P.O. Number: Order P.O. Number: Map Page: Map/Row/Column: Dispatcher: Ticket Number: _ Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY Cash Check # / Auth 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 whdretthe 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 curbfror 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 handling information, an'd•tb the material safety data sheets for additional information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE:'"' i' within one business day after the receipt of materials. 68UNIVERSAL INVOICE This Delivery Ticket incorporate- r( ')y reference Buyer's previously exi ,i edit Application, if any,,, Sellers Standard Terms and Conditions, Seller's Q trk, if any, and Seller's Order Confir•mativa i uding limitations of warranties), as if fully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees that, unless otherwise noted on the front hereof, all quantities and iterns were delivered as indicated and further expressly agrees to pay in accordance with the Agreement. AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH 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, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 frorn handling, crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. 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. Wash hands thoroughly with mild soap and water 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 flowing water for 15 minutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX. Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston. Texas 77024 02/12 For more information please visit www.cemexusa.com. Este ticket de entrega incluye Como referencia al comprador (ya previamente ejecutada en su aplicac16n de credito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estdndares y condiciones detal- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los rrrisrnos ya antes rnencionados y que las cantidades y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato; at menos que se identi- fique con una nota al frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomrta, granito, roca volcanica, arena, gravy y otros materiales silicios. Los productos de cernento incluyen Cemento de tipo Portland, de albaf ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de conereto incluyen cernento Portland y productos de agregados como piedra caliza, dolomita, granito, coca volcanica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mds de 0.025% de silicio crist.alino. Peli; ros: Mezela de cernento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y Ojos, y reacciones alergicas en la piel. Concreto seco y po.lvo de agregados, pueden causar irritaci6n en los Ojos, pie] y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n puede contener materiales silicos, los cuales pueden causar silicosis pulmonar y caneer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura caliza, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco. Se-uridad: La hurnedad puede causar la liberaci6n delamoniaco. La inhalaci6n del amoniaco puede causar toyer, irritaci6n o b quemaduras en la nariz, garganta y pulmones. ACUdir inmediatamente al medico. El riesgo en la salud depende en la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con Ojos y contacto prolongado con la piel. Use guantes, protecci6n en los Ojos y ropa Primeros adecuada para protecci6n. Ldvese las menos con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n respiratoria. Prirneros auxilios: En caso de contacto en los Ojos. inmediatamente fluya agua en la parte afectada por 15 minutes. Si se inhala polvo, exp6ngase a aire fresco. Si el cernento fresco time contacto con sus Ojos, lavelos a fondo con agua. Acuda a atenci6n mzdica inrnecliatamente si la irritaci6n continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informaci6n visita www.ceinexusa.com. 5 ? 8 32 0 Plant: Begin Loading: To Job: Arrive Job: Start Unloads finish Unload: Leave Job: Return Plant Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: Project Name: Project P.O. Number: Order P.O. Number. Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: LOAD CUMULATIVE ORDERED QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT Cash Check Charge Comments: Check # /Auth Code: I Signature of Driver Receiving Cash: Cash Received: I Total COD Order Amount to Collect Without Standby Charges: WATER ADDED: r 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 materialseWeere 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 handling information, an'd to the material safety data sheets for additional,inforination. 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. O a' 68UNIVERSAL CUSTOMER This Deliivery Ticket incorporate n•)y reference Buyer's previously•exi edit Application, if any, Sellers Standard Terms and Conditions, Seller's Q tu,si, if any, and Seller's Order Confirmation �...__uding limitations of warranties), as if fully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer 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 / FLY ASH Aggregate products are naturally occurring materials .including limestone, dolomite, granite, volcanic rock, sand, -ravel, and other siliceous materials. Cement products include Portland cement, masonry, pozzolaD (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, including - fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of arnmonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. Health risk depends on duration and Jevel.of exposure. Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection,,.::,lnopriate protective clothing. Wash hands thoroughly with mild soap and water 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 flowing water for 1.5 minutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX, Memorial. Hermann. Tower 929 Gessner, Suite 1900 V7 combined Houston, Texas 77024 02/12 For more information please visit www.cemexusa.cnm. Este ticket de entreaa incluye Como referencia al comprador (ya previamente ejecutada en su aplicaci6n de crt d.ito); cualquier terrnino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantias), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fueron entre-ados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contacto; at menos que se identi- fique con una rota at frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcanica, arena, Brava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaf ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados corno piedra caliza, dolomita, granito, roca volcanica, arena, grave, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mas de 0.025% de silicio cfistalino. >Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto seco y po:ivo de agregados, pueden causar irritaci6n en los ojos, pie]. y/o en ]a zona respiratoria. Polvo del. manejo en el trituramiento, pulido, cone y/o perforaci6n puede contener materiales silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura calida, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. La inhalacibn del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la saiud depende en la duraci6n y el Dive] de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la pie]. Use guantes, protecci6n en los ojos y ropa Primeros adecuada para protecci6n. Lavese las menos con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos trigs de los lirnites recomendados, use protece16n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya aqua en la parte afectada por 1.5 minutos. Si se inhala polvo, exp6ngase a a.ire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con aqua. Acuda a atenci6n medica inmediatamente si ]a irritaci6n contin6a. CEMEX, Memorial Hermann 'Power 929 Gessner, Suite 1.900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita w�w.cemexusa.c�c m. 1 _ CEmcx Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: Project Name: Project P.O. Number: Order P.O. Number: Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: -' Driver Number: Driver Name: End Use: LOAD CUMULATIVE ORDERED MATERIAL CODE .PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: Check Charge -� Comments: WATER ADDED: t <' GAL YARDS IN DRUM: r`r 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`yourasafety,A 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 handling information„and.tdthe material safety data sheets for additional information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED.SIGNATURE: f' within one business day after the receipt of materials. O j f4 68UNIVERSAL '' '` INVOICE This Delivery Ticket incorporates -- i reference Buyer's previously exec r it Application, if any, Seller's Standard Terms and Conditions, Seller's Qu( )n, ,r any, and Seller's Order Confirmatiu— ,.r, ing limitations of warranties), as if fully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees that, unless otherwise noted oil 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 / FLY ASH 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, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash earl 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of arnmonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. 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. Wash hands thoroughly with mild soap and water 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 flowing water for 15 minutes. If dust is inhaled., move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX. Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston, Texas 77024 02/12 For more information please visit www.cemexusa.com. Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los t6.rminos estandares y condiciones detal- Iados en caso de asf ser requeridos. Con este doctinrento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fueron entregados co no se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato; al merios que se identi- fique con una rota al frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENI7AS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcdnica, arena, gravy y otros materiales silicios. Los productos de cernento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cernento Portland y productos de agregados como piedra caliza, dolomita, granito, rota volcanica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mds de 0.025% de silicio cristalino. Peligros: Mezcla de cernento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y reacciones al6rgicas en la piel. Concreto seco y po.lvo de agregados, pueden causar irritaci6n en los ojos, pie] y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforaci6n puede contener materiales silicos, los cLiales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperature caliza, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la li.beraci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritaci6n o quemaduras en ]a nariz, garganta y pulmones. ACudir inmediatamente al medico. El riesgo en la salud depende en la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la pi.el. Use guantes, protecci6n en los ojos y ropa Primeros adecuada para protecci6n. Ldvcse las manor con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios° polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 rninutos. Si se inhala polvo, exp6ngase a aire fresco. Si el eemento fresco tiene contacto con sus ojos, lavelos a Tondo con agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/1.2 Para mds informaci6n visita www.ceinexusa.com. 5 6�.� 70 � 2 Ld Plant: (Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: :. +. i .., Project Code: Project Name: Project P.O. Number: Order P.O. Number: Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY Cash Check # /Auth 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: J — 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,ai 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., WARMNG:` P-roductImay 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: yoi;r. 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 handling infor n tion,,_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 AUTHORIZED.SIGNATURE: within one business day after the receipt of materials. O > 68UNIVERSAL CUSTOMER This Delivery Ticket incorporates hP,--;,reference Buyer's previously execu`--' ^nedit Application, if any, Seller's Standard Terms and Conditions, Seller's Quot r, r any, and Seller's Order Confirmation c ig limitations of warran.ies), aq if fully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms ... Conditions upon request. Buyer agrees that, unless otherwise noted. on the front hereof, all quantities and iterns were delivered as indicated and further expressly agrees to pay in accordance with the, Agreement. AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH 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, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash 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 silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. 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. Wash hands thoroughly with mild soap and water 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 flowing water for 1.5 minutes. If dust.is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. CEMEX, Memorial. Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston, Texas 77024 02/12 For more information please visit www.cemexusa.com. Este ticket de entrega include Como referencia al comprador (ya previamente ejecutada en sa aplicaci6n de eredito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6ri del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fueron entregados como se expresa en el mismo. Acepta pagan el monto de acuerdo al Contrato; al menos que se identi- fique con una rota al frente de este documento. 5 AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CVNIZAS VOLANTES Los productos de agregados son materiales natnrales como piedra caliza, dolomita, granito, coca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaf ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto .incluyen cemento .Portland y productos de agregados como piedra caliza, dolomita, granito, roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede contener mas de 0.025% de silicio cystalino. Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar initaci6n en los ojos, pie]. y/o en la zona respiratoria. Polvo del. manejo en el trituramiento, pulido, Corte y/o perforaci6n puede contener materiales silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura calida, reposar y tomar grandes cantidades de'agua. L,as cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. La .inhalaci6n del.amoniaeo puede causar toser, irri.taci.on o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con ]a piel. Use guantes, protecci6n en los ojos y ropa Primeros adecuada para protecci6n. Lavese las manos con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, .inmediatamente fluya agua en la parte afectada por 1.5 minutes. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900. V7 combinado Houston, Texas 77024 02/12 Para mas informacion vis.ita www.cemexusa.com. 0801 South Opan D.rive.., Jsnssrt.-Beat:h, PL 34957 (772).229-830 PAX.(1-72)'225wJ901 Januaiy 3, 2014 Mr. & Mrs. bTend.riclo 484 Nettles Blvd Jensell BCa.ch, rl 34957 RE: 484 Nettles Blvd Nettles Island Inc. has no objection to the house plans as submitted for lot 4,84, per the attached. My subsequent revisions or changes umst be submitted to Nettles Island for approval. All Nettles Island Contractor Rules and Regulations must be, followed. Nettles Island must receive the adjacent owner notice prior to const-tuction commencing. William I Tarkhis Operations Manager 6nk ) A,tc itectwalelimperson f � i 0 g.... r� . I P? 10YED ORIGINAL