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Q: OFFICE,USE ONLY: DATE FILED: PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: k_/4 CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED `l r i PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION SCA�N2Pie Virginia Avenue E�� (C � Ft. Pierce, FL 34982-5652 BY 772-462-1553 - St. Lucie county, APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 3103 NW Radcliffe Way 2. PROJECT NAME: Riverbend SITE PLAN NAME: Riverbend (PB 67 - 3 6 ) 3. PROPERTY TAX ID9: 4425-703-0031-0001 4. LEGAL DESCRIPTION (attach extra sheets if necessary): Riverbend (PB 67-36) 5. PLAT BOOK 6 7 6. PAGE NO. 36 7. BLOCK NO. 8. LOT NO. 2 6 9. PARCEL SIZE (ACRES/SQ FT.): 0.64 10. COMPLETE DESCRIPTION OF CONSTR New Construction-SFR LOT DIMENSIONS: PROJECT OR WORK ACTIVITY: 11. SETBACKS (ACTUAL) FRONT: 4BACK: 97 . 3 4 ' RIGHT SIDE: 26. 02, LEFT SIDE: 3 5. 13 ' 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [X] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: 14. 16. SQ. FT OF CONSTRUCTION: 4451 SFR VALUE OF CONSTRUCTION: $ 310,000.00 L 1tibs - 15. SF. FT 1st FLOOR: 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 w OWNER INFORMATION NAME: Standard Pacific of Florida ADDRESS: 3201 West Commercial Blvd. CITY. Ft. Lauderdale STATE: F1 ZIP: 33309 PHONE (DAYTIME): 954 232-2290 Email: permits@brownspermitting.com 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): ( .. ) CONTRACTOR INFORMATION ST. of FL REG.CERT #: CGC15 0 6 3 04 ST. LUCIE COUNTY CERT #: 28420 BUSINESS NAME: Standard Pacific Homes QUALIFIERS NAME: Michael T. Collins ADDRESS: 405 N. Reo Street Suite 330 CITY: Tampa STATE: F1 PHONE (DAYTIME): 954 232-2290 FAX NO. 954-434-8840 ARCHIT/ENGINEER: A. B. Design Group, Inc ADDRESS: 1441 N. Ronald Regan Blvd. CITY: Longwood STATE: FI PHONE (DAYTIME): (_) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ZIP: 33609 Email: Permits@brownspermitting. ZIP: 32750 ZIP: 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. om N 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 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 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. SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF Broward The foregoing instrument was acknowledged before me this 2-5 day of -P-ev 20 13 , by Robert Smithwick STATE OF FLORIDA p COUNTY OF D1niWlrYA The foregoing instrument was acknowledged before me this 25�-day of F� s , 20 13 , by Michael T. Collins who is personally known X or has produced who is personally known X or has produced as identification. 4 as identification. 4L *A Signature of Notary Signature of Notary SIVAN SHACHAR Commission No. MY Cd SION #FF007026 Commission No. A` �� SIV#da4HACHAR �'`• ".?FOF.... EXPIRES April 10, 2017 MY COMMISSION #FF007026 (407) 398-0153 FloridallotaryService.com FOFrvo,; EXPIRES April 10, 2017 (407) 398.0153 FlorldallotaryService.com NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZ 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. OFFICE USE ONLY B-_ h ILK) K) ad SECTION TOWNSHIP RANGE MAP NO. ZONING ® LAND USE LOT CVG % 115.(5n TAZ NO. FLOOD ZONE. FIRM MAP # �' 0(0 IST FIR ELV MAX HGT ►� CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER I 4 + SEWER 5Ef L-1 G SPRINKLERS STORMWATER - - - LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED REPORT CODE 101 HABITABLE AREA RADON FEE PERMIT FEE LIBRARY BRACT FEE � � PUBLIC BLD IMPACTFEE CORRECTION ��� PUBIC BID IMPACT FEE I PARKS IMPACr FEE ( � GENERAL SCHO OL T FEE 1 ROAD FEE jj�� ` i 2 CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS B RPACT 4"' � DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE FEE SPECIFY MECHANIC ROOF V NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: � 1 / I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE couNTEP,. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW ► �- �� RECEIVED DATE CnWr FT�n `114' ,J' PROPERTY INFORMATION :. . .... Address:. 310.3 Nw Radcliffe Way. Owners) `. Standard Pacific Of Florida . City / State / Zip: Saint. Lucie. County, FI 34990 . Parcel #: _:.. 4425-703-0031-'000/1 .' ,'- . _ Jurisdiction: .:;SAINT Ll1CIE COUNTY; Zoning: PUD Lot#: 26 Block: APPLICATION INFORMATION Permit Number: 1403-00.80 Stories: Automatic Sprinkler System? 'No . Permit Type:. BUILDING RESIDENTIAL (SFR) CONTRACTOR INFORMATION. :Contractor Name:: Michael T Collins:Fax Number: . 813-288-7610'. . Business Name: 'Standard Pacific Of Florida Gp Inc ., Email: Tcollins@Stanpac.Com Business Addr. 405 N Reo St Ste330 City / State/ Zip: Tampa ; FI .'33609 . REVIEWS AND COMMENTS Review Type. Status aReviewed gb Date Started Date Completed Date'Released ADDRESSING ASSIGNMENT . COMPLETE Lydia Galbraith 3/13/2014 3/13/2014 Comment: DOCUMENTS MISSING PENDING ' Angela Huff 3/7/2014. 3/7/2014 .:-Comment::. RECOPDED,NOTICE OF COMMENCEMENT . 3%13/2014 Comment: MECHANICAL.SUB CONTRACTOR IS ON HOLD. 3/13/2014 Comment::.. INDIVIDUAL VEGETATION, PERMIT APPLICATION REQUIRED. PLEASE. SUBMIT AS. SOON AS POSSIBLE. . 3/14/2014 -Comment: COPY OF THE RECEIPT ,FOR PAID,UTILI.TY(WATER) FRONT COUNTER REVIEW COMPLETE Angela Huff: 3/7/2014 3/7/2014 317/2014 Comment: .. PLANS EXAMINER REVIEW INCOMPLETE Ed Roseberry 3/18/2014 3/18l2014 Comment: ,. . PLEASE. INCLUDE; SOILS REPORT, AS REFERENCED. IN PLANS._ ...... ... .... 3/1812014 .. .... Comment:_ PLEASE INCLUDE FLAME SPREAD INDEX FOR INTERIOR FINISHES.:-.' 311.8/2014 . .. Comment: PLEASE INCLUDE SMOKE DEVELOPED INDEX FOR INTERIOR FINISHES. Comment: PLEASE SUBMIT ALL FASTENER REQUIREMENTS, AND. INSTALLATION SPECS FOR ROOF TILE WITH 3/18/2014 PRODUCT:APPROVALS IN. LIEU, OF RESISTANCE MOMENT IN TABLE 4 ON SHEET D-2. DESIGN:PRES8URES ARE REQUIRED. ZONING REVIEW INCOMPLETE Lydia Galbraith 3/13/2014 3/13/2014 Comment: : THE SURVEY_ INDICATES A 2 STORY RESIDENCE;HOW.EVER, THE PLANS INDICATE A ONESTORY RESIDENCE. PLEASE PROVIDE :2:CORRECTED SURVEYS. e Q � Planning & Development Services Building &,Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL. 34982 Phone:(772)462-2172 Fax:(772)462-6443 PROPERTY INFORMATION Address: 3103 Nw Radcliffe Way City / State / Zip: Saint Lucie County, FI 34990 Parcel#: 4425-703-0031-000/1 Zoning: PUD APPLICATION INFORMATION Permit Number: 1403-0080 Permit Type: BUILDING RESIDENTIAL (SFR) CONTRACTOR INFORMATION Contractor Name: Michael T Collins Business Name: Standard Pacific Of Florida Gp Inc Business Addr: 405 N Reo St Ste 330 City / State / Zip: Tampa, FI 33609 REVIEWS AND COMMENTS Review Type Status ADDRESSING ASSIGNMENT COMPLETE Comment: DOCUMENTS MISSING 4/2/2014 Comment: ENVIRONMENTAL REVIEW Comment: FRONT COUNTER REVIEW Comment: PLANS EXAMINER REVIEW Comment: 3/18/2014 ZONING REVIEW Comment: APR 1 1 2013 REVIEW COMMENTSp,blic Works St. Lucie County, FL Page 1 Owner(s): Standard Pacific Of Florida Jurisdiction: SAINT LUCIE COUNTY Lot#: 26 Block: Stories: Automatic Sprinkler System? No Fax Number: 813-288-7610 Email: Tcollins@Stanpac.Com Reviewed By Date Started Date Completed Lydia Galbraith 3/13/2014 PENDING Angela Huff 3/7/2014 VEG PERMIT FILED UNDER (S) FOR STANDARD PACIFIC OF S FL. - NO FEE COMPLETE Ben Balcer 4/1/2014 COMPLETE Angela Huff 3/7/2014 3/7/2014 Date Released 3/13/2014 4/1/2014 3/7/2014 INCOMPLETE Ed Roseberry 3/1812014 PLEASE SUBMIT ALL FASTENER REQUIREMENTS, AND INSTALLATION SPECS FOR ROOF TILE WITH PRODUCT APPROVALS IN LIEU OF RESISTANCE MOMENT IN TABLE 4 ON SHEET D-2. DESIGN PRESSURES ARE REQUIRED. 4/2/14 DESIGN PRESSURES ARE NOT INCLUDED IN SUBMITTED PRODUCT APPROVAL. PLEASE CONVERT RESISTANCE MOMENT DATA INTO DESIGN PRESSURES. PLEASE NOTE I HAVE WAIVED, FOR ONE TIME ONLY, THE REQUIRED RE -REVIEW FEE OF 75.00 COMPLETE Lydia Galbraith 3/13/2014 3/31/2014 3/31/2014 Planning & Development Services Building & Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL. 34982 Phone"(772)462-2172 Fax:(772)462-6443 PROPERTY INFORMATION Address: 3103 Nw Radcliffe Way City-/ State / Zip: - - Saint Lucie County, FI 34990 Parcel #: 4425-703-0031-000/1 Zoning: PUD APPLICATION INFORMATION Permit Number: 1403-0080 Permit Type: BUILDING RESIDENTIAL (SFR) CONTRACTOR INFORMATION Contractor Name: Michael T Collins Business Name: Standard Pacific Of Florida Gp Inc Business Addr: 405 N Reo St Ste 330 City / State / Zip: Tampa, FI 33609 REVIEWS AND COMMENTS Review Typg Status ADDRESSING ASSIGNMENT COMPLETE Comment: DOCUMENTS MISSING 4/2/2014 Comment: ENVIRONMENTAL REVIEW Comment: FRONT COUNTER REVIEW Comment: PLANS EXAMINER REVIEW Comment: 3/18/2014 ZONING REVIEW Comment: REVIEW COMMENTS Jurisdiction: Lot#: Stories: Reviewed By Lydia Galbraith 1 Owner(s): Standard Pacific Of Florida SAINT LUCIE COUNTY 26 Block: Automatic Sprinkler System? No Fax Number: 813-288-7610 Email: Tcollins@Stanpac.Com Date Started Date Compigto 3/13/2014 PENDING I Angela Huff 3/7/2014 VEG PERMIT FILED UNDER (S) FOR STANDARD PACIFIC OF S FL. - NO FEE COMPLETE Ben Balcer 4/1/2014 COMPLETE Angela Huff 3/7/2014 3/7/2014 Date Released 3/13/2014 4/1/2014 3/7/2014 INCOMPLETE Ed Roseberry 3/18/2014 PLEASE SUBMIT ALL FASTENER REQUIREMENTS, AND INSTALLATION SPECS FOR ROOF TILE WITH PRODUCT APPROVALS IN LIEU OF RESISTANCE MOMENT IN TABLE 4 ON SHEET D-2. DESIGN PRESSURES ARE REQUIRED. 4/2/14 DESIGN PRESSURES. ARE NOT INCLUDED IN SUBMITTED PRODUCT APPROVAL. PLEASE CONVERT RESISTANCE MOMENT DATA INTO DESIGN PRESSURES. PLEASE NOTE I HAVE WAIVED, FOR ONE TIME ONLY, THE REQUIRED RE -REVIEW FEE OF 75.00 COMPLETE Lydia Galbraith 3/13/2014 3/31/2014 3/31/2014 w HAR, 3 12014 Planning BDevelopment Services REVIEW COMMENTS - ING Building B.Code Regulation Division S;. L:.,iie County, FL.. 2300 Virginia Avenue Fort Pierce, FL 34982 Phone:(772)462-2172 Fax:(M)462-6443 PROPERTY INFORMATION Address: 3103 Nw Radcliffe Way City / State / Zip: Saint Lucie County, FI 34990 Parcel #: 4425-703-0031-000/1 Zoning: PUD APPLICATION INFORMATION Permit Number: 1403-0080 Permit Type: BUILDING RESIDENTIAL (SFR) CONTRACTOR INFORMATION Contractor Name: Michael T Collins Business Name: Standard Pacific Of Florida Gp Inc Business Addr: 405 N Reo St Ste 330 City / State 1 Zip: Tampa, FI 33609 Page 1 Owner(s): Standard Pacific Of Florida Jurisdiction: SAINT LUCIE COUNTY Lot#: 26 Block: Stories: Automatic Sprinkler System? No Fax Number: 813-288-7610 Email: Tcollins@Stanpac.Com . REVIEWS AND COMMENTS Review Type Status Reviewed By Date Started Date Completed Date Released ADDRESSING ASSIGNMENT COMPLETE Lydia Galbraith 3/13/2014 3/13/2014 Comment: DOCUMENTS MISSING PENDING Angela Huff 3/7/2014 3/7/2014 Comment: RECORDED NOTICE OF COMMENCEMENT I have NOC now 3/13/2014 Comment: MECHANICAL SUB CONTRACTOR IS ON HOLD. a 3/13/2014 Comment: INDIVIDUAL VEGETATION PERMIT APPLICATION REQUIRED. PLEASE SUBMIT AS SOON AS POSSIBLE. a 3/14/2014 Comment: COPY OF THE RECEIPT FOR PAID UTILITY(WATER) FRONT COUNTER REVIEW COMPLETE Angela Huff 3l7/2014 3l7/2014 317/2014 Comment: PLANS EXAMINER REVIEW PENDING Comment: ZONING REVIEW INCOMPLETE Lydia Galbraith 3/13/2014 3/13/2014 Comment: THE SURVEY INDICATES A 2 STORY RESIDENCE, HOWEVER, THE PLANS INDICATE A ONE STORY RESIDENCE. PLEASE PROVIDE 2 CORRECTED SURVEYS. Revised. 3/13/2014 Comment T,HE APPLICATION INDICATES A 5'BEDROOMI4 BATHROQM SFR THE PLANS INDfCATE 4 t3EpR€ 13�ATHROOM.-APPL-ICATION=WILLNEED 70 BE�ADtJUSTED TO MATCH-PLANSY—`I—will'�ad�j�u.�s;t'� 3/13/2014 Comment: PLEASE BE AWARE THAT ABOVE COMMENTS ONLY REFLECTS THE ZONING REVIEW. THE PLAt\ EXAMINER MIGHT HAVE ADDITIONAL COMMENTS. JOSEPH E. SMITH, CLERK 1`111THE CIRCUIT COURT - SAINT LUCIE COUNT— FILE # 3932343 OR BOOF 10 PAGE 1903, Recorded 03/07/2014 a( 1:25 PM NOTICE OF COMMENCEMENT Permit No. Tax Follo No. 4425-703-0031-000-1 State of Florida County of St. Lucie The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the fallowing information Is provided in this Notice of Commencement. Legal Description of Property: (and street address if available): ! Riverbend (PEI 67-36) 3103 NW Radcliffe Way, Palm City FL 34990 WT 2(. General description of Improvement:_ New Construction-SFR and or Pool Owner information or Lessee information if the Lessee contracted for the improvement: Name Standard Pacific of Florida Address 825 Coral Ridge Drive Coral Springs F1 33071 Interest in property: Name and address of fee simple titleholder (if different from Owner listed above): Contractor's Name: Standard Pacific of Florida Contractor Address: 825 Coral Ridge Drive, Coral Springs F1 33071 Phone Number: 954-575-2524 Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $ Name and address: Phone number: Lender Name: Phone Number: Lender's address: Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a)7., Florida Statutes: Name: Robert Smithwick Phone Number: 954-594-0387 Address: 825 Coral Ridge Drive Coral Springs FI33071 In addition to himself or herself, Owner designates Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes. Phone number of person or entity designated by owner: to receive a copy of the Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the contractor, but will be 1 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalty of per' are that I ave read the foregoing notice of commencement and that the facts stated therein are true to the best of my knowledge b - (Signature offer or Lessee, or Owner s o� Lessee's Authorized Officer/Director/Partner/Manager Robert Smithwick- VP (Signatory's Title/Office) The foregoing instrument was acknowledged before me this 2-7 day of 4�_ , 2013, By Robert Smithwick as Officer for Standard Pacific of Florida Name of Person Type of authority (eg. officer, trustee) Party on behalf of whom Instrument was executed DMISEBROWN """ Personally known X or produced Identification (Signature of Notary Public -St �frl�.Q ^�MM(y�COO�MSM�ISSSION#EE0i)QL,- �dnhkU�o to . ra, 20t< (Print, Type, or Stamp Commiss �unaE�'Mr.� Type of Identification produced STATE 0-91 FLORWA ST. LV k COUNTY T%1 18 SAT!: CERTIFYTHATTHIS I� TRUE AMD COHRIECT COPY OF THE L`81@IINAL. PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 BUILDING PERMIT SUB -CONTRACTOR SUMMARY Standard Pacific Homes will be using the following sub -contractors for the (Company/Individual Name) project located at 3103- NW Radcliffe Way 4425-703-0031-0001 Lot 26 (Street address or Property Tax ID #) It is understood that if there is any change of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical AC Quality Electric -Gary R. Evans EC13004128 Specialized Home Electronics, Inc -Dwayne Dia 92-CLVB-338-X Plumbing Ridgeway Plumbing CFC019077 Gary Kozan HVAC/ Engineered Air CAC045860 Mechanical Dennis A. Duff Roofing �i Le) CJM Roofing CCC1327323 Stephen Mallek Gas NA OFFICE USE ONLY: PERMIT ISSUE DATE: NUMBER: PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State ofFlorida -Certification Number-( Ifappticable).= EC13004128 AC Quality Electric have agreed to be the (Company Name/Individual Name) Electrical sub -contractor for Standard Pacific (Type of Trade) (Primary Contractor) for the project located at 3(c) 3 NJ W Zaacx� V�4 Lr- 2f, (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGNATURES ARE REQUIRED �&",/<�L (_� Gary R. Evans SIGN RE PRINT NAME DATE Business Name: AC Quality Electric Address: 2307 NW 115 Ave City/State/Zip: Coral Springs, F1 33065 Phone: 954-294-0101 email: al@acqualityelectric.com OFFICE USE ONLY: PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie -County -Contractor Certification -Number:- State of Florida Certification Number (If applicable): CAC045860 Engineered Air have agreed to be the (Company Name/Individual Name) xvAC sub -contractor for (Type of Trade) Standard Pacific (Primary Contractor) for the project located at 3lu 3 N j Z� ct p e K, W c► (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) i.�� �1 {�'�,�l.s �i.ls'"..x (v �•��E�I�:`._'i t�;��r g�»I:•t��.-1 �u::l` Dennis A. Duff 1111 / 3 GNATURE PRINT NAME DYFE Business Name: GrIgineered Air Address: 2520 N. Andrews Ave Ext City/State/zip: Pompano Beach, FL 33064 Phone: 954-449-1600 email: chrisw(cD-engineeredairlc.com OFFICE USE ONLY: PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie -County- Contractor Certification Number: State of Florida Certification Number (if applicable): Ridgeway Plumbing (Company Name/Individual Name) CFC019077 have agreed to be the Plumbing sub -contractor for Standard Pacific (Type of Trade) (Primary Contractor) for the project located at 'J10 3 pj InJ � C t W ., �• 2� (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGNATURES ARE REQUIRED Gary Kozan 09/19/2013 SIGNAT PRINT NAME DATE Business Name: Ridgeway Plumbing Address: 640 Industrial Ave City/State/Zip: Boynton Beach, F1 33426 Phone: 561-732-3176 email: kathy@ridgewayplumbing.com OFFICE USE ONLY: PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: z (p (p 3 State of Florida Certification Number (ifapp eabie): CCC1327323 CJM Roofing have agreed to be the (Company Name/Individual Name) Roof ing (Type of Trade) sub -contractor for Standard Pacific (Primary Contractor) for the project located at 3 103 'fS W 2ad d, e L4J (A-1- 2. L (Project Street Address or Property Tax ID ) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: sLCCDv No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGNATURES ARE REQUIRED &A4, Stephen Mallek IOM13 SIGNATURE PRINT NAME DATE Business Name: CJM Roofing Address: 4365 Okeechobee Blvd. City/State/Zip: WPB, FL 33409 Phone: 561-722-5988 OFFICE USE ONLY: email: tamLny@cimroofing@gmail.com PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Florida Certification Number (if applicable): Specialized Home Electronics, Inc. (Company Name/Individual Name) have agreed to be the Low Voltage sub -contractor for Standard Pacific (Type of Trade) (Primary Contractor) for the project located at S10 3 NI/1 mac({' r P (� (O -- 2� (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORIGINAL SIGNATURES ARE REQUIRED URE PRINT NAME DATE Business Name: Specialized Home Electronics, Inc Address: 12940 SW 128th Street City/State/Zip: Miami, FL 3318G Phone: 305-255-4466 email: rbarker@shealarms.com OFFICE USE ONLY: 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, 3103 NUT Radcliffe Way Palm City, F1 34490 Lot 26 (Parcel Id#/Legal description/Address) 4 4 2 5- 7 0 3- 0 0 31- 0 0 0 -1 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 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. Date STATE OF FLORIDA, COUNTY OF Broward ACKNOWLEDGED BEFORE ME THIS DAY OF 2/26/14 BY Robert Smithwick WHO IS PERSONALLY KNOWN TO ME PRODU D SIGNATURE OF NOTARY PUBLIC COMMISSION NUMBER Denise Brown 20 14 OR WHO HAS AS IDENTIFICATION. TYPE OR PRINT NOTARY aszr DENISE BROWN *c *SEXY OMMISSION#EE006M :+a: EXPIRES: November4, 2014 Bonded Tbru Notary Public Underwriters SLCPDSD Revised 08/24/2010 BOARD OF COUNTY COMMISSIONERS December 18, 2012 Patrick J. Ferland, P.E. Culpepper & Terpening, Inc. 2980 South 25'h Street Fort Pierce, FL 34981 RE: Application for Stormwater Permit: Riverbend Dear Mr. Ferland: PUBLIC WORKS DEPARTMENT Water -Quality Division We have reviewed the plans, calculations and received the stormwater fee for the above referenced project. The Stormwater Permit Application for the above referenced project is hereby approved subject to the following conditions: Upon. completion of the project and prior to requesting a Final Paving and Drainage Inspection, please submit three (3) copies of signed and sealed record plans with a signed and sealed letter of completion from the project engineer. The plans must depict at a minimum the location and finished grades of all buildings and paving, critical spot elevations, pavement markings, traffic signage, the location, type, size, material and inverts of all drainage structures and the location of any stormwater management facilities. Please be advised, operators of construction activities that propose to clear, excavate or fill 1.0 acre of land or more over the life of the project are required to obtain coverage under the Florida Department of Environmental Protection's National Pollutant Discharge Elimination System "Generic Permit for Stormwater Discharge from Large and Small Construction Activities" and a St. Lucie County Vegetation Removal Permit prior to any construction activity on site. A copy of the Notice of Intent to file for coverage under this permit must be submitted to this office as required to discharge to the County's Municipal Separate Storm Sewer System (MS4). A Stormwater .Pollution Prevention Plan must be developed and implemented to be in compliance With the permit. Elements of a SWPPP include Best Management Practices that will be utilized to minimize soil erosion and sedimentation from degrading the water quality of downstream water bodies. For more information, please contact the FDEP NPDES Stormwater Section and refer to section 1-7.7 of the Code of Ordinances of St. Lucie County, Florida. If you have any questions or concerns regarding this matter, please do not hesitate to contact me directly at (772) 462-2719. Sincerely, Michael Halter, P.E. Storm Water Engineer cc: file HAStormwater Permits\ Riverbend .doc p DEC 1-j 2012 ! Culpepper &:Ter!)P!;lr; ; CHRIS DZADOVSKY, District No. I . TOD MO\VERY, District N6.2 • PAUL'A A. LEWIS, District No. 3 • FRANNIE HUTCHINSON, District No. 4 • KIM JOHNSON, District-No.`5 Faye W., Outlaw, MPA, County Administrator, ICMA-CM MO Virginia Avenue - Fort Pierce, FL. 34982-5652 - Phone (772) 462-2511 - Fax (772) 462-2363 website; www.stiucieco.org 0�4- 1 �03 -00 0� ARCE ENGINEERING STANDARD PACIFIC 6510 `i' QTY: 1 LUMBER BRACING ood % 4 S, No.2 TOP CHORD Structural rood lhealhing directly applietl or NOTES 1) Wind: ASCE 7-10: 170mph(3see gusl)Vosd-132mph: h-2011: TCDL-6.0p,f: BCOL-6.0psl: Category %: E.p C; enclosed: MWFRS (Ion -rise) Lumber DOL-1.33 DOLw1.33. This truss is designed lot C-C for members and tortes, and TC , s, except end verticals. BI 2 % 4 SP SS, B2 2 % 4 SP SS. BJ 2 % 4 SP SS 2-0-8 oc BOT CHORD Rigid ceiling directly applied or 4-4-10 ac and C-C Interior(1) tone: plate grip for MWFRS lot reactions specified. SC 2 X 4 SP Nc.3'Except' BB 2 x 4 SP No.2 We 2 X 4 SP No.3 'Except' EV2 2 X 4 SP No.2 bracing. 2) Provide adequate drainage to prevent water ponding. J This Irms hos been designed lot a 10.0 per bottom chord live load nonconcurrenl with any other live foods. OTHERS 2 % 4 SP No.3 WEBS 1 Row at midpl 5-12 OTHER L.II 2 X 4 SP No.3 2-4-1 4 Ali plot.! ore ASZO ploles u.I... othef . indicated. Bearing at joint(s) 2, 22 considers paraDel to grain value using ANSI/TPI 1 angle to grain le -la. Building designer 1 - my REACTIONS (Ib/site) 2:1276/o-S-O. 22-1113/0-6-0 .91 should verily anical cty al beodny another 6) Provide mechanical connection (by others) of truss to scoring plate capable of withstanding 488 le uplift of joint 2 and Mo. Hart 2�214(LC 4) Mo. Uplift 2.-48B(LC 4), 22--371(LC 4) 371 It, uplift at joint 22. FORCES (Ib) -Maximum Compression/Maximum Tension TOP CHORD 1-2-i0/22.2-J�-3465/1278,J-4.-3357/1280,4-5w-5346/2193.5-6--2809/1189,6-7.-2177/981, 7-8--2177/981, LOAD CASES) Standard 2:-1I1J/502. 09"-9IO-6/502J SOT CHORD9-214/-3-134/31B7.12- -12.-1192/2670,10-11-1192/2670, 9-10-67/150 WEBS 4-14.-739/J39, 4-13w-989/2176. 5-13--280/863. 5-12--2257/975, 6-12w-103/500, B-10--979/2171. 7-10.-318/367, 6-10�-527/234 Lo 4x9 = A lx4 )I 7 l x4 II 5xUAsFW 1 x4 II 3x4 z.os3i�'' 3-2-0 +4-2-Q 9-0-0 3-2-0 1-0-0 4-10-0 13-0-0 4-0-0 16-10-0 17-10;0 20-10-0 3-,10-0 1-0-0 3-0-0 -H�,J y rYL o iZ7't>J ± 7 1. TYPE: C12 PLATE: SIMPSON STRONG TIE FURNISH A COPY OF THIS TRUSS DESIGN TO F t C NTRACTOR SEALING OF TRUSS DESIGN BASED UPON THESE DESIGN CRITERIA: 653M Grade A better ��'L ` i /%j , r T T os9 v�1(LU-o.i91'7=1u V>e4E a, PLATES GRIP 6c o.n vwl n -ose a-u a7ee 74o As2o Z46/195 I. Connector tales ore fabric from 20 ou a ASTM A653 or p 9 9 hot slgel. ..� • �f we 0.79 Ha. tt a.2D 77 /e /a ASt&1 246/195 (Mmd4 wmaK8 D.35 17-u aio3 2.0 -dipped alvamzed 2. Connector pules are applied to both laces of (russ al each 'oin .Where dimensions arp not hepwn, plates are symmetrically placed odou� joint or as �o). , .,• i t. �{ i •' + I i d!�'.t`GyJ;'' i LOADING DATE: Feb 2012 CRITERIA: ANSI TPI 1-2607(MATRIX)Version: SOUTHERN indicated by arcles 3. Ilin qnd fabric, Ion shall be act mollshed using equipment producing snug ` (i lingonlsgndluIlyembedded la�es. ,�`-i v' i rG�� �_ 10.2d TRUSS 4. UnlBss otherwise noted, compres�ion top chord to be conlinuously braced by the _ 001 sheathing. - 5. To sheathing. ermanenl structural restrainl shown i to revent buckling of individual truss ,.'•��' (� +y ILI G -a- TCLL 30.0 Pal.sNlncnare Z 00 33 COMPANIES me7�ber and Is no inlendetl a a bracing psan for the tool structure or as a plan for the of the roof to the building. _ )- : < _ TCDL 15.0 Lamb.rincreoe. BOLL 0.0 R.P 51,...In,, YES atlachmen� CAUTION: (n !� _ BCDL 10.0 Cod. FBC2010/TPIZ0a7 2590N.Kin Kings IIwB 6 Highway Fort Pierce, FI. 34951 Trus es pa a don erou and a copse dam, a and firsonal 'n f iLT]Af I handed Insiolled 9V� .r t and g racing sh wngon lnIs r�rowipqq is�4 11 •', BRACING. Refer to the Truss Plate Institute TPI) publication 6C51 2008 BUILDING l�L ,••v (772)464-4IG0 Fax:(772)315-0015 COMPONENT SAFETY INFORMATION. Gul a IIo good ractice for handling installing 4IjneloI plate connec led wood lr sse s. TPI I 199 practice Z18 Ncrib teej Slrpeel 610 E-mall: , F � UQ Su1te 312, Alexandria VA ?2314, 1pele hone: (/OSf b03- in o®t Ins(.or g Read all manufacture s WARNINGS enclosed with drawit ocka e. 305 521 NW Enterprise Drive o Port St. Lucie, Florida 34986 08: F3 V a.m. 05-27-2014 1 /1 (772) 924-3575 a (772) 924-3580 (fax) IN -PLACE DENSITY AND WATER CONTENT[' OF SOIL AND SOIL AGGREGATE BY NUCLEAR METHODS (SHALLOW DEPTH) - ASTM 6938 Project: Riverbend_ Project ID: 13-0183.00 Address: St. Lucie County, Florida Report ID:_ D-0109 Client: Standard_Pacific Homes, South Florida _ Date: 5/23/2014 Permit Now (jField Tech: Daniel Decaro Test Mode: Direct Transmission Area Tested: Lot No. 26 - Foundation Pad _ Soil Description: Tan fine sand, trace roots Proctor / LBR ID: P-0001 Max Density (PCF): 106.0 Opt Moisture (%): 12.5% Test Standard: -i-180 Compaction Required (%): 95.0%^ Probe Depth (in) Elev Wet Density (PCF) Dry Density (PCF) Moist. (%) Compaction Location ° Results Lot No. 26 - Northeast 12 0-1 117.1 105.3 11.2% 99.3% Pass Lot No. 26 - Center 12 0-1 117.7 105.6 11.5% 99.6% Pass Lot No. 26 - Southwest 12 0-1 116.5 104.9 11.1 % 99.0% Pass Testing Gauge Information: Manufacturer: Troxler Model: Density Standard (DS): 2173 Remarks: Testing Completed Below Slab Grade -egend for Elevation: 'R = Proofroll 3L = Springline 3G = Subgrade 3C = Basecourse TOP = Top of Pipe 1, 2, 3 =1st, 2nd, 3rd Lift FL = Final Lift BG = Below Grade BOF = Bottom of Footing FG = Finished Grade 3430 r S/N: 34784 Moisture Standard (MS): 609 CEIVED MAY 27 2014 2 y rest report shall not be reproduced, except in full, without the written approval of GFA International ota[e-v Environmental . Geotechnical . Construction Materials Testing • Special and Threshold Inspections • Plan Florida's Leading Engineering Source www.teamgfa.com �tedr. ve :i " abOnc. 0�` � :w �Vl /11-0 -5 - OD �C.' ` Pre- ConstructionV "UILIEWWTermite Treatment scrv:ccs 7670 Okeechobee Blvd., West Palm Beach, FI. 33411 Phone: 1-800-285-7378 Fax: 561-684-0122 Property Information Builder/Contractor Treatment Date S' a?o2 Time'�� Lot al( Block Name of Builder Subdivision Name Shell Contractor p � Street Address (If known) Construction Type /. _'-G7Monolithic []Floating/Stemwall OPatio City State Zip DEntry ODriveway 00ther: Owner's Name (If known) Product/Treatment Information Treatment Type: Underslab ❑ Patio/Driveway/Entry ❑ Final ❑ Wood Treatment ❑ Bait System ❑ Other Product: ❑ Di.sodium Octaborate ❑ Cypermethrin Imidacloprid Bifenthrin ❑ Permethrin \ ,.❑,, Other: Concentration , / Mixed Product Applied �07 Square Feet Treated `1//91 Linear Feet Treated 0 If this box is checked, then Final Perimeter treatment has been completed and the following statement is applicable: Certificate of Compliance: This building has received a complete treatment for the prevention of subterranean termites. This treatment is in accordance with the -laws and rules established by the Florida Department of Agriculture and Consumer Services. Applicator's Name (please print) Applicator's Signature HES-TE019 02/14 Hulett Environmental Services© 2014 Pre -Construction HUL.ETT Termite Treatment cnvironroental scrv:ccs 7670 Okeechobee Blvd., West Palm Beach, FI. 33411 Phone: 1-800-285-7378 Fax: 561-684-0122 Property Information Treatment Date 12 1L Time f oU Lot Subdivision Name Street Address (If known) Block City State Zip Owner's Name (If known) Builder/Contractor - Name of Builder Shell Contractor Construction Type Monolithic Floating/Stemwall OPatio OEntry ODriveway OOther: Product/Treatment Information Treatment Type: ❑ Underslab 13 Wood Treatment Product: ❑ Djsodium Octaborate O Imidacloprid 13 Permethrin Concentration . ry S — Square Feet Treated 13 Patio/Driveway/Entry EIT—inal Bait System ❑ Other ❑ Cypermethrin Bifenthrin ❑ Other: Mixed Product Applied Linear Feet Treated 26 0-- f this box is checked, then Final Perimeter treatment has been completed and the following statement is applicable: Certificate of Compliance: This building has received a complete treatment for the prevention of subterranean termites. This treatment is in accordance with the laws and rules established by the Florida Department of Agriculture and Consumer Services. Applicator's Name (please print) Applicato lgnature HES-TE019 06/13 Hulett Environmental Services© 2013 i SM C�t[i�et0� S� ybL`1.Ztat 3 Gale Insulation INSULATION INSTALLATION CERTIFICATE BUILDER:ad- -SUBDIVISION JOB ADDRESS: 3103 .vim CITY:. f Ct i »1 C i 4t PERMIT #: _ J V o 43 - o o 8o LOT/BLOCK: a. The undersigned hereby certifies that insulation has been installed in the above described property as follows: 1. Exterior CBS walls has been insulated with rg,41 c g e to a thickness of . 7 5 inches; which according to F , - ; I Cm rn pQA V will yield an "W' value of y. r Exterior frame walls has been insulated with to a thickness of inches, which according to will yield an "R" value of 2. Ceilings (flat) has been insulated with;l, J�Ar,,T4 s s 6 �1- �to a thickness of t a inches, which according to Du Cp r,t ,j will yield an 'W'value of 3 % Ceilings (vaulted) has been insulated with to a thickness of inches, which according to will yield an " W' value of 3. _ Interior knee walls has been insulated with to ;a thickness of inches, which according to will yield an "W' value of 4. Garage Partition walls adjacent to conditioned living space has been insulated with to a thickness of 3 . s' inches, which according to Owc..s C6;-11 n ti will yield an "W' value of it General Contractor/Builder Signature - TH FFIANT �L(&—IS PERSONA LLYANOW of�20. L_. Trisulation doitractors Signature License # CGC1512179 ME Sworn to and subscribed before me this �� day Notary Public, State of Florida 4 0 ;._dA A Z �J I . It--- f�o; 1601--A CROSSROADS PARKWAY • FT. PIERCE, Fl. L FT. PIERCE (77z) 46S-9191 • VERO BEACH (772) 589-1S14 • STUART TOLL FREE (866) 6194456 •. FAX (772) 489-67S$ JENNIFER SWEET Notary Public - State of Florida My Comm. Expires Jan 29. 2017 Commission * EE 069683 RECEIVED W 09•?n14 PlaMingA DaVelopMent 5gr*88 SUR4100:00is HeraWbil 01*10" 2300 A"raln[A Ave .0" 498 NOW. ,,IF 8 2 . . . . . . . . . .... 772-02-2110: Aix M-462-640 - R far.".80jq) -4wit sy. e"*raiy—pOiwRqlqOme 6 PatmW Widen -3 OgO Pic operWAddmist A)--LJ, -AL LI Oc -PA-1 M, A., MWOD N COTT0004P TOMW(SQ) DAVA, $W* PUME OF TOM SVMW AND 9QUIPMENrl KVRiOA I$pOOM V4WM$jbM HER06.. AVQ"-OFA?PROVALQF!MhWOW'. WE. At -AORM MOW other-fth that petwWO jn*jjnjj-tau&$" Odev, whichWhi q..' . r ancOs a. All conoltions %ftchgo document *0"0RReqqlrfiMentsf0r30Day 4 VEGETATI PERMIT AMENDED Permit#:20121219 Fee: $4,700.00 (already paid) Date Issued: 2/6/13 Property Owner: Standard Pacific of Florida, a Florida General Partnership c/o Michael DeBock Date Expires: Upon completion of work, or 2/6114, whichever occurs first. Contractor: TBD" (see disclosure statement on page 4 of application form) Parcel ID#:.. 4425'=343=0002=0005`4425-341=0001=0002; 4425-313 0003-0009 Project Location:.:.2900:Turnabout Lane,, Property Size!,. 53.81 aces Protect Description Applicant requests vegetation removal for construction of 47 plot single family subdivision 'per Resolution No;12 1,20'and nature (trail (as shgwrr on attached plans): Field Notes: 1. HABITAT :,*' - a. Up nd live oak :;(:9 8 acres) Upland scrub, pine and hardwoods (8 i1 acres) disturbed lands (15,7 acres) b' 'Wetlands r [3ay swamp (2 3 acres)jFreshWater.marst (0 7 _acres),Wet prairie (0.1 acres) — all we -ds,onsite to be preserved - 2. WILDLIFE; . 42 Gopher tortoises (perrnitted for relocation per FWCC Permit N.q: GTC-12- 00144 3. SIGNIFICANT ARCHAEOLOGICAL OR HISTORIC FINDINGS: None identified. Permit #20121219 Authorizes the following: According to St. Lucie County Land Development Regulations (Chapter 6.00.04) this project qualifies for a Vegetation Removal Permit. The following vegetation has been identified for removal: Phase I — Limited clearing for access to remove gopher tortoises and install protective barricades only. Clearing shall be limited to a path not to exceed ten feet in width. Preserve areas shall be clearly marked with flagging prior to any clearing activities. No clearing within the designated preserve areas is permitted. Phase II- Clearing of lots and roadways per the approved site plan. No clearing within the designated preserve areas is permitted exempt nature trail as shown on attached exhibit. Specific Permit Conditions: The property has native vegetation not authorized for removal. Areas outside of the development footprint outlined in 1 through 5 above shall be considered preservation/protection areas (Land Development Code Section 6.00.05.A.2). A conspicuous protective. barrier shall. be .placed and maintained around . the perimeter of protected area(s) of vegetation to form a continuous boundary as specified in the General Conditions of Issuance section. General Conditions of Issuance: • The following minimum standards for vegetation protection shall be applied to areas of vegetation designated to be preserved: ■ At a minimum distance of either ten (10) feet from the edge of groups of- protected vegetation or from the radius of the dripline from all protected trees, whichever is greater; ■ Protective barriers or protective designations shall remain in place until removal is authorized by SLC ERD, or until issuance of a certificate of occupancy; ■ In the event that any protective barriers are removed or altered and clearing activities are conducted within an area identified for preserve, SLC ERD is authorized to direct that all land clearing and site alteration work at the site be stopped until the barriers are restored and any necessary corrective actions taken to repair or replant any vegetation removed or damaged as a -result of these encroachments: _ • The preserve -'areas -and' -tree preservation areas shall 'be maintained in. their natural. state, so as not to -alter the, -water. and oxygen content of the. -soil .and impair;its function; • No grade changes or excaiation`of any,sort may be made within the barricaded areas; • If any excavation or other -activities :are:,expect , outside of the prdser-ve.,0r0a or dripline, the roots should first be',p'rbned..(to theydgpth of -,required excavation') to sever;fihem cleanly; • If underground ;utilities must be routed -through a,protected. root zone area; aunnehng under the roots shall tie+,required, • If irrigation most -be 7 ust be` installed, j it Ball be installed: -outside of the dripline of all `preserve areas and protected trees, • No fill material, construction;°r69terial,,`.conc,�ete, paint, ch6micals, -Or other foreign, materials shall be stored, deposited or disposed'_of within ;a vegetation preservation _area;- • No signs, permits,_ wires, or other _attachments_ shall.:be:: affixed :.or attached ..to protected vegetation; - • No equipment, including passenger vehicles, shall be driven, parked, or stored or repaired within designated vegetation preservation areas. PLEASE BE ADVISED THAT. . ANY- NATIVE VEGETATION DESTROYED OR DAMAGED OUTSIDE OF THE LIMITS ..OF CLEARING DUE TO CONSTRUCTION ACTIVITIES OR FILL PLACEMENT SHALL BE MITIGATED AT A RATIO OF 4:1 (4 INCHES OF REPLANTING FOR EACH INCH DESTROYED OR DAMAGED). Post Clearinq Requirements: 1. Mitigation: Mitigation requirements are to be met through onsite habitat setaside. PLEASE NOTE: • THIS IS NOT AN AUTHORIZATION TO PLACE FILL ON OR RE -GRADE PROPERTY. • PLEASE CONTACT A PROFESSIONAL SURVEYOR TO DETERMINE IF YOUR PROPERTY IS AFFECTED BY OR LIES WITHIN A FLOODPLAIN. g • THE APPLICANT SHALL KEEP THIS EXEMPTION POSTED ON -SITE AT ALL TIMES DURING LAND CLEARING. • THE PROPERTY OWNER AND/OR AGENT SHALL BE RESPONSIBLE FOR OBTAINING ALL APPLICABLE STATE AND/OR FEDERAL PERMITS. 5a s, Jf`, i6ty;w0oneKtal Alaoyew i3 `� '{' ♦ q r 4YH ` '$F� - . r"t\ i\ 6 i/ '.' /"' Y A y 1 Y !� 'P,� / " PRESERVE SIGN DETAIL F . mon 11• , : I C t t ,-., rS '�,�� r e` rF FV n ii� a�': i f.., � �� r�•, ?�� � ,�MF � � ,�d � _ PRESERVE AREA-d�,..�,��F'�.••.�'�� i �-L�..P�'�` • Aj��C(- O�fNSNE'7G�74Q�f-.'l:2.�r�.\x. �\;,:••�J,''R�ri . �' /� r.. r, yyI � *w-: i � z'._;�:ti+ t ",t } .i\ i�„j•$YN. 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It� `t'- i � f �f� ST LUC7E•'COIFtTY p 9. r+7 �1, h , ,-NADtE PRESYRVE4e� y x 1 ,F - t `•..-4 ,yYW .a.j°' W,.��,--y.,° �� c «y aa-,.. �, :.t`� 1 t f� ;•'fit -y,„ a i ULPPER RIVERBEND - HIDDEN POND TRAIL i +o PEwo cxu: S TERPENING, INC Gcrmud a-nrs (PRELIMINARY) UATE: r.A.11 5„I<,-_.� of All Star Pavers, Inc 4839 SW 148th Ave Box 259 Davie, FL 33330 (954)270-3178 tslack38@yahoo.com http://www.alistarpavers.com Bill To Denise Brown 19434 sw 60th ct Fort Lauderdale, FI 33332 Date Invoice No. 09/26/2013 2624 I1®e Date 10/01/2013 J Amountllue Enclosed $2,184.44 Please detach top portion and retum with your payment_ _ _ _ _ _ _ _ Description Quantity Uniicost Amount ° Removal and proper disposal of sod and dirt 628 0.95 596.60 ° Concrete pavers and installation 628 4.28 2,687.84 Color - TBD i Shape - TBD (all standard shapes) j Pattern - TBD j 0.00 0.00 ° Included in this proposal is the material, labor, 1" bedding sand, 1 ! 0.00 0.00 finishing sand, cement for borders, clean up, tax and delivery costs ° 33% upon acceptance 1 0.00 0.00 i 33% upon material arrival Balance upon completion ° When mixing thick and thin or old and new pavers, there WILL be a 1 0.00 0.00 color difference ° If required; Actual permit fees and filing costs will be added to the final 1 0.00 0.00 invoice. ° All Star Pavers, Inc, is not responsible for sprinklers, electrical, 1 0.00 0.00 plumbing and/or utility lines that may break during the excavation and installation process. All best practices will be followed to avoid any service interruption. Minor cracks and scrapes are expected and the responsibility of the homeowner. � I I` — Thank You for your business. Total i $3,284.441 Deposit $1,100.00 1 salnnce Due $Z;184:44 Proudly acceptinq Visa, Mastercard & Discover FAX # 866.499.2908 We also offer a 6 month same as cash payment option two Z Q Z-L Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Project Code: Project Name: Project P.O. Number. Ticket Date: elivery Address: Delivery Instructions Order Code / Date: 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 ] 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 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 INVOICE This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quotatii any, and Seller's Order Confirmation (i` a ding limitations of warranties), as if fully set forth on this Delivery Ticket ("Agree__ -__it"). Seller will provide the Standard Teri id 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 PRG)'JC�S / 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 anunonia can cause coughing and irritation or burs 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 aplicacion de eredito); cualquier termino estandar, condiciones del vendedor. propuestas del vendedor y orden de confirmation del vendedor (con limitations y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terrninos 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 e.1 m.i:smo. Acepta pagan el .monto de acuerdo al contacto; al 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, dolomita, granito, rocs volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albauilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cemento 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 mas de 0.025% de silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la zona respirato.ria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation puede contener materiales silicos, Jos 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toner, irritacion o quemad.uras en ]a nariz, garganta y pulmones. Acudir inmediatamente al. medico. El riesgo en la salud depende en la duration y el nivel de la exposition. Seguridad: Evite el, contacto con ojos y contacto prolongado con la pie]. Use guantes, p.rotecc.i6n en los ojos y ropa Primeros adecuada para protection. Ldvese las manos con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos mas de los limites recomendados, use protection respiratoria. Pr..imeros aux..ilios: En caso de contacto en los ojos, inmediatamente fluya agua en .la parte afectada por 1.5 minutos. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atencion medica inmediatamente si ]a irritacion continua. CEMEX. Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas information visita www.cemexusa.com. V'3'1i�3-cbgd 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: a 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 QUANTITY CQUAUMULAN IITYE QUANTED ITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT 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 control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling infoo.4gon, 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. 1 6BUNIVERSAL=t ' INVOICE This. Delivery Ticket incorporates her—, by reference Buyer's previously execute ' ",,edit Application, if. any, Seller's Standard Terms and Conditions, Seller's Quota if any, and Seller's Order Confirmation luding 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, 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. I:f 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 inctuye como referencia al comprador (ya previamente ejecutada en su aplicacion de credito); cualquier teimino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confirmation 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 mencionad.os y que ]as cantidades y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contacto; al 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, dolomita, granito, roca volcdnica, arena, grava y otros materiales silicios. Los productos de cemento incluyen 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 corno piedra caliza, dolomita, granito, roca volcdnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mds de 0.025% de silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y reactions alergicas en .la piel. Concreto seco y polvo de agregados, pueden causar irritation en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar ]a liberation del amoniaco. La i_nhalacion del amoniaco puede causar toser, irritacion o quemaduras en 1a nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo on la salud depende en. la duration y el nivel de la exposition. Seguridad: Evite et contacto con ojos y contacto prolongado con la piel. Use guantes, proteccion en los ojos y ropa Primeros adecuada para. proteccion. Lavese las manor con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos mds de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la paste afectada por 15 minutos. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ]dvelos a fondo con agua. Acuda a atencion mediea inmediatamente si la irritacion continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 coinbinado Houston, Texas 77024 02/12 Para mas information visita www.cemexusa.com. r A#kcC—MC—.X �a2,y�..o,,r Plant: Begin Loading: To Job: Arrive Job: Start Unload: I Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: ':f-_:i.aW. C,}..i�._. 'It`,._l:I',: `_•i�.t.''.t.lf..-. .. '•1.�..`':` .l�. -_ Project Code: Project Name: Project P.O. Number: Ticket Date: Delivery Address: Delivery Instructions: Order Code / Date: Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: r DriveName: End Use: . r. - t� -„ , I 'ti is .. _ .. _�. _.•.1 .. S_1'.1 t^�i' •1" L. 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 ] Check Without Standby Charges: Charge Comments: WATER ADDED: 'GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: ' SI glh ^} aterial ❑ LOAD WAS TESTED BY:/// �/ ;4�onant t� Notice: Our drivers will make every effort to place matenals where the customer designates, but the SPECIAL TERMS: Any water added is at customers own risk. If water is addedgibn• 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 irrity' 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 backsir+' / control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling information, and to the materia'Isafety data sheets for addir'' 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 D'.'y; '�', , : ; i; INVOICE ,"Delivery Ticket incorporates 'herein by reference Buyer', ��i: v: usly e,:ecut `-'redit Application, if any, Seller's Standard / s and Conditions, Seller's Quo , if any, and Seller's Ord-, 1 •nz,rn}allon-luding limitations of warranties), as if f-ally 1 ! forth on this Delivery Ticket ("Ag , ti,,aent"). Seller will provide th( :tan, ;+;1 Terms and Conditions upon request. Buyer agrees ppat, unless other,•, ise noted on the front hereof, all quantities and items : �erc d:;livered as indicated and further expressly agrees to ray in accord. r,-� with the Agreement. y _ ' GGREGATE / 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 incl.uye como referencia al comprador (ya previ.amente ejecutada en su aplicaci6n de credito); cualquier termino estdndar, 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 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 canti.dades y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al Contrato; al 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, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albahilerfa, 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, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener inns de 0.025% de silicio cristalino. 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 irritaci6n en los ojos, piel 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 inbalados. En caso de ser ingeridos, mantenerse en temperatura calida, reposar y tomar grander cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemadaras 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: Eviite el contacto con ojos y contacto p.rolongado con la piel. Use guantes, protecci6n en los ojos y ropa / os adecuada para protecci6n. Lavese ]as manos con jab6n suave y agua despucs del manejo de materiales. Evite inhalar polvos. Si se expone a polvos rods de. los limites recomendados, use protecci6n respiratoria. *' Primeros auxilios: Era caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por .1.5 minutos. i se inhala.polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con ua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 02 12 ado ' 929 Gessner, Suite 1.900 Houston, Texas 77024 - Para mas informaci6n visita www.cemexusa.corn. ZEMEX 1 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: OrderP.O. Number: Ticket Date: Delivery Address: (l 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 _'�1 UOM UNIT PRICE AMOUNT QUANTITY QUANTITY, QUANTITY Cash Check # /Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge Comments: �� i WATER ADDED-Z// `w'� GAL YARDS IN DRUM: rr ' WHEN ADDED. e SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE 4 ❑ LOAD WAS TESTED BY: Notice: Our drivers will make every effort to pKe maaterialsrwhere 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 curbsor 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.'— ' � r 68UNIVERSAL INVOICE This Delivery Ticket .incorporates her( ' ')y reference Buyer's previously execute(' ~ -.dit Application, .if any, Seller's Standard Terms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation ( ading 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 i.n. 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 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 comp referencia at comprador (ya previamente ejecutada en su aplicacion de credito); cualquier termino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confinnacion del vendedor (coil limitaciones y garantfas), Como acuerdo total del ticket de entrega ("Contrato"). E.1 vendedor proveerd los terminos estdndares 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 pagar el monto de acuerdo at contacto; at manos que se identi- fique con una nota at frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP). azulejo de azotea y estuco. Los productos de concreto incluven 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 cual puede contener mas de 0.025% de silicio cristalino. Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritacion en los Ojos, quemaduras en piel y ojos, y reacciones alergicas en la pie]. Concreto seco y polvo de agregados, pueden causar irritation en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation puede contener materiales silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura cdlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad° La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritacion o ° quemaduras en ]a nariz, garganta y pulmones. Acudir inmediatamente at medico. El riesgo en la salud depende en la duration y el nivel de la exposition. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, proteccion en los ojos y ropa Primeros adecuada para proteccion. Ldvese ]as manos con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios° polvos. Si se expone a polvos mas de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente tluya agua en la pane afectada por 15 minutos. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ldvelos a fordo con agua. Acuda a atencion medica inmediatamente si la irritacion continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para .mds information visita www.cemexusa.com. - ' I � `�y`=��ZZC G M C- X Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: �me:l'.._!. I_ I Project Code: 1 Project N 1 _-._. -_�.-- ._ `�` Project P.O. Number: Da"fe' i .! 1 ._ 1�'. . '.-.4}j ;'1! if -1 i ��<.} l 1—d�: :1��'!_. _ ._ • t':.: Ticket Delivery1 Address., Delivery' instructions:T. f/ Order Code / Date: Order P.O. Number: Map Page- Map/Row /Column: Dispatcher: Ticket Number:: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: " Ca! � �:5 t-c' i'1f t 'i 1"9f ir-.:-, �:. 4 f'1 r-tf"Pr"1� 6.1 1 I 1 I i_}t.i §-i rr'1_t"'. i--+.: 6µ{ �I-�1 ;.i_,I 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 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 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 17,1- 1 ! ' ] .1 :'„t. °L,_. <s INVOICE :..:. ..T., This Delivery Ticket incorporates herein by reference Buyer's previously execut-d Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quot; i, if any, and Seller's Order Confirmador ;luding limitations of warranties), as if fully set forth on this Delivery Ticket ("Ag..,. Gent"). Seller will provide the Standard Tc;„,,s 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, 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, vol.cani.c rock, sand, gravel., and other siliceous materials. These products, including fly ash, may Lontain 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 at comprador (ya previamente ejecutada en su aplicac.ion de credito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmation 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 pagar el monto de acuerdo al contrato; al 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, dolomita, granito, rocs volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen 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, grava, 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 cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y reacci.ones alergicas en la pie]. Concreto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation 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. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la liberation del amoniaco. La inhal.acion del amoniaco puede causar toser, irritacion o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. Et riesgo en la salud depende en la duration y el nivel de la exposition. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, proteccion en los ojos y ropa Primeros adecuada para proteccion. Ldvese las manos con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos. Si se inhala polvo, expongase a afire fresco. Si el cemento fresco tiene contacto con sus ojos, ldvelos a fondo con agua. Acuda a atencion medica inmediatamente si la irritacion continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mds information visita www.cemexusa.com. L4zzccmGX tad t , 2296 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: ,5,r,• +qa� E; t_..[.. ,._ sue• f. CE,;:..1^Cti..-:, j It'_._ tl..h —• Y' ` i i 1°4j..f f , Project Code: Project Name: 3 p•7I- T t"! .-..i e;.l,+ i ,, Ticket Date: Delivery Address: �-`�,� ��'�:3 .. �; �.r? i _G:?tea � � f:'•1 i=..S•;=;�'-4`,�^i Delivery Instructions: . 4 «j..� Sy i; _t. i"_`-_= 4Jt v.� ? 54��: [P'. r._•G.9+. ,I `t —..4 `I!`Ie:. Customer Job Number: Project P.O. Number. Order Code / Date: Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: _ .� o r �, e � i _ + t"•+.:. •.'.�: � t�• _f:. e.;_ �i N' t`I. T t.,i I LI_.I lt'); .f_•." f!•.t:7 : `* {- i=1�•: LOAD CUMULATIVE I ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY ?.fin 5 I_� i � 50 ! a: z r _'3 i •i rN.. •.., r.: , i_f i'� ' _' i''[ ('; !, � �-•I'_�3 w,.�= !i;;•i �:i �i,.Ji'-:`_ � �lf�(.-""s—i�.l•��,i�L. f =i i `i;.z. i'.? _f r L (.: i -I I, ti c Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: Check Charge Comments: •/ ,f WATER ADDED GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: --vim ❑ 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 you safety nd 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 tolthe mat al safety data sheets for additional information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in wriLg AUTHORIZED SIGNATURE: within one business day after the receipt of materials. n—=--; --,, 1 68UNIVERSAL aI ' 'I"5 r,?'•.}C_'i��'•' INVOICE 1 t�C ! t,i �{•, , This Delivery Ticket incorporates ho.-a;,i by reference Buyer's previously execu ' Credit Application, if any. Seller's Standard Terms and Conditions, Seller's Quo n, if any, and Seller's Order Confirmatic tcluding 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, 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 entrega incluye Como referencia al. comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier termino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confinnaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terminos estdndares y condiciones detal- Iados 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 e] mismo. Acepta pagan el mont0 de acuerdo al contaato; al 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, dolonuta, granito, roca volcdnica, arena, Brava y otros materiales silicios. Los productos de cemento incluyen 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, roca volcdnica, arena, grava, y otros materiales silicios. Estos productos .incluyen cenizas volantes (fly ash) .la coal puede contener rods de 0.025% de silicio cristalino. Peligros: Mezcla de cemento fresco y/6 cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n puede contener materiales siliccos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura cdlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritacion 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 piel. Use gumtes, protecc.i6n en los ojos y ropa Primeros adecuada para proteccion. Ldvese las menos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos rinds de los limites recomendados, use protecc16n. respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por ] 5 minutos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ]dvelos a fondo con agua. Acuda a atenci6n mddica inmediatamente si la irritacion continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1.900 V7 combinado Houston, Texas 77024 02/12 Para mds informaci6n visita www.cemexusa.com. 000 zZa r'lEMEX 5Its, ,tee 22SK2 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: C ID � k! -S T,,� LI C Ii 3 E R V S J,- C'O NIS' j L T R, N T" L Project Code: Project Name: 7-5 !'l ' I9 ' T, Ticket Date: Delivery Address: Delivery Instructions: T D `3 "1. L n': 7 Customer Job Number: Project P.O. Number. Order Code / Date: 4 7 Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Y, F, Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: G 3 1. 9 A 0 T Dt=W�y- HOR'N - pl 2Dt,-'6!'K- L LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION --Fuo—m— UNIT PRICE AMOUNT QUANTITY I QUANTITY QUANTITY I �.55 0 RED (5 --1 I;=- L Tf- RGNNE.!\ Cash Check# I Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge Comments: ATER ADDED: GAL YARDS IN DRUM: SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE LI 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. 68UNIVERSAL 1:71 R E 11 .I RI I I C',C) I CH., 1� 3, INVOICE This Delivery Ticket .incorporates h i by reference Buyer's previously execu -redit Application, if any, Seller's Standard Terms and Conditions, Seller's Quoi _ a, if any, and Seller's Order Confirmatio.. ...cluding 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. >t Fes.: 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 contrffl 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 entrega incluye Como referencia al comprador (ya previamente ejecutada en su aplicaci6n 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 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 pagar el monto de acuerdo al contacto; al 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, dolomita, granito, 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 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 cristalino. Peligros: Mezcla de cemento 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 polvo de agregados, pueden causar irritaci6n en los ojos, piel ,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 canticlacles de agua. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci& del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en la duraci611 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. Lavese ]as manos con jab6n suave y agua despues del manejo de materiales. Evite inhalar auxilios' polvos. Si se expone a polvos mas de Jos limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la paste afectada por 15 minutes. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ]avelos a fondo con agua. Acuda a atenei6n m.6dica inmediatamente si la irritaci6n continua. CEMEX. Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www.cemexusa.com. Aio,camax Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: ...ta7�r' "J1RU.'_ 191°. n: CC.0_iR.I>I i S Project Code: Project Name: ,.°�'J�:.._.t�w'..F ..1f_t..'....:-'ji.._ ,1�_ ,k: i�,l�'frj,».4i,,f `t•.,_!i`:i_� _. Ticket Date: Delivery Address: Delivery Instructions: �...w:, l � i.3Sv S.� @. i. .�� i)•fn ,". _. _.. 4,_jt"� I f E � £:'i`I'7�-a.i?� }6 ��I �.._�'^il :l;.'. Customer Job Number: Project P.O. Number. Order Code / Date: Order P.O. Number. t ,'y Map Page: Map/Row/Column: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: f.�f `� ,c.)c (' -Y }_t)'sC ;•..�ti �. kt_a`_i�•'G:.:r ir'.7�CE�7 �'{ji"11�'M ,lif.._A�('`t>.: �iL.I"-:131 LOAD CUMULATIVE ORDERED QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT Z:'s i-'(`4*�."?-` _a`j V I R ( 3t:d',9 :f' -:L CHQ,,R�G'_71 t 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. CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: ❑ LOAD WAS TESTED BY SIGNATURE SIGNATURE 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. O 68UNIVERSAL PRE V T !rti'. - :i. ',-)C,25756 LO":)i� 1'•t�_i{'/I - 4 INVOICE This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quo" n, if any, and Seller's Order Confirmatic . [eluding limitations of warranties), as if fully set forth on this Delivery Ticket ("A men!!'). Seller will provide the Standard'. [s 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, 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 cC�ain 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 entrega incluye comp referencia at comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier teimino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terminos estdndares 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 pagar el monto de acuerdo al contrato; al 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, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen 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, roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) ]a cual puede contener mas de 0.025% de silicio cristallno. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritation en los Ojos, quemaduras en piel y ojos, y reacciones alergicas en .la piel. Concreto seco y polvo de agregados, pueden causar irritation en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritation o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en Ia 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 proteccion. Lavese ]as 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 proteccion respiratoria. Prirneros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atenci6n medica inmediatarnente si la irritation continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www.cemexusa.com. _ I ( 5622 65 Plant: Begin Loading: To Job: .'Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: t)•� (D/:L .)13o Customer Code: Customer Name: w:,022f"1.-315 COkIS t RLJCT IGIN.! :REF V I_'CE S ". l.sr7NSi..)► TIPUxITIS ProjectCode Pro ect Name: Ticket Date:_ Delivery Address: Delivery Instructions: �rr.L_.tr CITY :1 :O C +. s RNUS RIGI-I . LEFT Oitii O s. LCt` N, RIOT +-ICI T ID T iJM� Pi T-301JT Lf:t-P%iE Customer Job Number: Order Code I Date: _ 4 ProjectP O Number: Order P.O Number. Map Page: .Map/Row/Column: j Dispatcher: Ticket Number: 7.31 `..r r� ,j ...., 1 Due O�,Job:_ Slump: �� o 5(^� Tru'k4N1 �ber-� r C��r .. Dri nr: umher.t_t DrV rpp, e: I I 4 r' Iv ..�l~�tJ'�)BERR." End Use: �•-• 4��.-2 0 �L� 1' LOAD CUMULATIVE ORDERED QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT _ 50 ..:.'t 1 50 6 `; {:'i i ! Jf:. •.4a-�, rC El7 `. �•" ., . 1247018 RCl—it?RGE FUEL_ SURCHARGE I o t_)t t 1c:'+_•r2 r Ztr3I ENVIRONMENTAL CHARGE Cash Check # IAuth 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 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 INVOICE Nium ; L= This Delivery Ticket .incorporates herein by 6ference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quoi a, if a,,iy.1„d Seller's Order Confinnatio, eluding limitations of warranties), as if'full.y, set forth on this Delivery Ticket ("A6____nent" ),I Sel1Lr will provide the Standard Z s 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, 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, rn%ay 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 arnmo- 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 aplicacion de credito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmacion del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor provee.ra 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 pagar el monto de acuerdo al contaato; al menos que se identi- fique con una nota a] frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca 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 cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y reacci.ones alergicas en .la piel. Concreto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforacion puede contener materiales silicon, 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberacion del amoniaco. La inhalacion 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 duracion y el nivel de la exposicion. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, proteccion en los ojos y ropa Primeros adecuada para proteccion. Lavese ]as manos con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos mas de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la paste afectada por 1.5 minutes. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atencion medica inmediatamente si la irritacion continua. CEMEX. Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www.cemexusa.con. ZZCcmx 56229653 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Project Code: Project Name: Project P.O. Number: Ticket Date: Delivery Address: er .. -, �.y " 3 I + I r ' fir. t ; .. _. l .i:1 Delivery Instructions: IT 7 3. ... F0 I Order Code / Date: Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Ticket Number: I 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 FUEL r �- ....:�1J.... f s:• = C..l.I7� .. �:!i li��i"l F�.hl j 11i_ �i--(Y^I I'��:�._ Cash Check # /Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge Comments: 1 WATER ADDED GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE ❑ LOAD WAS TESTED BY: r� Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customers ow�q 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 a ety 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 INVOICE This Delivery Ticket incorporates hE'�i by reference buyers previously executTUredit Application, if any, Seller's Standard Terms and Conditions, Seller's Quotation, if any, and Seller's Order Confirmation (including 1_imitations 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 / CONCREIWPRODUCTS / 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 anunonia 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 incluye comp referencia al. comprador (ya previ.amente ejecutada en su aplicac.i6n de credi.to); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confi.rmaci6n del vendedor (con limitaciones y garantfas), Como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rininos 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 canti.dades y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al Contrato; al 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, dolo.mita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen 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, roca volcanica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) .la cual puede contener mas de 0.025% de silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el tritu.ramiento, pulido, Corte y/o per.-foraci6n 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritacion o quemad.uras en la nariz, garganta y pul.mones. 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, protecc.i6n en los ojos y ropa Primeros adecuada para proteccion. Lavese ]as manos con jab6n suave y agua despues del manejo de materiales. Evi.te 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, in.med.iatamente fluya agua en la parte afectada por 1.5 minutos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ldvelos a fondo con agua. Acuda a atenci6n medica inmediatamente si la iiTitaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informati6n visita www.cemexusa com. �.,V' 1• ..� ate. l� 1 - r, ' T/A/CC-MC-X L '"gyp � F• I Plant: Begin Loading: To Job: Arrive,�V7i: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: 1,: i , _, Project Name: , ... '.j �! _.•f�. �'' ! i_. k:. __ Cr .., �!''�-1` 1..., �.. f-1''Y,'.,j'i�}" - -,{� !•`^ i. ! l:'ri Project P.O. Number" .' _ Order P.O. Number:' ,.:'-'.': , -';J TickeCDaie •.,,•.L...�..,, a Delivery Address:_ •}, •_ •r. .-i•r .i •_r i__,=•;� i.-: _ I s r�.I i,ti t }`• f., r,l... i�.; ._ I ', P ,�.,: •t.,i_ i4 .i_ li,..�..,�..•..,. F< Map Parge: Map/Row7Column: �� t ' f -. f...;�..�tT.f'!: i': I. V !.•: I, t!'r Delivery Inst�uotions:�i Dispatcher: Ticket Number: Due On Job: Slump: }.+ Truck Number: Driver Number: Driver Name: End Use: LOAD QUANTITY CUMULATIVE QUANTITY ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT 7�'0 y@ .� ��g,, "e i :. c.•: �1.-..,� , unt to Collect Cash Check # /Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amo Check Without Standby Charges: Charge Comments: Ias 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. IfXater 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 skim 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 safe_ydata 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. i 68UNIVERSAL INVOICE is Delivery Ticket incorporates herein by reterence Buyer's previously executea urearL AppncaLron, rr any, M]CI �; aLarivaru firms and Conditions, Seller's Quc in, if any, and Seller's Order Confirmatic ' lcluding limitations of warra%lties), as if, fully et forth on this Delivery Ticket ("A._,-ment"). Seller will provide the Standard' is and Conditions upon request. Buyer agrees hat, 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 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 02/1.2 For more information please visit www.cemexusa.com. Este ticket de entrega incluye corm referencia al comp.rador (ya previamente ejecutada en su aplicac.i6n 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 proveerd los terminos estandares y condiciones detal- lados on caso de as.f ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las canti.dades y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contacto; al mends quo 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, dolomita, granito, roca volcanica, arena, Brava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de conereto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita, grranito, roca volcanica, arena, grava, y otros materiales silicios. Estos productos .incluyen cenizas volantes (fly ash) .la cual puede, contener inns de 0.025% de silicio cristalino. Peligros: Mezcla de cemento :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 polvo de agregados, pueden causar irritaci6n en los Ojos, piel y/o en ]a zona respirato.ria. Polvo del m.anejo en el trituramiento, pulido, Corte y/o perforaci6n puede contener materiales siliccos, .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. Las cenizas volantes pueden contener amoniaco. Seguridad• La bumedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemaduras en .la nariz, garganta y pulmones. Acudir inmediatamente a]. medico. El riesgo en Ia salud depende en la duraci6n y el nivel de la exposici6n. Seguri.dad: Evite el. contacto con. Ojos y contacto p.rolongado con .la piel. Use guantes, protecci6n en los Ojos y ropa Primeros adecuada para protecci6n. Lavese ]as manos con jab6n suave y agua despu6s del .manejo de materiales. Evite inhalar auxilios• polvos. Si se expose 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 minutos. 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 mds informati6n visita www.cemexusa.com. I+ I' r -`lor ccmcx u5 6.21 2-9, S 6 0 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: L_`, �6 •.�1 `J �...L,S ) C�. NI_I_iic.� �. �.li �: :.J l_. �•?let .I. vL=�� L' I�IJill �Z i...{1_ 1 I''i }''�•+ Project Code: Project Name: rJ '•.1,-I t .µfj,' .r. : iS.l� ... .,�• Ticket Date: Delivery Address: 05 :'t.'.� / I I.._01--'2S, R i. c%SFr Ek!'.i.? Delivery Instructions: _. 1 . _. '_..'�'.,, �r.f q n .' �. I.. i.}P-•,,;. �i °.!r is. �. i, :r a "i..F `y j'i i..i �i I...j '�'..%t.j !''t _ .. �, . .r-ri•. .. Customer Job Number: Project P.O. Number. P'D f_.3 t....a$ 1.,_...+ Order Code / Date: Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Ticket Number: Due On Job,,. Slump: Truck Number: Driver Number: Driver Name: End Use: :,o .. _ �._.', •, BILLY f=+ PEN' i' I.st__) ; .-1'',! s_— (_� ° :' C LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY F1 Fi_.'_ `^i 5ZI 1. u d tt t i _::t_?2.d'%', r` EN v � RL'jitld'F_i?I. !'; _ L,1`if 1hi.d it Cash Check # /Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge ✓ Comments:f WATER ADDED: GAL YARDS IN DRUM: ,r WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE r0'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. I 0J .�...� . � EisAL PR- E k) 1 C,K, I_+!f?i'r: j LORD ' INVOICE This Delivery Ticket incorporates bPrein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quo m; if any, and Seller's Order Confirmatic icluding limitations of Nvarranties), as if• fully set forth on this Delivery Ticket ("A._-ment"). Seller will provide the Standard' is 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, 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 arnmo- ma. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or bunts 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 comp referencia at cornprador (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 proveera los terminos estandares y condiciones detal- lados en caso de as.% 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 pagar el monto de acuerdo at contrcto; at menos que se identi- fique con una nota at frente de este documento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS V Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaniler a, 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 cual puede contener mas de 0.025% de silicio cristalino. Peligros: Mezcla de cemento 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 polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la 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 L- en temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la liberaei6n del amoniaco. La inhalaei6n del amoniaco puede causar toner, irritacion o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente at 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, proteccion en los ojos y ropa Primeros adecuada para protecci6n. Lavese las manos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar auxilios• polvos. Si se expone a polvos inns de los lirnites recornendados, 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 aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atenci6n rn6dica inmediatarnente si la irritacion continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mds informaci6n visita www.cemexusa.com. s D �' as f� �l i v ZZCC-111C-X T•-+ rev 6:.i' � �' icy ix �7 i'l Plant: Begin Loading: To Job: Arrive Job: Start Unload: I Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: iAl Project Code: Project Name: Ticket Date: elivery A ress: Delivery Instructi ns: s 4 Customer Job Number: Project P.O. Number. Order Code / Date: Order P.O. Number. Map Page: Map/Row/Column: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: `�'iJ - , r �li�.r. r4i 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 Check Without Standby Charges: Charge Comments: / WATER ADDED: GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: r 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. O 11.E Q i 68UNIVERSAL INVOICE - This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's St Terms and Conditions, Seller's Quot; i, if any, and Seller's Order Confirmatior ... _,luding limitations of warranties), as . set forth on this Delivery Ticket ("Ap ient"). Seller will provide the Standard T ; and Conditions upon request. Buyer agree: 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 thF 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�rritation 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, an drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammor is 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 rn.inutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical. attention if irritation persists. CE.M.EX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston, Texas 77024 02/12 For more information please visit www.cemexLisa.com. Este ticket de entrega i.ncl.uye Como referencia al comp.rador (ya previamente ejecutada en su aplicacion. de credito); cualquier termino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confinnacion del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los ter-minos 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 pagar el MOM de acuerdo al contacto; al 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, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo 1P), 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 cual puede contener mas de 0.025% de silicio crystalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los Ojos, quemaduras en pie[ y ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforacion puede contener materiales silicon, 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. Las cenizas volantes pueden contener amoniaco. Seguridad• La humedad puede causar la liberacion del amoniaco. La inhalacion 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 duracion y el nivel de la exposicion. Seguridad: Evite el contacto con ojos y contacto prolongado eon ]a piel. Use guantes, proteccion en los ojos y ropa Primeros adecuada para proteccion. Ldvese las manos con jabon suave y agua despues del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto en los Ojos, inmediatamente fluya agua en la paste afectada por 1.5 minutos. Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atencion medica inmediatamente si la irritacion contimia. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www.cemexusa.com. FORM 405-10 FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION Florida Department of Business and Professional Regulation - Residential Performance Method Project Name: Standard Pacific RB Stamford Lot 26 Builder Name: Standard Pacific Homes Street: 3 t o 3 TAW 2d G1:1T-C l ial Permit Office: St. Lucie City, State, Zip: Port St. Lucie , FL, Permit Number: Owner: Standard Pacific Homes Jurisdiction: Design Location: FL, Fort Pierce Odl- 1._ New construction or -existing New (From Plans) 9. Wall Types (3971:5- sqft.) - -Insulation - Area 2. Single family or multiple family Single-family a. Concrete Block - Int Insul, Exterior R=4.1 3646.00 ft2 b. Frame - Wood, Adjacent R=11.0 325.43 ft2 3. Number of units, if multiple family 1 c. N/A R= ft2 4. Number of Bedrooms 4 d. N/A R= ft2 10. Ceiling Types (3483.0 sqft.) Insulation Area 5. Is this a worst case? No a. Under Attic (Vented) R=30.0 3483.00 ft2 6. Conditioned floor area above grade (ft2) 3483 b. N/A R= ft2 Conditioned floor area below grade (ft2) 0 c. R= ft2 11. Ducts R ft2 7. Windows(965.0 sqft.) Description Area a. Sup: Attic, Ret: Attic, AH: AC 1 First Floor 6 640 a. U-Factor: Dbl, U=0.60 472.06 ft2 SHGC: SHGC=0.31 b. U-Factor: Dbl, U=0.59 288.00 ft2 12. Cooling systems kBtu/hr Efficiency SHGC: SHGC=0.32 a. Central Unit 57.0 SEER:15.00 c. U-Factor: Dbl, U=0.77 136.00 ft2 SHGC: SHGC=0.22 13. Heating systems kBtu/hr Efficiency d. U-Factor: other (see details) 68.99 ft2 a. Electric Heat Pump 56.0 HSPF:8.50 SHGC: other (see details) Area Weighted Average Overhang Depth: 8.469 ft. Area Weighted Average SHGC: 0.300 14. Hot water systems a. Electric Cap: 50 gallons 8. Floor Types (3483.0 sqft.) Insulation Area EF: 0.910 a. Slab -On -Grade Edge Insulation R=0.0 3483.00 ft2 b. Conservation features b. N/A R= ft2 None c. N/A R= ft2 15. Credits Pstat Glass/Floor Area: 0.277 Total Proposed Modified Loads: 48.74 PASS Total Standard Reference Loads: 65.44 1 hereby certify that the plans and specifications covered by Review of the plans and t"E S'r this calculation are in compliance with the Florida Energy specifications covered by this Digitally signed by Chris Wildroudt Code. DN: cn=Chris Wildroudt, c=US, calculation indicates compliance I �S, Chris o=Engineered Air, LLC, ou=New - Construction Sales and with the Florida Energy Code. Before construction is completed PREPARED BY: - ngmeenng, DATE: ,aH=rhdew__�Png6n reda'r1lr, -W this building will be inspected for rM_r-O-U-d# .m compliance with Section 553.908 ,. * � Date: 2014.02.10 14:03:01-05'00' I hereby certify that this building, as designed, is in compliance Florida Statutes. ✓ g with the Florida Energy C n4BUILDING COD 41'4 OWNER/AGENT: OFFICIAL: DATE: f DATE: - Compliance requires certification by the air handler unit manufacturer that the air handler enclosure qualifies as certified factory -sealed in accordance with 403.2.2.1.1. - Compliance requires completion of a Florida Air Barrier and Insulation Inspection Checklist - Heat sys #1 may be undersized. Size of 56.0 was increased to 69.9 for simulation. Please review the Manual J8 report. 2/10/2014 1:58 PM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 1 of 6 PROJECT Title: Building Type: Owner: # of Units: Builder Name: Permit Office: Jurisdiction: Family Type: New/Existing: Comment: Standard Pacific RB Stamford User Standard Pacific Homes 1 Standard Pacific Homes St. Lucie Single-family New (From Plans) Bedrooms: 4 Conditioned Area: 3483 Total Stories: 1 Worst Case: No Rotate Angle: 0 Cross Ventilation: Whole House Fan: Address Type: Lot # Block/SubDivision: PlatBook: Street: County: City, State, Zip: Lot Information 26 Riverbend St. Lucie Port St. Lucie , FL, CLIMATE V Design Location TMY Site IECC Design Temp Zone 97.5 % 2.5 % Int Design Temp Heating Design Daily Temp Winter Summer Degree Days Moisture Range FL, Fort Pierce FL_ST_LUCIE_CO_INTL 2 39 90 70 75 722 62 Low BLOCKS Number Name Area Volume 1 Blockl 3483 37334.9375 SPACES Number Name Area Volume Kitchen Occupants Bedrooms InfilID Finished Cooled Heated 1 AC 1 First Floor 3483 37334.9387 No 5 4 1 Yes Yes Yes FLOORS # Floor Type Space Perimeter R-Value Area Tile Wood Carpet 1 Slab -On -Grade Edge Insulatio AC 1 First Floor 372 ft 0 3483 ft2 -__ 0 0 1 ROOF / V # Type Materials Roof Gable Roof Area Area Color Solar Absor. SA Emitt Tested Emitt Deck Pitch Tested Insul. (deg) 1 Hip Barrel tile 3895 ft2 0 ft2 Medium 0.65 No 0.9 No 0 26.6 ATTIC / V # Type Ventilation Vent Ratio (1 in) Area RBS IRCC 1 Full attic Vented 300 3483 ft2 N N CEILING # Ceiling Type Space R-Value Area Framing Frac Truss Type 1 Under Attic (Vented) AC 1 First Floor 30 3483 ft2 0.11 Wood 2/10/2014 1:58 PM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Page 2 of 6 WALLS Adjacent Cavity Width Height Sheathing Framing Solar Below # Ornt To Wall TypeSpace _ P Fraction gbspr rrarfo 1 E Exterior Concrete Block - Int Ins0gC 1 First Flo 4.1 13 0 10.67 0 138.7100 0.4 0 0.4 0 2 E Exterior Concrete Block - Int InS6IC 1 First Flo 4.1 10 0 10.67 0 106.6999 0.4 0 0.4 0 3 E Exterior Concrete Block - Int Ins0NC 1 First Flo 4.1 13 0 10.67 0 138.7100 0.4 0 0.4 0 4 E Exterior Concrete Block - Int Ins 91C 1 First Flo 4.1 12 0 10.67 0 128.0400 0.4 0 0.4 0 5 S Exterior Concrete Block - Int Ins0iC 1 First Flo 4.1 80 0 10.67 0 853.5999 0.4 0 0.4 0 6 S Exterior Concrete Block - Int InSigIC 1 First Flo 4.1 13.5 0 10.67 0 144.0449 0.4 0 0.4 0 7 W Exterior Concrete Block - Int InsAC 1 First Flo 4.1 34 0 10.67 0 362.7799 0.4 0 0.4 0 8 W Exterior Concrete Block - Int Ins9C 1 First Flo 4.1 20 0 12.67 0 253.3999 0.4 0 0.4 0 9 N Exterior Concrete Block - Int Ins04IC 1 First Flo 4.1 14 0 10.67 0 149.3800 0.4 0 0.4 0 10 N Exterior Concrete Block - Int InsAC 1 First Flo -4.1 24 0 10.67 0 256.0800 0.4 0 0.4 0 11 N Garage Frame - Wood AC 1 First Flo 11 8 0 10.67 0 85.36000 0.4 0.4 0 _ 12 W Garage Frame - Wood AC 1 First Flo 11 6 0 10.67 0 64.02000 0.4 0.4 0 13 W Exterior Concrete Block - Int Ins&C 1 First Flo 4.1 18 0 10.67 0 192.0599 0.4 0 0.4 0 14 N Exterior Concrete Block - Int InSiMC 1 First Flo 4.1 50 0 10.67 0 533.5 ft2 0.4 0 0.4 0 15 S Exterior Concrete Block - Int InsiXC 1 First Flo 4.1 6 0 10.67 0 64.02000 0.4 0 0.4 0 16 E Garage Frame - Wood AC 1 First Flo 11 16.5 0 10.67 0 176.0550 0.4 0.4 0 17 S Exterior Concrete Block - Int InsAC 1 First Flo 4.1 12 0 10 0 120 ft2 0.4 0 0.4 0 18 E Exterior Concrete Block - Int InsiNC 1 First Flo 4.1 20.5 0 10 0 205 ft2 0.4 0 0.4 0 DOORS # Ornt Door Type Space Storms U-Value Width Height Area Ft In Ft In 1 W Insulated AC 1 First Flo None 0.6 2.67 0 8 0 21.36 ft2 WINDOWS Orientation shown is the entered, Proposed orientation. Wall Overhang v # Ornt ID Frame Panes NFRC U-Factor SHGC Area Depth Separation Int Shade Screening 1 E 1 Metal Low-E Double Yes 0.77 0.22 48 ft2 23 ft 0 in 2 ft 0 in None None 2 E 1 Metal Low-E Double Yes 0.4 0.31 21.28000 23 ft 0 in 2 ft 0 in None None 3 E 2 Metal Low-E Double Yes 0.77 0.22 48 ft2 13 ft 0 in 2 ft 0 in None None 4 E 3 Metal Low-E Double Yes 0.6 0.31 16.17000 6 ft 0 in 2 ft 0 in None None 5 E 4 Metal Low-E Double Yes 0.77 0.22 40 ft2 8 ft 0 in 2 ft 0 in None None 6 S 5 Metal Low-E Double Yes 0.6 0.31 116.9783 1.33 ft 0 i 2 ft 0 in None None 7 S 5 Metal Low-E Double Yes 0.6 0.31 22.68000 1.33 ft 0 i 2 ft 0 in None None 8 S 5 Metal Low-E Double Yes 0.6 0.31 9.180000 1.33 ft 0 i 2 ft 0 in None None 9 S 6 Metal Low-E Double Yes 0.59 0.32 80 ft2 18 ft 0 in 2 ft 0 in . None None 10 W 7 Metal Low-E Double Yes 0.6 0.31 116.9783 1.33 ft 0 i 2 ft 0 in None None 11 W 8 Metal Low-E Double Yes 0.59 0.32 128 ft2 12 ft 0 in 4.67 ft 0 i None None 12 W 8 Metal Low-E Double Yes 0.4 0.31 24.88439 12 ft 0 in 1 ft 0 in None None 13 N 9 Metal Low-E Double Yes 0.59 0.32 80 ft2 18 ft 0 in 2 ft 0 in None None 14 N 10 Metal Low-E Double Yes 0.6 0.31 22.68000 9 ft 0 in 2 It 0 in None None 15 W 13 Metal Low-E Double Yes 0.6 0.31 58.48919 1.33 ft 0 i 2 ft 0 in None None 16 N 14 Metal Low-E Double Yes 0.6 0.31 27.34560 1.33 ft 0 i 2 ft 0 in None None 2/10/2014 1:58 PM EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software . Page 3 of 6 WINDOWS Orientation shown is the entered, Proposed orientation. # Wall Ornt ID Frame Panes NFRC Overhang U-Factor SHGC Area Depth Separation Int Shade Screening 17 18 19 20 21 22 N 14 Metal N 14 Metal N 14 Metal N 14 Metal S 15 Metal S 17 Metal Low-E Double Yes Low-E Double Yes Low-E Double Yes Low-E Double Yes Low-E Double Yes Low-E Double Yes 0.6 0.31 38.99279 1.33 ft 0 i 2 ft 0 in None 0.6 0.31 9.180000 1.33 ft 0 i 2 ft 0 in None 0.4 0.31 16.17000 1.33 ft 0 i 2 ft 0 in None 0.4 0.31 6.652800 1.33 ft 0 i 2 ft 0 in None 0.6 0.31 13.67280 1.33 ft 0 i 2 ft 0 in None 0.6 0.31 19.71199 2 ft 0 in 1 ft 0 in None None None None None None None GARAGE # Floor Area Ceiling Area Exposed Wall Perimeter Avg. Wall Height Exposed Wall Insulation 1 660 ft2 660 ft2 72 ft loft 1 INFILTRATION # Scope Method SLA CFM 50 ELA EgLA ACH ACH 50 1 Wholehouse Best Guess 0.000500 4567.9 250.77 471.62 0.3650 7.3410 HEATING SYSTEM # System Type Subtype Efficiency Capacity Block Ducts 1 Electric Heat Pump None HSPF: 8.5 56 kBtu/hr 1 sys#1 COOLING SYSTEM # System Type Subtype Efficiency Capacity Air Flow SHR Block Ducts 1 Central Unit Split SEER: 15 57 kBtu/hr 1710 cfm 0.75 1 sys#1 HOT WATER SYSTEM # System Type SubType Location EF Cap Use SetPnt Conservation 1 Electric None Garage 0.91 50 gal 70 gal 120 deg None SOLAR HOT WATER SYSTEM FSEC Cert # Company Name Collector Storage System Model # Collector Model # Area Volume FEF None None ft2 DUCTS V # -- Supply - -- Return -- Air Percent Location R-Value Area Location Area Leakage Type Handler CFM 25 Leakage QN RLF HVAC # Heat Cool 1 Attic 6 640 ft2 Attic 160 ft2 Default Leakage AC 1 First F (Default) (Default) % 1 1 2/10/2014 1:58 PM EnergyGaugeO USA - FlaRes2010 Section 405.4.1 Compliant Software Page 4 of 6 TEMPERATURES Programable Thermostat: Y Ceiling Fans: Coolin [ ] Jan [ j [ ]Feb [ ]Mar f ] A r [ ] Ma [Xj Jun [X] Jul jXj Au �X] Se [ j Oct [ ]Nov j ]Dec Heating Jan [X] Feb [X] Mar j Apr [ ] May [ j Jun [ j Jul j j Aug [ ]Sep [ ]Oct [X] Nov [X] Dec Venting [ ]J Jan j[ ] Feb [[X] Mar [X] A r [ ] May [ ] Jun [ ]Jul [ ] Au [ ] Se [X] Oct [X] Nov [ ]Dec Thermostat Schedule: HERS 2006 Reference Hours Schedule Type 1 2 3 4 5 6 7 8 9 10 11 12 Cooling (WD) AM 78 78 78 78 78 78 78 78 80 80 80 80 PM 80 80 78 78 78 78 78 78 78 78 78 78 Cooling (WEH) AM 78 78 78 78 78 78 78 78 78 78 78 78 PM 78 78 78 78 78 78 78 78 78-- 78 78 78 Heating (WD) AM 66 66 66 66 66 68 68 68 68 68 68 68 PM 68 68 68 68 68 68 68 68 68 68 66 66 Heating (WEH) AM 66 66 66 66 66 68 68 68 68 68 68 68 PM 68 68 68 68 68 68 68 68 68 68 66 66 2/10/2014 1:58 PM EnergyGauge® USA -. FlaRes2010 Section 405.4.1 Compliant Software Page 5 of 6 FORM 405-10 Florida Code Compliance Checklist Florida Department of Business and Professional Regulations Residential Whole Building Performance Method ADDRESS: PERMIT #: Port St. Lucie, FL, MANDATORY REQUIREMENTS SUMMARY - See individual code sections for full details. COMPONENT SECTION - - SUMMARY -OF REQUIREMENT(S)- - CHECK Air leakage 402.4 To be caulked, gasketed, weatherstripped or otherwise sealed. Recessed lighting IC -rated as meeting ASTM E 283. Windows and doors = 0.30 cfm/sq.ft. Testing or visual inspection required. Fireplaces: gasketed_ doors & outdoor combustion air. Must complete envelope leakage report or visually verify Table 402.4.2. ` Thermostat & 403.1 At least one thermostat shall be provided for each separate heating controls and cooling system. Where forced -air furnace is primary system, programmable thermostat is required. Heat pumps with supplemental electric heat must prevent supplemental heat when compressor can meet the load. Ducts 403.2.2 All ducts, air handlers, filter boxes and building cavities which form the primary air containment passageways for air distribution systems shall -� be considered ducts or plenum chambers, shall be constructed and sealed in accordance with Section 503.2.7.2 of this code. 403.3.3 Building framing cavities shall not be used as supply ducts. Water heaters 403.4 Heat trap required for vertical pipe risers. Comply with efficiencies in Table 403.4.3.2. Provide switch or clearly marked circuit breaker (electric) or shutoff (gas). Circulating system pipes insulated to = R-2 + accessible manual OFF switch. Mechanical 403.5 Homes designed to operate at positive pressure or with mechanical ventilation ventilation systems shall not exceed the minimum ASHRAE 62 level. No make-up air from attics, crawlspaces, garages or outdoors adjacent to pools or spas. Swimming Pools 403.9 Pool pumps and pool pump motors with a total horsepower (HP) of = 1 & Spas HP shall have the capability of operating at two or more speeds. Spas and heated pools must have vapor -retardant covers or a liquid cover or other means proven to reduce heat loss except if 70% of heat from site -recovered energy. Off/timer switch required. Gas heaters minimum thermal efficiency=78% (82% after 4/16/13). Heat pump pool heaters minimum COP= 4.0. Cooling/heating 403.6 Sizing calculation performed & attached. Minimum efficiencies per Tables 503.2.3. Equipment efficiency verification required. Special equipment occasion cooling or heating capacity requires separate system or variable capacity system. Electric heat >10kW must be divided into two or more stages. Ceilings/knee walls 405.2.1 R-19 space permitting. 2/10/2014 1:58 PM. EnergyGaugeO USA - FlaRes2010 Section 405.4. 1. Compliant Software Page 6 of 6 ENERGY PERFORMANCE LEVEL (EPL) DISPLAY CARD ESTIMATED ENERGY PERFORMANCE INDEX* = 74 The lower the EnergyPerformance Index, the more efficient the home. Port St. Lucie, FL, 1: New construction or existing - 2. Single family or multiple family 3. Number of units, if multiple family 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned floor area (ft2) 7. Windows" Description a. U-Factor: Dbl, U=0.60 SHGC: SHGC=0.31 b. U-Factor: Dbl, U=0.59 SHGC: SHGC=0.32 c. U-Factor: Dbl, U=0.77 SHGC: SHGC=0.22 d. U-Factor: other (see details; SHGC: other (see details; Area Weighted Average Overhang Depth: Area Weighted Average SHGC: New (From Plans) Single-family 1 4 No 3483 Area 472.06 ft2 8. Floor Types Insulation a. Slab -On -Grade Edge Insulation R=0.0 b. N/A R= c. N/A R= 288.00 ft2 136.00 ft2 68.99 ft2 8.469 ft. 0.300 Area 3483.00 ft2 ft2 ft2 9. Wall Types Insulation Area a. Concrete Block - Int Insul, Exterior R=4.1 3646.00 ft2 b. Frame - Wood, Adjacent R=11.0 325.43 ft2 c. N/A R= ft2 d. N/A R= ft2 10. Ceiling Types Insulation Area a. Under Attic (Vented) R=30.0 3483.00 ft2 b. N/A R= ft2 c. N/A R= ft2 11. Ducts R ft2 a. Sup: Attic, Ret: Attic, AH: AC 1 First Floor 6 640 12. Cooling systems a. Central Unit 13. Heating systems a. Electric Heat Pump 14. Hot water systems a. Electric b. Conservation features None 15. Credits kBtu/hr Efficiency 57.0 SEER:15.00 kBtu/hr Efficiency 56.0 HSPF:8.50 Cap: 50 gallons EF: 0.91 Pstat I certify that this home has complied with the Florida Energy Efficiency Code for Building o4�ii3E Construction through the above energy saving features which will be installed (or exceeded) in this home before final inspection. Otherwise, a new EPL Display Card will be completed based on installed Code ompliant features. Builder Signature: Date: 'y ?-(� I tom( �5i RE Address of New Home: 3 (]?j &ddi�qCity/FL Zip: P S L �.coDWF �c,'� 3 4� 53 *Note: This is not a Building Energy Rating. If your Index is below 70, your home may qualify for energy efficient mortgage (EEM) incentives if you obtain a Florida EnergyGauge Rating. Contact the EnergyGauge Hotline at (321) 638-1492 or see the EnergyGauge web site at energygauge.com for information and a list of certified Raters. For information about the Florida Building Code, Energy Conservation, contact the Florida Building Commission's support staff. **Label required by Section 303.1.3 of the Florida Building Code, Energy Conservation, if not DEFAULT. EnergyGauge® USA - FlaRes2010 Section 405.4.1 Compliant Software Stamford Model HVAC Load Calculations for Standard Pacific Homes RHVAC. HVAC: LoADs, R�;��>rwa�I�I7TAL, Prepared By: Chris Wildroudt Engineered Air LLC CACO45860 2520 N Andrews Ave Ext Pompano Beach, FL 33064 954 974-7277 Monday, February 10, 2014 Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. Rhvac = Residential &Light Commercial"HVAC Loads Elite Softiniare General-Project Information .. Project Title: Stamford Model Designed By: Chris Wildroudt Project Date:-2-10-14 - Client Name: Standard Pacific Homes Company Name: Engineered Air- L-LC CAC045860 Company Representative: Chris Wildroudt Company Address: 2520 N Andrews Ave Ext Company City: Pompano Beach, FL 33064 Company Phone: 954 974-7277 Company Fax: 954 973-1883 Desi n Data, Reference City: Fort Pierce, Florida Building Orientation: House faces East Daily Temperature Range: Medium Latitude: 27 Degrees Elevation: 25 ft. Altitude Factor: 0.999 Outdoor Outdoor Outdoor Indoor Indoor Grains Dry Bulb Wet Bulb Rel.Hum Rel.Hum Dry Bulb Difference Winter: 42 39.4 n/a n/a 70 n/a Summer: 90 75 50% 50% 75 42 Check`Fi�� ures s Total Building Building Supply CFM: 1,965 CFM Per Square ft.: 0.564 Square ft. of Room Area: 3,483 Square ft. Per Ton: 831 Volume (ft') of Cond. Space: 35,411 BuildingLoads. <<_ Total Heating Required Including Ventilation Air: 50,280 Btuh 50.280 MBH Total Sensible Gain: 43,180 Btuh 86 % Total Latent Gain: 7,134 Btuh 14 % Total Cooling Required Including Ventilation Air: 50,314 Btuh 4.19 Tons (Based On Sensible + Latent) Notes ; 1; .. Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. S:\NEW CONSTRUCTION\Chris Elite Files\Stan Pac Riverbend Stamford.rh9 Monday, February 10, 2014, 1:50 PM Rhvac - Residential & Light Commercial HVAC Loads .- Engineered Air, LLC [Margatel,LFL..,3306 ® Elite Software Development; Inc. Stamford Model 3' Pa a 3 Total Building Summary Loads 71 Component Areas Sen-",-,_, . ��- " Laf Sen_ Total Description ". <:" . "�"Quan.Loss'" .Gain Gain Gain Lo-E French Door: Glazing-Low-E French Door, u-value 96 2,068 0 1,552 1,552 0.77, SHGC 0.22 Lo-E Fixed Glass: Glazing -Low E Fixed Glass, u-value 46.2 518 0 578 578 0.4, SHGC 0.31 Lo-E operable: Glazing-Low-E Operable Glass, u-value 155.8 2,622 0 5,308 5,308 0.6, SHGC 0.31 Lo-E French Door: Glazing-Low-E French Door, u-value 40 862 0 924 924 0.77, SHGC 0.22 Lo-E operable: Glazing-Low-E Operable Glass, u-value 316.2 5,319 0 6,275 6,275 0.6, SHGC 0.31 Lo-E S G D: Glazing -Low E Sliding Glass Door, u-value 288 4,760 0 5,532 5,532 0.59, SHGC 0.32 Lo-E Fixed Glass: Glazing -Low E Fixed Glass, u-value 22.8 256 0 286 286 0.4, SHGC 0.31 11J: Door -Metal - Fiberglass Core 21.4 192 0 192 192 13A-4ocs: Wall -Block, board insulation only, R-4 board 2476 9,915 0 5,417 5,417 insulation, open core, siding finish 12E-Obw: Part -Frame, R-19 insulation in 2 x 6 stud 304.1 311 0 311 311 cavity, no board insulation, brick finish, wood studs 12B-Osw: Part -Frame, R-11 insulation in 2 x 4 stud 205 298 0 298 298 cavity, no board insulation, siding finish, wood studs 16D-30: Roof/Ceiling-Under Attic with Insulation on Attic 3482.9 3,121 0 3,344 3,344 Floor (also use for Knee Walls and Partition Ceilings), Vented Attic, No Radiant Barrier, Dark Tile, Slate or Concrete, R-30 insulation 22A-pl: Floor -Slab on grade, No edge insulation, no 372 10,302 0 0 0 insulation below floor, any floor cover, passive, light dry soil Subtotals for structure: 40,544 0 30,017 30,017 People: 5 1,500 1,400 2,900 Equipment: 2,000 2,400 4,400 Lighting: 0 0 0 Ductwork: 3,017 428 2,591 3,019 Infiltration: Winter CFM: 218, Summer CFM: 112 6,719 3,206 1,848 5,054 Ventilation: Winter CFM: 0, Summer CFM: 0 0 0 0 0 AED Excursion: 0 0 4,924 4,924 Total Building Load Totals: 50,280 7,134 43,180 50,314 Check Fi is Total Building Supply CFM: 1,965 CFM Per Square ft.: 0.564 Square ft. of Room Area: 3,483 Square ft. Per Ton: 831 Volume (ft3) of Cond. Space: 35,411 [-Building Loads Total Heating Required Including Ventilation Air: 50,280 Btuh 50.280 MBH Total Sensible Gain: 43,180 Btuh 86 % Total Latent Gain: 7,134_ Btuh 14 % Total Cooling Required Including Ventilation Air: 50,314 Btuh 4.19 Tons (Based On Sensible + Latent) Notes Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads -according to the manufacturer's performance data at your design conditions. S:\NEW CONSTRUCTION\Chris Elite Files\Stan Pac Riverbend Stamford.rh9 Monday, February 10, 2014, 1:50 PM Rhvac -Residential &Light Commercial HVAC Loads Elite Software Development, Inc.: Engineered Air, LCG Stamford Model' Mar ate,`FL 33063 Page 4 System 1 AC 1 - First Floor Summary Loads Component s Area Seri Laf Sen Total: Description_ �... Quan Loss Gain` _._ Gain.�Gairi; Lo-E French Door: Glazing-Low-E French Door, u-value 96 2,068 0 1,552 1,552 0.77, SHGC 0.22 Lo-E Fixed Glass: Glazing -Low E Fixed Glass, u-value 46.2 518 0 578 578 0.4, SHGC 0.31 Lo-E operable: Glazing-Low-E Operable Glass, u-value 155.8 2,622 0 5,308 5,308 0.6, SHGC 0.31 Lo-E French Door: Glazing-Low-E French Door, u-value 40 862 0 924 924 0.77, SHGC 0.22 Lo-E operable: Glazing-Low-E Operable Glass, u-value 316.2 5,319 0 6,275 6,275 0.6, SHGC 0.31 Lo-E S G D: Glazing -Low E Sliding Glass Door, u-value 288 4,760 0 5,532 5,532 0.59, SHGC 0.32 Lo-E Fixed Glass: Glazing -Low E Fixed Glass, u-value 22.8 256 0 286 286 0.4, SHGC 0.31 11 J: Door -Metal - Fiberglass Core 21.4 192 0 192 192 13A-4ocs: Wall -Block, board insulation only, R-4 board 2476 9,915 0 5,417 5,417 insulation, open core, siding finish 12E-Obw: Part -Frame, R-19 insulation in 2 x 6 stud 304.1 311 0 311 311 cavity, no board insulation, brick finish, wood studs 12B-Osw: Part -Frame, R-11 insulation in 2 x 4 stud 205 298 0 298 298 cavity, no board insulation, siding finish, wood studs 16D-30: Roof/Ceiling-Under Attic with Insulation on Attic 3482.9 3,121 0 3,344 3,344 Floor (also use for Knee Walls and Partition Ceilings), Vented Attic, No Radiant Barrier, Dark Tile, Slate or Concrete, R-30 insulation 22A-pl: Floor -Slab on grade, No edge insulation, no 372 10,302 0 0 0 insulation below floor, any floor cover, passive, light dry soil Subtotals for structure: 40,544 0 30,017 30,017 People: 5 1,500 1,400 2,900 Equipment: 2,000 2,400 4,400 Lighting: 0 0 0 Ductwork: 3,017 428 2,591 3,019 Infiltration: Winter CFM: 218, Summer CFM: 112 6,719 3,206 1,848 5,054 Ventilation: Winter CFM: 0, Summer CFM: 0 0 0 0 0 AED Excursion: 0 0 4,924 4,924 System 1 AC 1 - First Floor Load Totals: 50,280 7,134 43,180 50,314 Check Figures Supply CFM: 1,965 CFM Per Square ft.: 0.564 Square ft. of Room Area: 3,483 Square ft. Per Ton: 831 Volume (ft3) of Cond. Space: 35,411 System Loads.-_,'; Total Heating Required Including Ventilation Air: 50,280 Btuh 50.280 MBH Total Sensible Gain: 43,180 Btuh 86 % Total Latent Gain: 7,134 Btuh 14 % Total Cooling Required Including Ventilation Air: 50,314 Btuh 4.19 Tons (Based On Sensible + Latent) Notes; , Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. S:\NEW CONSTRUCTION\Chris Elite Files\Stan Pac Riverbend Stamford.rh9 Monday, February 10, 2014, 1:50 PM korida Building Code Online Page 1 of 2 PD 3 pL3fif1 c" u BaS Home Log In User Registration I Hot Topics i Submit Surcharge I Stats & Fads Publications FBC Staff 1 BaS Site Map I Links i f (gU$Ine$s�,?i; ; product Approval f rofess*61 USER: Public User Replation Product Approval Menu > Product or Application Search > Application List > Application Detail FL *- - - - - - - - - - - - - - - - - - - - --FL7473-R5- - - - - - Application Type Affirmation Code Version 2010 Application Status Approved Comments Archived Ci Product Manufacturer EAGLE ROOFING PRODUCTS FLORIDA LLC Address/Phone/Email 1575 East Cit. 470 Sumterville, FL 33858 (800)400-3245 annettes@eagieroofing.com Authorized Signature Technical Representative Address/Phone/Email Quality Assurance Representative Address/Phone/Email Category Subcategory Compliance Method Florida Engineer or Architect Name who developed the Evaluation Report Florida License Quality Assurance Entity Quality Assurance Contract Expiration Date Validated By Certificate of independence Annette Sindar annettes@eagleroofing.com Greg Peterson 1575 East CR 470 Sumpterville, FL 33585 (800)400-3245 gregp@eagleroofing.com Roofing Roofing Tiles Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer 01 Evaluation Report - Hardcopy Received Robert Nieminen PE-59166 Architectural Testing, Inc. 12/31/2014 John W. Knezevich, PE .11 Validation Checklist - Hardcopy Received FL7473 R5 COI Trinity ERD CI - Nieminen.odf Referenced Standard and Year (of Standard) Standard ASTM C1492 FRSAfM 07320 SSTD 11 Equivalence of Product Standards Certified By Sections from the Code Year 2003 2005 1997 htW://www.floridabuilchna.orgJpr/nr apu dtl.asvx?varam=wGEVXQwtDq... 10/11/2013 Florida. Building Code Online Page 2 of 2 01 affirm that there are no changes in the new Florida Bt Code which affect my product(s) and my product(s) are it compliance with the new Florida Building Code. Documentation from approved Evaluation or Validation Entity =Yes ':: No NJA FL7473 R5 COC sitr032712 Affirmation FL7473-R4.odf Product Approval Method Method 1 Option D Date Submitted 03/27/2012 Date Validated 03/27/2012 Date Pending FBC Approval Date Approved 04/02/2012 Summary of Products i473.1 jEagle Roof Tiles .imits of Use Approved for use in HVHZ: No Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: N/A Other: See Section 5 of Evaluation Report for Limits of Use.' rile roofs are analyzed for wind resistance through nrertuming moment. Refer to FRSA/TRI 07320 for rvertumino moment limitations. medium and FL7473 R5 II er062311FINAL EAGLE FL7473-R3 TIL Verified By: Robert J. M. Nieminen PE - 59166 Created by Independent Third Party: Yes Evaluation Reports FL7473 R5 AE er062311FINAL EAGLE FL7473-R3 TII Created by Independent Third Party: Yes Back Next Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 Phone: 850-487-1824 The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :. Refu Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request; send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.48 'Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Dep with an email address if they have one. The emails provided may be used for'offical communication with the licensee. However email address public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made avail the public. To determine if you are a licensee under Chapter 455r FS., please dick here . Product Approval Accepts: FOR-EREm t relit G d I� _."�S'�Ftl > 41-4Anlk—,IA,*�ainv% Af-1 1()/11 /91)11 IRD RINITYi .I EXTERIOR RESEARCH t DESIGN, LLC. FL CERTIFICATE OF AUTHORIzATION #9503 March 27, 2012 Ted Berman, P.E. Ted Berman and Associates, LLC. 925 41 st Street, Suite 104 Miami Beach, FL 33140 RE: [EAGLE ROOFS G PRODUCTS PLORIDA LLC Affirmation of r-L7473-R3 Dear Ted: This letter serves to document that we have reviewed FL7473-R3 and our Evaluation Report E 1322C.09.06-R2 dated 06/23/2011, which forms the basis thereof, with respect to the 2010 Florida Building Code. Nothing in the Code has changed that affects our Evaluation Report, and we have authorized the applicant to document compliance with the 2010 FBC through the Affirmation Process. Please contact our Connecticut office with any questions. Respectfully submitted, Robert Nieminen, P.E. Vice President Florida Reg. No. 59166 robertnieminen antrinmrerd.com The facsimile seal appearing on this document was authorized by Robert Nieminen, P.E. 59166 on 3/27/2012. This does not serve as an electronically signed document. Original, signed & sealed hardcopies forthcoming via courier WILDING SCIENCE KEtC•AI<;dM I DESIGN j COi%lSU►_TATION' MAIN OFFICE: 80 YESLER WAY, SUITE 200 1 SEATTLE, WA 98104 1 TEL: 206 467 0054 1 FAX:206 267 0267 CONNECTICUT: 353 CHRISTIAN STREET, UNIT 13 1 OXFORD, CT 06478 1 TEL: 203 262 9645 I FAX: 203 262 9243 LABORATORY: 10 MAUNEY COURT I COLUMBIA, SC 29201 1 TEL: 803 988 8133 1 FAX: 803 988 81 1 1 EXTERIOR RESEARCH & DESIGN, LLC. Certificate of Authorization #9503 UNIT #13 �IW '.ED 353 CHRISTIA OXFORD,�CT 06478 PHONE: (203) 262-9245 FAX: (203) 262-9243 EVALUATION REPORT Eagle Roofing -Products -Florida LLC. - - - Evaluation Report E1322C.09.06-R2 1575 East Country Road 470 FL7473-R3 Sumterville, FL 33585 Date of Issuance: 02/24/2009 Revision 2: 06/23/2011 SCOPE: This Evaluation Report is issued under Rule 9N-3 and the applicable rules and regulations governing the use of construction materials in the State of Florida. The documentation submitted has been reviewed by Robert Nieminen, P.E. for use of the product under the Florida Building Code and Florida Building Code, Residential Volume. The products described herein have been designed to comply with the 2007 Florida Building Code sections noted herein. DESCRIPTION: Eagle Roof Tiles LABELING: Each unit shall bear labeling in accordance with the requirements the Accredited Quality Assurance Agency noted herein. CONTINUED COMPLIANCE: This Evaluation Report is valid until such time as the named product(s) changes, the referenced Quality Assurance documentation changes, or provisions of the Code that relate to the product change. Acceptance of this Evaluation Report by the named client constitutes agreement to notify Robert Nieminen, P.E. if the product changes or the referenced Quality Assurance documentation changes. TrinityJERD requires a complete review of this Evaluation Report relative to updated Code requirements with each Code Cycle. ADVERTISEMENT: The Evaluation Report number preceded by the words "TrinitylERD Evaluated" may be displayed in advertising literature. If any portion of the Evaluation Report is displayed, then it shall be done in its entirety. INSPECTION: Upon request, a copy of this entire Evaluation Report shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This Evaluation Report consists of pages 1 through 4. Prepared by: Robert J.M. Nieminen, P.E. Florida Registration No. 59166, Florida OCA ANE1983 The facsimile seal appearing was authorized by Robert Nieminen, P.E. on 06/23/2011 This does not serve as an electronically signed document. Signed, sealed hardcopies have been transmitted to the Product Approval Administrator and to the named client CERTIFICATION OF INDEPENDENCE. 1. TrinityiERD does not have, nor does it Intend to acquire or will it acquire, a financial interest in any company manufacturing or distributing products it evaluates. 2. Trinity ERD is not owned, operated or controlled by any company manufacturing or distributing products it evaluates. 3. Robert Nieminen, P.E. does not have nor will acquire, a financial interest in any company manufacturing or distributing products for which the evaluation reports are being issued. 4. Robert Nieminen, P.E. does not have, nor will acquire, a financial interest in any other entity involved in the approval process of the product. 1 ROOFING SYSTEM EVALUATION: 1. SCOPE: Product Category: Roofing Sub -Category: Roofing Tiles Compliance Statement: Eagle Roof Tiles, as produced by Eagle Roofing Products Florida LLC, have demonstrated compliance with the following sections of the Florida Building Code through testing in accordance with the following Standards. Compliance is subject to the Installation Requirements and Limitations / Conditions of Use set forth herein. 2. STANDARDS: Section Property Standard Year 1507.3.5 Physical Properties ASTM C1492 2003 1507.3.7 1715.2.1 Overturning Moment SSTD 11 1997 3. REFERENCES: Entity ATL (TST 3782) ATL (TST 3782) ATL (TST 3782) 844) Examination ASTM C1492 ASTM C1492 ASTM C1492 FRSA/TRI 07320 & SSTD 11 Quality Assurance DESCRIPTION: Reference RT0324.01-11 RT0324.02-11 RT0324.03-11 Membership Letter Service Confirmation Date 04/03/2011 04/03/2011 04/03/2011 11/29/2005 Exp.12/31/2014 1 AIR, DOUBLE EAGLE BEL AIR, PONDEROSA, DOUBLE EAGLE PONDEROSA and GOLDEN EAGLE are uu (flat) -profile concrete roof tiles having a smooth or textured surface. Bel Air Golden Eagle Exterior Research and Design, LLC. Certificate of Authorization #9503 17" 12W Double Eagle Bel Air Double Eagle Ponderosa Evaluation E1322.09.06-R2 FL7473-R3 1 2: 06/23/2011 Page 2 of 4 A } RUNIERD � 4.2 4.3 NALIBU are medium -profile concrete roof tiles. HNL. tqw CAPmRmo are high -profile concrete roof tiles. S. (LIMITATIONS: 5.1 This Evaluation Report is not for use in the HVHZ. 5.2 Fire classification is not part of this evaluation; refer to FBC Section 1505.2 or current Approved Roofing Materials Directory for fire rating of this product. 5.3 Installation shall comply with manufacturer's current published instructions, but not less than the requirements of FBC Section 1507.3 and the FRSA/TRI 07320. 5.4 For mechanically attached tiles, attachment for wind load resistance shall be in accordance with FRSA/TRI 07320/8-05. 5.5 For mortar -set or adhesive -set tiles, attachment for wind load resistance shall be in accordance with FBC Section 1609.5.3 and the mortar or adhesive manufacturer's Product Approval. 5.6 All products in the roof assembly shall have quality assurance audit in accordance with the Florida Building Code and F.A.C. Rule 9N-3. 5.7 This Evaluation Report is limited to use on projects in areas subjected to weathering indices of 50 or less (negligible weathering), as outlined in Figure 1 of ASTM C1492-031, reproduced below for reference. 50 _. 50 ... .%%% WEATHERING REGIONS NEGLIGIBLE WEATHERAN'6- MOOtRATE WEATHERING SEVERE WEATH'1:RiNG' Exterior Research and Design, LLC. Certificate of Authorization #9503 Evaluation Report E1322.o9.o8-R2 FL7473-R3 Revision 2: 06/23/2011 Page 3 of 4 0 IV 1114 . "� TRNTYIERD 6. INSTALLATION: 6.1 Eagle roof tiles may be mechanically fastened, mortar -set or adhesive -set. Installation shall comply with manufacturer's current published instructions, but not less than the requirements of FBC Section 1507.3 and the FRSA/TRI 07320. 7. LABELING: 7.1 Each unit shall bear the imprint or identifiable marking of the manufacturer's name or logo. Tile lots shall be labeled in accordance with the requirements of the Accredited Quality Assurance Agency noted herein. 7.2 Tile not tested for freeze -thaw shall state clearly that the lot has not been tested for freeze - thaw acceptance on all lot tags or certification. S. BUILDING PERMIT REQUIREMENTS: As required by the Building Official or Authority Having Jurisdiction in order to properly evaluate the installation of this product. 9. MANUFACTURING PLANTS: Contact the noted QA agency for information on product locations covered for F.A.C. Rule 9N-3 QA requirements. 10. QUALITY ASSURANCE ENTITY: Architectural Testing, Inc. — QUA1844; (717) 764-7700 - END OF EVALUATION REPORT - ' ASTM C1492-03, Standard Specification for Concrete Roof Tile, © ASTM International Exterior Research and Design, LLC. Certificate of Authorization #9503 Evaluation Report E1322.09.06-R2 FL7473-R3 Revision 2: 06/23/2011 Page 4 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: (Standard Pacific of Florida GP Inc.) PROPERTY ADDRESS: Riverbend Lot No. 26 Port St Lucie, FL 34984 PERMIT #:56-SF-1519959 APPLICATION # : AP 1135037 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR929535 LOT: 26 BLOCK: SUBDIVISION: Riverbend PROPERTY ID #: 4425-703-0006-000-7 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065( F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, .WHTCH' SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,200 ] GALLONS / GPD Septic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D L 767 ] SQUARE FEET Drainfield SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: Top Of Catch Basin Se corner I ELEVATION OF PROPOSED SYSTEM SITE [ 4.00 ][ INCHES FT BELOW ]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 14.001 INCHES FT ][ABOVE BELOW L BENCHMARK/REFERENCE POINT D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow 0 of 460 gpd. T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s. 64E-6.013(3)(f), FAC. E R SPECIFICATIONS BY: rew Gatewood TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Specialist II Andrew R Gatewood DATE ISSUED: 02/11/2014 EXPIRATION DATE: DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1135037 SE919472 St. Lucie CHD 08/11 /2015 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The Agency Clerk's facsimile number is 850-410-1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, .and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. Florida's Leading Engineering Source • Geotechnical - Construction Materials Testing • Threshold and Special Inspections • Plan Review & Code Compliance 'tFRNATIO"� March 25, 2014 Standard Pacific Homes, South Florida 3201 West Commercial Blvd. #230 Ft. Lauderdale, Florida 33309 RE: Geotechnical Exploration - Riverbend Lot 26 NE Corner of Gilson Rd. & NW Turnabout Ln. St. Lucie County, Florida GFA Project # 13-0065.00 GFA International performed a geotechnical exploration for the site with Cone Penetrometer Test (CPT) soundings and auger borings on each lot. The results are presented in the GFA Geotechnical Report entitled "Proposed Riverbend Development: Lots 1 - 47" dated February 14, 2014. For Lot 26, the subsurface soil conditions are generally favorable for the support of the proposed structures on shallow foundations. An allowable bearing capacity of 2,500 or 3,000 psf may be used for foundation design provided the site preparation recommendations contained in the report are followed. For site preparation recommendations, basically the subgrade soils should be improved with compaction from the stripped grade prior to constructing the foundation pads. The top 2 feet below stripped grade should be compacted to a minimum of 95% density prior to placing fill to achieve final grade. Fill (including stemwall backfill) should be placed in 12-inch lifts and compacted to achieve a minimum 95% density. After excavation for footings, the subgrade to a depth of 2 feet below bottom of footings should be compacted to achieve- a minimum 95% density. Test results and inspection reports will be submitted under separate cover. We appreciate the opportunity to be of service to you on this project and look forward to a continued association. Please do not hesitate to contact us if you have any questions or comments, or if we may further assist you as your plans proceed. Sincerely, GFA International, Inc. FBPE,,RA ��fcVW. VIb16r, P. WIOr 86ote.�hnicil En veer Faorida Registrgid i �d .675 off'• 5-(p� �: �� s ° e ES S;10 %%`�� 521 NW Enterprise Drive - Port St. Lucie, Florida 34986 - (772) 924.3575 • (772) 924.3580 (fax) • www.teamgfa.com OFFICES THROUGHOUT FLORIDA L�+ a b Planning & Development Services Department 65 /0 Fc Building & Code Regulations Division 2300 Virginia Avenue, Fort Pierce, FL 34982 — (772) 462-1553 Certification for Design Load.Compliance.. Project Name: _1lue1 /l� Project Address: 3 l 3 LJ "-"I C(4:1; Permit #: Occupancy Type: Construction Type: V 3 INSTRUCTIONS FOR USE: • This certification must be completed, signed, and sealed by the design professional of record. • Submit (2) `copies for residential, (3) copies for commercial with all permit applications involving the following: o New Residences (single or multi -family) o - Residential Addition o Any accessory structure requiring a building permit o Any non-residential structure. * Note: Form not required for interior renovations provided that no exterior structural elements are affected and certain minor building permits at the discretion of the local building official. Contact the # above for questions. DESIGN PARAMETERS AND ASSUMPTIONS USED: (complete all that apply) 1. DESIGN CODE: Florida ! Code 2010 Edition with 20 — Supplements using ASCE 7-10 2. Structure Designed as (check one): Enclosed Partially Enclosed Open 3. Risk Category: _I kll 111 IV Exposure Category: is B C D 4. Design Wind Velocity IM mph ASD X LRFD End Zone Width: _4,67 ft 5. Mean Roof Height /R ft Roof Pitch: 4 :12 Parapet: ft 6. Components & Cladding Design Pressures Used: (PSF, based on 10sgft @ 15'MRH, clearly label on all plan openings): Zone 1: Zone 2: 0, o_ Zone 3: f _ Zone 4:._.f2,L Zone 5: d, Garage: 3 6�,6 7. Design Loads: Floor: PSF Roof/Dead: of_PSF Roof/Liver Balcony: 6 PSF Dock: _ PSF Deck: — PSF Stairs: 6_PSF Fence: 157 PSF Railings: PSF 8. Were Shear Walls Considered For Structure? Yes Not Applicable Explain Why Not: 9. Is A Continuous Load Path Provided? _kYes Not Applicable Explain Why Not: 10. Design Soil Bearing Pressure: PSF Soil Test Reports Submitted? Yes „DESIGN PROFESSIONAL CERTIFICATION STATEMENT:., .._ ................__.._.,..._ _ I certify that, to the best of my knowledge and belief, the attached plans & specifications have been designed to comply with the applicable structural portions of the building codes currently adopted and enforced by St. Lucie County. I also certify that structural elements depicted on these plans provide adequate resistance to the design forces specified: Signature, Date, and Seal Cale 1101cnnupla, PE Print Name Speclafty Engineering Consultar t�l� & Co. Cert Auth. 1599 SW 30th Ave., Suite 20 ....... Boynton Beach, FL 33426 FL PE# 056214 FL CA# 009217 Company Name & Address SLCCDV Form # 020-12 Revised 3/15/12 (JS) 0- '`1�£ Building Permit # Planning & Development Services Department Building & Regulations Division Product Review Affidavit Owners Name Standard Pacific Homes Applicant: Lot 26 Product Opening Design Pressures Product Rated Design Pressure Manufacturer Model Number Product Approval Number Glass Type Method of Attachment Windows +42.5/-57.5 +80/-80 PGT 700 FLA1-1013.14 Impact 2-Tapcon in Head, 5-Jamp Mullions PGT FLA 1-0922.01 Fixed Glass +43.9/-47.5 +80/-80 PGT 701 FL-13-0502.03 Impact Tapcons-Max O.0 Spacing 12" Block Glass NA Skylights NA Sliding Glass Doors Swing Type Doors +40.0/-43.6 +50/-55 Therma Tru Smooth Star FL-14665.1 Imapct Wood Screws French Doors +34.9/-38.5 +55/-55 Therma Tru Smooth Star FL12334.1 Impact Install w/CBS Const. 1X buck w/ITW 1/4" anchors Garage Doors +40.4/-36/8 + Amarr 950 13-0503.6/.8 Impact 2 X 6 Vertical wood jam attachment to 2000 PSI Concrete using Hurricane Protection NA Hitli quick bolts Roof Ventilation Roofing Material NA P(1) -39.1 P(2) -68.1 P 3 -100.7 Eagle Roofing Capistrano FL7473.R5 NA Mechanically (2) #8 2 1/2" Screws I have reviewed the above components or cladding and I have approved their use in this structure. These products provide adequate resistance to the wind loads and forces specified by current code provisions. Name: Signature: seal Design Prof: j�fl7-EC-7- Cert. No. ? Date: