HomeMy WebLinkAboutSUBMITTED PAPERSPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.'
Fort Pierce, FL 34982 Cq��E®
(772)462-1553`UCie
B CO
SPECIALTY PERMIT APPLICATION Unary
❑ Electrical ❑ Plumbing ❑ HVAC P Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
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1. Location/SiteAddress: �L1 Z� �v' ' `G�� na
2. Parcel ID Number: I LI �(+7 � �-U ` " 1 r ow
Office Use
'
-
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•
isi
3. Comjplete Description of Project or Work: � STD ` 2 Z-5`
/? 1_ _ 1•_ n V I o.�w 10 ' 1 11n1-0/J l . 1 r--, -I r,
4. Owners Information 5. Contractors Information
Name: Me- 1-enz:l <
Address: 2-4 -72)me1 n� D(we
City: �-4 - �! fC 2 State: ec,
Zip: 4 Phone: 4U6 1 Z 1 45
6. Value of Construction: $ l -1 [ 0 —
FL Reg/Cent #:
County Cert#: 7- l-a & 4 -7
Business Name: I 1�� IC l,.O c3�
Phone: 340-U 111 Fax: -25Lto --M 7
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
compliance with all applicable laws regulating co structionading.
Y1 z° v Ifl. -�Sr'1
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS l DAY OF 20 I Z- BY '1 1 (f�U
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
BARBARA ELLUZZI
MY C,O�MMISSION # EE073023
EpPIRES March 13, 2015
A DENTIFI ATION.
��
IGNATURE OF NOTARY 7 TYPE OR PRINT NAME OF NOTARY
r
COMMISSION NUMBER�d� ��:, (40
E
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF. COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 'TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000.
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or blue ink
only) or typed: This permit application is to be used only for those activities that are not otherwise included
under a primary building permit. This application may not be used for any activity that includes structural
alteration. The information to be provided with this application includes:
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
Indicate the street address or general location of
property where the building activity is taking place.
Indicate the tax identification number of the
property where the building activity is taking place.
Fully describe the activity to take place.
Indicate the name and address of the owner of the
property on which activity is taking place.,
Indicate the State of Florida registration number (if
applicable), St. Lucie County contractor license
number and the name of the business doing the
work.
6. Value of Construction Indicate the total value of the work to take place.
Total cost of construction includes all current retail
material and labor costs associated with the
building/construction activity. Construction value is
used to. determine the permit fee. 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.
❑ Gas
Attach 2 piping schematics with tank size, location, and BTU of each appliance
❑ Shed:
Attach 2 plot plans,.2 copies of DCA letter and plans, 2 anchor specifications
Fence
Attach 2 plot plans showing location of fence height of fence and type of fence
❑ Siding
Attach 2 copies of manufactures specifications
❑ HVAC
Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement
This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 34982. All permit applications must be filled out completely before submission. No applications will be
accepted for processing after 4:30 P.M. For assistance, in completing this application, please call (772)
462-1553, during regular office hours (8:00 AM - 5:00 M), Monday through Friday.
NOTE: Emergency electric service change out inspections will not be performedafler 3: 00 PM without
special arrangements and additional fee paid.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.
Property Appraiser - St.Lucie nty, FL
- - Page 1 of 1
PROPERTY RECORD CARD 1 .
Donald J McKenzie Record: 1 of 1
<<Prev Next» Spec.Assmnt
Taxes Exemptions Permits Home Print
Property Identification
V�CIF CO
Site Address: 2420 TAMARIND DR
ParcellD: 1436-601-0004-000-5
Sec/Town/Range: 36 :34S :40E
Account #: 12115
y�
Map ID: 14/35N
Land Use: SF Res
.�
Zoning: RS-4
City/Cnty: St Lucie County
Ownership and Mailing
Legal Description
Owner: Donald J McKenzie Mercedes McKenzie FORT PIERCE SHORES -UNIT 1- BLK 1 LOT 3 (OR 342-1092)
Address: 2420 Tamarind Dr
Fort Pierce FL 34949-1508
Sales Information
Assessment 2011 Final
Total Land and Building
Date Price Code Deed
Book/Page 2011 Final: 172100
Land Value: 83700 Acres: 0.27
11/1/1980 70000 00 CV
0342 / 1092 Assessed: 135920
Building Value: 88400
4/1/1980 17500 01 CV
0331 / 0155 Ag.Credit: 0
Finished Area: 1642 SgFt
3/1/1974 40100 00 CV
0224 / 1786 Exempt: 50000
Taxable: 85920
Taxes: 1945.04
BUILDING INFORMATION
Exterior Features
View:
-
RoofCover:
SD - Dim Shingle
RoofStruct:
HP - Hip
ExtType:
HB - HB
YearBit:
1997
Frame:
-
Grade:
B - B
EffYrBlt:
1997
PrimeWall:
BS - CB Stucco
StoryHght:
0010 -1 Story
No.Units:
1
SecWall:
-
Interior Features
BedRooms:
3
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/FI:
STD
1/213ath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CU - Carpet
%A/C:
100
%Heated:
100
%Sprinkled:
0
Special Features and Yard Items
Land Information
Type Y/S
Qty. Units Qual.
Cond. YrBlt.
No. Land Use
Type
Measure Depth
1 0100-SF Res
230 -Front Ft
66 178.8
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
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Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
o"*"m° Code: o"m"m° w°m.
3026481 LTI DEVELOPMENT COMPANY INC
Project Code: Project Name:
.
Ticket Date: om*°ry Address:
10/09/12 DIAMOND SANDS LOT 42
'
Delivery Instructions:
5 MILES NORTH OF JENSEN CAUSEWAY
ON R1A.
1%40RTF1 GATE
Customer Job Number: Order Code Date: .
Project nuNumber order. PO.
^NO^PC}
Map Page: w,�n=mm o"m" .
Dispatcher:
GFanni
rw��w��.
� '.
32284651'
`
Due On Job:
Slump:
Truc N�!gbger:
Driver Number:
Driver Name:
End Use:
LOAD
CUMULATIVE I
ORDERED
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
10.00
30.0(l
40.01
1176167 6500 PRPM YD3
7.50
22.50
.75
,
1382600 FIBERMESH LB �
�
1.00` 1247818 FUEL 9URCHARGE
1.00 1202749 ENVIRONMENTAL CHARGE
�
This --y Ticket incorporates herein by reference Buyer's previously executed Credit Application, it
: and( )nditions, Seller's Quotation, .if any, and Seller's Order Confirmati( icluding limitations of wa,ra,ft«Cs), as it tuiiy
h,:, forth on this Delivery Ticket ("A ment"). Seller will provide the Standard' is and Conditions upon request. Buyer agrees
less otherwise noted on the f hereof, all quantities and items were delivered as indicated and further expressly agrees to
,.a- accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
n�--.-late products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
�)us materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
-,--tcts include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand, gravel, and
tier 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: I:n. 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.cemcxusa.com.
Este ticket de entrega incluye como referencia at comprador (ya previamente ejecutada en su aplicaci6n de crddito); 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 at contrato; at menos que se identi-
frque 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, 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 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 irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones alergicas en la piel. Conereto 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, come 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 caliza, 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, irritaci6n o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente it medico. El riesgo en la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el. contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. 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 protecci6n respiratoria.
P.rimeros auxilios: En caso de contacto en los ojos, inmed.iatamente fluya agua en la parte afectada por 15 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 inmediatarnente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para m1s informaci6n visita www.cemexusa..com.
E M M <
54984399
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Feturn Plant:
j_j'3ii/1.0 90
Customer Code: Customer Name:
3 0 2 6- 4 & I LT DEYELOC)MENT CDYIPANY INC
Project Code: Project Name:
Ticket Date: Delivery Address:
DIAM(XID 3-ANT)SA.-OT 4-
Delivery Instructions:
5 5 "1 L _E(,; !AORTH OF JENSEN CAUSEWAY
ON
r 1 RTI D I 1.0 F PTE
Customer Job Number. Order Code / Date:
0 15 i 0 0119:11.21
Project P.O. Number. Order P.O. Number-:
�Nci Po
Map Page: Map/Row/Column:
Dispatcher.
S F
Ticket Number.
2284799
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
a,
10.3'
,5.00
0 7 1
1. o a
�JIDSF CONTRERAS
7s
B L 6M r WAI 4
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY I QUANTITY QUANTITY
10. () C) 4110. (K) 40. 01 1176167 C-,5(-.)C) PRPIYI YD
7.5(.-,,, 30. 0() .75 1382,600 FIBERKH"SH 150 L B
1. 00 1247818 I-'-UEI- SURCHARGE
1.00 1 2 7 f+ 9, ENVIRONMIENTM- C'HARGE
Cash Check #/ Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Chairges:
Check
Charge Iz
Comments:
\_/ �. W EA; C� —GAL YARDS IN DRUM!
—WHEN-ADDED.
SIGNATURE
/RB'� LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
Q LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials'where the customer designates, but the SPECIAL TERMS ater added is at customers own risk. If water is added on job, concrete strength
a te
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer gu? ted WAR. ING: 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 s 1 ;1
;; y�q�afety 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 in f1rallon, a�to e-material safety data sheets for additional Information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHED I TURE-
within one business day after the receipt of materials.
ulyl
68UNIVERSAL. PIREV TRK.- 1.0025316- INVOIC� LOAD.- N
'> > icket .incorporates herein 1— reference Buyer's previously executed Credit Application, if any, Seller's Standard
ditions, Seller's Quotatio any, and Seller's Order Confirmation (in ing limitations of warranties), as if fully
sc Delivery Ticket ("Agreement"). Seller will provide the Standard Term- -..d Conditions upon request. Buyer agrees
.•!ierwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees to
!: r -.Y mce with the Agreement.
AGGREGATE/ CEMENT / CONCRETE PRODUCTS / FLY ASH
.,,• )roducts are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
r raterials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
D:**kld Is. include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand, gravel, and
iceous. materials. These products, including fly ash, may contain more than 0.02.5% crystalline silica.
CAUTION!
•r^x: 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.
x %ety: 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
t 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
*,--rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitations y
,rarantfas), Como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal-
'.idos en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades
materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contacto; al menos que se identi-
-,que 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, rota volcanica, arena, grava y otros
materiales silicibs. Los productos de cemento incluyen Cemento de tipo Portland, de albaiiilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, rocs 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: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los Ojos, quemaduras en piel y ojos, y
reacci.ones alerg.icas en la pie]. Concreto seco y po.lvo de agregados, pueden causar irritacion en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, come y/o perforation 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..
La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritacion a
Seguridad: quemaduras en la 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 piel. Use guantes, proteccion en los ojos y ropa
Primeros adecuada para proteccion. Lavese las manos con jabon suave y agua despues del manejo de rnateriales. 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 pate afectada por 15 minutos.
Si se inhala polvo, expongase a aire 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
02112 Para mds informacion visita www.cemexusa.com.
ZZCCMC-X 549 4402
11r...,
Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
Customer Code„
CusYo er Na e;
COMPANY J:NL:
Project Code:
Project Name:
Ticket DpteA r_I I _
D:gv fA,d7d1 fliti1 t t.�5 }.� 1��
eaVeE p
,'nrlO:T% t �jL
r)FY:Pi
C%URTrr•} I;CST#
Customer Job Number: Order Code / Date:
60 ;Itii{)"4�ti
Project P.O. Number. Order P.O. Number
Map Page: Map/Row/Column;
Dispatcher
Ticket Number: `
Due, slump: Slump: cr Truc Numbel'I "t ; D iver,Nurr}ber- Dr vev Name: • End Use: I `
a � �r i,;�ra{_... .t., �t_ a.f) ;t'i I- BE_TTE1�? I_�.C}IJi,n l�lFti._L.
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
6()a 01,
11.7 167
t j{'){:) P(Mlyl YD3
7 a 5C1
37:. 50
. 7.'_7
1 '.,ts2i::0 0
F :I DVERME ". 1.1 1 `:;f") !�:?
:la()t;) }P'li. 7811t F=LIEL 11CfiAl3C:ifW
t12 7�t'3 i-9'at! !'R171�i1+Iw�1�l�'t'1._ C;` �{? GE~
4 r._ ,
J Cash Check # / Auth Code: Signature of Driver Receiving Cash:
] Check
Charge
Comments:
Notice: Our drivers will make every effort to place materials where the/customer desig
Company assumes no responsibility for damages inside curb or property line. Customer
terms of sale and delivery and accepts concrete as is. Due to important factors which
control after delivery, this Company will not accept any responsibility forllthe finished results
returned concrete. Buyers exceptions and claims shall be deemed waived unless made
within one business day after the receipt of materials.
1
I••-rREt1 T�{li- :I.()()r._.�60
68UNIVERSAL
. - I Cash Received:
Total COD Order Amount to Collect
Without Standby Charges:
v ,
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE,
CURB LI E'ER�OSSED AT /AGENT'S REQUEST:
SIGNATURE
❑ L9AD WAS TESTED , . BY:
iatesI b t'Ke SPECIAL TERMS:, Any water added is at customers own risk. If water Is added on job, concrete strength
agr a too the is no longer guaranteed. WARNING: Product may cause skin and/or eye,irritation: CAUTION: 'Material
�73 t of�our may be hazardous to your safety and health. Please refer to the backside of this ticket for impoitant
No creditt,lor safety handling information, and to the material safety data sheets for additional information. .
airs inw tmg AUTHORIZED SIGNATURE:
71{ 0
INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any. Seller's Standard
Terms and Conditions, Seller's Quota if any, and Seller's Order Confirmation uding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agrucutent"). Seller will provide the Standard Te, iin 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 cornprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confinmaci6n 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 cornprador acepta los mismos ya antes mencionados y que ]as cantidades
y materiales fueron entregados como se expresaen 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 albaflilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
g.ranito, 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 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, cone y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritacion o
quemadu as en .la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el. contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Ldvese las manor con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmmediatamente 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 irritacion continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.ceinexusa.com.
ZZEMEX 54984394
Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload. Leave Job, Return Plant:
09 o / 10 9 0
Customer Code: customer Name: customer Job Number: Order Code Date:
302611-81 LTI DEVELOPMENT COMPANY INC 606,
Project Code: Project Name: Project P.O. Number: Order P.O.,Number:,
'EI PO
Ticket Date: Delivery Address: Map Page: Map/Row/Column:,
DIA1110111D 07il'MS LOT 42
Deli Instruction' Dispatche'i.,
,very s: M T LES NORTH OF JENSEN CAUSEWAY Fa n rt i TI.A
Ticket Number.
3228445-3.'
Due
Slump:
Truck Number:
Driver Number
Driver Name:
End Use:
6gn.Job:
212
3
34t -
10027 9-1
1. Or
9009
WIL.L.IAN DEPINO
BLDNG. -WALL..
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDEREDI
QUANTITY
MATERIAL CODE
I I
PRODUCTION DESCRIPTION
uOM
I
UNIT PRICE I
AMOUNT
10. CIO
F-10. 00
-40.01 1,175167
6-500 PFRPM
7. j 0
1 15. 0 0
.75 1382600
FIBERKIF--(3111 1.30
LB
i. 00
1 2:A7818,
FUEL SURCHARGE
1. 00
1202"74S,
ENV I RONIMENI-nl- CHAK-33E
WCash
Check # Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect,
Without -Standby Charges: .
Check
Charge
Comments:
WATER ADDED: -GAL YARDS IN DRUM:
WHEN ADDED.
)SIGNATUR
CURB LINE CROSSED AT OWNER'SIAGENT'S REQUEST:
SIGNATURE
C) LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials where the customer des
ignates, 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 and health. Please refer to the backside of this ticket for important'o
control after delivery, this Company will not accept any responsibility for the finished results. Nocredit for safety handling - 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 SIGRATy
within one business day �fter the receipt of materials. 0ply
68UNIVERSAL V'REY -FRK-. 1002536J
INVOICE
LOAD !--MIA,,
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotati f any, and Seller's Order Confirmation (i ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agre-.—at"). Seller will provide the Standard Teri—, 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 wann, 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 ineluye Como referencia at comprador (ya previamente ejecutada en su aplicacion 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 ]as cantidades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo at contrato; at menos que se identi-
fique con Una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, 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) 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 pier y ojos, y
reacciones al6rgicas en la pier. Conereto seco y polvo de agregados, pueden causar irritacion en los ojos, pier y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n 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.
Se uridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritacion o
g quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente at medico. El riesgo en' la salud depende en
la duracion y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la Piet. Use guantes, protecci6n 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 mas de los limites recomendados, use protecci6n respiratoria.
Primeros aux.ilios: 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 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.com.
ZbEMEX
l E i 0
5494393
Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
a
Customer Code: Customer Name: Customer Job Number: Order Code / Date:
, 02..ES4S:l L-1-1 DEVELOPMENT COMPANY INC
Project, Code: Project Name: Project P.O. Number: Order P.O. Number:'
NO PO ,
Ticket Date: Delivery Address: Map Page: Map/Row/Column: ,
10,r►y9/ 12, DTAVIOND SANDS I-OT 40.1,, .
DeliveryInstructions: Dispatcher.
MILES WORTH OF ....r1:..rVSEN CAUSEWAY Gral-InInp • , .
ON q 1 n- . Ticket Number:
Due On Job:
Slump:
Truck Number:
I Driver Number:
Driver Name:
End Use: t ^;, '
o7t� a
` . tru:;
:Lt;�yi";5;:61.
lc ��0o7
(33 EG LOIN%ELL.
BLi�N6.—.., lWAL' _'
LOAD
QUANTITY
CUMULATIVE I
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE .
AMOUNT
1.0. oo
1. 0. 1)Q
tt 0. 01 1. 176 s 67
6500 P RPM
D 3
.-'7: 150
7.50
.73 1.382600
F"TBERiYIP�H 15o
LB
. '
1. c';f_; 121,,7818 FUEL StJRr_;NARGE
1 20;7� :7'49? ENVIRONMENTAL. CHARGE
Cash Check # 1 Auth Cade: Signature of Driver Receiving Cash: �® Cash eceived: Total COD Order Amount to Collect
Without.Standby Charges;
] Check ,•
Charge
Comments: ^
'IVVA7ERADDED: GAL YARDS INbRUM
0- WHEN ADDED:
,
00.
VG`e
5t'CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
/� V 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 saf tyW
ease 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 oty 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 i// '
68UNIVERSAL PRE 1f RK-. V L:OCAD NUM e J
INVOICE.
This Delivery Ticket incorporates her-;- by reference Buyer's previously execute,' 0-edit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotal if any, and Seller's Order Confirmation uding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees to
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, 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 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 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, dolonvta, 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 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: Mezc]a 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 eftrituramiento, pulido, torte y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmbnar.y, cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura caliza, reposar y tomar grandes cantidades_ de aqua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar ]a liberaci6n del amoniaco. La'in0daci6n del amoniaco pued-e causar toser, irritacion o
quemaduras en la naric, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el nivel de la exposition. ,
Seguridad: Evite el contacto con ojos y contacto prolongado con ]a piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecu.ada para protecci6n. Lavese las manos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 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 irritaci6n continda.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.cemexusa.com.