HomeMy WebLinkAboutSUBMITTED PAPERSOFIfE USEI�TLY: �'J
DATE FILED:
PLAN REVIEW FE RECEIPT NO.. `� PERMIT NUMBER: -63 V
I�
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VugWa Avenue Cq YN�D
B
Ft. Pierce, FL 34982-5652
77242-1553 St Lucie Coup
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITYMONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: �QU3 .E> 0.,�� g5A :P00 Sc�xrA l j3_c,,p FA ?!)q q Sa
2. PROJECT NAME: I)Y1 V-ew CA w SITE PLAN NAME:
3. PROPERTY TAX ID #: iG -S X oo-mil - ow 13
4. LEGAL.DESCRIPTION (attach extra sheets if_necessary): ao ]�L-ua 5A -?Cxry,-unA Q - h1CIC
a_Iai IQ(mr,. -,�y 1 aaror, LaSb-aaz 1 -5jp P=MiCebLd,
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
r C ° -�rlc�° 1 a� ) Co X qXq OK C-,01 G� Ley CHIC T.
10. COL TEE C N OF CONSTRUCTION P OJECT OR WORK ACTPVITY:
CwZW-y ek, C G Y�
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE:" LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
oz�� -
14. SQ. FT OF CONSTRUCTION: ' 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $ ��9�
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
RECORDEDNotice ofCommenoement must be submitted withthis application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
7
OWNER. INFORMATION
NAME: 1
ADDRESS: -Ppc,-kA
CITY--, (bY' ',:::SCk\ CX* L-LA c 1 e STATE: i� ZIP:
PHONE (DAYM-AE): �io� , " Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:.
ADDRESS:
CITY:
PHONE-(DAYTW): ( )
ARCHIT/ENGINEER
ADDRESS'
CITY:
PHONE (DAYTIME): (_)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
FAX NO.
STATE:
STATE:
STATE:
ST. LUCIE COUNTY CERT #:
Email:
ZIP:.
ZIP:
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
CERTMCATION: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 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 AWROVEMENTS 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.
W11
OR
STATE OF FLORIDA 01
COUNTY OF
The foregoing instrument was acknowledged before
me this4Jday of �� 20J0__,
by c a -Y-�
who is personally known or Gas produced
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF _"
The foregoing instrument was acknowledged before
me this day of , 20
by
who is personally known or has produced
as identification. as identification.
Satnd of Notark Signature of Notary
r
Commission N , ;yy TRACEY A. SAYE Com ission No. (Seal)
,_. Notary Public - ate• or florid•
sN = My Comm. Exptr•s F•p 20, 2016
Commid•lon # EE 17d027
NOTE: TWO (2) SIGNATURES MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, 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 OWNERBUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY
SECTION
22�2
TOWNSHIP
ZONING
X54
LAND USE
FLOOD ZONE.
FIRM MAP #
CONST TYPE
OCCUP TYPE
WATER
SEWER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
2
RANGE
06
�%✓
LOT CVG %
IST FIR ELV
MAX OCCUP
SPRINKLERS
LOT SPLIT
REQUIRED
/207 - 0 as-. K: 1
MAP NO.
TAZ NO.
MAX HGT
# OF FLRS
STORMWATER
LOT SPLIT
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
LIBRARY
PUBLIC BID
PUBIC BID
PARKS
MACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING: / /_
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE r
RECEIVED
DATE ray .n X�J�a a .•:� p r
COMPLETED LlsY�ioi^ 0 3fa1,° sdfGc`� Sri
�. :;. s d
AM sat s 1 33 w noinimlc;
St. Lucie County
Building & Zoning Department
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even
though you do not have a license. You must provide direct, on -site supervision of the construction yourself. You
may build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a. cost of
under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially
improved for sale or lease. If you sell or lease a building you -have built or substantially improved your self within
one year after the construction is complete, the law will presume that you built or substantially improved it for sale
or lease, which is a violation of this exemption. You may not hire' an unlicensed person to act as your contractor or
to supervise people working on your building; it is your, responsibility to make sure that people employed by you
have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not licensed.to perform the work being done.
Any person working on your building who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct -.F.I.C.A. and withholding tax and provide workers'
compensation for that employee, all as prescribed by law. - Yourconstruction must comply with all apphq�b��s,
ordinances, building codes, and zoning regulations. Initial
I understand that the building official .and inspectors are not there to design or give advice on �o V�' o eet
the minimum code. Initial'' U
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial �—
I understand that if I compensate ,any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and li the
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate al
cost, which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection, an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zon}pg Department -to tlae Florida State Department of Professional. Regulation. Signed and ackaQwledged on this
day of tj It of 20 1
ex;t,_ �ridll-
Own Buil er Si e
f
STATE OF FLO A
COUNTY OF Q ,
The fo a oing p'stiuent as acknowledged before me thi� day of , 20
by ` who is personally known to me, or who has
zilofNotaryl
as identification.
S�° `�'�; : TRACEII A. BLYE
Type orPrmt 14ame o t _. • . a i)► PWk . SW of Wide
Title: Notary Public Commission Nurlb-�,/l ? 7 �� My Comm. Expitat fib 29, 2011
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 3698328 OR BC, 1384 PAGE 594, Recorded 04/27/2012 --a-.2:13 PM
NOTICE OF COMMENCEMENT
Permit No. - Tax Folio
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 following information is provided in this Notice of Commencement.
Legal Description of Property: (and street address if available):
� � � Z��p'C nQ-O; unik R1r k \a 1b�Cma� 3t11,�kL>{ (QS"U aaa)
General description of Improvement: Y�c��JICA O\Y�VP W Qe ul
Owner information or Lessee information if the Lessee contracted for the improvement:
Name Y
Address 3 i lil} ILleiC EI 3-AQC3L
Interest in property:
Name and address of fee simple titleholddener (if different from Owner Misted above):
Contractors Name: ') W / �` l
Contractor Address: Phone Number:
Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $
Name and address: Phone number:
Lender Name: Phone Number:
Lenders 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: Phone Number:
Address:
In addition to himself or herself, Owner designates of to receive a copy of the
Lienor's Notice as provided in Section 713.13(i)(b), Florida Statutes.
Phone number of person or entity designated by owner:
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[, 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 perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowledge and belief.
ct
(Signature of Owner or Lessee, or Owner r Lessee's Authorized Officer/Director/Partner/Manager TRACEY A. KYE
Nobly PtMk • flNa of FlodQr
(Signatory's Title/Office) 'oy My Dom• �b E.174 2011
n / v ' Centndnial I EE 1T�64T
The foregoing instrument was acknowledged before me this, day Apt 21 O
By ` dAJ AO I B inAiij as Dw Q 4 y' Q i 2f Un.fi`-H for S Q q
Na of Person - J Type of authority (e.g. ffice ,trustee) Party on behalf of whom instrument was executied
/ Personally known r produced Identification_.
lttgaatrille of NotaryPu lic- at o Florida)
(Print, Type, or Stamp Commissio ed Name of Notary Public)
Type of Identification produced
STATE 0f FLORIDA
ST. LUCIE COUNTY
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,
-- ! 0. t7 Z),Iq - QED 1J
el Id#/Legal description/Address)
��3 i3Y �T �s� . IQ
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.
Property Owne Name (Please Print)
ihkoA, ho
Pro rty O ignature D e
Y��STATE OF FLORIDA, COUNTY OF
C�)" ?
ACKNOWLEDGEQ.BEFORE ME THIS DAY OF 20
BY / d Z42 t"'�'Gfl�1 a -I IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED 1 JJ (
SIGNATURE OF NOTARY PUBLIC,
COMMISSION NUMBER
AS IDENTIFICATION.
�OV1.
NOTARY \
01AWN MIIANE
th; PAY C4Mh1SI0N # DO 852587
x>;;#�XHiR a: March 22, 2013
@e( ed Thru Notary Public Undo writers
SLCPDSD Revised 08/24/2010
Property Appraiser - St.Lucie�'--, nty, FL Page 1 of 1
PROPERTY RECORD CARD
Michael Bonagura
Record: 1 of 1 <<Prev Next » Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
CO
Site Address:
203 Bay St
ParcellD: 3419-510-0084-000-3 G,G
Sec/Town/Range:
22 :36S :40E
Account*: 41827
Map ID:
34/22N
RS-4
Land Use: SF Res
City/Cnty: St Lucie County
Zoning:
Ownership and Mailing
Legal Description
Owner:
Michael Bonagura
RIVER PARK -UNIT 2- BLK 12 LOT 12(MAP 34/22N) (OR 650-222;
Address:
203 Bay St
3379-2186)
Port St Lucie FL 34952-1315
Sales Information
Assessment 2011 Final Total Land and Building
Date Price Code Deed
Book/Page 2011 Final: 45600 Land Value: 9600 Acres: 0.26
4/5/2012
100 0114 WD
3379 / 2186 Assessed: 46600 Building Value: 36000
8/1/1989
100 01 WD
0650 / 0222 Ag.Credit: 0 Finished Area: 2380 SgFt
11/1/1972
30000 00 CV
0208 / 2391 Exempt: 25500
Taxable: 20100
Taxes: 408.94
BUILDING INFORMATION
(m
61M
(�n
m
� e•
is a
Exterior Features
View:
-
RoofCover:
ExtType:
HC- - HC-
YearBlt:
Grade:
C- - C-
EffYrBlt:
StoryHght:
0010 -1 Story
No.Units:
Interior Features
BedRooms:
3
Electric:
FullBath:
2
HeatType:
1/2Bath:
0
HeatFuel:
%A/C:
100
%Heated:
Special Features and Yard Items
Type
Y/S Qty.
Units Qual. Cond. YrBit.
DWC - Driv-Concret
Y 1
720 AV AV 1959
UTL3 - UTILITY AVG
Y 1
288 AV AV 1999
FS - Fibrglss Shg
RoofStruct:
GA - Gable
1959
Frame:
-
1959
PrimeWall:
BP - Conc Block
1
SecWall:
HP - Hardi Plank
MX - MAXIMUM
PrmintWall:
DW - Drywall
FHA - FrcdHotAir
AvgHt/FI:
ELEC - Electric
Prm.Flors:
TZ - Terrazo
100
%Sprinkled:
0
Land Information
No. Land Use
Type
Measure Depth
1 0100-SF Res
220 -Front Ft
91.9 125
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://www.paslc.org/prc.asp?prclid=341951000840003 4/27/2012
SOUTHCOAST PEST CONTROL INC.
1758 SW. CABIN PL.
PALM CITY, FL. 34990
772-370-4120
PEST CONTROL LICENSE # JB 110518
CERTIFICATE OF COMPLIANCE FOR TERMITE PROTECTION
(as required by Florida Building Code (FBC) 18116.1.7)
Treatment address: �� S-F • L c
Permit # ��/— a - ao y^ D"? 6
Builder. �4 G-Q I �Q g u rd—
V
Date of treatment: s-/v
Area treated: b r v
Gallons used: a 6
Chemical name: CROSSCHECK
Method of treatment: RODDED
Date of final treatment:
Time of treatment: ,3 3 4
Percentage of solution:.6%
Other:
THE BUILDING HAS RECEIVED A TREATMENT FOR THE PREVENTION OF SUBTERRANEAN
TERMITES. TREATMENT IS IN ACCORDANCE WITH RULES AND LAWS ESTABLISHED BY
THE FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES.
Applicator: Dan Salica
� o
VA 4
1142 Water Tower Road, Lake Park FL 33403
Administration.Office:1-877-484-9994 / Fax:561-848-1501 7
South East Florida Division Dispatch: 561-84'4-9994 / Central Florida Div #n Dispatch:p7d339-5311
558948
I lQall QBQN ��a101��l���ili�lE00��IIID�BBIB ��! I��I
Concrete Tested ❑ Yes ❑ No 1-01r#4
Water Added at Customer's
Cylinders Taken ❑ Yes ❑ No
Request
gals. to full load
Comments
gals. to 2/3 load
gals. to 1/3 load
Customer's Rep - Water Added
NOT RESPONSIBLE FOR
WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
skin and wash exposed skin areas promptly with water. If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH TIME
cement products.
7-71
PLAISY .
`T %T# L,ORDER
#
LQAD SIZEI-
MIX SLUMP
DATE
t1 f
Ate.:-°".?r.7
]TRUCK#
A.7
9
C,
d" A tv)
CUSTOMER #
SOLDTO _ V
P.O. # _
PROJECT# _
-�i9 •..^-Y
.., •S i9riT SIC^ f•`f1 .fir—•o^�r-•r A' Thl
,G O 1C E
Cra •s 4
DELIVERY ADbRESS "" ° ° ") •` ` ° '"" ` ° '
�ZONE#_
USE.
DRIVER
v5nIr r"r
r•+-h•j r rd-+Tr
smr_._ n.- _.�..n.
' '
TIME DUE
INSTRUCTIONS""
PRODUCT DESCRIPTION
I.I.O.M.
UNIT PRIC
•
•
•
10 0 0
20. C0
20.'-10D
30040000
3000 REf-
CYD
1.00
F IBEw.RR
F"IBERR
1. C
o
ENV I RO
ENV I RO DISPOSAL
1.t:0
2
FUEL SURCHARGE
i
SIGNATURE
OR RECEIPT- CONCRETE
AND ACKNOWLEDGEMENT
OF HAZARD
WARNING
a eye Goncrete company will not assumeliability or any property damage or any
rSUB-TOTAL
" equip ent any deliveries beyond the curb line.
pamag+r
A ire '114� ... TAX
—r l;;—__-" AUTHORIZED BY
SHIPMENT SUBJECT TO CC�NDITyI,ONS ON REVERSE SIDE. TOTAL
V
THIS DELIVER MADE SUBJECT TO THE FOLLOWING NDITIONS:
Customer agrees to provide a suitable roadway for our trucks from the street pavement to the place of delivery of mate ' rial.
If such suitable roadways are not provided, we reserve the,.right to stop deliveries until conditions are remedied and, in such
event, customer will be held responsible for any'lots caused ffi6reby.
2. When delivery is made beyond the curb line at the customer or customer representative's request, any damages including,
but not limited to, sidewalks, driveways, buildings, trees, shrubbery, septic tanks and septic systems, including the drain
field, are at the owner's risk.
3, The customer agrees to reimburse said Company for loss of time and equipment by reason of such delivery, and also to
indemnify and save harmless said Company from any and all claims, demands and suits for or on account of or in any
manner caused by or arising from private driveway delivery.
4, Customer acknowledges that all material and services shown,have been received, that truck times shown are correct, and
that the amount of water added at the customer's request is shown correctly, CAUTION: The addition of water reduces
concrete strength and durability.
5. We are not responsibly for finished results obtained from this load of concrete; many important factors affecting the ultimate
quality of the completed job.are beyond our scope of responsibility and control.
6. A charge of $1.00 per minute will be charged after 8 minutes per cubic yard unloading time is exceeded,
7. The customer agrees to provide a suitable wash down facility for our trucks and tools at the place of delivery of material.
8.* The customer hereby Agrees to pay all costs and expenses of collection, including a reasonable attorney's fee, if he shall
fail to pay for the merchandise reflected in this invoice, when due: Past due accounts are subject to a 1 -1/2% service
charge on the unpaid past due balance, The customer hereby acknowledges receipt of the complete copy of this contract,
® I
t
1142 Water Tower Road,, Lake Park FL 33403
Administration Office: 1-877-484494 / Fax:561-848-1501 8 y •' � '
South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311
565256
Concrete Tested ❑ Yes 'N�� LOT #
iNattt Added at usfomer's
Cylinders Taken ❑ Yes t0,No
i f3eq est
"
gals. to full load
Comments
��, �!
gals. to 2/3 load
gals. to 1/3 load
Customer's Rep - Water Added
NOT RESPONSIBLE FOR
WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR
SURFACE DISCOLORATION
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
skin and wash exposed skin areas promptly with water. If any cement_powder or
CONCRETE WILL REDUCE ITS STRENGTH
mixture gets'into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH TIME
cement products.
M.
PLANT
TICKET# ORDER
#
TRUCK #
°LOAD SIZE (
MIX SLUMP
DATE
1.{),�i
.ri' i
'^ry7
.�i;•
.l• f)
';{)t)f) j� F.
�)(r"i�ia_V.. 12
CUSTOMER #
SOLDTO
- '
P.O. #
PROJECT#
v
f-;ni:u)TmF"I.7 C't'lmrFnT- fi'P' TN1i"!_
Fs?1 1
DELIVERY ADDRESS
ZONE#
USE
DRIVER
2T)7% -BAY !P)T
�3TI....IJi': T E
DWAY
Rn h r? ri- 17',n , i 1 in rt
INSTRUCTIONS �f
TIME DUE
• •
••• •
••• •�
••• ® •
I.I.O.M.
•UNT
•
•
•
1.50
31. �'
0 31.50
,:�� ){:�%{�)f){-){..)
:.�,i i00 RE G
C:YD
1. {='
{ ,
I I' C" 41� #
I-1 I s f1 iY
1 a C
o
FUEL SURCHARGE
i /
OR RECEIPT - CONCRETE
AND.ACKNOWLEDGEMENT
OF HAZARD
SIGNATURE
WARNING
asc meyer , oncre a company willnot assumeliability or any property damage or any SUB -TOTAL
damage f/gr"aany/deyliveries beyond the curb line.
4
J TAX
AUTHORIZED BY
SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL
.� .=
1. Customer agrees to provide @auitable roadway for our from the street pavement to the place of delivery of material.
If such suitable roadways are not provided, wereserve the right to stop deliveries until conditions are remedied and, insuch
event, customer will beheld responsible for any loss caused thereby. .
2. When delivery ismade beyond theuurb|inee1th8oua+OmororouekornernapneSeDtadive'onaquemt' anydamages including,
but not limited to, sidewalks, driveways, buildings, trees, shrubbery, septic tanks and septic systems. including the drain
field, are 8tthe owner's risk.
3. The customer agrees ioreimburse said Company for loss oftime and equipment bvraaa0nofGuchde|ivery,end;dooto
indemnify and save harmless said Company from any and all claims, demands and suits for oronaccount oforinany
manner caused bworarising from private driveway delivery.
4. Customer acknowledges that all -material and services shown have been received, that truck times shown are correct, and
that the amount ofwater added mtthe customer's request is shown correctly. CAUTION: The addition of water reduces
concrete strength and durability,
5. We are not responsible for finished results obtained from this load of concrete; many important factors affecting the ultimate
quality ofthe completed job are beyond our scope ofresponsibility and control.
G. A charge of $1.00 per minute will be charged after 8 minutes per cubic yard unloading time is exceeded.
'
7. The customer agrees to provide a suitable wash down facility for our trucks and tools at the place ofdelivery ufmaterial.
8. The customer hereby jagrees to pay all costs and expenses of collection, including areasonable attorney'afee, ifheshall
fail to pay for the merchandise reflected in this invoice, when due: Past due accounts are subject to a 1-1/2% service
charge onthe unpaid past due balance. The customer hereby acknowledges receipt of the complete copy of this contract.
" MACC
HV
�i1�ER
CONCRETE
COMRjkNY'
OI` rLORIDA
r
I G.
1142 Water Tower Road, Lake Park FL 33403
Administration Office: 1-877-484-9994 / Fax: 561-848-1501
..,South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311
56525
fli' Il pi oil In
Concrete Tested ❑ Yes M No LOT #
Water Added at Customer's
Cylinders Taken ❑ Yes q No
equest
gals. to full load
Comments
,, �, gals. to 2/3 load
to 1/3 load
-
� gals.
—Customer's Rep - Water Added
NOT RESPONSIBLE FOR
WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR,
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
skin and wash exposed skin areas promptly with water. If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH TIME
cement products.
f,Itt
qo
711111112,7
ORDER#
TRUCK #
LOAD SIZE
MIX SLUMP
DATE
7("�
�r7
16')
1tD. t"0
,.,+;. 00 REG
5
CIF—May--12
CUSTOMER #
SOLDTO
P.O. #
PROJECT#
2927
GARDINER CONCRETE It><IC.
381,1.
DELIVERY ADDRESS
ZONE#
USE
DRIVER
203 BAY 91'
STL.IJC: I E
IiWAY
Frw,anc i scci Mateo
INSTRUCTION$
TIME DUE
F'SI-
I (_Dg -� raj
• •
••r r
••• •r
••r r •U.O.M.AMOUNT
•
•
•
10. t.)C?
30. Q0
30. i„0
4'a('.ihe't,(�)C7(, O
.s000 RES
CYD
i n t
o
i~� I BEE R R
4� I BE R R
1.0)
()�
ENV I CEO
ENV I RO DISPOSAL
1, C
o
rt
2
FULL Sl..fRr.;`I-1ARGE
5 SIGNATURE
OR EECEIPT - CONCRETE
AND ACKNOWLEDGEMENT
OF HAZARD
WARNING
asc Meyer oncrete ompany will not assumeliability or any property amage or any SUB -TOTAL
e damage fo 'atiy deliveries beyond the curb line.
luipm4nt
✓v ) I / / `:L
TAX
A / / t S AUTHORIZED BY
SHIPMENT SUBJECT TO CONDTIONA1 REVERSE SIDE. TOTAL
1 . Customer agrees to provide a suitable roadway for our trucks from the street pavement to the place of delivery of material.
If such suitable roadways are not provided, we reserve the right to stop deliveries until conditions are remedied and, in such
event, customer will be held responsible for any loss caused t6ereby.
2. When delivery is made beyond the curb line at the customer or customer representative's request, any damages including,
but not limited to, sidewalks, driveways, buildings, trees, shrubbery, septic tanks and septic systi)ms, including the drain
field, are at the owner's risk.
3. The customer agrees to reimburse said Company for loss of time and equipment by reason of such delivery, and also to
indemnify and save harmless said Company from any and all claims, demands and suits for or on account of or in any
manner caused by or arising from private driveway delivery,
4. Customer acknowledges that all material and services shown have been received, that truck times shown are correct, and
that the amount of water added at the customer's request is shown correctly. CAUTION: The addition of water reduces
concrete strength and durability.
5. We are not responsible for finished results obtained from this load of concrete; many important factors affecting the ultimate
quality of the completed job are beyond our scope of responsibility and control.
6. A charge of $1.00 per minute will be charged after 8 minutes per cubic yard unloading time is exceeded.
7. The customer agrees to provide a suitable wash down facility for our trucks and tools at the place of delivery of material.
8. The customer hereby pigrees to pay all costs and expenses of collection, including a reasonable attorney's fee, if he shall
fail to pay for the merchandise reflected in this invoice, when due: Past due accounts are subject to a 1-1/2% service
charge on the unpaid past due balance. The customer hereby acknowledges receipt of the complete copy of this contract.
l
1142 Water Tower Road, Lake Park FL 83403�3, �
Administration Office: 1-877-484-9994 / Fax: 561-848-1501 l
South East Florida Division Dispatch: 561-844-9994 / Central Florida` 1�sldn QiS-' h i753�91311
P 9.
nq111qiq111
Concrete Tested ❑ Yes EfltQ� LOT #
Water Added at Customer's
Cylinders Taken ❑ Yes F 1 0
Request
_ gals. to full load
Comments
gals. to 2/3 load
+.A�// gals. to 1/3 load
`�'9"
Custo'mjdr's Rep - Water Added
NOT RESPONSIBLE FOR
WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
skin and wash exposed skin areas promptly with water. If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH TIME
cement products. G ,
On Job Begin Pour
YA9 Y S�
- -ItA
PLANT
TICKET#' ORDER
#
TRUCK #
LOAD SIZE
MIX SLUMP
DATE
i t7:%
P� �; e;G,
171
i 0- Cidm
000 RFG
F!
t'r;ci•--M,:4vW-i
CUSTOMER #
SOLDTO
P.O. #
PROJECT#
1.1::•i
rn Tt kl•=P rnKIf'RF_. F- TKIf"
DELIVERY ADDRESS
ZONE#
USE
DRIVER
:N-i-•: A0V CRP
An 1 -, In
INSTRUCTIONS
TIME DUE
Cal -i'ti
howl
PRODUCT CODE
PRODUCT DESCRIPTION
UN IT PRICE
AMOUNT
•
•
•
10. 00
10. CC)
20. 0,)1
0040 )00
3000 REG
C;YD
1. GO
F"IRERR
FILSER6
1 e C
o
ENV I RID
ENV I RO DISPOSAL.
1. C
CI
2
FUEL SURCHARGE,
i
SIGNATURE
OR RECEIPT - CONCRETE
AND ACKNOWLEDGEMENT
OF HAZARD
WARNING
asc fneyer Concrete- Company will not assume liability for any property damage or any SUB -TOTAL
equipment damage for any deliveries beyond the curb line.
1 TA_ X
I AUTHORIZED BY
SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL
THIS DELIVEP MADE SUBJECT TOTHE FOLLOWING 0DITIONS:
1. Cu������Gs�pmv���a����ma��forour�c��m�����p�ome(���o�o � ��me�h�.
if Such Suitable roadways are not provided, we, reserve the right to stop deliveries until conditions are remedied and, in such
event, customer will beheld responsible for any loss caused thereby.
2. When delivery is made beyond the curb line at the customer or customer representative's request, any danNageaincluding,
but not limited to, S|dewa|ka. Uriwmways, bui|diuge, trees, shrubbery, septic tanks and septic systems, including the drain
field, are at'he owner's risk. `
3. The customer agrees tnreimburse said Company for loss Oftime and equipment byreason of' such delivery, and also to
indemnify and save harmless said Company from any and all claims, demands and suits for or on account of or in any
manner caused bynrarising from private driveway delivery.
4. Custorner acknowledges that all material and services shown have been received, that truck times shown are correct, and
that the amount ofwater added edthe customer's request is shown correctly. CAUTION: The addition of water reduces
concrete strength and durability.
5. We are not responsible for finished results obtained from this load of concrete; many important factors affecting the ultimate
quality ofthe completed job are beyond our scope mfresponsibility and control.
G Acharge of $1,00 per minute will be charged after 8 minutes per cubic yard unlo'dding time is exceeded.
7 The customer agreas to provide a suitable wash down facility for our trucks and tools at the place cddelivery ofmaterial.
8, The customer hereby ?,grees to pay all costs and expenses of collection, including a reasonable attorney's fee, if he. shall
fail topay for the merchandise reflected in this invoice, when due: Past due accounts are subject to a 1-1/2% service
oharQeuntheunpaidpdotdueba1@nm*.Th8cuetannarhenybyaoknow|edgesreoeiptnftheonrnp|etecopyofthiacon1nao1
•A r'
SOUT14COAST :PEST CONTROL INC.
1758 SW. CABIN PL.
PAI M CITY, FL.. 34990
772-370-4120
PEST CONTROL LICENSE # JB 110518
CERTIFICATE OF COMPLIANCE FOR TERMITE PROTECTION
(as required by Florida Building Code (FRC) 18116.1.7)
Treatment address. ,
Permit # :/ a ^ �.�,o 7 — p,.?ef
Builder: 1 "� �-� I R'g u'ra` Date of final treatment:
V
Date of treatment:
\ �v 0- W aY , pa:� I c�
Area treated: 1J ►' �
Gallons used: � 6
Chemical name: CROSSCHECK
Method of treatment: RODDED
Time of treatment:
.9 4
Percentage of solution:.6%
Other:
THE BUILDING HAS RECEIVED A TREATMENT FOR THE PREVENTION OF SUBTERRANEAN
TERMITES, TREATMENT IS IN ACCORDANCE WITH RULES AND LAWS ESTABLISHED BY
THE FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES.
Applicator: q11 Salica
,;,,
M All S 4 2012
�UtJ:l l: t,,,�tSts
St. Lucie County, FL
TO 39dd 1daw00N0SIQdW 99090bEZLL 99:90 9OOZ/bT/LO