HomeMy WebLinkAbout10092007CB AgendaCRYt~
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HOME OF PELICAN ISLAND
BUILDING DEPARTMENT
1225 MAIN STREET • SEBASTIAN, FLORIDA 32958
TELEPHONE: (772) 589-5537 • FAX (772) 589-2566
SEBASTIAN CONSTRUCTION BOARD
REGULAR MEETING
OCTOBER 9, 2007 - 7:00 P.M.
CALL TO ORDER
PLEDGE OF ALLEGIANCE
ROLL CALL
APPROVAL OF MINUTES:
ANNOUNCEMENTS
OLD BUSINESS:
NEW BUSINESS:
THOMSON/PROMETRIC EXAM: PIERCEY, NORMAN G/PAINTING
VIOLATION HEARINGS:
ELLIS HYERS/STROM DEPOT SALES INSTALLATION & SUPPLY, INC.
1352 SHORELINE CIR- 26-172(5), DIVERSION OF FUNDS
26-172(10), ABANDONMENT OF A CONSTRUCTION PROJECT
BUILDING OFFICIAL MATTERS:
BOARD MATTERS:
ATTORNEY MATTERS:
RECORD SCORES IN SCOREBOOK
15 MINUTES TO PUBLIC
ADJOURN
NOTE: IF ANY PERSON DECIDES TO APPEAL ANY DECISION MADE ON THE ABOVE
MATTERS, HE/SHE WILL NEED A RECORD OF THE PROCEEDINGS AND FOR SUCH
PURPOSES, HE/SHE MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE
PROCEEDINGS IS MADE, WHICH RECORD INCLUDES THE TESTIMONY IN EVIDENCE ON
WHICH THE APPEAL IS BASED. TWO OR MORE ELECTED OFFICIALS MAY BE IN
ATTENDANCE
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HOME OF PELICAN ISLAND
BUILDING DEPARTMENT
1225 MAIN STREET • SEBASTIAN, FLORIDA 32958
TELEPHONE: (772) 589-5537 • FAX (772) 589-2566
SEBASTIAN CONSTRUCTION BOARD
REGULAR MEETING MINUTES
SEPTEMBER 11, 2007 - 7:00 P.M.
Meeting was called to order by Ch. Garland at 7:00 P.M.
Pledge of Allegiance was led by Ch. Garland.
ROLL CALL: Present: Ch. Garland Mr. Dalessandro
Mrs. Carbano Mr. Morris
Mr. Bulla Mr. Widup
Absent: Mr. Hosey -excused
APPROVAL OF MINUTES: Regular meeting held 7/10/07.
MOTION: Widup/Carbono
I make a motion we approve the minutes of meeting held 7/10/07 as written.
A voice vote was taken -passed unanimously.
OLD BUSINESS: Gregory Perugini / Perugini Construction
Re: Abandonment of Construction Project-Diversion of funds
Report from Building Official, Wayne Eseltine, stating he does not
feel the need for Perugini to come back in front of Construction board
since Perugini has relinquished his license. After discussion, motion
was passed that Perugini does not need to come back in front of
board at this time, but if he ever does work in City of Sebastian, he
will need to go in front of board before able to pull any permits.
MOTION: Widup/Bulla
I make a motion that Gregory Perugini need not come back in front of construction board
at this time.
ROLL CALL: Mrs. Carbano -yes Mr. Bulla -yes
Mr. Widup -yes Ch. Garland -yes
Mr. Dalessandro -yes Mr. Morris -yes
NEW BUSINESS: Thomson * Prometric Exam
William J. Perez /Master Electrician
Mr. Perez was sworn in by Ch. Garland.
MOTION: Moris/Widup
I make a motion we approve Mr. Perez to take the Master Electrician exam.
ROLL CALL: Mrs. Carbano -yes
Mr. Widup -yes
Mr. Dalessandro -yes
Mr. Bulla -yes
Ch. Garland -yes
Mr. Morris -yes
Motion carries 6 - 0.
Richard Reeves /Master Electrician
Mr. Reeves was sworn in by Ch. Garland.
MOTION: Carbano/Widup
I make a motion we approve Richard Reeves to take the Master Electrician exam.
ROLL CALL: Mr. Bulla -yes
Mr. Widup -yes
Mr. Dalessandro -yes
Mr. Morris -yes
Ch. Garland -yes
Mrs. Carbano -yes
Motion carries 6 - 0.
Vinay Pinto /Tile & Marble
Mr. Pinto was sworn in by Ch. Garland.
MOTION: Garland/Morris
I make a motion we approve Vinay Pinto to take Tile & Marble exam.
ROLL CALL: Mr. Morris -yes
Mr. Widup -yes
Mr. Dalessandro -yes
Mr. Bulla -yes
Ch. Garland -yes
Mrs. Carbano -yes
Motion carries 6 - 0.
Presentation from Wayne Esletine, Building Official, regarding continuance of
sponsoring contractors for license and future role of the Construction Board. After
lengthy discussion, board was polled and unanimously agreed that due to the
current shortage of staff due to recent cut backs in the Building Department and
the financial gains and losses involved with sponsoring contractor licensing, the
Board has left the decision to staff to make a recommendation to City Council on
the future role of the Construction Board
VIOLATION HEARINGS: None
BUILDING OFFICIAL MATTERS: None
ATTORNEY MATTERS: Mr. Carl Bonester should be sponsored to take the structural
concrete exam for type of work he intends to do.
MOTION: Morris/Widup
ROLL CALL: Mr. Bulla -yes Mr. Morris -yes
Mr. Widup -yes Ch. Garland -yes
Mr. Dalessandro -yes Mrs. Carbano -yes
RECORD SCORES IN SCOREBOOK: Carbano/Widup
There being no further business, meeting adjourned at 8:40 P.M.
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HOME OF PELICAN !BLAND
CONSTRUCTION BOARD
1225 Main Street
Sebastian, FL 32958
(772)388-8245 Phone
(772) 589-2566 Fax
APPLICATION FOR CERTIFICATE OF COMPETENCY
DATE: ~ - '~
i- I,
APPLICATION FEE: ~ 1
BOARD SECRETARY:
'~F~ ' 7G8&ff959§EN::>:=3fSA~3e ~fF'.~EB;i =~~9'dP 5'7f~aF66~3~v<=:~r78~i&2^" ~la~'-;-.~-,,,
-li~il8,9:.
APPLICATION FEE MUST ACCOMPANY THIS APPLICATION. ALL CHECKS SHALL BE MADE
PAYABLE TO THE CITY OF SEBASTIAN.
WITHIN THE PROVISIONS OF ARTICLE VI. SEC. 26, CODE OF ORDINANCES WHICH REGULATE AND
GOVERN CONTRACTORS WITHIN THE CITY OF SEBASTIAN. FLORIDA. I HEREBY APPLY FOR A
CERTIFICATE TO QUALIFY AS A CONTRACTOR OR SPECIALTY CONTRACTOR UNDER THE
CLASSIFICATION INDICATED BELOW.
GENERAL (®] BUILDING
PLUMBING [ _ ] MASTER
ELECTRICAL ~] MASTER
CLASS "A" A/C
SPECIALTY CONTRACTOR
APPLICANT'S FULL NAME:
COMPANY NAME: y S ,~ ~ ~~, ~ ',,,~ PHONE: ~ ~?- (~~"~_~(.;~~
BUSINESS ADDRESS: l c~' ~"~' ! ~ ~~' ~~~, ~~- ~ ~.,
~.
CITY: V e r ill ~ -, c ~ STATE: ~ ~ ZIP CODE: ~j (~
RESIDENTIAL
C~ JOURNEYMAN
JOURNEYMAN
CLASS "B" A/C
SPEC IFY TRADE
I AM QUALIFYING FOR: SOLE PROPRIETORSHIP [PARTNERSHIP [~ CORPORATION/LLC
APPLICANT'S TITLE:
MAILING ADDRESS: ~ C~ 1 ~ ~~ k~` ~P ~-~-~ ~, PHONE: ~ Z- (~?j`3-S ~`7
ZIP CODE: SZ~ (~~'~
PLACE OF BIRTH: ~~.~ ~ ~1,~~®~ ~ L =' ~} ~;-
CITY: V C,f'L d ~ r: r I--. STATE:
CITIZEN OF THE UNITED STATES: YES ~ NO
I
0
IF THE BUSINESS ORGANIZATION NAMED ON PAGE I OF THIS APPLICATION IS A SOLE
PROPRIETORSHIP, PLEASE PROVIDE THE FOLLOWING INFORMATION:
OWNERS NAME:
STREET ADDRESS: , ~ 1 ~ ~ `1 ~~ ~ w r i~ ~ ~
CITY: ~~,~ ~~ ~ STATE: r~
- C ~ • ZIP CODE: ~ c~
IF THE BUSINESS ORGANIZATION NAMED ON PAGE I OF THIS APPLICATION IS A PARTNERSH
PLEASE PROVIDE THE FOLLOWING INFORMATION: IP,
OWNERS NAME:
STREET ADDRESS:
CITY: STATE:
ZIP CODE:
OWNERS NAME:
STREET ADDRESS:
CITY: STATE;
ZIP CODE:
~.•,r''°"~*~'" -~+LtA b J#~Bk~_m sLHdA't~t=:;..:l.ll'litiilea'a~s=
IF THE BUSINESS ORGANIZATION NAMED ON PAGE I OF THIS APPLICATION IS A CORPORATION/LL
CHARTERED BY THE STATE OF FLORIDA, PLEASE PROVIDE THE FOLLOWING INFORMATION: C
PRESIDENT NAME;
ADDRESS: CITY/STATE:
V.P. NAME:
ADDRESS: CITY/STATE:
SEC. NAME; ADDRESS:
CITY/STATE:
TREASURER NAME:
ADDRESS: CITY/STATE:
WILL YOU AS QUALIFYING AGENT HAVE ANY OWNERSHIP IN THE FIRM?
IF S0, GIVE DETAILS:
WILL YOU BE A FULL TIME EMPLOYEE OF THIS FIRM?
IF S0, GIVE DETAILS:
2
-~ '+ai#:R.fr~„..reh.T.. -' _~-+Tf~7t :7SN719].7'N..~: 7T-~..~. --~C3::
A"~I.3::F~N __ 'F.> 57yFGC7.tl;Jlitl ~~~.
IF ANY OF THE QUESTIONS BELOW ARE ANSWERED YES, PLEASE EXPLAIN IN DETAIL ON A
SHEET. SEPARATE
HAS THE APPLICANT OR THE ORGANIZATION BEING QUALIFIED EVER:
I . FAILED TO COMPLETE A CONTRACT? YES NO
2. BEEN A MEMBER OF A FIRM WHICH FAILED TO PAY ALL SUB-CONTRACTORS.
MATERIAL SUPPLIERS OR EMPLOYEES O
N A CONTRACT?
~. HAVE ANY UNPAID, PAST DUE BILLS OVER 90 DAYS OR CLAIMS FOR LABOR,
MATERIAL OR SERVICES?
a
`-'
4. HAD LIENS, SUITS OR JUDGMENTS OF RECORD OR PENDING AS A RESULT'
OF CONSTRUCTION? 0
~. BEEN CONVICTED OF ACTING IN THE CAPACITY OF A CONTRACTOR
WITHOUT A LICENSE?
6. BEEN CONVICTED OR PRESENTLY CHARGED WITH A FELONY?
7. HAD A CONT'RACTOR'S LICENSE REVOKED OR SUSPENDED?
AFF- IDAVIT
THE UNDERSIGNED HEREBY CERTIFIES THAT ~ WILL ACT ONLY FOR HINI~I~RSELF OR THAT
HE/SHE IS LEGALLY QUALIFIED TO ACT ON BEHALF OF THE BUSINESS ORGANIZATION
SOUGHT TO BE CERTIFIED IN ALL MATTERS CONNECTED WITH ITS CONTRACTING
UNDERTAKEN BY HIM/HERSELF OR SUCH BUSINESS ORGANIZATION AND THAT HE WILL
CONTINUE DURING THIS CERTIFICATION TO BE ABLE TO SO BIND SAID BUSINESS
ORGANIZATION. IF ANY TIME DURING THIS CERTIFICATION HE CEASES TO B$ ABLE TO SO
BIND OR ACT FOR THIS BUSINESS ORGANIZATION HE/SHE WILL ~IEDIATELY NOTIFY THE
BOARD IN WRITING.
ANY WILLFUL FALSIFICATION OF ANY INFORMATION HEREIN, INCLUDING ALL
SUPPLEMENTARY PAGES AND ATTACHMENTS IS GROUNDS FOR DISQUALIFICATION.
Signature of Applicant: ~,~,~.,T_ _ ~~
y~~~. G,
STATE OF FLOR,~I^D~A<
COUNTY OF ~' tc~..c C~y~~t ~e~
The foregoing instrum as ackno~~~ledged before me this ~~
b3'-~ MCL.~1 ~ ~ ("_c.eLr ~ day °f ~C , 20
Type of identification produced: who is per onall known or who has
_ L , produced identification.
Official Signature o Notary Public
Notary Seal
~.ti~av $~~.,, iRACI E. HATCH
~~° °°~; Nofary Public - Sfafe of Florida
~ '~;~+NCormr~sgonE~iesNw29,2008
,;~ ~.P= Commisslon # DD 375275
~~~~"~~~~ 8orxled BV Naftonol Nofa
ryAssn.
VERIFICA~T(ION OF CONSTRUCTION EXPERIENCE
NAME OF EMPLOYEE: °. V~'/()')(j~ ~( ~~Q~
EMPLOYED BY:
ADDRESS: `f'(~ ~jj}( ~p`~~j CITY/STATE: V~(k~2~'~'- ~ t-
FROM _ ®~ ,~~ ) ,~ TO p~~'t`j
DATE/YEAR DATE/YE T
DURING THE ABOVE DATES OUR RECORDS REFLECT THAT THE ABOVE EMPLOYEE PERFORMED IN
THE CAPACITY OF: (HANDS ON EXPERIENCE ONLY)
~ ~.pe~~I So,/ ~ -,
F ~ -'rl'l~ Cry--~sV1'~ r~ ~l ~~~~-~~-r-~t..
'~+rmr`r°'~a:3®Bt~°9;ir~:-_; ~,°.6"AF~ .°3®3,3€~9L'~-'J:~.='~&~S
~...'.FSYB~,G?:•.`',.=1k A9~![~2'S4?::Z:'~~8~3 ~'.6'~mi~.Y,'.,
ALSO, ATTACH A LETTER WHICH MUST BE ON COMPANY LETTERHEAD WHICH SHALL HAVE
QUALIFIER'S NOTARIZED SIGNATURE SHOWING LICENSE NUMBER ALONG WITH THE APPLICANT'S
SUPERVISORY STATUS.
(IE.) I AM THE QUALIFIER FOR THE AB CONSTRUCTION FIRM AND HOLD A CURRENT
CERTIFICATE OF COMPETENCY # q S FROM _~~,~-,~,,~ 6L
AS A A-,~,~/~,~,/~ CONTRACTOR. (CITY/STATE)
BUSINESS QUA FIER (Original Signatures Required)
Signature: ~ "°/~
'`'---'printed Name: ~~~ ,y„~ Date: /4 ~ ~7
STATE O LO D~
COUNTY OF ~K ,~,G,~
The going ins ment vas acknowledged before me this ~_ day of (~f -v ,6-C/20 C~ ']
by ~ ~ ~ who is impersonally known or who has produced identification.
Type of ident' ication produc d: 1, n" L _
~ ~ ~v
Official Signature of Notary Public
,,.SPRY X~e,, TRACI E. HATCH
~°.~,~f~; Notary Public - Stafe of florid,^.
U ~ ' NTyCorrtmi~gon 6q~ies Nw29, 200)8
9~F°FF~°P Commission # DD 375275
Bonded By Nafional Notary /~~sn.
~.m - -.
THIS FORM MAYBE DUPLICP,TE. VERIFICATION FORMS MUST BE FURNISHED TO SUBSTANTIATE THE
MINIMUM EXPERIENCE REQUIRED IN THE CATEGORY FOR WHICH APPLICATION IS MADE.
IF SELF-EMPLOYED; VERIFICATION CAN BE SUPPLIED FROM BUSINESS RECORDS, COPIES OF PAST AND
CURRENT LICENSES, CERTIFICATE OF COMPETENCY, ETC.
FOR CORPORATION/LLC ONLY
I HEREBY CERTIFY THAT
QUALIFYING AGENT FOR
LOCATED AT
IS THE
AND THAT HE HAS AUTHORITY TO ACT FOR THE FIRM OR CORPORATION IN ALL MATTERS
CONNECTED WITH OUR CONTRACTING BUSINESS, TO TAKE THE QUALIFYING EXAMINATION
FOR THE FIRM AND WILL SUPERVISE THE CONSTRUCTION AND INSTALLATION UNDER THE
CERTIFICATE OF COMPETENCY ISSUED.
I FURTHER CERTIFY THAT WE WILL IMMEDIATELY NOTIFY THE SEBASTIAN CONSTRUCTION
BOARD IF THE ABOVE NAMED QUALIFYING AGENT SHALL SEVER CONNECTION WITH THE
FIRM OR IS NO LONGER ACTIVELY SUPERVISING THE CONSTRUCTION AND INSTALLATION
WORK UNDER CONTRACT.
SIGNATURE OF CORPORATE OFFICER:
(OTHER THAN APPLICANT QUALIFYING THE CORPORATION)
PRINTED NAME OF CORPORATE OFFICER
a
,~
TKAT Services, Inc.
P. O. Box 6295 Vero Beach, Florida 32961 Phone 772-778-8871 Fax 772-978-0716
October 2, 2007
RE: Norman Piercey, Painting and supervisory experience.
City of Sebastian Construction Board
1225 Main Street
Sebastian, FL 32958
To Whom It May Concern:
This letter is being written to verify Norman Pierceys employment with our
company, Serene Quality Services, Inc. (doing business as Toby Lamm's
Painting). Our company name has been changes, and is now TKAT Services,
Inc. Norman was employed with us for a period of almost 4 years. During this
time, he retained the position as Supervisor. He managed a crew of 2-6 men,
and ran all jobs given to him smoothly and without mishap. He is definitely a
craftsman of his trade. We consider Norman a valued and well-trusted
employee. If you have any questions regarding Norman's employment, please
call our office, we would be more than happy to help you.
Thank you,
~---~
y J. Lamm
President/Owner
TKAT_ Services, Inc.
LGT
Thank you for choosing TKAT Services, Inc ~
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SEBASTIAN CONSTRUCTION BOARD
CITY OF SEBASTIAN
STATE OF FLORIDA
NOTICE OF VIOLATION HEARING
IN THE MATTER OF: Mr. Ellis Nyers/Storm Depot Sales Installation and Supply, Inc.,
562 NW Interpark Place, Port St. Lucie, FI. 34986.
GREETINGS:
The Sebastian Construction board of the City of Sebastian hereby notifies you of
an alleged violation of the Sebastian City Code of Ordinances. The Sebastian
Construction Board contends that the following violations exist: 26172(5),
Diversion of funds and 26~i 72(10) Abandonment of a Construction Project.
The brief legal description of the real property upon which this violation occurred
is: 1352 Shoreline Cir.
Accordingly, the Sebastian Construction Board has set this matter for a hearing
on Tuesday, the 9th day of Oetober, 2007 at 7:00 P.M. at 1225 Main Street, City
Council Chambers, Sebastian, Florida.
YOU ARE REQUESTED to appear before the Board at that time to answer and
defend the allegations that you have violated the above cited provisions of the
Code of Ordinances of the City of Sebastian.
If you fail to attend, the Board may base its findings and act solely on the
presentation made by the Construction Board.
YOU MAY APPEAR WITH OR WITHOUT AN ATTORNEY. YOU HAVE A RIGHT TO
SUBPOENA WITNESSES AND DOCUMENTS AND CROSS-EXAMINE THE OTHER
PARTY'S WITNESSES. SUBPOENAS ARE AVAILABLE IN THE CONTRACTOR LICENSING
OFFICE LOCATED IN THE BUILDING DEPARTMENT.
If the Board finds that you have committed a violation, it may order immediate
compliance with the Code and provide in the order, in the event of failure to
comply with the order within a period of time set forth therein, that a fine NOT TO
EXCEED $500.00 be imposed for the period of non-compliance, and/or suspend
certificate holder, revoke a certificate, place certificate holder on probation as
well as file a complaint with DBPR.
G
If any decision of the Board affects you and you decide to appeal any decision
made at this meeting with respect to any matter considered, you will need a
record of the proceedings and for such purposes, you may need to ensure that
a verbatim record of the proceedings is made, which record includes the
testimony and evidence upon which the appeal is based.
(THE ABOVE NOTICE IS REQUIRED BY STATE LAW. ANYONE DESIRING A VERBATIM
TRANSCRIPT SHALL HAVE THE RESPONSIBILITY AT HIS OWN COST TO ARRANGE TO
PROVIDE THE TRANSCRIPT.)
Please be advised that the procedures of the Board are governed by the Code
of Ordinances of the City of Sebastian. Copies of these Ordinances may be
obtained at the office of the City Clerk, City of Sebastian.
PLEASE GOVERN YOURSELF ACCOR®INGLY
SEBASTIAN CONSTRUCTION BOARD
§ 26-].72 SEBAS TT,41~! i~'.rJi ~N.
r
act sh?il constitute prima facie evi ence o an intent to evade the provisions of this
article.
(4) Acting in the capacity of a contractor under any certificate of competency issued by
the board pursuant to this article or any state certification issued'oy the department,
except ir? the na~~~e of the certiucate holder as set forth on the issued certificate of
competency or the state certification or lrt accordar_ce with the personnel of the cer-
tificate holder as set forth in the application for the certificate or state certification,
or as later changed as provided in this article or pursuant to F.S. ch. 489, as amended
from time to time, or any rule or regulation promulgated pursuant thereto.
(5) Diversion of funds or property received for the completion of a specified construction
project or operation nr as a result of the diversion the contractor is or will be unable
to fill the terms of his obligation or contract.
(E) Failure in any material respect to comply 4vith the provisions of this article.
(7) Failure to maintain insurance coverage as set by the board.
(8) Failure to provide proof of worker's compensation insurance to the building official
or his designees upon demand for such proof.
(9) Falsification of application or testimony given before the board.
(10) Abandonment of a construction project in which the contractor is engaged or under
contract as a contractor. A project is to be considered abandoned if the contractor
terminates such project without notification to the prospective owner or current owner
for at least 30 days vv~ithout just cause, such as acts of God causing construction delay.
('11) Vl-iCatirig vi: t112 eXaminatl0n reniiired 1iV tl]1S aS"tlcle.
~ ---
(12) Giving or offering to give, directly or indirectly, any city employee, council member,
board member or the city manager anything of value, monetary or otherwise, with
intent to influence such employee or board member in the discharge of his duties
under the provisions of this article.
(13) Attempting or threatening to coerce or coercing through physical act, injury or damage
to the city manager, or to any council member, board member, city employee or any
family member or property of any board member or city employee, with intent to
influence such board member or employee in the discharge of his duties under the
provisions of this article.
(14) The filing of a petition in bankruptcy, either voluntarily or involuntarily, the making
of an assignment for the benefit of creditors or the appointment of a receiver for a
contractor or an entity which is qualified to engage in the business of a contractor by
the holder of a certificate of competency issued by the board or a state certification
issued by the department. Provided, hovJe~~er, that such act shall only empower the
- _
HOME OF PELICAN ISLA"5'C~ r~~d~~Y~
CONTP,AC I OP. LICENSING
1225 Pd1AliJ STREET • SEE.ASTIAN, FLORIDA:32950
TELEPHOf~lE: 1772) 3P,8-8245 ^ FAX (772j 589-2566
PLE:~SL PRI;v'f CL1':\RL1'
CASE NO:
DATE OF ST.4TEKIFNT: ~ ~7 '~ ~ ~~j '~;.'
DATE OF OFFENSE: lj °~~ " U
LOCATION OF
OFFENSE: ~ j52 S~//Gi4E,Z/i(,i= C//C' CITI' S ~73/I-S ~//?Gr-~ STATE I%'~-- ZIP :.Zyj ~'
COP~IPr\INTAi!T (Sj
NAr~IE: f~E,(~/Vis h~ili~cvCF S
COMPLAINTANT'S
ADDRESS:_j~.Z S'f/G.~rCj~~ t /f' CITI' ~L<l~-~S``'//`!/1,,, .-,
STATE/ "G.-_ZIP o'~GJ~~`
COMPLAINTf\N T'S 1-IOME
PHONE:'7J.1-,3~c`l' ~~+~~ WORK CELL '--_
COl'dTRACTOR'S _ -`
NAME: ~~L_,/) l7 Y~/C~S
NAME OF COMPANY: ,~~c~~ j /~ =~~; (~
CONTRACTOR/COMPANY ~~^^
:4DDRESS:~(cZ Nw%~l~l1~'Ac~K '~CITYPG,~! S% ~,GtilC STATE r`~ 2[P
I> 1~'~-'/~~S +~~'~GL'~,.~ S do hereby voiuniariiy mai<e the
following statement without tlu-eat, offer of benefit or favor by any persons
whomsoever.
Did you find this person(s) and/ company through the newspaper, yellow pages
and/or fliers? YES ~~ ~}Z
If NO or Other. ho\v?
What was your initial reason for calling this person and/or company?
5~177~I-/~~ j4°;= I ~/~/~ GF ~ >F~i fi~/f' ~~/t' i C ~,
ll)
An Equal Opportunity Employer"
Celebrating Our 75th Anniversary
.~':~I]tii ~a:'l; [~]~ nnl]]e C,T i-11'- 1-i::l"~`ill(ti) .•'1]i; C~tll)e [C~'•/fii.ll llt=illi~ tt_~1 %11 C' i_?Ii'_Ill~~ 1c_~
Did this person (glue name. ~L~-!S ~~~~"S ~' . [=11 ~'i,Ll il]ai Ile/~'
licensed and insured? 'ES ~~'U
If YES, did he/sh l,]o~v you sornet]]ing that lecl you to believe that he!she vas licensed
and insured? 'ES NO
If YES, what type of docun]ent ?:vere you shown? ~~~"~C i S
Were permits rewired to do the svorh? YES NO
Did he/she tell you that he/she would pull the permit? ES NO
Were you charged for the permit? ES NO
Were you given a start and completion date? YES NO
If YES, was the job started as promised? YES i~Q~-
If N0, what was the reason? ~ I~t~r/'% ~^,~v ~ CGG~i.L~ ~~~~
~--/ '-q ' C-^[~-/S /`I' ~~5~ C'f~(,~~ 1,~G / '/ rr/~ /1~1 Y ~/T~rC ~C
VJas tl-ie completion date as promised? YE5
If NO, what was the reason?
Once completed ~a%ere you satisfied with the job? ~'ES NO
If ~~~0, ~~,~]~/
~--~
Did you make a compl,~int to the contractor/company? YES ~~ NO
What was the comulaint? - ~%% , ~ ~'S ~~ ~~ ~~ j~
~?CL~- ~r~U~l~ ~jGf~~~ ~'l?~~ j~ - ~/!~~/~iI1~2S ~/i' ~j~~L~L~y~
(?;i
«~hat \~;as their response to ;-our coliil_,laint'?
~~ ~-
Did the eontractol;~cnnipany ever place a lien on your property? YES \IO}
If YES, \vhat elate \vas the lien filed?
In ~JOLII~ 04VI1 \\~01-ds, what Is the comp(aint?
Please )rint cleal-li~. /~ nC
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Ir 1'OU I~'ELI) ~90RE \\'IZI"l'In'G ROO\i, PLEASE USE .4 SEPARr\TE SHECT OF PAPER.
(3)
I~ `:~~)_1 ItCI'.`~_ ~I11`•/ Oi~i.he ;~i.~llC~`:`.'in°- D1~ ~I=;~ lll.;i!:c i:C~j,jCS ~ut~l ~ICC«ch [~i iilis ltf~iCl_l`, ~ '-'_
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i0~.i ~'ce~-, CLC Ol1'?il-I~IIs.j
l_onU 1C[s :Ind; Ul~ llll'oICC`_;
~.l
Z'Eti (~
Copies of adl'ertiscmenis%tliers
Business card
Cancelled checks l:fi-ont and bacl:j
Receipts for cash payments
Copies of any correspondence
T]otice of any liens
I SWEAR OR AFFIRM THE STATENIE
CORRECT AND TRUE. /~
SIGNATUP~E:
STATE OF FLORIDA ^~
COUNTI' OF y p ~ ~ ~ ~C ~y b ~
E III] THIS AFFIDAVIT TO BE
Sworn to and subscribed before me the 1'1 ~` day
o®, 20 ~Ittl#~ll/f~rr/~
. ~ A. iii
~. ~MISSIOryF'ro ' ~~ i
• v° 20 '-P ' 'O r
MY COM1Vt ~a~XPl~:',~' y
A~y o #DD40$7b2 0 • ~'
1=orni of I.D. t ~'Q~ o~~\\~~
A ff i a n t ~~ ~t~' 1~~~ ~~~,\f l0 • ~-1 - 0 r
3 L-~
YES NO
-YES NO
YES NO
-,
YES _NO
YES CNO,_
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"~UF~I~LY, IN.C
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~, ~ ~ ~ ~,~ ~~ 562 NW fnterpa-rk Place
r ~ ; ~ ~ ~(~ Port St. Lucie, f L 34'986
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~~ ~~ ~ ~ (~ 772-344-2299
~ Fax: 772-344-~ 546
Martin`County #$P02740 St. Lucie County;~23249 PSL X3377
fort Pierce #CONT2484.06 Clty of Stuart #AP02020009
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Color Selection On
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Customer Initial
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Ai time of remeasure, if there'are<any discrepancies nolrted by the fiefd engineer, you will tre contacted v ~f,:
by your sales represertfaNve~.6etare proceeding. ° ~ ~- _
50% DEPOSIT REQUIRED ~ ~ <a _;:;~ ,>~ __, f,.~ ~~~.. ~ ~-.~
r ~ t.~ Price a .c- ~- ,~`G.' -....... y~,.
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total"~ontra~t G-i _~ t..~ _
_ (60% ~eposlt Required) .;~, ;,. ~"s~,-• .-.
.Amount Paid
x- _ -~--___ ._ ,..__ . _..._~~-~......._~~ . ~ ~ ....._
. YO'U MUST BE PRESENT TO SfiGN OFI' AT INSTA!_tiATiON CbMP'LETION. ~-.... - ~ r ~:
YOUR BALANCE DUE ATTHA~TTfNFE IS~~, - ' ~
,....
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SELLER AND THE PURCHASER AGREE TO-THE SALE AND.INSTALLAI'IONANDIOR DELIVERY OF TE1E ABOVE SPECIFIED GOODS FOR THE ABOVE
SPECIFIED PRICE URON THE TERMS AND'CONDITIONS HEREINAFTER 5ET FORTH AN0 CONTINUED ON THE REVERSE SIDE OF.THIS PURCHASE
ORDER~(HEREINAFTER REFERRED TO AS THE "CONTRACT"). THE TERMS AND CONDITIONS SET FORTH ON THE REVE"RSE SIDE OF THIS
CONTRACT, INCLUDING THE DESCRiPTIOt~ AtVO LIMITATIONS OF ALL 1NARaANTtES AND GUARANTEES ARE fNCORPORATED INTO THIS
° CONTRACT AS IF FULLY SET FORTH ON~THylS PAGE. THE TERMS AND CONDITIONS OF THIS CONTRACT MAY NOT 8E MODIFIED EXCEPT IN
.Wjt1TIN'G SIGNED BY THE SELLER'S DULY AUTHORIZED REPRESENTATIVE.
PURCHASER CERTIFIES BY HIS SIGNATURE BELOW THAT HE HAS READ; FULLY WNDERSTANpS AND ACCEPTS ALL THE TERMS AND
CONDtTIONS'OF THIS CONTRACT ANp HAS'RECEIVED A COPY OF THIS CONTRACT, ,
~~ ~ Pty; C ~'SyRK3FfT~TtJ'CANCEL. THIS IS A HOME SOLICITATION SALE. IF YOl1 DO NOT WANT THE~GOODS OR SERVICES, YOU MAY CANCEL
r,l~l • * NT~F~ACT ~gPROV1DIN ~ WRITTEN N~TICE TO:SEILER IN PERSOI~F,.BY TELEGRAM OR MAIL. THIS NOTICE MUST INDICATE THAT YOU
F ; D • m WANT~THE' GOOO~S.OrZ SERVIOtES~4ND`MUST BE DELIVERED OR PCSSTMARKED BEFORE MIDNIGHT OF THE THIRD BUSINESS DAY
;~ • gA ~O~J~SIGN ~THI'S CONTRACT 1F Y,OU CANCEL THtS CONTRACT, YOUR DEPOSIT WILL BE REFUNDED IN FULL. '
~_Y'
,.'~ s~ - -~ D~~~N~~AG`~EPTED ~ SELLER`S ~ AGREED ANDACCEPTED BY
R~ '~ ~ REPRESENTATIVE
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