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OLD NORTH STATE MASONRY, LLC <br />P. O. Box 1260 <br />Matthews, NC 28106 <br />OLD NORTH STATE Phone: (704) 971-4060 Fax: (704) 847-1187 <br />AA A C(1 Pl RV <br />«C = EXTRA WORK ORDER <br />Date: "bL" 1 ONSM Project No. 12—F I <br />Project: <br />Location: <br />Firm: <br />Address: <br />Description of work: <br />; S"Zti J- <br />ex:Nc �:o rooms b \ 1 :� <br />Labor <br />No. Men Reg. OT Total <br />Bricklayer Foreman: <br />bl'� Lull <br />Bricklayer: <br />Mixer <br />Labor Foreman: <br />Table Saw <br />Laborer: <br />j hv' <br />Miscellaneous: <br />V Hammer Drill <br />Materials <br />Quantity Equipment Hours <br />Block <br />bl'� Lull <br />Brick <br />Mixer <br />Grout <br />Table Saw <br />Mortar <br />y S Cutoff Saw <br />Sand <br />V Hammer Drill <br />Joint Rein <br />Hilli Shot Gun <br />Misc.1 <br />Misc.1 <br />Misc. 2 <br />Misc. 2 <br />Above additional work to be pedo®ed oader sept difio i i ie@I co mt oaks dbernise sd ated. <br />Authorized Signature: .Signature as a is verif' e$tion thd1oket No. <br />Date: -Colo' work "Curr , but not an agreement <br />(Signature) ONSM Representatve Q Sglleontraet 0 3 9 4 f1 0 <br />EVZON TOAM <br />F-7 <br />Attachment number 3\n <br />Page 170 <br />