EL-11-945Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 160956
Scheduled Inspection Date: June 15, 2011
Inspector: Devaney, Michael
Owner: TERRY, JOHN
Job Address: 29 NW 96 Street
Miami Shores, FL 33138-
Permit Number: EL -5 -11 -945
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number (305)754 -2361
Parcel Number 1131010330430
Phone: (786)331 -3967
Building Department Comments
ALARM BURGLAR
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 14, 2011
For Inspections please call: (305)762 -4949
Page 22 of 23
• 7, 1e� S-525-.7953
Miami Shores Vi lage
Building Department ►( 2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): . Oklvl r . T.e.rr'!,P Phone #:
Address: 2'i OW q9 Sth' l-
City: M al.ryt.i- State: �• Zip: 33150
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: aA Ci 044"
City:
Miami Shores County: Miami Dade Zip: '53150
Folio/Parcel #: ((— 3 l® l- 0 3 3- 0430
Is the Building Historically Designated: Yes NO ✓ Flood Zone:
CONTRACTOR: Company Name: Phone #: oil' c�(Qco- 50 51
Address: 10785 MARKS WAY
�= FL 33025
City:
Qualifier Name: (.e..e r MC�,c oft, rt a Q,Q 2
State Certification or Registration #: FoDo 1 1 a---/ Certificate of Competency #:
Contact Phone #: 6:154-4.0(.0 Email Address: Gi Yirl 141ad. C.)(V1
DESIGNER: Architect/Engineer: Phone #:
Zip:
Phone #: 4/54-au c 37
Value of Work for this Permit: $ �P 30 • -� Square/Linear F
UNew
Type of Work: Address terition
Description of Work:* Cr S'v-t1 7 fJ 10 Li-rjt o.(
itillitita 9p81 ioliti
eatettmmo3 'Ts, 4; ,,,,s
"'_^" _'.,.. jje :k ii} w
i..J. r:' as. � ib
"a' * * * * * * * *9: ****
* * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ � " � Permit Fee $ CCF $ CO /CC $
NIP-
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ 1
TOTAL FEE NOW DUE $ I 0 g (Q
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations . as indicated. 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 a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature X
Owner or Ag
The foregoing instrument was acknowledged before me this 19`g-
day of MGiy ,20// ,by
who is personally known to me or who has produced
�4hn
tification . who did take an oath.
Sign:
Print:
My Co
APPROVED BY
Signature.
Contrac or
The foregoing ins; / ; ent was acknowledged before me this 2v
day of M , 2011 , by Gezry go-Asfressce
who is personally known to me or who has produced
as identification and who did take an oath.
Structural Review
(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
M !Commission Exp res:.,.
gy k:*, t ocary put Mate o1 Eu
4,4 " [iarbera curzu
"
Zoning
Clerk
RESIDENTIAL SERVICES CONTRACT
CONTRACT DATE: "K. / 1 i204 TOWN NO: 418
_30K) 23120
CUSTOMER NO: — JOB NO: LEAD SOURCE.
ion 1. Customer Info
. dr Security Services, Inc. (ADT)
(°We° or °Us° or "Our/ Office Address
10. .4 t S 74444KS VS
24TR / F L 330
Attafr 6 Lo ar �^
(964,1 4K 0740
(Tel: 1- 800 -ADT -ASAP,
1- 800 -238 -2727
Customer Name • ,p e
( °You° or "Your) O Lj J (�
•
Address pity 2.dl Ntc) 9 Th g
� v 51.104,, S
State / Zip FL 3'3 go
Protected Premises' Telephone
❑Traditional Phone ❑ Other (Qualified) ❑ Other (Non -Quaff
Altemate Telephone 1
Affinity Name & No.
Tax Exempt No.
Tax Expire. Date
fled)
(Circle one) Home / Cell / Work w/ ext.
IF FAMILIARIZATION PERIOD IS
Alternate Telephone 2 (Circle one) Home / CeII / Work w/ ext.
REJECTED INITIAL HERE
.. --
Communications Authorization : You hereby authorize ADT to furnish information and/or updates regarding your security system and new ADT and/or
third party products and services available to ADT customers to the contact information provided by you. You may unsubscr)be or opt -out by.emailing
donotcontacteadtacom or by calling 88$= DNC4ADT (888 -362- 4238), Initial here
Confirmation of Appointments: You hereby expressly authorize ADT to call you using an automated Ilin device to deliver a prerecorded message to
A. • r - 1 : i_ . . :•. i tit- ,t ..t , -. • ,uub -r i• .b •v- Initial here= ,
_'
System Ownership: 13 Customer - Owned `, DT-Owned
Section 2. Services to be Provided
Standard Monthly Service, Burglary
ce includes Customer Monitoring Center Signal - Receiving and
Notification Service for Burglary, Manual Fire, and Manual Police Emergency
Monthly Service Charge
Munldpal Construction Permit Fee
❑ Customer to obtain construction permit
Other
Standard Monthly Service, Fire /Smoke Detection
Service includes: Customer Monitoringg Center Signal Receiving and
Notification Service for Fire, Manual Fire, and Manual Police Emergency
Installation Price
429 * Oe)
Taxable Amount
❑ Carbon Monoxide ❑ Flood ❑ Low Temp
Non- Taxable Amount
❑ Medical Alert
Connection Fee
766
,$%Safewatch Cellguard®
/ C.
Sales Tax on Installation*
❑ Secu ' Link®
Total Installation Charge*
' 00
ended Limited Warranty /Quality Service Plan (QSP)
' PVC
Deposit Received
❑ Guard Response Service
Balance Due upon Installation*
❑ Monthly Recurring Municipal Fee (Subject to change based on local law)
❑ Customer to obtain and pay for municipal alarm use permit
*If applicable sales tax not shown, it will be added to your first invoice.
❑ Other
Total Monthly Service Charge
.,.c .7.4/9
❑ Initial/Annual Recurring Munidpal Fee - billed separately
jsubject to change based on local law)
LLII Customer to obtain and pay for initial/annual municipal alarm use
permit. Your failure to obtain and provide ADT with your municipal
alarm use permit registration number could result in no municipal fire/
police res 'onse to an alarm from our •remises and/or a fine.
Initial/
Annual Fee
Estimated Start Date
Estimated Completion Date
YOU ACKNOWLEDGE AND ADMIT THAT: (1) WE HAVE EXPLAINED TO YOU THE FULL RANGE OF EQUIPMENT AND SERVICES AVAILABLE TO YOU; (2)
ADDITIONAL EQUIPMENT AND SERVICES OVER THAT DESCRIBED HEREIN ARE AVAILABLE AND MAY BE OBTAINED FROM U5 AT AN ADDITIONAL COST
TO YOU; (3) YOU HAVE CHOSEN AND HAVE CONTRACTED FOR ONLY THE EQUIPMENT AND THE SERVICES DESCRIBED IN THIS CONTRACT; (4) THE INITIAL
TERM OF THIS CONTRACT I5 FOR THREE (3) YEARS; AND (5) YOU SHOULD. MANUALLY TEST YOUR SYSTEM MONTHLY WITH ADT AS WELL AS UPON
ANY CHANGE TO THE TELEPHONE SERVICE IN YOUR PREMISES TO CONFIRM PROPER TELEPHONE LINE SEIZURE AND THAT SIGNAL TRANSMISSION IS
FUNCTIONING PROPERLY BY CALLING ADT AT 1-800-ADT-ASAP (AND FOLLOW THE PROMPTS). WE ARE NOT A SECURITY CONSULTANT.
YOU ACKNOWLEDGE AND ADMIT THAT BEFORE SIGNING YOU HAVE READ THE FRONT AND BACK OF THIS PAGE IN ADDIT1ON TO THE ATTACHED PAGES
WHICH CONTAIN IMPORTANT TERMS AND CONDITIONS FOR THIS CONTRACT. YOU STATE THAT YOU UNDERSTAND ALL THE TERMS AND CONDMON5 OF
THIS CONTRACT, INCLUDING, BUT NOT LIMITED TO, PARAGRAPHS 5, 6, 7, 8, 9, 10 AND 22. YOU ARE AWARE OF THE FOLLOWING: NO ALARM SYSTEM CAN
GUARANTEE PREVENTION OF LOSS; HUMAN ERROR IS ALWAYS POSSIBLE; WE MAY NOT RECEIVE ALARM SIGNALS IF THE TELEPHONE UNE OR OTHER ALARM
TRANSMISSION SYSTEM I5 CUT, INTERFERED WITH, OR OTHERWISE DAMAGED OR IF TELEPHONE OR ELECTRICAL SERVICE IS UNAVAILABLE FOR ANY REASON.
THIS CONTRACT REQUIRES FINAL APPROVAL OF AN ADT AUTHORIZED MANAGER BEFORE ANY EQUIPMENT /SERVICES MAY BE PROVIDED. IF APPROVAL IS
DENIED, THIS CONTRACT WILL BE TERMINATED AND ADT'S ONLY OBUGATION TO YOU WILL BE TO NOTIFY YOU OF SUCH TERMINATION AND REFUND ANY
AMOUNTS PAID IN ADVANCE.
SECOND AND THIRD PAGES OMPANY THI$ PAGE WM- ADUITIO AL TEN *AND AND CONDITIONS
ADT R- ..:
1
Rep D No. =,
• �,
Rep. License No. (If Required): ► -rnal Signatu ;'-: 1' -d
NOTICE OF CANCELLATION
YOU, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION OF THIS RIGHT.
1 of 6
Office Copy
02010 ADT Security Services, Inc. (08/10)
tqC131 Fire &
Security
Permit Information
osoz 12
ADT Security Services, Inc.
2801 Gateway Drive
Pompano Beach, FL 33069
(800) 866 -6650
(954) 917 -2422 Fax
Sales Rep: Stoat/1m.
Date: dr`iz/zon
Install gt /120/1
as
Job #:
Customer Name:
`
1i J't C
I
Tel 1:
2
Address: z `t Nta 46 T ff .s--7-
Suite#:
Te12:
City: i /Q/11
Other:
••0104 CS
"'
Sirens /Sounders:
ZIP: 3 3 is-0
Municipality:
Alt Contact:
Holdup Buttons:
BURG DEVICE TOTAL:
Tel:
Lot#:
I Block#:
~
I Subdivision:
Folio#: I l
0.1 0S3 0 4 0
Master Permit#:
Job Cost: $ (23 eb
System Type(s):
Automation
'1 Burg
❑Access QFire ❑CCTV Home
Job Type:
❑Under Construction Prewire Only Prewire & Trim
BurSlar Alarm Devices
Control Panels:
1
Audio Glassbreaks:
Property Owner:
Keypads:
`
Security Screens:
I
Door/Window Contacts:
2
Smoke Detectors:
Motion Detectors:
l
Other:
Sirens /Sounders:
Other:
Holdup Buttons:
BURG DEVICE TOTAL:
S
CCTV Devices
ICameras:
Business Park:
Monitors:
Property Owner:
VCR/DVRs:
CCTV DEVICE TOTAL:
I
Access Devices
Card Readers:
Maglocks/Door Strikes:
Shunt/RTE Motion Detectors:
Other:
Shunt/RTE Buttons:
ACCESS DEVICE TOTAL:
•
Control Panel Model(s):
Business Park:
Control Panels:
Property Owner:
Smoke Detectors:
Horns:
Pull Stations:
Duct Detectors:
Strobes:
Transmitters:
Heat Detectors:
Horn/Strobes:
Waterflow Connections"
Fire Pump RUN Connections:
Fire Pump FAIL Connections:
PIV/Tamper Connections:
~
Hood Connections:
Other:
- - -- - - - -- - - --
Shopping Center:
Business Park:
Building#:
Property Owner:
Owner's Address:
Comments (continue on back if needed)
R.• m r