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EL-11-2120
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170668 Permit Number: EL -11 -11 -2120 Scheduled Inspection Date: March 06, 2012 Inspector: Devaney, Michael Owner: BROOKS, FLORENCE Job Address: 1500 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1122320320350 Phone: (786)331 -3967 Building Department Comments BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 6A6 "7-/e March 05, 2012 For Inspections please call: (305)762 -4949 Page 20 of 20 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 05/14/2012 Applicant 1500 NE 104 Street Miami Shores, FL 33138- 1122320320350 Block: Lot: FLORENCE BROOKS Owner Information Address Phone CeII FLORENCE BROOKS 1500 NE 104 ST MIAMI SHORES FL 33138 -2666 Contractor(s) Phone Cell Phone ADT SECURITY SERVICES, INC (786)331 -3967 Valuation: Total Sq Feet: $ 1,451.00 0 1 Type of Work: ELECTRICAL Additional Info: ALARM SYSTEM INSTALLATION Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.00 $2.00 $0.40 $100.00 $3.00 $1.60 $110.20 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -11 -11 -42569 11/15/2011 Check #: 0131519 $ 50.00 $ 60.20 11/16/2011 Check #: 131543 $ 60.20 $ 0.00 Available Inspections: Inspection Type: 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. November 16, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date November 16, 2011 1 • 6618 Miami Shores Village Building Department 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 Type: Electrical OWNER: Name (Fee Simple Titleholder): Address: City: ;ta15291 L) BY: a ,o_ — Permit No. "j 11 `2J W Master Permit No. ��t ✓t> C-k1G(sTo IkDw Lp soo , • �� t 04 Sm-E T {41 A fr l Y4-E5 State: 1g- Phone #: Zip: 3 3 1 3 6 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: I SA) 0 t E (O -1 S kLe - County: Miami Dade Zip: 3-3 13 City: Miami Shores Folio/Parcel #: I( 3Z - 03sv Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: IL T S'EC `°(v " 0 t 6 ---) g tLS Address: City: o Qualifier Name:64 8 / t„(L/ I vn e or Regis #: �- � State: Phone #: zip: '73 0 V3— Phone #: State Certification o gi g )1 . Certificate of Co tency #: Contact Phone #: 5`r' `�/�,/,, -5b(� / Email Address: k.e((i1.. C J T . DESIGNER: Architect/Engineer.. Phone #: d S( Value of Work for this Permit: ..2 Type of Work: Address �JAlteration Description of Work: Square/Linear Footage of Work: New ❑RepairlReplace tj t,(,1rCj CCc I/" Gi r A..) 1 ❑Demolition a*** x*** *** **** * *** * *********.r***********Fees *M************ +*** * *** * * * ***r ** ****a+********* Submittal Fee $ Permit Fee $ t' 'cPo CCF$ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 no be approved and a reinspe ee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of OCT , 20 (L , by L , who is personally known to me or who has produced Z)L-- As identification and vitWellttin#11 oath. NOTARY PUBLIC: ��` ........••0/' �i 4, 'O 3 Z.,* a" Sign: Print: My Commission Expires: ***** ***************** ** APPROVED BY it ✓:/ got i 4P407c tkMia : ' CS;'' 'o �llll! No* #�,,,~ film' el Oe /5e, t/ Plans Examiner Zoning ntractor The foregoing instrument was acknowledged before me this /5 day of JL t '� , 20 IL, by y a1 u who is me or who has produced rsonally known t as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: ............. ADAM M. RAMIREZ , i`! ..-a MY COMMISSION d EE 091724 EXPIRES: May 9, 2015 ' RP�ty� .° Bonded Thru Notary Public Underwriters � Structural Review (Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk Miami -Dade My Home My Home mianniatadle. a� Show Me: Property Information Search By: Select Item - IA Text only m Property Appraiser Tax Estimator Property Appraiser Tax Comparison Summary Details: Folio No.: 11- 2232 - 032 -0350 Property: 1500 NE 104 ST Mailing FLORENCE F BROOKS EST Address: OF Living Units: 1516 NE 104 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2666 Property Information: Prima Zone: ry 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 2,338 Lot Size: 8,850 SO FT Year Built: 1960 $0/$285,969 32 52 42 RIVER BAY City: PARK ADDN PB 40 -72 Legal LOT 14 BLK 4 LO7 SIZE Description: 75.000 X 118 OR 15594- 2841 0792 1 OR 00000- 0000 0700 01 Assessment Information: Year: 2011 2010 Land Value: $127,493 $106,604 Building Value: $158,476 $159,503 Market Value: $285,969 $266,107 Assessed Value: $285,969 $162,239 Exemption Information: MESI 2011 2010 'r'! Applied $25,000 r nd Homestead: 5=1111.111111 m MEM $0 $500 Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $0/$285,969 $50,500/ $111,739 County: $0/$285,969 $50,500/ $111,739 City: $0/$285.969 $50.500/ $111 ,739 School Board: $0/$285.969 $25.500/ S176.730 Sale Information: Sale Date: /2000 ' I n.nro ir,r en Page 1 of 2 ACTIVE TAOOCA SELECTN` m Aerial Photography - 2009 0 112 ft My Hong - I Pr uper5 i,rformation I Property Taxes My iveigliborhoud 1 Property Appraiser Home I Using Our Site 1 Phone Directory 1 Privacy I Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. fo Legend Property Boundary Selected Property ird "re Street Highway Miami -Dade County Water W E http:// gisims2. miamidade .gov /myhome /propmap.asp 11/7/2011 / This Document Prepared By: DENNIS J. OCONNOR, ESQ. McPhillips, Fitzgerald & Cullum, LLP 9165 Park Drive Miami Shores, FL 33135 Panel Ifs Numbo : ::,2413241.511 111111111111111111111111111111111111111111111 CFN 201180755704 DR Bk 27888 Ps 24751 (1as) RECORDED 11/09/2011 10:51:55 DEED DOC TAX 2.220.00 HARVEY RUVIN. CLERK. OF COURT rIAMI -DADE COUNTY, FLORIDA LAST PAGE Personal Representative's Deed This Personal Representative's Deed, made this a el—clay of October. 2011 A.D. between Diane B. Shoaf (a/k/a Carolyn Diane Dugoni Shoat) as Personal Representative of the Estate of Florence F. Brooks, deceased, whose mailing address is 1516 NE 111_r Street, Miami Shores, FL 33138, GRANTOR, and Fausto Roberto Albuja and Laura (lean Alhuja, his wife, whose address is 1500 NE 100 Street, Miami Shores, FL 33138, GRANTEES. Witnesseth that the GRANTOR, for and in consideration of the sum of TEN DOLLARS (S10) -- DOLLARS, and other good and valuable consideration to GRANTOR in hand paid by GRANTEES, the receipt whereof is hereby acknowledged. has :ranted, bargained and sold to the said GRANTEES and GRANTEES' heirs. successors and assigns forever, the following described land, situate, lying and being in the County of Miami -Dade, State of Florida to wit: Lot 14, Block 4, River -Bay Park Addition, according to the .nap or plat thereof, as recorded in Plat Book 40, Page 72, of the Public Records of Miam -Dade County, Florida. *Personal Representative herein affirms that Decedent died testate. without surviving spouse and /or minor children, and did not desire the subject property to anyiine.al heirs. This instrument is given pursuant to the powers bestowed in the Last Will and Testament of the decedent. *This is not, nor has ever been the homestead property of I)i.ole R Shoal(alk/a Carolyn Dianc Dugoni Shoat) whose home address is 1516 NT 10.1 Street, Miami Shores, FL 33138. To Have and to Hold the same in fee simple forever. The GRANTOR warrants that the property is free of all encumbrances, except the lien for real estate taxes not yet due and payable and restrictions. reservations, and easements of record, and that lawful seisin of and good right to convey the property and will defend the same against the lawful claims ol'all persons. In Witness Whereof, the GRANTOR has hereunto set his hand and seal the day and year first above written. Signed, sealed and delivered in our presence: Pri w. ted Name: ess. Printed Name: e.,, /.W, �`j.raK.r+vns Witness (Seal) DIANE B. SIIOAF (a/k/a /AROLYN, DIANE DUGONI SHOA1) Personal Representative of the Estate of Florence F. Brooks. deceased. STATE OF FLORIDA COUNTY OF MIAMI -DADE r��{ The foregoing instrument was acknowledged before me this dac of October. 2011 by Diane B. Shoaf (alkla Carolyn Diane Dugoni Shoat) as personal representative. and he is personally known to me or has produced as identification. Signature of Notary Public Printed Name of Notary Public MY CQMa1SSf05 i DD PAO EXPIRES. Fabruari m, 203 g„seatM, 13ed0,403N yr ees R39- HP R1bujU Book278881Page2475 CFN #20110755704 Page 1 of 1 CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self- performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must m,ust be attached) LCt tt A— r lSlU AL$ti PROPERTY OWNER: PERMIT # c r ADDRESS: l L E \ O 4 S FOLIO NUMBER: ! t • 2:2-3 Z • d 3 2 ° 0 3 S-0 FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): 0111ll10000/1 `,� 1%y1S�01180 JJJJ■ 813033# ; *_ O RgSIGNATURE: a� *I .Vie 0 VIEWER: •':'?Nois � /,1111 //Il altgliguA T REVIEWER SIGNATURE: DATE: F PRINCIPAL STRUCTURE (attach appraisal): . DATE: bl') Created on June 2009 SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material ALL HARDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool fatal 1 RESIDENTIAL SERVICES CONTRACT CONTRACT DATE 11 / 0 rIn 7 CUSTOMER ACCOUNT NO T-d4 r# 2.27/ 41 i Illu11D11 1 5104UE12 n 6 9 9 JOB NO b LEAD SOURCE ADT Security Services, Inc. ("ADT1 Customer Name Office Address ( °Customer° or T or °me° or 'my") www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) L/ A F A- 5. U c A Address 0 0 1,1 0 S T State ZIP Protected Premises' Telephone 3 3 3 79 / 3 S% 6 7 City M s!-�o /f S Tax Exempt No. 0 Traditional Phone 0 Other (Qualified) 0 Other (Non - Qualified) Alternate Telephone 1 IF FAMILIARIZATION PERIOD IS Alternate REJECTED INITIAL HERE Telephone 2 (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL 3 7 3 9 9 Tax Expire Date 0 Home 0 Cell 0 Work 0 Home 0 Cell 0 Work / im a (1 Iz 4 u If A 0 Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third -party products and services to the contact information provided by me. I may unsubscribe or opt out by emailing donotcontacti4ADT.com or by calling 888.DNC4ADT (888.362.4238). Initial here Confirmation of Appointments: I authorize ADT to call me using an automated calling device to deliver a pre- recorded message to set/confirm appointments and provide other information and notices about the alarm system at the telephone number(s) provided by me. Initial here Alarm System Ownership: 0 Customer -Owned d ADT -Owned 1 ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, I HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS 5 AND 18 OF THE TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT I5 THREE (3) YEARS. (C) ADT IS NOT A SECURITY CONSULTANT AND CANNOT ADDRESS ALL OF MY POTENTIAL SECURITY NEEDS. ADT HAS EXPLAINED TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN PROVIDE ME. ADDITIONAL EQUIPMENT AND SERVICES OVER THOSE IDENTIFIED IN THIS CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM ADT AT AN ADDITIONAL COST TO ME. I HAVE SELECTED AND PURCHASED ONLY THE EQUIPMENT AND SERVICES IDENTIFIED IN THIS CONTRACT. (D) NO ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF L055 OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF ROUGE, FIRE AND MEDICAL EMERGENCY PERSONNEL IS OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER I5 INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS THAT I MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME I CHANGE TELEPHONE SERVICE, BY CAWNG 1.800.ADT.ASAP OR BY LOGGING IN TO WWW.MYADT.COM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBUGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS 1 PAID IN ADVANCE. DT epresentative Name I )(ki —/ Customer's Appro Rep. License No. (If Required) 0� yS °+ re Required (Must match Customer Name in Section 1 above) ID No. 12_,&-I G G / NOTICE OF CANCELLATION I, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. •111 r - • • - •r. • -• FINANCIAL DISCLOSURE STATEMENT THERE I5 NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. r A. NUMBER OF PAYMENTS FOR THE INITIAL TERM 15 36. 5g 00 B. AMOUNT OF EACH PAYMENT 15 $ (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) LATE CHARGE - PAYMENT 15 DUE PURSUANT TO MY SELECTED BIWNG FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BIWCHARGE WILL BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A ONE -TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN NO EVENT WILL THIS AMOUNT EXCEED $5.00. TOTAL OF PAYMENTS FOR THE INITIAL TERM IS (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) 20 PREPAYMENT — IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND TOTAL OF PAYMENTS PRIOR TO i 19 OF THIS CONTRACT FOR THE END OF THE INITIAL TERM ADDITIONAL INFORMATION OF THIS CONTRACT, THERE 15 NO I ABOUT NONPAYMENT, DEFAULT PENALTY OR REFUND. AND ACCELERATION. 1 of 6 Administrative Copy 02011 ADT. All rights reserved. (04/11) RESIDENTIAL SERVICES CONTRACT CONTRACT DATE 1111 CUSTOMER ACCOUNT NO �miu 5104UE12 I 1111 6 9 8 s 9 JOB NO LEAD SOURCE 2 of 6 ©2011 ADT. All rights reserved. (04/11) ® Standard Monthly Service, Burglary Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency ® Standard Monthly Service, Fire/Smoke Detection Service includes: Customer Monitorin g Center Signal Receiving and Notification Service for Fire, Manual Fire and Manual Police Emergency Monthly Service Charge ' I a C $ I" - 0 Initial/Annual Recurring Municipal Fee billed separately (Subject to change based on local law) 0 Customer to obtain and pay for initiaVannual municipal alarm use permit Failure to obtain and provide ADT with the municipal alarm use permit registration number could result in no municipal fire/police response to an alarm from the premises and/or a fine. 1 A d i 5+ S Municipal Electrical Permit Fee 7 0 Customer to obtain electrical permit o U 1 Initial/Annual Fee 1 7 S "- ft, Carbon Monoxide 0 Flood 0 Low Temp O Medical Alert $ 11\1( $ Installation Price $ 1451 — Taxable Amount $ +9 Safewatch Cellguard° $ (ts1 C Non - Taxable Amount $ O SecurityLink° $ Connection Fee $ b Extended Limited Warranty/Quality Service Plan (Q $ 1 C $ 1 NI L Admin Fee Sales Tax on Installation* Deposit Received $ $ $ O Guard Response Service ® Other �O T Q LS Total Monthly Service Charge $ ? 7 'U u *If applicable sales tax not shown, it will be added to the first invoice. •I • ••II-1 • •- . -• Balance Due upon Installation* $ ,� -2 ■ °��'5 C4 ,sae _ o\ .c.s. ,�e a� Control p �� co-' .6 °+ \, ,. ' a o e, 1 e Panel 50l 3 K as .`l en`'°� �Se' Oe�e segos' °g ;), .0: s .. et. ,, Jxsi -,, \s¢ Ssa,�e ce use ` sQ�¢c ,kco O°°sS 0 ` 3` Ois°°G.b s0 ee.¢aOe�yLCaiOO°e�eSaeeast`Oae (,� POS pP She s.9 vs)Q \�a Pot Q ' QssceQe Comments Le ��NN ac(Leis tIi f z I Includes: Foyer 1 1 14 rt iq.€ €IZ-- Living Room l% & M O I E Family Room Office Dining Room Kitchen Laundry Room Z 1 1- rt -I ■■■ 1 1 1 ■■ �■■■�■■ ■■■■■■■ Hallway Master Bedroom Master Bath Bedroom 2 1 ■■■■.■ ■ Bedroom 3 ■ Bath 2 Basement 1 Garage SID(' 6a,4le0NO 1 ■ Totals ( I 1 I 1 I E= Existing Equipment Estimated Installation Start Date ' / I 'INSTALLER NOTES 1-41.g4 9900 0100 4 L 14 '1`13 MI4py 2 of 6 ©2011 ADT. All rights reserved. (04/11)