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EL-11-1580Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 170120 Permit Number: EL -8 -11 -1580 Scheduled Inspection Date: February 21, 2012 Inspector: Devaney, Michael Owner: LEONE, DEBORAH Job Address: 5 NW 105 Street Miami Shores, FL Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1121360050320 Phone: (786)331 -3967 Building Department Comments BURGLAR ALARM Passed Er Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments vzfi 'e• / a- February 17, 2012 For Inspections please call: (305)762 -4949 Page 30 of 34 Miami Shores Village RECEIVi-" Building Department AUG z s zon 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. 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): � . c4 f � Phone #: Address: 5 /Y ) / O c 31 City: Mf4All 5ffd2ES State: �L Zip: 33 /Sb Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: cs n W t o j City: Miami Shores County: Miami Dade Fo`li /Parsec #: --cam' `-' k -0b5' c Is the Building Historically Designated: Yes NO Flood Zone: Zip: 3315D CONTRACTOR: Company Name: Phone #:`' �a�6 Address: City: ! "7 State: ' N Zip: Qualifier Na _ State Certification or Re istra on #: C g � � � ` fz-/ Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: ', /cDV6 Square/Linear Footage of Work: Type of Work: ❑Address f4Alteration New ❑Repair/Replace ❑Demolition Description of Work: � � at� * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ teP,0 ' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \ 0 Bonding Company's Name (if applicable) Bonding Company's Address ,r 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 MR 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 Ownei'or Agent The foregoing instrument was acknowledged before me this I day of ? h � 1 C , u � , 2 0 l � , by who is personally known to me or who has produced L $O p (I,) 5 D S-11° As identification and who did take an oath. T. T T NOTARY PUBLIC:.,,• Sign: Print: 6e �(,e ✓/Q My Commission'Expires: APPROVED BY GERRY BRIERRE MY COMMISSION # EE 100904 EXPIRES: June 7, 2015 Bonded Thru Notary Public Undervniters (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Signature tor The for s. m instrument was acknowledged before me this Z day of ,20 L, by (1-e-cr92 tilkitv,r N?Mr`, wholonally know Ito me or who has produced as ' - . ' : 'o and who did take an oath. Plans Examiner Structural Review NOTARY P Sign: ` Ap.:. /, Print: /4664).4 44i \a ot ADAM M. RAMIREZ .r_ MY COMMISSION # EE 091724 • • EXPIRES: May 9, qF' „Q•�� ru Notary Public 01 Underwriters My Commission Expires: Zoning Clerk RESIDENTIAL SERVICES CONTRACT CUSTOMER ACCOUNT NO 2 Z JOB NO LEAD SOURCE ADT Security Services, Inc MDT") Office Address (078( M164/Z(CS (L 44E P(414144. .g.oZ( t Address Customer Name (°Customer° or °I° or °me° or °my') 3bs d-3 -a 79/ www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) IF FAMILIARIZATION PERIOD I5 REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) AL 0 L. N W 1 0 3 TN T See ( DP Protected Premises' Telephone 3 3 S 0 3 0 7 7 8 S 7 City s u 0 Tax Exempt No. A Traditional Phone 0 Other (Qualified) 0 Other (Non - Qualified) Altemate Telephone 1 Alternate Telephone 2 EMAIL 3 0 7 7 7 7 Tax Expire Date 0 Home 8 Cell 0 Work 0 Home 0 Cell 0 Work L ®vE =1�L c 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 donotcontact @ADT.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: ® Customer -Owned 0 ADT -Owned I 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 IS 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 LOSS 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 I5 ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL IS OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER JS 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 W W W.MYADT.COM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL I5' DENIED, THEM THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS I PAID )N ADVANCE. i ) ADT Representative blame Rep. License No. (If Required) Customer's Approval: Orig l Signature Required (Must match Customer Name in Section 1 above) x Rep. /0,413 ID No. NOTICE OF CANCELLATION 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 )F THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION )F THIS CONTRACT AND RECEIPT OF THIS NOTICE. FINANCIAL DISCLOSURE STATEMENT THERE I5 NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. A. NUMBER OF PAYMENTS FOR THE INITIAL TERM IS 36. B. AMOUNT OF EACH PAYMENT IS $ �� �- (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILIJCHARGE 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) PREPAYMENT - IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR THE END OF THE INITIAL TERM ADDITIONAL INFORMATION OF THIS CONTRACT, THERE IS NO ABOUT NONPAYMENT, DEFAULT PENALTY OR REFUND. AND ACCELERATION. 1 of 6 Administrative Copy ©2011 ADT. All rights reserved. (04/11)