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EL-11-2134Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 174497 Scheduled Inspection Date: June 07, 2012 Inspector. Devaney, Michael Owner: POLANCO, DEYSI Job Address: 1183 NE 91 Terrace Miami Shores, FL 33138- Permit Number: EL -11-11 -2134 Project <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132050010200 Phone: (786)331 -3967 Building Department Comments INSTALL BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Ree, June 06, 2012 For Inspections please call: (305)762 -4949 Page 20 of 24 April 10, 2012 City of Miami Shores Building Department 10050 Northeast 2nd Avenue MAY 1 8 2612 Re: Burglar Alarm Permit# EL -11 -11 -2134 1183 NE 91 TER. To Whom It May Concern: (09Si 5i 2 ADT Security Services 10785 Marks Way Miramar, FL 33025 Tel: 954 266 5275 Fax: 954 266 5180 LIC#: EF0001121 I am respectfully requesting to extend the referenced permit for an additional 90 days in order to arrange a specific time schedule with the property owner /tenant. Upon resolving the time, an inspection will be scheduled. Than e Manginelli EF0101121 Electrical Qua ifier e,VIIP MARIA D. P REZ ° ��� State of Florida �'� Notary Public 7 2016 • mm Expires May o # EE 196354 Miami Shores Village Q MEW Building Department IR Nov 1 6 201 )--� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 i rp 't 4' INSPECTION'S PHONE NUMBER: (305) 762.4949 BUII. MG 1,1196/5-7-0;L- Permit No. 6 —1434" PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical - OWNER: Name (Fee Simple Titleholder): be Si e2 Phone #: — 39v g /// Address: 1/93 4/2e. 9'/ 4ee_. City: //l // -47"' State: 71- zip: .0/3 6 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: //93 Ng* q/ % ,-,9--e °cam City: Miami Shores County: Miami Dade Zip: .33/38 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ADT SECURITY SERVICES Address: 10785 MARKS WAY Phone#: r.5- 06(9'°5933 g City: State: Zip: Qualifier Name: laE'eE . 7)1j' State Certification or Registration #: �Ft9©© //a J Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Phone#: Certificate of Competency #: Value of Work for this Permit: $ & /d. ®D Square/Linear Footage of Work: Type of Work: ❑Address /Alteration 7 ONew ORepair/Replace ODemolition Description of Work: �!?S/�ti %/ .e t.. G i9V s4(05s'/V% : *** *** * * * * ** ** * * * * * ******* * *** x* ***** Fees*************** *** ***m **x :************* ****** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ' 1.40 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. v4/ e0.3e0.54 Signature —66/ ., ":424k Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged befo e me this / day of / %/9 , 20 it , by ®� , day of ' , 20 IL, by Ali • :1(4 who is personally known to me or who has produced who is p ovally know or who has produced As i , as identification and who did take an oath. �? "' MAURO FERNANDES NOTARY PUBLIC: ; MY COMMISSION 0 EE 129767 NOTARY PUBLIC: EXPIRES: September 13, 2015 • . • ..ed Ttuu Notary Pubs Underwriters Sign: Print: My Commission Expires: 10 2-7- ZO /,j Sign Print: My Commiss a k************* ** ******* ,. nkaksksk********** ************************* ****** APPROVED BY RiMIREZ MY MISSION b EE 091724 EXPIRES: May 9, 2015 Bonded Thru Notary Public Undervriters * * * ** Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk My Home Show Me: 'Property Information Search By: 'Select Item _:.! El Text only JProperty Appraiser Tax Estimator Property Appraiser Tax Comparison Summary Details: Folio No.: 11- 3205 - 001 -0200 Property: 1183 NE 91 TER Mailing Address: DEYSI M POLANCO 8237 SUNSET STRIP SUNRISE FL 33322- Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0081 VACANT LAND Beds /Baths: 0/0 Floors: 0 Living Units: 0 Adj Sq Footage: 0 Lot Size: 10,000 SQ FT Year Built: 0 Legal Description: WATERSEDGE PB 9- 141 LOT 23 LESS W15FT & W45FT OF LOT 24 BLK 1 LOT SIZE IRREGULAR OR 14600- 3186 0590 1 COC 26253 -1723 26426 -1852 0208 3 Assessment Information: Year: 2011 2010 Land Value: $144,000 $120,000 Building Value: $0 $0 Market Value: $144,000 $120,000 Assessed Value: $144,000 $120,000 Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$144,000 $0/$120,000 County: $0/$144,000 $0/$120,000 City: $0/$144,000 $0/$120,000 School Board: $0/$144,000 $0/$120,000 Aerial Photography - 2009 0 113 ft My Horne 1 Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser Home 1 Using Our Site 1 Phone Director 1 Privacy 1 Disclaimer 7. VttiNIMI 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. http: / /gisims2. miamidade .gov /MyHome /propmap.asp 11/14/2011 RESIDENTIAL, SERVICES CONTRACT CONTRACT DATE il CUSTOMER ACCOUNT NO 6)0 ICh62 I 11 JOB NO LEAD SOURCE 0a •u- 1 • ADT Security Services, Inc ( "ADT") Office Address p /©7a5 /u%4OPf1S clAY www.MyADT.com 1.800.ADT.ASAPa (1.800.238.2727) FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. Customer Name ~ ,�d \Pd l I ■ ( "Customer' or 'I" or "me" or "my) 4 4' / =Yi=p f LL B. AMOUNT OF EACH PAYMENT 15 $ 46-00 TOTAL OF PAYMENTS FOR THE INITIAL (A. TIMES B.) (EXCLUSIVE OF ANY AND RATE INCREASES) 7i ;I >�,rJ� ,11v APPUCABLE TAX , FEES, FINES (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) Address / / laj NIL. 0» 7'QNI^ PREPAYMENT - IF I PREPAY THE TOTAL OF PAYMENTS PRIOR TO THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE IS NO PENALTY OR REFUND. SEE SECTIONS 2, 7,15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. City //414 / S4 R15- State Pi ZIP GE ` G - nni Tax Exempt No Protected Premises' `7� / 1 ] M 'i / D Telephone /TT / Tax Expire Date D / Y Y 0 Traditional Phone O Other (Qualified) 0 Other (Non - Qualified) Alternate Telephone 1 0 Home 0 Cell 0 Work IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE Alternate Telephone 2 0 Home 0 Cell 0 Work (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL Communications Authorization: I authorize products and services to the contact information 888.DNC4ADT (888.362.4238). Initial here ADT to provide me with information and updates about the security system and new ADT and provided by me. I may unsubscribe or opt out by emailing donotcontact@ADT.com or by calling third -party Confirmation of Appointments: 1 authorize appointments and provide other information ADT to call me using an automated calling device to deliver a pre - recorded message to setkonfirm and notices about the alarm system at the telephone number(s) provided by me. Initial here Alarm System Ownership: ID Customer -Owned 0 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 UMITED TO PARAGRAPHS 5 AND 18 OF THE TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT 15 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 IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POUCE, FIRE AND MEDICAL EMERGENCY PERSONNEL 15 OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER IS 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 IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS I PAID IN ADVANCE. ADT Representative Name �^ Rep. f Required) No. Rep. 9 " (If Required) ID No. JJCCGGJJ 'lrC7/ Customer's Approval: Original Signature Required (Must match Customer Name in Section 1 above) l'/ri/ y / 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. 1 ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. .• i.I -r 1 - e•- ••' • -. FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. A. NUMBER OF PAYMENTS FOR THE INITIAL TERM IS 36. LL B. AMOUNT OF EACH PAYMENT 15 $ 46-00 TOTAL OF PAYMENTS FOR THE INITIAL (A. TIMES B.) (EXCLUSIVE OF ANY AND RATE INCREASES) TERM 15 $46. APPUCABLE TAX , FEES, FINES (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BIWNG FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILL/CHARGE 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 55.00. PREPAYMENT - IF I PREPAY THE TOTAL OF PAYMENTS PRIOR TO THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE IS NO PENALTY OR REFUND. SEE SECTIONS 2, 7,15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. 1 of 6 Office Copy ©2011 ADT. All rights reserved. (04/11) / I IIII1 III 11111 IM I II I 1 RESIDENTIAL SERVICtS CONTRACT 5104UE12 \ / , NO SOURCE CONTRACT , / Ot C/ ' / 1 NO DATE AC CO Section 2. Services to be Provided (continued) Monthly Service Charge 0 Initial/Annual Recurring Municipal Fee billed separately (Subject to change based on local law) Initial/Annual Fee % "75 CO $ / het✓ a1 Standard Monthly Service, Burglary Service includes Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency �� 0 Customer to obtain and pay for initial /annual 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. *Standard Monthly Service, Fire/Smoke Detection Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Fire, Manual Fire and Manual Police Emergency t / -P / Municipal Electrical Permit Fee Customer to obtain electrical permit O Carbon Monoxide 0 Flood 0 Low Temp $ Installation Price $ 8/4 . GO 0 Medical Alert $ Taxable Amount ® Safewatch Cellguard0 $ /NC Non - Taxable Amount O SecurityLink° $ Connection Fee 0 Extended limited Warranty/Quality Service Plan (QSP) $ 7/‹. Admin Fee O Guard Response Service $ Sales Tax on Installation* O Other $ Deposit Received $ 49 , 50 Total Monthly Service Charge $ 45, 00 Balance Due upon Installation* $ 4” .50 *If applicable sales tax not shown, it will be added to the first invoice. • • •I 'I • •' I '• Control �\ 0o�� s�1 �° sae Le��A`'a� eca o�• cG° \ eZ` °a�z 4 ..° .ems 4° s50�0s �. C. O�`t C.c�tsy�cte. oz Qet<i a`l e °,o s,`'e Oe �seaY- ' • Panel •lQ �. / ta'�' ° ko ir. ¢ �Qa °S ao 0° ,fi r" tQ e 0 & C J`° 43 Gvpe ,e Oe Cr-0744° C.- is V PO.ck. VD ce P�/ /Comments Package Name: Includes: Foyer J Living Room Family Room Office Dining Room Kitchen Laundry Room Hallway Master Bedroom 1 Master Bath Bedroom 2 Bedroom 3 Bath 2 Basement Garage 1 Totals,.N, ... installation Start Date T 1 /J1 t T Estimated INSTALLER NOTES Wiz /244c /s7M 2 -n I Ac fvlj� / J/ rzoi/ 2, ii kay,i/Aeg / f 14 «X- 3 c— Pu) ('ivy ?Asic Pao RF P - 172_s49a +41 0/6) L449 Ad /pw ot 2 of 6