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EL-11-2304Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 173949 Permit Number: EL -12 -11 -2304 Scheduled Inspection Date: May 24, 2012 Inspector: Devaney, Michael Owner: RHODES, LISA Job Address: 1341 NE 103 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 1132050300140 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 CREATED AS REINSPECTION FOR INSP- 173864. No one home at 5:24 p.m.. P/2_, 7-e-7 May 23, 2012 For Inspections please call: (305)762 -4949 Page24of33 f 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 RECEIVED DEC 13 2011 Permit No. —S-OM Master Permit No. R C - q — 11— toy Permit Type: Electrical OWNER: Name (Fee Simple Titleholder)t.ISA RHODES Phone#: Address: 1341 NE 103 STREET city: MIAMI SHORES State: FL zip: 33138 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 1341 NE 103 STREET City: Miami Shores Folio/Parcel #: 11- 3205 - 030 -0140 County: Miami Dade Zip: Ls the Building Historically Designated: Yes CONTRACTOR: Company Name: ADT Address: 10785 MARKS WAY NO Flood Zone: Phone#: city: MIRAMAR State: FL zip: 33025 Qualifier Name. GEORGE MANGINELLI Phone#: State Certification or Registration #: Certificate of Competency #: EF0001 121 Contact Phone #: 954266 -5027 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 966.75 Square/Linear Footage of Work: Type of Work: ❑Address Alteration New ❑Repair/Replace ❑Demolition Description of Work: INSTALL BURGLAR ALARM ***** * * * **** ** ** ** ** ** * * *** * * ** ******** Fees . * * * * * * * * * **** ** * * * * **** ** * *****x *** * * * * * ** Submittal Fee $ Permit Fee $ 6 2 16474' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ .too COPY CustNo-169810980 JobNo- 01 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Stale 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. 1 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 certlfied copy of the recorded notice of commencement must posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence f h posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signam Owner or Agent The foree�gooi g instrument acknowledged before day of {.�jt�( 201 t, by Sjl■ who if Bally known to me or who has produced ll \ \JJ As identification and who did NOTAR UBLIC: 'gnature Contractor he fore:oin t was acknowledged before me th day of 20 t', by who is personally known to me or who has produced V•11(‘ as identification and who did take a f NOTARY ' UBLIC: Sign: Print. ' t. Print My Commission Expires: >' My Commission Expires: * * * * * *** * ** ** APPROVED ************ * * * * * * *** * * * * * * ** * * * * *** * * *** ** Vii/ �--ta %/ l 1,� P ans Examiner Zoning Engineer (Revised 07 /10/07)lRevised 06/10/2009) Clerk checked COPY CustNo- 169810980 JobNo- 01 RESIDENTIAL SERVICES CONTRACT jCONTRACT DATE. _ 4 1. ' / l TOWN NO: 6 6 2.3) 3. '+et c CUSTOMER NO: !bI8° JOB NO: nAe 11 '+m I 5104UE11 11 1111101 01 LEAD SOURCE* 1'." Section 9. Customer o unto ADT Security Services, Inc. ( "We" or "Us" or "Our") Office i b '3 6 S c3(.-1-e-7-7-7 (41-7"4,11-1 I (Tel: 1 -800- ADT -ASAP) 1- 800 - 238 -2727 (ADT) Address Customer Name L-1 5 iyt T- -'4-0 DES ('You" or "Your ") Address 1 3 t-i- ( ,...SE City 11.41A-1.4 ) ,S14-a (ES State / Zip 33 LIS t 1 Protected Premises' Telephone -719 33 Z '7 s5.6 0 Traditional Phone ❑ Other (Qualified) 0 Other (Non -Qual Alternate Telephone 1 Alternate Telephone 2 EMAIL A.M iNr4T4E' Q. n.( A-C . CoM O 3 s- riz_E"'T Affinity Name & No. Tax Exempt No. Tax Expire. Date fied) (Circle one) Home 1 Cell / Work w/ ext. (Circle one) Home / Cell / Work w/ ext. IF FAMILIARIZATION PERIOD REJECTED INITIAL HERE IS Communications Authorization: third party products and services donatcontact@adt.com or by calling You hereby authorize ADT to fumish information available to ADT customers to the contact information 888- DNC4ADT (888 - 362 - 4238). Initial here You hereby expressly authorize ADT to call you at the telephone number(s) shown -Owned DADT -Owned and/or updates provided regarding your by you. You may calling device here security system and new ADT and/or unsubscribe or opt -out by emailing to deliver a prerecorded message to Confirmation of Appointments: set/confirm a service/iinstallat',Lppointment using an automated above Initial System Ownership: ustomer Sectil ) Lo Serviees to Copp Provided IS1 tandard Monthly Service, Burglary Service indudes: Customer Monitoring Center Signal Receiving Notification Service for Burglary, Manual Fire, and Manual and Police Emergency Monthly Service Charge r 1 hx- Municipal Construction Perm ft Fee u (MN.(1 Aktl(ej 0 Customer to obtain construction permit `, (-� t `j Other C 14tandard Monthly Service, Fire /Smoke Detection Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Fire, Manual Fire, and Manual Police Emerged 1, f L Installation Price SS-- Taxable Amount ❑ Carbon Monoxide ❑ Flood 0 Low Temp Non- Taxable Amount O Medical Alen Connection Fee 0•1fewatch CellguarcP 1'34— Sales Tax on Installation* Total Installation Charge* Deposit Received PM A( —Ir a .1s- 11 06.15 ❑ Securitylinle )3c_ I314ended Limited Warranty /Quality Service Plan (QSP)� o Guard Response Service Balance Due upon Installation* ❑ Monthly Recurring Munidpal Fee (Subject ❑ Customer to obtain and pay for to change based on local law) municipal alarm use permit I NI C If applicable sales tax not shown, it will Estimated Start Date be added to your first invoice. + `� I j 41 1 0i( 4 ii , Eftther G -- S P EM Total Monthly Service Charge separately alarm use municipal municipal fire/ a fine. 5BT Initial/ Annual Fee ❑ Initial/Annual Recurring Municipal Fee - billed (Subject to change based on local law) 0 Customer to obtain and pay for initial /annual municipal permit. Your failure to obtain and provide ADT with your alarm use permit registration number could result in no police response to an alarm from your premises and/or Estimated Completion Date YOU ACKNOWLEDGE AND ADMIT ADDITIONAL EQUIPMENT AND TO YOU; (3) YOU HAVE CHOSE TERM OF THIS CONTRACT IS, ANY CHANGE TO THE TELEP FUNCTIONING PROPERLY BY CA YOU ACKNOWLEDGE AND ADMIT WHICH CONTAIN IMPORTANT THIS CONTRACT, INCLUDING, BUT GUARANTEE PREVENTION OF LOSS; TRANSMISSION SYSTEM IS CUT, THAT: (1) WE HAVE EXPLAINED TO YOU THE FULL RANGE OF EQUIPMENT AND SERVICES AVAILABLE TO YOU; (2) THAT DESCRIBED HEREIN ARE AVAILABLE AND MAY BE OBTAINED FROM US AT AN ADDITIONAL COST FOR ONLY THE EQUIPMENT AND THE SERVICES DESCRIBED IN THIS CONTRACT; (4) THE INITIAL EARS; AND (5) YOU SHOULD MANUALLY TEST YOUR SYSTEM MONTHLY WITH ADT AS WELL AS UPON YOUR PREMISES TO CONFIRM PROPER TELEPHONE LINE SEIZURE AND THAT SIGNAL TRANSMISSION i5 1-800-ADT-ASAP (AND FOLLOW THE PROMPTS). WE ARE NOT A SECURITY CONSULTANT. SIGNING YOU HAVE READ THE FRONT AND BACK OF THIS PAGE IN ADDITION TO THE ATTACHED PAGES FOR THIS CONTRACT. YOU STATE THAT YOU UNDERSTAND AU. THE TERMS AND CONDITIONS OF TO, PARAGRAPHS 5, 6, 7, 8, 9, 10 AND 22. YOU ARE AWARE OF THE FOLLOWING: NO ALARM SYSTEM CAN 1S ALWAYS POSSIBLE; WE MAY NOT RECEIVE ALARM SIGNALS IF THE TELEPHONE LINE OR OTHER ALARM OR OTHERWISE DAMAGED OR IF TELEPHONE OR ELECTRICAL SERVICE 15 UNAVAILABLE FOR ANY REASON. OVER AND HAV ONTRACTED FOR THREE (3) NE SERVICE NG ADT THA BEFORE TERMS AND CONDITIONS NOT LIMITED HUMAN ERROR INTERFERED WITH, THIS CONTRACT REQUIRES FINAL APPROVAL OF DENIED, THIS CONTRACT WILL BE TERMINATED AMOUNTS PAID IN ADVANCE. SECOND AND THIRD AN ADT AUTHORIZED MANAGER BEFORE ANY AND ADTS ONLY OBLIGATION TO YOU WILL BE PAG.ES.A.0 MPANY ldiS2�446 THE. Ap'Ar!TIOLiE O Ali AP ,o /G!l tVi{s- i `f EQUIPMENT TO NOTIFY YOU T( Sii , 14 /SERVICES OF AND MAY BE PROVIDED. IF APPROVAL IS SUCH TERMINATION AND REFUND ANY CO TI NS . L dkl-- Rep' No.: .11 Rep. License No. (If Required): O ' i 1 Signature Required 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 ©2010 ADT Security Services, Inc. (08/10)