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EL-11-944Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP- 174166 Permit Number: EL -5 -11 -944 Scheduled Inspection Date: May 29, 2012 Inspector: Devaney, Michael Owner: DE LA ROSA, LEO Job Address: 460 NW 112 Terrace Miami Shores, FL 33168- Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (305)751 -7067 Parcel Number 1121360010180 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 7 et/ ,22 / May 25, 2012 For Inspections please call: (305)762 -4949 Page 27 of 30 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 21526 55/ 4- Permit N4 Master Permit No. OWNER:: ` NW Name (Fee Simple Titleholder): Lop I d se L t I1O 2 Phone #: Address: T) 0 1 !IL �� r. 1 City: MQI" 1 State:) Zip: 3 .7)1 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: +(D D ^ V L I !� sa.T. City: Miami Shores County: Miami Dade Zip: 3 1(0 B Folio/Parcel #: 1k- 213IL 0 V' - 0 3 0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: AD-r S`ec_.LM I-N \J ` -S Phone#: CO-1 V iq Address: t 0150 yv-Ica r c>0.1 ° City: y I M VVi, ( State: `� Ls Zip: y330 ZS Qualifier Name: (96 Yl9c r 9 { I Phone#: Gt44 4-2,U ' &O2 9 State Certification or Registration #: Certificate Hof Compete #: 1m W Contact Phone#: Email Address: Q\C (UOL di- . (. OVIA DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Add��resss�s''``,� ❑Alteration ❑New ❑Repair/Res ac ❑Demolition Description of Wor ." �± %041 , Mall& ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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 $ 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 FT ECTRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of s ch posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent �y� The foregoing instrument was acknowledged before ore /me this / 4 day of , 20 . , by Leopoldo CGS I (� C , day of who is personally known to me or who has produced who is identi NOTARY PUBLIC: Signature C tractor The foregoing instrument was acknowledged befor Sign: s per known as NOTARY PUB me this4.1 o. t , 2016 C 54 ( AA- Va. -4/-0 l My Commission Expires: 0 3/0-0 Sign Print: My Commission of Florida play 7, 2016 0 196354 ***** axe * * * * ** * ***** * * * * *** ***x ************************************************ * * * * * * * *** *** *** ******** * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk i Miami. Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. , —94i BUILDING PERMIT APPLICATION FBC 20 55r:7-1 cis0 MAY 2 3C�3 2:2 6517 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): CEO PDLDo CA• RCS --SJ2-. Phone #: 305 —75l- 7ol07 Address: L(k> (12_ 1-�r . City: L&io# u... State: Fi- 114•e1dL2-. Zip: la Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 4460 )3() 112. 1-e-rr .e- • City: Miami Shores County: Miami Dade Zip: . t4 Folio/Parcel #: ,(% OO I — O I$t Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone #: (4% XaC -5057 Address: City: 167,E KS WAY Zip: Qualifier Name: 6.4-(01_, uG,Tap e2p a Phone #: S (o ^SoS 7 State Certification or Registration #: XOOl 121 Certificate of Competency #: ADT SECURITY SERVICE Contact Phone #: a` "&tQ(o - % Email Address: DESIGNER: Architect Engineer: Phone #: Value of Work for this Permit: $ R{ , Square/Linear Footage of Work: Type of Work: UAddress El/Alteration UNew URepair/Replace UDemolition Description of Work: rat,a..r 10-!' iirpAvi') 1 d e-0 i Gek.S tie* *** * * ** * * ** *C * * * * * * * * * * * * * * * * * * **** Fees************* *** *** *** ********* ***** *** *** ** Submittal Fee $ Scanning Fee $ Notary $ Training/Education Fee $ Permit Fee $ IPA ,,e'® CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Cpm any'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 Owner or A . ent The foregoing instrument was acknowledged before me this 1 s The foregoin• '.s trument was acknowledged before me this 20 day of Ck. , 20 IL, by L-z° D de `4 1[..0 , day of , 2011_, by Greg -ac, .1240-4(444.1:. 4.1:. , who is personally known to me or who-has produced who is personally known to me or who has produced as identification and who did take an oath. As identification and who did take an oath. NOTARY ' IC: Sign: (^, Print: My_osi su'ssionExpires: * * * ** ** * * **** * *** **** ANAT.OATE(iA MY COMMISSION #DD 863378 Bonded Um S: June 18 Undertakers fig. Notary Public 1�Gaf/ APPROVED BY f'.9' Plans Examiner Zoning NOTARY PUBLIC: Sign: Print: My Commission Notary PubEc State of F90t Barbara %;orzo My Com aission DD775417 Expires 04106/2012 Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09) Clerk Property Information Map rnia ida + e..90 Property Information Map s My Home Miami -Dade County, Florida 4i T4ST Aerial Photography - 2009 0 This map was created on 5/20/2011 10:45:19 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. 110 ft Page 1 of 2 Summary Details: Folio No.: 11- 2136 -001 -0180 Property: 460 NW 112 TER Mailing Address: LEOPOLDO DE LA ROSA JR 460 NW 112 TERR MIAMI FL 33168 -3328 Property Information: Primary Zone: 0700 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 1,507 Lot Size: 7,500 SQ FT Year Built: 1955 Legal Description: NEW MIAMI SHORES ESTS PB 51-80 LOT 2 BLK 2 LOT SIZE 75.000 X 100 OR 18910 -2807 12 19991 COC 26147- 1197/1198 06 2007 5 OR 26147 -1197 0607 01 Assessment Information: Year: 2010 2009 Land Value: $41,535 $85,626 Building Value: $116,212 $124,998 Market Value: $157,747 $210,624 Assessed Value: $86,320 $84,051 Exemption Information: Year: 2010 2009 Homestead: $25,000 $25,000 2nd Homestead: YES YES Taxable Value Information: Year: 2010 2009 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $50,000/ $36,320 $50,000/ $34,051 County: $50,000/ $36,320 $50,000/ $34,051 City: $50,000/ $36,320 $50,000/ $34,051 School Board: $25,000/ $61,320 $25,000/ $59,051 Sale Information: Sales Sales which are Qualification isqualified as a result of http: / /gisims2 .miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.go... 5/20/2011 RESIDENTIAL SERVICES CONTRACT CONTRACT DATE: CS / 18 /Oil 1l TOWN NO: sv32 bssi CUSTOMER NO: JOB NO: 11 1111 I 11 11 11 5104UE11 I I LEAD SOURCE* _BAG - 1 •11- I • ADT Security Services, Inc. (ADT) ( "We" or "Us" or "Our ") Office Address 1078S 1C 5 14.17044 a'ulap4 -� 2")�+�;�t')V( /f / 's�7 cFL- r336�> fla.fi;' . (5/4" rrlie- �+j C�J s bg' w a 44`0 (Tel: 1-800-ADT-ASAP) 1-800-238-2727 Customer Name .p ,�,�,�,� ( "You" or "Your ") �CL,) Address E 6c; � W . z T . „` City N 2 Silo RAS State / Zip FL 8314$ Protected Premises' Telephone S4 lb 6 ❑Traditional Phone 0 Other (Qualified) ❑ Other (Non -Qual Altemate Telephone 1 p 422 d >: 5 Alternate Telephone 2 . Affinity Name & No. Tax Exempt No. Tax Expire. Date fled) (Circle one) Home eft Work w/ ext. (Circle one) Home / Cell / Work w/ ext. IF FAMILIARIZATION PERIOD 15 REJECTED INITIAL HERE r " °u Alk 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 unsubscribe or opt -out by emailing donotcontact@adt.com or by calling 888- DNC4ADT (888 -36Z-4238). Initial here PA* Confirmation of Appointments: You hereby expressly authorize ADT to call you using an automated callin device to deliver a prerecorded message to set/confirm a service/installation appoigtment at the to hone number(s) shown above: Initial here System Ownership: 0 Customer -Owned T -Owned tandard Monthly Service, Burglary ce includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire, and Manual Police Emergency Monthly Senrice Charge s / ✓ Munidpal Construction Permit Fee Customer to obtain construction permit Other ❑ Standard Monthly Service, Fire/Smoke Detection Service indudes: Customer Monitoring Center Signal Receiving and Notification Service for Fire, Manual Fire, and Manual Police Emergency Installation Price 1 Taxable Amount ❑ Carbon Monoxide ❑ Flood 0 Low Temp Non- Taxable Amount O Medical Alert - Connection Fee afewatch Cellguar& „ f/C__ Sales Tax on Installation* Total Installation Charge* TS /3 4.1 ❑ Securitylink® ❑ Extended Limited Warranty /Quality Service Plan (QSP) Deposit Received 1 ❑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 53.90 j ❑ InitiaVAnnual Recurring Municipal Fee - billed separately (Subject to change based on local law) 0 Customer to obtain and pay for inital/annual munidpal 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 response to an alarm from your premises 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 US 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 1S 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 UNE SEIZURE AND THAT SIGNAL TRANSMISSION 1S 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 ADDITION TO THE ATTACHED PAGES WHICH CONTAIN IMPORTANT TERMS AND CONDITIONS FOR THIS. CONTRACT. YOU STATE THAT YOU UNDERSTAND ALL THE TERMS AND CONDITIONS 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 15 ALWAYS POSSIBLE; WE MAY NOT RECEIVE ALARM SIGNALS IF THE TELEPHONE UNE OR OTHER ALARM TRANSMISSION SYSTEM iS CUT, INTERFERED WITH OR OTHERWISE DAMAGED OR IF TELEPHONE OR ELECTRICAL soma 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. •11 . i 1* ZO ': - . ,—•„'_1 , 1 ■ _erilei_ s :u '►DC• 'Usk ADT ep.:_ fi%'T Rep. License No. (If Required): Rep ■ Ara :. ,nom. 'O ® t �y ginal Signature R- • >• wed 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) t• wo I Fire& Security ADT Security Services, Inc. Permit Information 2801 Pompano Beach, FL 33069 Cvs 30 g (800) 9-2420 (954) 917-2422 Fax Sales Rep: Business Park: Date: Or/20/Z641/ Install Date: dr/ /2w/, Job #: .9"' ik Customer Name: 110 V,t. AA as 4- Door/Window Contacts: Tel 1: Address: 4 cV 4/1„, 112 -TL. 7 lm` Suite #: Tel 2: City: ?y T a ,,,L, ZIP: Es ma Municipality: Alt Contact: Tel: Lot#: Block#: Subdivision: BURG DEVICE TOTAL: Folio#: /1 21 ?3 C w' 0180 Master Permit#: Job Cost: $ TC% System Type(s): Automation Rillurg ]Access QFire ❑CCTV ,Home Job Type: QUnder Construction Prewire Only Prewire & Trim Burglar Alarm Devices Control Panels: Business Park: Audio Glassbreaks: Maglocks/Door Strikes: Keypads: Shunt/RTE Motion Detectors: Security Screens: Other: Door/Window Contacts: Smoke Detectors: Motion Detectors: ACCESS DEVICE TOTAL: Other: '(LLW ,* Sirens/Sounders: Other: Holdup Buttons: BURG DEVICE TOTAL: 1 CCTV Devices Cameras: I Monitors: VCR/DVRs: I CCTV DEVICE TOTAL: I Access Devices Card Readers: Business Park: Control Panels: Maglocks/Door Strikes: Smoke Detectors: Shunt/RTE Motion Detectors: Horns: Other: Pull Stations: Shunt/RTE Buttons: Strobes: ACCESS DEVICE TOTAL: Transmitters: Fire Alarm Devices: 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: Commercial Info Shopping Center: Business Park: Building#: Property Owner: Owner's Address: Comments (continue on back if needed) 11/LARA4 qtcr-IP ?•?