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EL-12-1715Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 182247 Permit Number: EL -9 -12 -1715 Scheduled Inspection Date: December 03, 2012 Inspector: Devaney, Michael Owner: GOLDBERG, GEOFREY Job Address: 79 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (305)724 -6646 Parcel Number 1132060130130 Building Department Comments BURGLAR ALARM INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Commen November 30, 2012 For Inspections please call: (305)762 -4949 Page 24 of 29 „. 4t i9e /% ? 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 UI DING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 19 FBC 20 mm--ovm;id Mi SEP1 2012 AY B Y: Permit No.' -\ V1; nt5 Master Permit No. City: Miami Shores County: Folio/Parcel #: ■7 a2-06 ®l.5 ® /3e) Miami Dade Zip: Fa /-as" Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ,/ Phone #: Address: .. /Lio City: /1,119'” V I LZ /G /IL✓thi %cam State: 71- Zip: ?F31( Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: TLLC. Phone4(400 6'3' Address: /??7 ,e.5— /1.-or-7C(.3 City: /72110-0/77e7 ',Y��'i /� •State: 'C�'� Qi Zip: 3i���:. . Qualifier Name: /%/,�'tJ� /e teiC- ' 2 c , Phone #: State Certification Registration #: 6 M DO9 Certificate of Competency #: Contact Phone# Q,./._}.9Z/69 -50.,D-.3 Email Address: W4/a, 2,* C DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 0°6 Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: Alteration New ❑Repair/Replace yea- ❑Demolition ****x: k: k*: k: k: k*******: k :k*:k.f **%k=6:k>k*:i: *:k-k-k* $:k:kFees'$:k:k*x*:k:K>k k: k****** *- k: k: k: k- l:: K **ek *:k:ic:g ****:k*ek****** Submittal Fee $ Permit Fee $ 7"' e' a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ L� 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. 1 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 ., reinspection fee will be charged. Signature Owner gent Contractor The foregoing instrument was acknow =aged before m this ' The foregoing instrument was acknowledged before me this 7 day o60-17d/44f400 /2, by / if who is personally known to me or who has produc As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: * * * * * * * * * * * * * * * * * * ** CAROL N. YOUNG MY COMMISSION # EE 092203 t EXPIRES: May 10, 2015 Bonded Thru Notary Public Undeneriters day of /. x!20 a by &2ZJ CiG2 - eue a who is personally known to I11 'w' c ae s'pWduced ose $ `e. as ideIVIta ne iwKOktake an oath. NOTARY PUB fi TQ,p r �o� ;: ° �, � vtr oov +; ¢73.65 e �m My Commission Expires: C ieli7) 9/,6_ Sign: Print: * ** * *** ** k* **** * * * * *** k * * * ** ** ** ***** k * ****** k***** * * * * * *** * * * ** ***** * * ** * ** k * *** * * *** APPROVED BY ���L 4/59y-zctiiy Plans Examiner Structural Review (IZcniced 3 /12 /21)12)1Rccised 1)7 /10/07)(Reviscd 06 /I1) /201)9)IRe ked 3/I5/09) Zoning Clerk 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 be attached) PROPERTY OWNER: 1 1 0 1 1 / 4 4 IL ? PERMIT # ADDRESS: 79 Ai& 9i S7'72 FOLIO NUMBER: /1 060/.- ' I LOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: 22V c ad's / '2� I/ (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): ,C70 VALUE OF PRINCIPAL STRUCTURE (attach appraisal): OWNERS SIGNATURE: DATE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: DATE: Created on June 2009 Miami -Dade My Home My Home Show Me: Property Information Search By: Select item ,.; f Text Only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Summary Details: Folio No;: 11 -3206- 013 -0130 Property: 79 NE 91 ST Mailing _ GEOFFREY M GOLDBERG Address: 1 Living Units: 79 NE 91 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2807 Property Information: Primary Zone: 1000 SGL FAMILY - 2101 -2300 SQ CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 3/3 Floors: 1 Living Units: 1 Adj Sq Footage: 2,871 Lot Size: 9,750 SQ FT Year Built: 1949 $0/$393,950 MIAMI SHORES SEC 1 City: AMD PB' 10-70 LOT 21 & Legal • W1/2 LOT 22 BLK 1 LOT Description: SIZE 75.000 X 130 OR 17029 -2907 1295 4 COC 23411- 2130 05 2005 1 OR 23411 -2130 0505 00 Assessment Information: Year 2012 2011 Land Value: $108,537 $83,490 Building Value: $285,413 $286,984 Market Value: $393,950 $370,474 Assessed Value: $393,950 $370,474 Taxable Value Information: Year: 2012 2011 es Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $0/$393,950 $0/$370,474 County: $0/$393,950 $0/$370,474 City: $0/$393,950 $0/$370,474 School Board: $0/$393,950 $0/$370,474 Sale Information: = x/2005 =MEM 672,500 =T 11 -2130 es Qualification- Descrt . /on: View Additional Sales Additional Information: Click here to see more information for this roperty: nmrnun tv nevelnnmenf flsfnc t Page 1 of 2 ACTIVE TOOL SELECT Legend Property Boundary Selected Property Street HIghWay Miami -Dade County Water Aerial Photography - 2009 0 113 ft My Home' Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser Home 1 Using Our Site 1 Phone Directory I Privacy 1 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. http : / /gisims2. miamidade .gov /myhome /propmap.asp 9/5/2012. RESIDENTIAL SERVICES CONTRACT (ACTIVATION) b2'92 /34/- CONTRACT DATE o D0 CUSTOMER ACCOUNT NO 1111 inn 1111 n 5404UE00 00 Q i 9 SOB , NO LEAD /�}/ L,;-2%/i / /�° SOURCE - 1st •ai- .I.f• _ ,�.,_...__... , ■ ADT LLC dba ADT Security Services ( °ADT') Office Addrr /071.5--- ,c , 1/.SaA7, ,/` /�B 25 3 ? �` DL9AO� // ,0M � 'O S a %�i? / WWW.MyADT.com 1.800.ADTASAP® (1.800.2382727) THERE Customer Name +� V�4q I ( °Customer° or °I° or °me° or °my°) �/�i%//!s°N l /LVf2 /r/ 0 I TERM IS $ �"`� Premises' "' /� ^f [- V SI / I 5V I Address / 7 _ I B. AMOUNT (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) / 1 r" c1 S I L 22 9 City. /V /l / O /1 State ZIP / a PREPAYMENT - IF 1 PREPAY THE TOTAL OF PAYMENTS PRIOR TO - THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE 15 NO PENALLY OR REFUND. a1Y ._ f Tax Exempt No. �- . - `� Tax Expire Date Protected Premises' 1 Telephone 0 Traditional Phone 0 Other (Qualified) 0 Other (Non Qualified) Alternate �2 �0 4 Telephone 1 I 1 Home C9 ►/ Cell 0 Work Alternate C ? /' O Home ® Cell 0 Work Telephone 2 a mli / O Fill in if billing address is the same Add / INe W 1 157— 1 I I III I I I city ��/ 4/ /I �N�� S 1 1 1 State 12- ZIP POEM IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL 1 : I I 1 1 1 1 1 III I 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 third -party provided by me. 1 may unsubscribe or opt out by emailing donotcontact@adt.com or by calling Confirmation of Appointments: I authorize appointments and provide other information ADT to call me using an automated calling device to deliver a pre - recorded message to setkonfirm the alarm system at the telephone number(s) provided by me. Initial here and notices about EQUIPMENT TO REMAIN THE PROPERTY OF ADT. All equipment installed by ADT pursuant to this Contract shall be owned by ADT unless ADT has agreed to give me ownership of the equipment in a separate written agreement. ADT has the right upon termination of this Contract to remove or disable any or all of the equipment owned by ADT, in which case I will not be able to use the equipment for any purpose. See Paragraph 7 of the - Terms and Conditions for more information. 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 Toss 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 possiblpvand the respoltte time of police, fire and medical emergency personnel is outside the control of ADT. ADT may not receive alarm signals if communications or power is interrupted for any reason. (E) ADT recommends that 1 manually test the alarm system monthly and any time I change telephone service, by calling 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 dented, then this Contract will be terminated, and AD Vs only obligation will be to notify me of such termination and refund any amounts 1 paid in advance. . - ADT Representative I9� lf/l / Rep. License No. Rep. ��L (If Required) 1 ID No. GS Customer's Approval Original 'nature ( 41/A Required (Must match Customer Name in Section 1 above) .- -- Yi/6/ IZ tlallir NOTICE O 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 NOTICEOF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 1 ACKNOWLEDGE BEING VERBALLY INFORMED OF M RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. - i•1 -ri - •• -P• i. -• FINANCIAL DISCLOSURE STATEMENT IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. THERE A. NUMBER OF PAYMENTS FOR THE INITIAL TERM 15 36. �7 -99 OF EACH PAYMENT IS $ TOTAL OF PAYMENTS FOR THE INITIAL (A. TIMES B.) (EXCLUSIVE OF ANY AND RATE INCREASES) TERM IS $ �"`� APPLICABLE TAXES, FEES, FINES B. AMOUNT (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 BILL/CHARGE WILL BE SENT /MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A ONE -TIME LATE CHARGE ON EACH PAYMENT THAT 1S MORE THAN TEN (10) DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN NO EVENT WILL THI5 AMOUNT EXCEED 55.00. PREPAYMENT - IF 1 PREPAY THE TOTAL OF PAYMENTS PRIOR TO - THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE 15 NO PENALLY OR REFUND. SEE PARAGRAPHS 2, 7, 15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. 1 of 6 Administrative Copy FV 1'L�f1V 1 LL , +can.,, All rights reserved. (06/12) RESIDENTIAL SERVICES CONTRACT (ACTIVATION) 062 ?21 ?4 iq 549 CONTRACT DATE 9 l 0 CUSTOMER ACCOUNT NO e e 1111 111 5404UE00 r JOB NO GO LEAIsg_ SOURCE frig . ... . Section 2, Services to. Provided dffi Standard Monthly Service, Burglary Seroice includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency (continued) Monthly Service Charge 0 Initial/Annual Recurring Munidpal Fee billed separately (Subject to change based on local law) Initlal/Mnual Fee — ,- $ i A0 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. �, s o Standard Monthly Service, Fire/Smoke Detection Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Fire, Manual Fire and Manual Police Emergency tt Municipal Electrical Permit Fee 0 Customer to obtain electrical permit O Carbon Monoxide 0 Flood 0 Low Temp $ Installation Price :otr $/„ `' O Medical Alert $ Taxable Amount $ ® Safewatch Cellguarda $ l ,t> Non- Taxable Amount $ O SecurityLink® $ Connection Fee $ Q t l Extended Limited Warranty /Quality Service Plan (QSP) $ 7 j . Admin Fee $ O Guard Response Service $ / Sales Tax on Installation * / ` 2 �.4 L LL?$ O Monthly Recurring Municipal Fee (Subject to change based on local law) O Customer obtain and pay for municipal rm use permrY Total installation Charge* '/ $ iT g. _ z G/. O Other ' / �z $ Ai Deposit Received $ 341 Total Monthly Service Charge $ S • 9 9 Balance Due upon Installation* $ - 0 *If applicable sales tax not shown, it will be added to the first invoice. ' 1• • ••11'1 • •' 1 .I '• OiN °S�cac �14g oo��`¢oc��oc.e�`o* \`� \a° `a�e�1\' ,04-- Panel /Qaa j 5 '' ate \" °44.0fe TV�P / oAASe / vy Doi; so �oyeo. ,i,, o c o 'o ooa c pO V� Is ..�. Is 1, Comments Package Name: Indudes: Foyer , J Ale APC //4G Living Room / v / / -"R/ Family Room dioiS Office 3 9j//7 7/e Dining Room 2 fr7s7/ /O J G7/ Kitchen 2 .- ,x.1,2 AoS � Laundry Room Hallway Master Bedroom �—� J Masten Bath / 0 /�' / AO S/ AL Bedroom 2 / A445 Bedroom 3 � Bath 2 4) iiisa L /;g ," Basement .7` lf'zl ��ri Lpit/ ,A / Garage 0 ,`//29 /0 p r d7L ,1„9�641 () 3060 & Price Per Piece TOtals E = Existing Equipment. Estimated Installation Start Date -57/1/113A1[2.- INSTALLER NOTES 2 Of 6 ©2012 ADT LLC dba ADT Security Services. All rights reserved. (06112)