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EL-13-1119
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 194356 Permit Number: EL -5 -13 -1119 Scheduled Inspection Date: July 02, 2013 Inspector: Devaney, Michael Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street MIAMI SHORESFL 33138- Project: <NONE> Contractor: ADT LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (786)925 -4181 Parcel Number 1122320290250 Building Department Comments ALARM SYSTEM INSTALLATION Infractlo 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 Comments CREATED AS REINSPECTION FOR INSP- 194005. No access at 4:13pm. July 02, 2013 For Inspections please call: (305)762 -4949 Page 8 of 23 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 Permit Type: Electrical JOB ADDRESS: 10 ?0 U IOM dl O[ LVED MAY 21 J013 FBC 20 Permit No.E.l 1 ✓ —1119 Master Permit No. City: Miami Shores County: Miami Dade Zip: 33/ le Folio/Parcel #: // c9 –4 q 43670 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): (57(2,,e/-47a.. Vi'ra— 441A/ Phone j?6 ) c 57 ? Address: %Z%a7 ,VC /e7, c S ePQ : City: L�%/�''77/ L97eA cS' State: ©17 _ Zip: Cc3 /c3�' Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 44(",,a Address: /0715— /%7 2f ; City: : 2 /,- an97ja1 State: ,, �/ -47' .. Zip: a5025--- Qualifier Name: C% �l.4.72 )) . Phone #: State Certificatio or Registration #: Certificate of Competency #: Contact Phone # 5 J�(Q J Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ • CO Square/Linear Footage of Work: T e of Work: DAddress Type of Work: Alteration • ONew ORepair/Replace j. &eg,�r72 /7J7 i�Q Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * **** Submittal Fee $ Permit Fee $ /4' At 049 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 a Application is hereby 'made to.obtain a permit to do the work and installations as indicated. I certify that no work or installation s as commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regula 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 inspec ts. which occurs sev 7) days after the building permit is issued. In the absence of such posted notice, the inspection will not approved and a rei'on fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 3 a day of 9410i ,2015,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: G'Cf Sign: Print: My Commissio f lg -O Signature Contractor The foregoing instrument was acknowledged before me this /7 day of c `> , 20 43, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: �1� Print: � C� Krixt i1 O5 My Commission Exp. NOTARY PUBLIC y rf STATE OF FLORIDA p3//7 �� i COnnm# EE878249 • i 211912017 Plans Examiner Zoning Structural Review Clerk (Revised 3 /12 /2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) Notice to Building Official of Use of Private Provider Project Name: < -- 6'2,7 , r. F/ Parcel Tax ID: //' ,P1c943o` —De; 9 4�527 Services to be provided: Plans Review _ Inspections X Note: If the notice applies to either private plans review or private inspection services the Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute. I, , the fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: MTCI Private Provider Services Private Provider: Lester Triana Address: 97 N. E. 15th Street, Homestead, Florida 33030 Telephone: (305) 246 -0696 Fax: (305) 242 -3716 Email Address (Optional): mtc@mtcinspectors.com Florida License, Registration, or Certificate #: PE65707 I have elected to use one or more private providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I make any changes to the Listed private providers or the services to be provided by those private providers, I shall; within 1 business day after any change, update this notice to reflect such changes. The building plans review and/or inspection services provided by the private provider is limited to building code compliance and does not include review for fire code, land use, environmental or other codes. 1 of 2 The following attachments are provide as required: 1. Qualification statements and/or resumes of the private provider and all duly authorized representatives. 2. Proof of insurance for professional and comprehensive liability in the amount of $1 million per occurrence relating to all services performed as a private provider, including tail coverage for a minimum of 5 years subsequent to the performance of building code inspection services. Individual Corporation Partnership Print Corporation Name Print Partnership Name �i∎ By: By: (signature) , (signature) (signature) P t Print Print Name: S d'1 v - iq (tS4- Name: Name: Address: /astle: V& /0f,< W's: Its: 992/.a.47-/ c.P , 334 ddress: Address: Tele one No. 'Ig`a)v�/�rDODO Please use appropriate notary block. STATE OF COUNTY OF ylad-W• Individual Before me, this 311 day of , 20 _4, personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed. Telephone No. Corporation Before me, this personally appeared Telephone No.: day of ,20 , of ,a corporation, on behalf of the state corporation, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed. Partnership Before me, this day of , 20, personally appeared partner /agent on behalf of a partnership, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed. Personally known ; or Produced identification Type of identification produced j Signature of Notary Notary Public: NOTARY STAMP BELOW My commission expires: 2 of Print Name Page 1 of 1 MIAMI -DADE COUNTY OFFICE OF THb PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Carlos Lopez - Cantera Property Appraiser Property Information: Folio 11- 2232 -029 -0250 Property Address 1020 NE 104 ST Owner Name(s) REAL 7 LLC Mailing Address 1020 NE 104 ST MIAMI FL 33138- Primary Zone 1100 SGL FAMILY - 2301 -2500 SQ Use Code 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths/Half 4/3/0 Floors 1 Living Units 1 Adj. Sq. Footage 2,994 Lot Size 11,520SQFT Year Bulk 1951 Legal Description EVENINGSIDE PB 44-53 LOT 12 BLK 2 LOT SIZE SITE VALUE OR 16491 -2011 0894 4 OR 28032 -0383 0212 01 Assessment Information: Current Previous Year 2012 2011 Land Value $199,066 $165,888 Building Value $341,759 $342,558 Market Value $540,825 $508,446 Assessed Value $540,825 $238,725 Exemption Information: Current Previous Year 2012 2011 Homestead $0 $25,000 2nd Homestead $0 $25,000 Senior $0 $0 Veteran Disability $0 $0 Civilian Disability $0 $0 Widower) $0 $0 Disclaimer: Aerial Photography 2012 Taxable Value Information: Current Previous Year 2012 2011 Exemption/Taxable Exemption/Taxable County $0/$540,825 $50,000/$188,725 School Board $0/$540,825 $25,000/$213,725 City $0/$540,825 $50,000/$188,725 Regional $0/$540,825 $50,000/$188,725 Sale Information: Date Amount OR Book -Page Qualification Code 2/2012 $470,000 28032 -0383 Sales qualified as a result of examination of the deed 8/1994 $0 16491 -2011 Sales which are disqualified as a result of examination of the deed 5/1993 $182,000 15953 -5295 Sales which are qualified 12/1982 $195,000 11656 -1381 Sales which are qualified The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, its use, or its interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provided regardless of the cause of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full disclaimer and User Agreement at http: / /www.miamidade.gov /info /disclaimer.asp. Property information inquiries, comments, and suggestions email: pawebmail @miamidade.gov GIS inquiries, comments, and suggestions email: gis @miamidade.gov Generated on: Thu May 2 2013 http: / /gisweb. miamidade .gov /PropertySearch/printMap.htm 5/2/2013 9 0 HIJD4 . Type of Lean A. Settlement Statement (HUD• -1) OMB Approval No. 2502 -0265 0 1. FHA 0 2 RHS glg 3 Cons Drugs l a Pile Number l 7 Loan Number ii 4 V.A. fl a Com 1.,., 1 13.122 RE 1 1538115202 ID: C. NOTE; This form o furnished to give you a atatemant of actual settlement costs. Amounts paid to and by the settiemant agent are shown Items f marked "(p.o.c)° were paid sumac the cloSi g); hay ara shown here for utfoimaUonai proposes and am not included la the totals. D. NAME OF BORROWER: MICHAEL PUOLISI std SABRINA VORA- PUOLISI, husband and wits Address of Barmen 1020 NE 134 Street Miami Shores, Florida 33135 REAL 7, LLC a Florida Limited Liability Company 100 North Biscayne Blvd Ste 600, Miami Florida 33132 Evereank ISAOA 301 W Bay Street, Jacksonville Florida 32202 1020 NE 104 Street Mlamt Florida Law Offlcee of Elizabeth 1 Hutson, PA 7700 North Kendall Drive. Suite 702 Miami Florida 33158 7700 North Kendall Drive S Ate 702 Miami Florida 33358 5/9113 DISBURSEMENT DAIS: 8/9/13 0. Mortg, Its Case Num. E NAME CIF SELLER: Address of Seller: F NAME OF LENDER: Address of Lender. G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Address: Place of Settlement 1 SETTLEMENT DATE: Phone: 335 -275 • : .. orrower s ransaclion : `. :. ` • --..+ - 100. Gross amount due from borrower- - • 101. Contract sates pace - � � � � �' 760,000.00 .K Summary of oust due lo - - M1OO. Gross amount duo in seller : - 401. Contract sates price 402. Personal •toy " 780,000.00 102. Personal • .;, yf 403. Settlement charges to borrower Woe 140 c 27,231,08 403. 404. 434. 108. Adjustments for items paid.bys ell er•in'advence,'r :' >'::» 08.. r' ;:i:': -' 405. Ad "o3 stme Its for items paid by seller Inadvonce •: 408. City/town taxes 407. Corn taxes 1 Cou taxes' 106. Assessments 408.Assessments 408. 109. 110. 4101 111. 411. 112 412. 120. Gross amount due from borrower. -,200. Amounts paid or In behalf of borrower:: ;: ;.;.;:': 231.0, . osIO or earnest mon,, 787.231.08 ..::...:........ ... 50 000.00 420. Gross amount due to seller: . - '500. Reductions irraritotmt due tosotler:.:..:.._. .....'...:• .......... 601. Excuse de • oslt see mstructlons) 780,000.00 .........:...:'....'.......,.. v.02. Pdnapal amount of new bents) 475 000.33 502. Settlement Ohs , _ - to salter line 1400 63,114.54 435.8x/ aln toan(s) taken au. act to 5p3. Exls , bans taken fishiest to 204. Pdnra..: amcunt of second mortgage 604. Pa . of first a Imortga 205' 505. Payoff of second mo age loan 606. 2118. _ 207. 507. 208. Prin., al amt of mortgage held by seller 308.00 608. Prinapel amt of mortgage held by seller 609. Seller Paid Teta Search and Lien Search • : contract 306.00 202. Seller Pald Tide Search and lien Search Per contract 209a .:Adjustments for items unsaid by seller. 210. C /town taxes 509e. Adjustments for Items unpaid by seller 510. (30095050 taxes 211. Corn taxes from 01/01/13 to 05/02113 5 035.51 511. Co taxes from 01101/13 to 06/09/13 5 035.51 212. Assessments 612. Assessments 213. 513. 21'. 514. 215. Seller crechl to closing costa pre • = cis and escrows 8,500.00 515. Seiler credit to elost .r casts • re .: ds and escrows 6 503.00 216. 516. 217. 517 218. 818. Ng. _ ..- "' --' 784231.08 519. .3. Total .-: d bytfor borrower. '300. -Cash 520. Total reductions 19 amount due seller. • 600: 84,958.35 780,0110.00 at settlement from /to borrower: --' - .• . -.- -`? 301. Cross amount due from born: wet (one 120) Cash at setdemen olfrom seller: 801. Gross amount due to seller (lino 420) 302. Less amount paid by/for the :borrower (tine 220) (538.841.81) 802. Less total reductions in amount dim seller Dine 520) (84,966.35) 303. Cash ( g From 0 To ) Borrower. 250,389.68 803. Cash ( [✓J To i _1 From ) Seller. 6 06, 043.88 The Pubno Reporting Eurden for this collection of irdoanafon is estimated at 36 mmutes per response for coliadt :a, rav(awrng, and reporting Ute dais This agency may not collect this utfnmtatioo, and you era not moused to compkrte tills form, unless It displays a currently valid OMB oaniml :far bar. Np confidentiality is assured; this disclosure la mandatory. This is deo:g,1a21a prevkle 155 parries to a (2ESPA covered transaction with tcformatior dime the seft§mant process GotiblaTimed) HUD -1 SETTLEMENT STATEMENT ADDENDUM Fite Number: 13-122 RE I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements mad f. n my account or by r,., is transaction.. 1 further certify that 1 have received a copy of the HUD-1 Settle 1` Statement. Borrower Sabrina Vora- Puglisi Seller(s) REAL 7, ILC a Florida limited Liability Company y. Justin G Brook Attorney in Pact (Cozpoxate Seal) Settlement Agent The HUD -1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. Law 0ffices of Elizab -_ J. Hu. 4 P.A_ dir Sy: Date: WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can Include a fine and imprisonment For details sae: Title 18 U.S. Code Section 1001 and Section 1010. DoubteitmeO HUD -1 SETTLEMENT STATEMENT ADDENDUM Rle Number. 13 -122 RE I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. 1 further certify that I have received a copy of the HUD -1 Settlement Statement. Borrower(s) Michael Puglisi l3TAL 7, LL0 a Florida L;m, ility Company Hy: Sabrina Vora- Puglia' Seller(s) .7ustin G..$roo Attorney in Fact (Corporate Seal.) Settlement Agent The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction i have caused or will cause the funds to be disbursed In accordance with this statement Law Offices of 51iz_` .7.. n =on, U.A 5 c\,\ + 3 rrrr�..rs WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U,S, Code Section 1001 and Section 1010 Qoubtenmea 4!/ 1i Ifr &10-tcl L(/4 - Sri Z RESIDENTIAL SERVICES CONTRACT CONTRACT jAr / 1 2) CUSTOMER DATE N`I �I _ �]/ ACCOUNT NO 11 11 11 5401 UE00 11 11 II 3 O 3 LEAD SOURCE 1 Apj LLC dba ADT Seaeritir Services ( "ADT ") Office Address • 11 tin I d q,,y, A. (H '2,3010 j./-Lfc1 fr ciIO� -30c ?iv qCqt1 www.MyADT.com 1.R00:ADT.ASAP® (1.800.238.2727) Alternate Telephone 1 O Fill in if billing address is the same Billing Address Customer Name ( "Customer" or "I" or "me" or "my ") v i S Premises' Address City POI 00 N4. re, T tit Tax Exempt No. Protected Premises' Telephone 512 0 Home 0 Cell 0 Work Alternate Telephone 2 State El ZIP Tax Expire Date /m 0 Traditional Phone 0 Other (Qualified) 0 Other (Non- Qualified) 0 Home 0 Cell 0 Work City IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE EMAIL State ZIP (see Paragraph 14 of the Terms and Conditions for explanation) • Communications Authorization: I authorize ADT to provide me with information and update's 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 EQUIPMENT TO REMAIN THE PROPERTY OF ADT. All equipment installed by ADT pursuant to this Currtract 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 tif the following: (A) This Contract consists of six (6) pages. Before sitju.ng 6is Contract,, have read, understand and agree to each and every term of this Contract, including but not limited to Paragraphs 5 and 18 of the la ins °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 arity needs. ADT has explained to me the full range of equipment and services that ADT can provide me. Additional equipment and services over tii , se identified irtthis Contract are available and may be purchased from ADT at an additional cost to me. I have selected and purchased only the equip(t,r,nt antiervice`s identified in this Contract. (D) No alarm system can provide complete protection or guarantee prevention of loss or injury. Fires, fluou,, 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 police, fire and medical emergency personnel is outside the control of ADT. ADT may not receive alarm signals if communications or power is interrupter( for any. reason. (E) ADT recommends that I manually test the alarm system monthly and airy 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 equiment or qprvices, and if approval is denied, then this Contract will be terminated, and ADT',, only obligation•will be to notify me of such termination a d ref,pnd any amounts I paid in advance. ADT Representatliye Customer's Approval: Original Signature `Requir I, THE COSI- OMER, MAY CANCEL THIS AFTER THE DATE OF THIS TRANSACTIOt, OF THIS-RIGHT. I ACKNO DGBEic =,.. OF THIS CONTRACT AND ECErPT`'OF 1= yt match -Custo)rler Name in'Settion 1 above) Rev;,- License No. (If Required) :`NO4fICE(1 >ANCELLATION A.; ASACTION .,NY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY ,EE THE ATTA9 ci ED NOTICE OF CANCELLATIOV =ORM FOR AN EXPLANATION ERB •LLYINF( < <(MED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION NOTI EY Rep. ID No. In r itrwi FINANCIAA.; ;CLOSURE STATEMENT. THERE IS i,: " FINANCE alit '..e OR.COS-I CREbIT (0% APR) ASSOCIATED WITH THIS. CONTRACT. q9. alb. A. NUMBER OF PAYMENTS FOR THE INITIAL TERM IS 36. B. AMOUNT OF EACH PAYMENIT.IS s, t WEAL MiPAYM fI R THE INITIAL TERM IS 16I (TOTAL MONTHLY SERVICE CHARGE' FROM BE L�1A/,) TiR i ( OF ANY APPLICABLE TA ,,S�, S AND RATE INCREASES) 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 I5 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. 1 of 6 PREPAYMENT — IF 1 PREPAY THE TOTAL OF PAYMENTS PRIOR TO j THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE IS NO PENALTY OR REFUND. SEE PARAGRAPHS 2, 7, 15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. Administrabave Copy ©2012 ADT LLC dba ADT Security Services. All rights reserved. (06/12) RESIDENTIAL SERVICES CONTRACT MI 1 11111 5401 UE00 CONTRACT DATE i ron 2. Services O Standard Monthly Service, Serviceincludes: Customer Monitoring Receiving and Notification Service Manual Fire and Manual Police Emergency rl �~ 3 /0 /� , I I =CUSTOMER. I ACCOUNT X10 (continued) Charge / 9 '1(11 0 sr -,ti. i JOB NO LEAD SOURCE to be Burglary Center for Burglary, Provided Signal 1 Monthly,Service ! $ b- O *, Initial /Annual (Subject to Recurring change to obtain permit alai municipal Municipal Fee billed separately based on local law) Initial/9pnual Fee 3 l- Customer alarm use the municipal result in no from -thee preinIfes and pay for initial/annual municipal Faire to obtain anti provide ADT with use permit registration number could fire /police response to an alarm a a fine. ,. , i O Standard Monthly.$ervice, Fire/Smoke Detection Ser/ice includes: Customer,M•?nitoring Center Receiving and(Notification Service for Fire, Manual and Manual Police Emergency Signal Fire Temp t � Municipal Electrical Permit Fee, 0 Customer to obtain electrical` p`eiiit installation Price I � f� ` Gq Cli I+ / O Carbon Monoxide 0 Flood 0 Low O Medical Alert $ s. taxable Non TakB t O Safewatch Cellguard ®f.-r' - :Je Amount $ O SecurityLink® $ Connection Fee $ O Extended Limited Warranty /Quality Service Plan (QSP) cs__c Admin Fee $ O Guard Response Service $ Sales Tax on Installation* $ O Monthly Recurring Municipal Fee (Subject to change based on local law) 0 Customer to obtain and pay for municipal alarm use permit Total Installation Charge *fa O Other $ Deposit Received $ •o' Total Monthly Service Charge $ C Balance Due upon Installation* $ Z 9! • Control Panel Package Name: 1 . t It well be added to the first invoice. 14 1' If II • •- 1 . % s o`5\ �, P¢c aQ l J /\`� s Pc , / Q P N S°,' i1/4F- Q °o� s° C.00� s� O \ o r ¢ 0 402 L�s rQo ao ®,0), 4„.4 CZY ' \O?�°J a�� ¢ \ J po5 �o ?,r¢aQQ ` C` PQ Comments Includes: Foyer l Living Room Family Room Office Dining Room Kitchen Laifridry Hallway Master Bedroom (11 iailfig1cf Ai Master Bath Bedroom 2 Bedroom 3 Bath 2 Basement Garage Price Per'Pielce Totals INSTALLER NOTES Estimated Installation Start Date I firdisnerrt /EYE 2 of 6 ©2012 ADT LLC dba ADT Security Services. All rights reserved. (06/12)