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EL-12-1233Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 188418 Permit Number: 4L -7 -12 -1233 Scheduled Inspection Date: April 03, 2013 Inspector: Devaney, Michael Owner: PHILLIPS, KATHLEEN Job Address: 440 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060140050 Building Department Comments BURGLAR ALARM INSTALLATION 03/15/2013 - SAME QUALIFIER 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 Comments /X.247' 9 April 03, 2013 For Inspections please call: (305)762 -4949 Page 18 of 21 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 10 Permit No. Master Permit No. 4-'4' 7 -/-2- htg3 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Phone #: Address: 7S® Ai, 9s' 177 City: iro oath' S State: Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: ff 0 �( / /7 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: Od7�f `.3 -X-4 % �.! City: 4,1 ovt� 14040- S te: /" Zip: 006 �� alif /r Name: ,LOGO / / Phone #: State Certifi cati on or Registration #y/ tiree) 0/! .2/ Certificate of Competency #: Contact Phone #: f.(,P' 'I' 5:27f# Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: 9,3��%'XG�.�•� %.� Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address /� ❑Alteration New ❑Repair/Replace Description of Work: /C e/%4% -- 71'2'1x33 ❑Demolition ****+ x: x**: xx :***:x:**** * ***** * * * ***** ****** Fees****** ****x: *: a***+ x* ***:x**********:xx:*:x*** * * *** Submittal Fee $ Permit Fee $ tap ` ' CCF $ CO /CC $ Scanning Fee $ 5 (,� 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 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this' . day of , 20 _, by , day of V , 20 ,by QCQle /12a/Zi >,# �. who is personally known to me or who has produced who is personally known to me or who has produced U As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission ********:***:******************************** *** * *** **** *** ******** * ****** ** �f3 a APPROVED BY :01.4_ /1.0 /It.49-,- Plans Examiner Structural Review Clerk MARIA D PEREZ iA ? Notary Public - State of Flo, is *M**** Commission # EE 19F- (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3115/09) .e,4//g(e77 UILDING PERMIT APPLICATION Fsc 20 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 M� ",MEN �� BY:. ,12' 1233 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Phone#: ` Address: tkv ISE 9 Z Sr (eon City: Li( A-N ( fl1 vef State: Zip: .77 1 J' Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 44'3 SZ- sr. City: Miami Shores County: Miami Dade Folio/Parcel #: / /3ZO o/gazz Is the Building Historically Designated: Yes NO Flood Zone: Zip: 3 7 -7 g CONTRACTOR: Company Name: XV)/ a-4 Phone# Address: /.l City: inir./ State: / Zip: c ar Z5 Qualifier Name: eieg /-fib. 40102/1-ee Phone#: State Certification o Registration #: 2,2° ' ,,�� f Certificate of Competency #: Contact Phone#: (� ems% °, Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ / e OQC Square/Linear Footage of Work: Type of Work: UAddress 'Alteration New URepair/Replace Demolition Description of Work: D iv/a ✓ j /t,,r) 1/9 f7'q /% **** ***** ** *+ n*** ***+x**************x.**** Fees***** *****a ************* *****a************** Submittal Fee $ Permit Fee $ //1:06.' Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ DBPR $ Technology Fee $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ trZe'"° 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.FCTRICAL 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. Si Signature Owner or Agent Contractor The foregoing nsXnent was acknowledged before me this The foregoing instrument was acknowled : ed before me this t9c9 - I e. day of , 20 , by , day of `. ` 20 by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 401.11..11114# Gj..... • ?oaf• _ai °99 ;* -cy ******* ** *** * * **** M * * *a * ** ** *** 1tc * ******** * * * * * ******** may***** ******** * *********** ***•xa*** ft11MO �sl4r Plans Examiner Zoning f. / who is personally known to me or who has produced t oeaaaaa®®® as identifi ,jht drake an oath. NOTARY PUBLIV.a, G AMY �, .r®® r. to • ®p in 737:15,5 z 00,1 z a 0 r r�r ,fig c� o Print '� ,/ A {.r/o''._v q�� My Commission Expia,:O� '' ...... / /1 ,. s*. ® °LO1Z1®R' os% Sign: APPROVED BY Structural Review Clerk (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) A. Settlement Statement (HUD -1) B. Type of Loan OMB Approval No. 2502 -0265 1. - FHA 2. RHS 3. X CONV. UNINS. 4. VA 5. COW. INS. e. File Number. 120214 7. Loan Number. 0896998345 8. Mortgage Insurance Case Number. C. Note:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower. Javier Ortiz and Laura Fernandez Ortiz, husband and wife 440 NE 92nd St. Miami Shores, Florida 33138 E. Name & Address of Setter. Gladstone Phillips and Kathleen Phillips 440 NE 92 Street Miami Shores, Florida 33138 F. Name & Address of Lender. Regions Bank d/bla Regions Mortgage 2050 Parkway Office Circle Birmingham, Alabama 35244 G. Property Location: 440 NE 92 Street Miami Shores, Florida 33138 Lot The West 6 inch, Miami Shores Section 2, Miami -Dade County, Florida H. Settlement Agent: Guaranty Trust & Title, Inc. 1909 Tyler St. Suite 306 Hollywood, Florida 33020 954-920 -0766 fax: 954 -920 -0729 1. Settlement Date: June 27, 2012 Place of Settlement: Guaranty Trust & Title, Inc. 1909 Tyler St., Suite 306 Hollywood, Florida 33020 Phone: (954) 920 -0766 Purchase Money Mortgage J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due From Borrower: 101. Contract Sales Price 102. Personal Property 103. Settlement Charges to Borrower (line 1400) 104. 786,332.00 26,060.06 400. Gross Amount Due To Seller 401. Contract Sales Price 402. Personal Property 403. 404. Adjustments for Items Paid by Seller In Advance: 106. City / Town Taxes 107. County / Parish Taxes 108. Assessments Sanitation and Stormwater Fees Jun 27, 2012 thru 109' Dec 31, 2012 120. Gross Amount Due from Borrower. 385.51 812,777.57 786,332.00 Adjustments for Items Paid by Seller in Advance: 406. City / Town Taxes 407. County / Parish Taxes 408. Assessments 409 Sanitation and Stormwater Fees Jun 27, 2012 thru 385.51 Dec 31, 2012 420. Gross Amount Due to Seller. 786,717.51 200. Amounts Paid by or in Behalf of Borrower: 201. Deposit or Earnest Money 202. Principal Amount of New Loan 203. Existing Loan(s) taken subject to 30,000.00 581,250.00 500. Reductions in Amount Due to Seller: 501. Excess Deposit (see instructions) 502. Settlement Charges to Seller (Line 1400) 503. Existing Loan(s) taken subject to Payoff of First Mort gage Loan #0038427308 to 5,330.90 204. Daily interest credit 504. Wells Fargo Home Mortgage - Loan # 0038427308 ..$4.0.........., 205. Cure for 10% Tolerance 87.15 505. Payoff of Second Mortgage Loan 68218009648699 to Bank of America- Loan # 68218009648699 67,277.29 206. 506. Purchase Money Mortgage Adjustments for Items Unpaid by Seiler. Adjustments for Items Unpaid by Seiler 510. City / Town Taxes 210. City / Town Taxes 211. County / Parish Taxes Jan 1, 2012 thru Jun 26, 2012 5,047.83 511. County / Parish Taxes Jan 1, 2012 thru Jun 26, 2012 5,047.83 212. Assessments 512. Assessments 213. 513. 220. Total Paid by 1 for Borrower: 616,384.98 520. Total Reductions in Amount Due Seiler. 290,386.02 300. Cash at Settlement from 1 to Borrower: • 600. Cash at Settlement to 1 from Setter 301. Gross Amount due from Borrower (line 120) 812,777.57 601. Gross Amount due to Seller (line 420) 786,717.51 302. Less Amount Paid by /for Borrower (line 220) 616,384.98 602. Less Reductions Amount due Seller (line 520) 290,386.02 303. Cash From Borrower: $196,392.59 603. Cash To Seller $496,331.49 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this Information, and you are not required to complete this form, unless It displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. ate: June 27, 2012 Loan Number: 0896998345 File Number: 120214 Settlement Charges Paid from Paid from Sellers Funds at Settlement Total Sales / Broker's Commission: Division of Commission (line 700) as follows Borrower's Funds at 701. Settlement 702. 703. Commission Paid at Settlement 704. Commission paid for transaction to Keller Williams Eagle Realty (poc $18,094.00 by Borrower) 800. Items Payable in Connection with Loan: 801. Our origination charge (from GFE #1) $6,762.50 802. Your credit or charge (points) for the specific interest rate chosen (from GFE #2) to Regions Bank $- 5,812.50 803. Your adjusted origination charges (from GFE #A) to Regions Bank 950.00 804. Appraisal Fee- $300.00 POC -B (from GFE #3) to Juan L. Quinones (poc $300.00 by Borrower) 805. Credit Report (from GFE #3) to Equifax Mtg Svcs 18.00 806. Tax Service (from GFE #3) to 1st American Tax Service 74.00 807. Flood Certification (from GFE #3) to Corelogic 7.50 900. Items Required by Lender to be Paid in Advance: 901. Daily interest charge from Jun 27, 2012 to Jul 1, 2012 @ 63.7000 / day for 4 days (from GFE #10) to Regions Bank 254.80 902. Mortgage Insurance Premium (from GFE #3) 903. Homeowner's Insurance (from GFE #11) to Tower Hill Insurance- Policy #P001914056 3,130.08 904. Wind Insurance Premium (from GFE #11) to Citizens- Policy #FRJW6344950 5,397.00 1000. Reserves Deposited with Lender: 1001. Initial deposit for your escrow account (from GFE #9) to Regions Bank 7,228.18 1002. Homeowner's Insurance 3 months @ $260.84 per month to Regions Bank $782.52 1003. Mortgage Insurance 1004. Property Taxes 10 months @ $864.94 per month to Regions Bank $8,649.40 1005. Windstom/2nd Hazard 3 months @ $449.75 per month $1,349.25 1099. Aggregate Adjustment $- 3,552.99 1100. Title Charges: 1101. Title services and lender's title insurance (from GFE #4) - Title Search Fee to Fidelity National Title insurance Company $75.00 - Scan and storae to Full Access $24.95 - Runner to court House to Two Hands or more $31.25 - Independent Closer to MJS & Co. $145.00 - Lenders Overnight /Handling to Guaranty TYrust & Title inc $29.95 1,264.35 1102. Settlement or Closing Fee to Guaranty Trust & Title, Inc. $495.00 195.00 1103. Owner's Title Insurance (Fidelity National Title Insurance Company) (from GFE #5) to Guaranty Trust & Title, Inc. 4,007.00 1104. Lender's Title Insurance (Fidelity National Title Insurance Company) to Guaranty Trust & Title, Inc. - Lender's Premium $25.00 - Endorsement 8.1(25) $35.00 - Endorsement 9.1 $403.20 1105. Lender's Title Policy Limit $581,250.00 1106. Owner's Title Policy Limit $786,332.00 1107. Agent's Portion of the Total Title Insurance Premium $3,129.14 1108. Underwriter's Portion of the Total Title Insurance Premium $1,341.06 1109. Title Search Fee 1200. Government Recording and Transfer Charges: 1201. Government Recording Charges (from GFE #7) 182.10 1202. Deed $10.60 Mortgage $171.50 Releases $0.00 1203. Transfer Taxes (from GFE #8) 3,197.05 1204. City /County tax/stamps Deed $0.00 Mortgage $0.00 1205. State tax/stamps Deed $4,718.40 Mortgage $2,034.55 4,718.40 1206. Intangible Tax to Clerk of the Circuit Court $1,162.50 1207. Other Tax 2 1208. Rec CMA Affidavit (from GFE #7) to Clerk of the Circuit Court 10.00 1300. Additional Settlement Charges: 1301. Required services that you can shop for (from GFE #6) 1302. Survey to Global Dimensions, Inc - Inv # 20294 350.00 1303. Municipal Lien Search to Lightning Lien Letters. Inv# 12 2633 195.00 1304. Courthouse Courier /Copies, misc. to Two Hands & More, Inc Inv #120214 62.50 1305. Utility Escrow _ _ _ _ ate: June 27, 2012 Loan Number: 0896998345 File Number: 120214 parison of Good Faith Estimate (GFE) and HUD Charges Charges That Cannot Increase HUD Line No. Good Faith Estimate HUD Our origination charge # 801 6,762.50 6,762.50 Your credit or charge (points) for the specific interest rate chosen # 802 - 5,812.50 - 5,812.50 Your adjusted origination charges # 803 950.00 950.00 Transfer taxes #1203 8,065.30 3,197.05 Charges That in Total Cannot Increase More Than 10% H HUD Line No. G Good Faith H HUD Govemment Recording Charges # #1201 2 250.00 1 182.10 Appraisal Fee- $300.00 POC -B # # 804 1 100.00 3 300.00 Credit Report # # 805 1 18.00 1 18.00 Tax Service # # 806 7 74.00 7 74.00 Flood Certification # # 807 7 7.60 7 7.50 Total 4 449.50 5 581.60 Increase between GFE and HUD Charges 1 132.10 2 29.39% Good Faith HUD Initial deposit for your escrow account #1001 4,459.68 7,228.18 Daily interest charge from Jun 27, 2012 to Jul 1, 2012 @ 63.7000 / day for 4 days # 901 955.50 254.80 Homeowner's Insurance # 903 6,000.00 3,130.08 Wind Insurance Premium # 904 0.00 5,397.00 Title services and lender's title insurance #1101 1,588.80 1,264.35 Owner's Title Insurance #1103 4,006.66 4,007.00 Your initial loan amount is $581,250.00 Your loan term is 30 years Your initial interest rate is 4 % Your initial monthly amount owed for principal, interest, and any mortgage insurance is $2,774.98 includes [ X] Principal [ X ] Interest [ ] Mortgage Insurance Can your interest rate rise? [ ] No. [ X ] Yes, it can rise to a maximum of 9 %. The first change will be on 07/01/2022 and can change again every 12 months after 07/01/2022. Every change date, your interest rate can increase or decrease by 2 %. Over the life of the loan, your interest rate is guaranteed to never be LOWER than 2.375% or HIGHER than 9 %. Even if you make payments on time, can your loan balance rise? [ X ] No. [ ] Yes, it can rise to a maximum of $ . Even if you make payments on time, can your monthly amount owed for principal, interest, and mortgage insurance rise? [ ] No. [ X ] Yes, the first increase can be on 08/01/2022 and the monthly amount owed can rise to $4,120.13. The maximum it can ever rise to is $4,120.13. Does your loan have a prepayment penalty? [ X ] No. [ ] Yes, your maximum prepayment penalty is $ . Does your loan have a balloon payment? [ X ] No. [ ] Yes, you have a balloon payment of $ due in years on . Total monthly amount owed Including escrow account payments [ ] You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. [ X] You have an additional monthly escrow payment of $1,575.53 that results in a total initial monthly amount owed of $4,350.51. This includes principal, interest, any mortgage insurance and any items checked below: [ X] Property taxes [ X ] Windstorm /2nd Hazard [ ] Flood insurance [ ] [ X ] Homeowner's insurance [ ] Your initial loan amount is $581,250.00 Your loan term is 30 years Your initial interest rate is 4 % Your initial monthly amount owed for principal, interest, and any mortgage insurance is $2,774.98 includes [ X] Principal [ X ] Interest [ ] Mortgage Insurance Can your interest rate rise? [ ] No. [ X ] Yes, it can rise to a maximum of 9 %. The first change will be on 07/01/2022 and can change again every 12 months after 07/01/2022. Every change date, your interest rate can increase or decrease by 2 %. Over the life of the loan, your interest rate is guaranteed to never be LOWER than 2.375% or HIGHER than 9 %. Even if you make payments on time, can your loan balance rise? [ X ] No. [ ] Yes, it can rise to a maximum of $ . Even if you make payments on time, can your monthly amount owed for principal, interest, and mortgage insurance rise? [ ] No. [ X ] Yes, the first increase can be on 08/01/2022 and the monthly amount owed can rise to $4,120.13. The maximum it can ever rise to is $4,120.13. Does your loan have a prepayment penalty? [ X ] No. [ ] Yes, your maximum prepayment penalty is $ . Does your loan have a balloon payment? [ X ] No. [ ] Yes, you have a balloon payment of $ due in years on . Total monthly amount owed Including escrow account payments [ ] You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. [ X] You have an additional monthly escrow payment of $1,575.53 that results in a total initial monthly amount owed of $4,350.51. This includes principal, interest, any mortgage insurance and any items checked below: [ X] Property taxes [ X ] Windstorm /2nd Hazard [ ] Flood insurance [ ] [ X ] Homeowner's insurance [ ] Note: If you have any questions about the Settlement Charges and Loan Terms is ted on this form, please contact your tender. Date: June 27, 2012 Loan Number: 0896998345 File Number: 120214 ors er Ortiz and Laura Fernandez Ortiz 440 NE 92nd St. Miami Shores, Florida 33138 Sellers Gladstone Phillips 440 NE 92 Street Miami Shores, Florida 33138 Kathleen Phillips Property Addresses 440 NE 92 Street Miami Shores, Florida 33138 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. I further certify that I have rear vela copy of HIED -1 Settlement Statement. Borrower: Borrower: and Laura Femandez Ortiz, Javi Ortiz Address Address er. Seller: Gladstone PhiII Address Ps Ka lean Phillips Address 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 _n f the parties hereto. Settlement Agent:/ WARNING: It is a crime to kn and imprisonment. For details Date: June 27, 2012 tatements to the United States on this or any other similar form. Penalties upon conviction can include a fine e 18 U.S. Cade Section 1001 and -Section 1010. My Home Show Me: Property Information Search By: Select Item Text only tJ Property Appraiser Tax Estimator Propertv Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: ACTIVE TOOL: SELECT Folio No.: 11- 3206 -014 -0050 Property: 440 NE 92 ST Mailing Address: GLADSTONE PHILLIPS &W KATHLEEN 440 NE 92 ST MIAMI FL 33138 -3155 Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 4/3 Floors: 1 Living Units: 1 Adj Sq Footage: 2,909 Lot Size: 12,752.07 SQ FT Year Built: 1925 Legal Description: MIAMI SHORES SEC 2 PB 10- 37W5IN OF LOT 6& ALL LOTS 7 & 8 BLK 49 LOT SIZE 100.410 X 127 OR 19770 -2783 07 2001 1 OR 19970 -2783 0701 00 Assessment Information: Year: 2011 2010 Land Value: $159,409 $198,757 Building Value: $274,791 $276,407 Market Value: $434,200 $475,164 Assessed Value: $422,466 $416,223 Exemption Information: ear: 2011 2010 Homestead: $25,000 $25,000 nd Homestead: YES YES Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $50,000/$372,466 $50,000/$366,223 County: $50,000/$372,466 $50,000/$366,223 City: $50,000/$372,466 $50,000/$366,223 School Board: $25 ,000/$397,466$25,000 /$391,223 Sale Information: (Sale Date: 17/2001 Aerial Photography - 2009 0 My Home 1 Propertv Information I Property Taxes My Neighborhood 1 Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer AINSW 113 ft 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. Legend eae Property Boundary Selected Property Street Ne Highway Miami -Dade County Water WE 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: lei' or -1 PERMIT # ADDRESS: 7' 'O e Z& FOLIO NUMBER / /gib? O/ 02V FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) /6/3.02,c TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURE (attach appraisal): OWNERS SIGNATU ' L , DATE: ( ` Z PLANREVIEWER: PLAN REVIEWER SIGNATURE: DATE: Created on June 2009 RESIDENTIAL SERVICES CONTRACT ?472`703 vkt4- i„2_1,Lito00 io un IIII 5401U E00 IB W'r CONTRACT L / DATE 2 `i / I Z CUSTOMER i t' Q ' ( ( JOB I LEAD ACCOUNT NO v-' 1 NO SOURCE - i. 1 • I - Info ADT LLC dba ADT Security Services ( °ADT' � Office Address SCTIP 1)1 A z 36 1 q(02.$11/ www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) Customer Name q ("Customer' or °I° or 'me" or "my") �{ ; V ' �- U 11 i� I U 1• i1 Z- ,1 Premises 1 0 hl e 9 2. A Q S 1 0. E E -r- City N1 1 A PI I 5 I-\ -) f i. 5 State I` ZIP 33 1 3 Tax Exempt No Tax Expire Date 111/11/10 Protected Premises` ( 2 2 3 24,, 0 Traditional Phone 0 Other (Qualified) 0 Other (Non - Qualified) Telephone Altemate U S J Q Telephone 1 t Z O H ome ® Cell O Work Alternate O Home O Cell O Work Telephone 2 O Fill in if billing address is the same Billing Address - City - State ZIP IF FAMILIARIZATION PERIOD I5 REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL l k V I 0 B; ( L (. 5 0 L { Ir H e 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. I 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 set/confirm 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 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, induding but not limited to Paragraphs 5 and 18 of the Terms and Conditions. (B) The initial term of this Contract is threp.(3)years. (G' 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 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 authorizjed 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. Representative ✓1R Z- Rep(If License Required) ID No. s- Customer's Approval: Original Signature (t& / — Required (Must match Customer Name in Section 1 above) Db 29 13 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. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. 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 15 36. B. AMOUNT OF EACH PAYMENT IS • (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) TOTAL OF PAYMENTS FOR THE INITIAL TERM I5 (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) 1088 — LATE CHARGE - PAYMENT 15 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 IS 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. PREPAYMENT - IF 1 PREPAY THE TOTAL OF PAYMENTS PRIOR TO THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE 15 NO PENALTY OR REFUND. SEE PARAGRAPHS 2, 7, 15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. ©2012 ADT LLC dba ADT Security Services. 1 of 6 Administrative Copy All rights reserved. (06/12) RESIDENTIAL SERVICES CONTRACT CONTRACT DATE 9 CUSTOMER ACCOUNT NO 1111 11 54O1UEOO 10 JOB NO r LEAD SOURCE Section 4. Billing 0 Check received for. 0 Installation: Check # 0 Annual Service Charges Collected: Check # Amount Amount I authorize ADT: 0 To withdraw all (1) Service Charges and (ii) Contract Termination Charges (see Paragraph 2. Early Termination of this Contract) from my bank account ® To charge my credit/debit card for all (1) Service Charges and (ii) Contract Termination Charges (see Paragraph 2. Early Termination of this Contract): O Annually 0 Semi - Annually 0 Quarterly 0 Monthly Choose one: 0 Checking 0 Savings Name of Bank/Credit Union ABA Routing Number Bank Account Number Recurring Service Charge Amount Name as it appears on bank account Plus tax ® Installation 0 3 monthly credit/debit card payments of equal amounts (available only for telephone orders with an installation price over $400 or field sales with an installation price over $1,500) 0 All/Recurring Service Charges O Annually 0 Semi - Annually 0 Quarterly 0 Monthly O VISA ® MasterCard 0 Discover 0 AMEX Credit/Debit Card Number Expiration Date MM YY Recurring Service Charge Amount Cardholder's Name • Plus tax I authorize ADT to debit my bank account for the amount of all Recurring Service Charges If I am using a debit card, I authorize ADT to debit my bank account for the amount of all and all Contract Termination Charges (see Paragraph 2. Early Termination of this Contract) Recurring Service Charges and all Contract Termination Charges (see Paragraph 2. Early indicated above. l may revoke this authorization only by notifying ADT and my bank in Termination of this Contract) indicated above. I may revoke this authorization only by writing at least 10 business days before the scheduled debit If no oval is filled above, notifying ADT and my bank in writing at least 10 business days before the scheduled debit. service charges will be withdrawn monthly. If no oval is filled above, my credit/debit card will be charged monthly. I authorize ADT to withdraw the amounts in this section from my bank account or credit card through an Automated Clearing House (°ACH °). These payments are for the equipment and services described in this Contract. This authorization will remain in effect until the termination date of this Contract or until I cancel it in writing, whichever occurs first. I also agree to notify ADT in writing of any changes in my account information at least 15 days prior to the next billing date. If a payment date falls on a weekend or holiday, payment may be executed on the next business day. Because this is an electronic transaction, these funds may be withdrawn from my account each month as early as the transaction date. If the date or amount of the withdrawal changes, or if Contract Termination Charges (see Paragraph 2. Early Termination of this Contract) apply, ADT will notify me at least 10 days prior to the payment being collected. If an ACH transaction is rejected for non- suffident funds (NSF), ADT may attempt to process the charge again within 30 days, and an NSF charge may apply. The origination of ACH transactions to my account must comply with the provisions of U.S. law. I am an authorized user of this credit card or bank account, and 1 will not dispute the payment with my credit card company or bank, so long as the amount corresponds to the terms indicated in this Contract. ®To send me a bill: 0 Annually Semi- Annually O Quarterly 0 Other Authorized Account Signature: DOA Approval i If no oval is filled, ADT will send bill quarterly. Section 5. Customer and System Data Municipality Police Name tiq 5 Municipality Medical Responder Name Cross Street Municipality Fire Name Patrol Name & Number A 5 2 0 li Job Type ® New Sale 0 Change Over 0 Upgrade Affiliation Member # Control Type ® HW ® RF Permit Number Burglar Alarm: ® Yes 0 No Fire / Smoke: € Yes 0 No Two -Way Voice: 0 Yes ® No Cellular Model* Cs S 7 U 6 0 0 Parallel ® Standard Section 6. Password This password must be issued to all users of the alarm system, induding all people listed in Section 7. An optional, secondary password for service individuals, housekeepers, tenants, etc is available upon request. A password must be no less than three (3) and no more than five (5) characters in length and may not contain any punctuation or spaces, offensive language or non - standard spelling. Customer may change passwords and contacts by going to www.MyADT.com or by calling ADT toll -free at 1.800.ADT.ASAP. Section 7. Emergency Contact List These are the individuals who may be called in the event of an alarm. Because they may need to meet the authorities in response to an alarm, I will provide them access to my premises, the password, and the keypad code. By selecting the "Yes° designation on the right I am identifying which of these individuals may be called prior to notification of the authorities. 3Oc do) 7 1S Customer/Emergency Contact #1 Print First/Last Name Phone Home O Phone Home Customer/Emergency Contact #2 0 Print First/Last Name Phone Home 0 Phone Horne AltematelEmergency Only Contact 0 Print Firstll.ast Name Phone Home 0 Phone Home 3 of 6 Cell O Cell O Cell O Cell O Cell O Cell O Work O Work O Work O Work O Work O Work • Yes O Yes O Yes O Yes 0 Yes 0 Yes 0 No 0 No 0 No O No O No 0 No ®2012 ADT LLC dba ADT Security Service: All rights reserved. (06/12