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EL-13-301 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-202400 Permit Number: EL-2-13-301 Scheduled Inspection Date: November 04,2013 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ENGEL,JERRY AND SARAH Work Classification: Alarm Job Address:351 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122310130290 Project: <NONE> Contractor: ADT LLC Building Department Comments BURGLAR ALARM INSTALL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 01,2013 For Inspections please call: (305)762-4949 Page 35 of 37 L Miami Shores Village Building Department s i 0 7 2-w 'D 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 i � o 0 3 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No.R(..-2. - 13 -30 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical A OWNER:Name(Fee Simple Titleholder): � ( Phone#: Address: $is 1 N ` o s C City: ,t,@Ct ffi -F-OS State: Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 85 1k 9 2 [ V 3 2T City: Miami Shores County: Miami Dade Zip: Folio/Parcelt Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: AW 1 1 r- Phone#: Address: 10785 MARKS WAY City: StaMIRAMAR, FL 33025 Zip: Qualifier Name: �� c� Phone#: M State Certification or Registration#:F -) 1 C®, Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of TEI= — Submittal Fee$ Permit Fee$ IWO CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ % J 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 CONDMONERS,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 Cont&ctor The foregoing instrument was acknowledged before me this The foregoing instrum nt was acknowledged before me this-OL day of ,20_,by day of Q � ,20 a,by *2n!RAI 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 PUBLIC: NOTARY PUBLIC: <;26�Sign: Sign: Print: Print: My Commission Expires: My Commiss' "" s: LUISmm CASTRO MY CAA1 ISSION#EE 147407 � EXPIRES. TMu NNdary Public urderxrdem s Rskskkk�kxekkkkkkksksAsks kBa�axe�a�e�akkkkkkkkkkkkIa9kkkkkkkkxcxek�8akkkkkakkk% kskkkkkR�% kkkkkk daR�kk L APPROVED BY �'��d Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami Shores Village -_ IC 2 Department =� F3 Buildin g � ' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 y.° ° °°°°°°°°°°° Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical r OWNER:Name(Fee Simple Titleholder): 7 °O M I Cay(��� Phone#f� Address:_ 3.s-/ AF 10 gl ST City: N t#2/ 'Ages State: F(_ Zip: 3 3/M Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: c 36-1 <a,5 City: Miami Shores County: Miami Dade Zip: Folio/Parcelk 1 2-13/ 0 f3 0 2'FG Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: Phone#: oe" Address: City: State Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 401 11_)z9z7'4 , Submittal Fee$ Permit Fee$�'r� �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ L i 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 qpd a reins a tion fee will be charged. Signature Signature Owne or Age Contractor The foregoing instrument was ackwwledged before me this The foregoing instrument was acknowledged before me this_j *'� day of 6,20 L2,by Me_ F� C-L. day of >2d3 by who is pecrsonally known to me or who has produced b L who is personally known to me or who has produced f `t 33 7 1 Ars identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: r l�l2 f CR ft�� Print ® ®. My Commission eEFWBFEW My Commission Expires: 3 ••u3 N EVMS:>bme7,2015 m ?u ill `lo noNH 9: A�a�>ksksk>ksIaksk>k>k>k T.Xwb-- 9onded7tuu PubdCUs a p�'.ee � MY W" APPROVED BY Plans Examiner ®0�eaeeea®r®�® Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Notice to Building Official of t Use of Private Provider Project Name: f Parcel Tax ID: ft o2)3/ 013 L3--Q��Q 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. 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. 15`h 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 I 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 i years subsequent to the performance of building code inspection services. Individual Corporation Partnership Print C e oration Name Print Partnership Name By rl Gam : (s gn r (si ature) (signature) Print Print Print Name:i t` FIV Name: A.DT LLG Name: Address: 3 j-1 WE toy'- Its: its: (&M I i I Addrcs IRAMAR F1 33096 Address: Telephone No.: Telephone Telephone No. No.: Please use appropriate notary block. STATE OFFC COUNTY OF_ Fes(_ Individual Corporation Partnership Before me,this day of Before me,this A?* day of Before me,this day 20]3,personally o2 ,20,j of ,20_,personally appeared eroML EW&eL personally appeared appeared who executed the foregoing instrument, of partner/agent on behalf of and acknowledged before me that same ,a was executed for the purposes therein corporation,on a partnership,who executed the expressed. behalf of the state corporation,who foregoing instrument and acknowledged executed the foregoing instrument and before me that same was executed for acknowledged before me that same was the purposes therein expressed. executed for the purposes therein expressed. Personally known r d identification ✓ Type of identification produced bL E 62. �3 3 7/ 3 33"'0 r Signature of otary Print Name Notary Public:NOTARY STAMP BELOW My commission ex r� pMBREW e M1Y COMMISSION It EE 1004 ORRE&Jere 7,2015 Bonded Ttnu Notary Unde wbm 2 of 2 :P , .a IIWYYW�YYI�YWV��tl11YY � RESIDENTIAL SERVICES CONTRACT 073 7 48?8 6401UEOO ONrTE a o 8 Nm RCE D ACCOUNT NO o SOURCE Section 1. Customer • ADT U.C. Customer Name dba ADT Security Services(`ADT" (°[ustarmr•or•I•or'me'or'my). Office Address KkkplA g t �( 3302, Premises' Address S (Q J I state A zip vuww.MyADT.com Tai Exempt No. t, Tax Expire Date m ' 1.800.AD't.ASAP• Protected Premises' O Traditional Phone O Other(Qualified) O Other(Non-Quallfled), (1.800.238.2727) Telephone Alternate 7 O Home eCell O Work Altemate J 2 6 T G O Home CCd O Work Telephone 1 Telephone 2 C3 Fill in if billing address Is the same Bi {rig At� r�ss city State EE] ZIP IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL Communications Authorization:I authorize ADT to provide me with information and updates 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 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 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 I 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 denied,then this Contract will be terminated,and ADT's only obligation will be to notify me of such termination and refund any amounts 1 paid i ADT Representative Rep.License No. Rep.FRA (If Required. ID No. Customer's Approval:Original Signatur�Rq (Must t�Customer Name in Section 1 above) / NOTICE OF CANCELLATION THE CUSTOMER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY kFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION )F THIS RIGHT.I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION )F THIS CONTRACT AND RECEIPT OF THIS NOTICE. 'iSection 2. Services to be Provided FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT(0% APR)ASSOCIATED WITH THIS CONTRACT. A.NUMBER OF PAYMENTS OR THE B.AMOUNT OF EACH PAYMENT IS $ TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $ l y o 7 r, j INITIAL TERM IS 36. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) (A.TIMES B.)(EXCLUSIVE OF ANY APPLICABLE TAXES,FEES,FINES AND RATE INCREASES) LATE CHARGE-PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING ENT-IF I PREPAY THE I SEE PARAGRAPHS 2 7,15 AND FREQUENCY,PRIOR TO THE START OF SERVICE.MY FIRST BIWCHARGE WILL TOTAL PREPAYM M PAYMENTS PRIOR TO I SE OF THIS CONTRACT FOR BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS.ADT MAY IMPOSE A THE END OF THE INITIAL TERM I ADDITIONAL INFORMATION ONE-TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN(10) OF THIS CONTRACT THERE IS NO ABOUT NONPAYMENT DEFAULT DAYS PAST DUE,UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW,BUT IN PENALTY OR REFUND. AND ACCELERATION. NO EVENT WILL THIS AMOUNT EXCEED 55.00. I of 6 Administrative Copy X2012 ADT LLC All rights reserved.( 61 Services. . RESIDIt"AL SERVICES CONTRACT 5401 UEOO CAN DATE L'LI/ I r / :ACCOUNT NO ENO m SOURCIE LEAIJ Section 2. Services to be Provided (continued) r Monthly Servlco ItddaUArouwl Reaming Munidpal Fee biped separately DdWAmuW Fee &Standard Monthly Service,Burglary ' (subjeu tO based on local law) Service includes:Customer Monitoring Center Signal O Customer to obtain and pay for.1nidallannual muntdpal Receiving and Notification Service for Burglary, 7 QC alarm use PPmBt Fab to"attain and prmdde ADT with Manual Fire and Manual Police Emergency G 1 the municipal alum rmh registration numbe5mu1d result M rro muNdpal Rrelpolice response to an aWrm from the premisearnil/ot'a fine. O Standard Monthly Service,Fire/Smoke Detection Service,includes:Customer Monitoring Center Signal Municipal Electrical Permit Fee Receiving and Notification.Service for Fire,Manual Fire $ O Customer to obtain ektrltal permit and Manual Police Emergency O Carbon Monoxide O Flood O Low Temp Installation Price $ y/ O Medical Alert Taxable Amount M Safewatch Cellguard® $ t NC t Non-Taxable Amount O SecurityLink® $ Connection Fee tD Extended Limited Warranty/Quality Service Plan(QSP) $ I�C L Admin Fee O Guard Response Service $ Sales Tax on Installation* $ i3) O Monthly Recurring Municipal Fee (Subject to change based on local law) O Customer to obtain and pay for Total Installation Charge* municipal alarm use permit O Other $ Deposit Received Total Monthly Service Charge 7 7 �7AC Balance Due upon Installation* L *If applicable sales tax not shown,it will be added to the first invoice. iSection 3. Equipment to be Installed i // //l / ``l/ Control °� Sew L/a� Panel /Comments i Packnage Na e Includes:] (f-fk6tl14C zj K Foyer Living Room Family Room 1 ;' Office t Dining Room C Kitchen CO TAe ._R.f. –--– — – Laundry Room ,44 Hallwa y Master Bedroom - -- i— — -- - - -- ---j - � _ I Master Bath Bedroom 2 Bedroom 3 — Bath 2 y I i Basement i Garage i Price Per Piece t Totals I E=Existlog Equipment Estimated Installation Slarif Date® t 3 INSTALLER NOTES ©2012 ADT LLC dba ADT Security Services. Z Of 6 All rights reserved.(06/12)