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EL-13-1053l Miami Shores Village :1,0 Building Department APS:2C14 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 By. Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical FBC 20 Permit No. Master Permit No. C` ` l3 — 1650 JOB ADDRESS: &g &1—,OA 071 City: Miami Shores County: Miami Dade Zip: ",4AG Folio/Parcel#: ��' �O,iG d �[% d %O!? Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): �G -lam y Ggo-go/Phone#: Address: 4*_ (FW r/D-7- � j 0'. - City: *5�7 �1t� State: �� Zip: 35-0.2 Tenant/lxssee Name: Phone#: Email: CONTRACTOR: Company Name: d � ti . J -Y Phone#:95�.�'��•3� Address: _ 8� GAY City: denow State: AL Zip: 0-0 if Qualifier Name: DI- ♦ Phone#: State Certification or Registration #: ��, �':�J' 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 DAlt�ation ONew ORepair/Replace �,, U _ _ .4 Description of Work: w F / r S - /IS - Submittal Fee $ Permit Fee $ CCF CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ODemolition TOTAL FEE NOW DUE $ /a 3 • d,d ' Bonding Company's Name (if applicable) Bonding Company's'Address city State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. . ) / /I //& Signature /� Signature�— Owner=Agen�t 7`��Cntra�ctor The for ng ins went was acknowledged before me this / -The foregoing ins ant was acknowl gad before me this X day of , 20 , byi// i'}}/�� C] lay of , 20 !/,by /tel who is personally known tome or who has produced y�who is p sonally known to me or who hasproduced As identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: V7 Sign: / Print: J �6 , / '� r K1 it f✓ Y�1 Print: /100 ROBLES NOTARY PUBLICSTATE My Commission Exp' My Commission Expires: OF FLORId.�z ,•,�� p�e� JESSE WALTERS Comm# FF007936 ' Notary Public - State of Florida Explfes 4H4/2017 APPROVED BY Commission # EE 837922 Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami Shores Village Building Department 90050 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 FBC 20 CTF . MAY 1 l ` f:.. . _ �®oom00000ae000 Permit No. 0 Master Permit No. JOB ADDRESS: 7 (C /V r' O �1` S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: d— 8D -O(, 01°7 0730 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): /��?L.�. �O� e� �.Qzy, Phone( : Address: 4;//S /&=— L27&42e-.. City: �1'%fCe-��' I_S ykw s• State: 77 Zip: t /3S` Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: A®_-S� %v7% 0-21AMINS-10M, i�lricl.� 2v City:. State: �� Zip: Qualifier Name: 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 Description of el 27 ❑Demolition =k��x:ex��%k�k��:�e:gac�k�k�uaex��x��FTX�k�:gx>;::�•xFel'S�x��Y�>,exxxx�:xxkxTxT�e:��kT%�k�:k�k�::�xx��=:e�%��k� Submittal Fee $ Permit Fee $ /0et? �O ` ®® CCF $, Scanning Fee $ Radon Fee $ CO/CC $ 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City state Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property, is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) dans after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. . / A / IM -7 a /-1 Signatur Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of JJfJV—, 200, by , who is personally known to me or who has pro uced 61 - As identification and who did take an oath. The foregoing instrument was acknowledged before me this day of L5 7, 20, 3, by , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: �e / I n NOTARY PUBLIC: Sign: Sign: , Print: C)e Rd C- Print: �- M Commission Ex i .��"'.' M Commission Ex ires: A W9 L. I l�RDS Y P ltd _ r Y P NOTARY PUBLIC MY CMMMM # EE 10W /f EMRE& June 7, 2D15 ` L STATE OF FLORIDA garde Thru try Pu* tis Comm# EE878249 xXcx$::g •;: $;k:(e:Exae dc>(e aexr,. %k �kx:;:>;exxx,Esg�k �k>k %kik Y,exsg �:x�e:g Y,e$e �K %k . -'e7 APPROVED BY Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Recised 00/1012009)(Revised 3/15/09) Clerk 5/13113 g isweb.miamidade.g ovProperW)ewch/printMap.htm MIAMI-DADE COUNTY OFFICE OF THE PROPERTY APPRAISER Print Report PROPERTY SEARCH SUMMARY REPORT Property Information: Current Previous Year Folio 11-3206-017-0780 Property Address 415 NE 102 ST County Owner Name(s) CESAR M BORIA ANGULO &W KENDRA L CAMPBELL BORJA School Board Mailing Address 415 NE 102 ST MIAMI SHORES FL 33138-2452 City Prim ary Zone 1000 SGL FAMILY - 2101-2300 SQ Regional Use Code 0001 RESIDENTIAL - SINGLE FAMILY Sale Information: Beds/Baths/Half 2/2/0 OR Book -Page Floors 1 $360,000 Living Units 1 3/2005 Adj. Sq. Footage 1,538 Sales which are qualified Lot Size 8,850 SQ FT 20778-0630 Year Built 1950 $240,000 Legal Description AMD PL OF MIAMI SHORES SEC 4 PB 15-14 E1/2 OF LOT 14 ✓1< LOT 15 BLK 92 LOT SIZE 75.000 X 118 OR 20778-063010 20021 COC 263841925 04 20081 9/1989 Assessment Information: 14273-2544 Sales which are qualified 9/1989 Current Previous Year 2012 2011 5/1972 Land Value $126,737 $110,206 Building Value $140,383 $141,198 Market Value $267,120 $251,404 Assessed Value $258,946 $251,404 Exemption Information: Current Previous Year 2012 2011 Homestead $25,000 $25,000 2nd Homestead $25,000 $25,000 Senior $0 $0 Veteran Disability $0 $0 Civilian Disability $0 $0 Widower) $0 $0 Disclaimer: Carlos Lopez-Cantera Property Appraiser Aerial Photography 2012 Taxable Value Information: Current Previous Year 2012 2011 6temption/Taxable Examption/Taxable County $50,000/$208,946 $50,000/$201,404 School Board $25,000/$233,946 $25,000/$226,404 City $50,000/$208,946 $50,000/$201,404 Regional $50,000/$208,946 $50,000/$201,404 Sale Information: Date Amount OR Book -Page Qualification Code 4/2008 $360,000 26384-1925 Sales which are qualified 3/2005 $399,000 23227-3220 Sales which are qualified 10/2002 $259,000 20778-0630 Sales which are qualified 6/2002 $240,000 20519-1108 Sales which are qualified 9/1989 $84,000 14273-2544 Sales which are qualified 9/1989 $0 00000-0000 Sales which are disqualified as a result of examination of the deed 5/1972 1 $40,000 00000-0000 1 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/d`isclaimer.asp. Property information inquiries, comments, and suggestions email: pawebmail@miamidade.gov GIS inquiries, comments, and suggestions email: gis@miamidade.gov Generated on: Mon May 13 2013 gisweb.miarrddade.gov/PropertySmeh/printMap.htrn 1/1 Notice to Building Official of Use of Private Provider Parcel Tax ID: J% - 3 A 6 01 i 6??D 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, I the fee owner, affirm ADT my contractor, has entered into an agreement 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 Email Address (Optional): mtc@,mtcinspectors.com Florida License, Registration, or Certificate#: PE65707 Fax: -(305) 242-3716 I have elected to use oneor 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 (sign re) Print Name: &0 Address: qj e ) NORM( Skks'Fc X313 Tele one No. Please use appropriate notary block. STATE OF FL COUNTY OF 4t Individual Before me, this 77-P - — day of 204_:� personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed. Corporation Print Corporation Name By: (signature) Print Name: Its: Address: Partnership Print Partnership Name By: (signature) Print Name: Its: Address: Telephone Telephone No. No.: Corporation Partnership Before me, this day of personally appeared of 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. 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 u entification Type of identification produced &� U-:.� 7 / Signature of Notary . Print Name Notary Public: NOTARY STA WOOMMM # EE 10M EXPIRES' June 7,2D15 My commission expires: WWW TrwNlokvyaubticu*mft s 2 of 2 for ADT's rthsWation'of tib` JAL SERVICES CONTRACT 1111111101111 (G) ADT will not be P U Ir �. O � 11L 5401 UE04 fungi; wet or dry ( {�( j all appkicable c- �� [4 I U' J� laws Burin- CONTRACT CUSTOMER JOB m LEAD o- DATE ACCOUNT NO NO SOURCE Section• • ADT LLC Customer Name dba ADT Security Services ("ADT') (-Customer- or -l- or'me' or'my') Office Address M t Rq r�i>4It FC 33021 Affirm Z I / 1 0121 a3 3 - a7�� City State ® ZIP i 3 ' vvWw.MyADT.com tTax Exempt No. Tax Expire Date m 800.ADT.ASAP® Protected Premises' O f C9 Traditional Phone O Other (Qualified) O Other (Non -Qualified) (800.238.2727) Telephone `k Alternate 0 9 4. j O Nome .0 Cell O Work Alternate I d 9 j t O Home 0 Cell O Work Telephone 1 J Telephone 2 O Fill in if billing address is the same Billing ' Address City ; ,' t' State m ZIP IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL 'Z A ' I flU�AkkldA/141 I 111 TO 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 If I have provided or do provide ADT with a phone number, including but not limited to a cell phone number, a number that I later convert to a cell phone number, or any number that I subsequently provide for billing purposes, I agree that ADT may contact me at thistthese number(s). I also agree to receive calls and messages, including pre-recorded messages and calls and messages from automated dialing systems, at the number(s) provided. 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 tern 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 canriot 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 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 ADrs only obligation will be to notify me of such termination and refund any amounts 1 paid kn advance. . ADT Representative + n Rep. License No. Rep. A�} (If Required) ID No. t Customerl Approval: ��Oqg inal SI nature Required (ki&t match Custom r.Name in Section 1`above) X 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 S7 (?q PAYMENTS FOR THE B, AMOUNT OF EACH PAYMENT IS INITIAL TERM IS 36. (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 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. TOTAL OF PAYMENTS FOR THE INITIAL TERM 15 $2 U� (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) PREPAYMENT - IF I PREPAY THE SEE PARAGRAPHS 2, 7, 15 AND TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR THE END OF THE INITIAL TERM ADDITIONAL INFORMATION OF THIS CONTRACT, THERE IS NO ' ABOUT NONPAYMENT, DEFAULT PENALTY OR REFUND. AND ACCELERATION. ©2013 ADT LLC dba ADT Security Services. 1 of 6 Administrative Copy All rights reserved. (02/13) -RESIDENTIAL SERVICES CONTRACT 111111111111 6401 UE04 CONTRADAcr © o 2AC sTom R ` 6 - C J `.' JOB m LEAD NO SOURCE Section 2. Services to be Provided (continued) Monthly Service Charge O Initial/Anrmal Recurring Municipal Fee billed separately initiaVAnnujFeve "Standard Monthly Service, Burglary (Subject to change based on local law) O Customer to obtain and pay for Initialtannual municipal Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency $ Cfff alarm use permit Failureto obtain and provide ADT with, the municipal alarm use registration number could permit y result in no municipal fire/police response to an'alarm from the -premises andtor a fine. Standard Monthly Service, Fve/Smoke Detection Service includes: Customer Monitoring Center Signal Service INC L Municipal Electrical Permit Fee Receiving and Notification for Fire, Manual Fire O Customer to obtain electrical pcnnh and Manual Police Emergency O Carbon Monoxide O Flood O Low Temp — - $ Installation Price s t g x - -- O Medical Alert : Taxable Amount - - C Safewatch Cellguard® $ t PJ < < Non -Taxable Amount O SecurttyLink® Two -Way Voice $ Connection/Activation Fee ® Extended Limited Wamanty/Quality Service Plan (QSP) $ r N C L Admin Fee O Guard Response Service $Sales Tax on Installation* $ -Fd g[ O Monthly Recurring Municipal Fee (subject to change based on local law) — Total Installation Charge* r ! Trip Charge Received _ O Customer toobtain and pay for municipal alarm use permit O Other Deposit Received . b Total Monthly Service Charge > fi�� Balance Due upon Installation* *If applicable sales tax not shown, it will be added to the first invoice, if not collected at the time of installation. Section• • to be Installed Control- I�i2J k al / 05 S Oe : yea c�\ o� �l\' •CZ`O ��l'a�l`. a0` i �5� C,°• �Se S�a� �.,e °er,� �,e Panel- � / Qa % Sop P �°� •c�P Q°` of Q°. c Qa'Comments PCS ge Name: V © lrE o.J� wl BV � 9c, r, x I Includes: Foyer y ----- t-- - 1 � C L 1 (7A FL -- Living Room (R L �LCt Family Room _ office ft�e> I R F I�r '1= t Jt P— Dining Room 1 Ce)_ uLRt Kitchen ( f Io oni KGF Qt T /M UniE Laundry Room I I r® t Hallway I D i Crf 9 aJEt Master Bedroom a. R Master Bath SM! ICC "� O' F Bedroom 2 i Bedroom 3 Bath 2 Basement Garage Price Per Piece Totals a i E = Existing Equipment Estimated Installation Start Date NOTES ©2013 ADT LLC dba ADT Security Services. 2 Of 6 All rights reserved. (02/13)