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EL-13-383Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229376 Scheduled Inspection Date: March 05, 2015 Inspector: Devaney, Michael Owner: PIMIENTA, ERIC Job Address: 6 NE 106 Street Miami Shores, FL Project: <NONE> Contractor: ADT LLC sunaing uepartment comments BURGLAR ALARM INSTALLATION Permit Number: EL -2-13-383 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (786)280-3974 Parcel Number 1121360060080 INSPECTOR COMMENTS False Inspector Comments Passed Ej/ 786-280-3974 ERIC FailedOF / Correction ❑ Needed J� Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 04, 2015 For Inspections please call: (305)762-4949 Page 32 of 38 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 Permit Type: Electrical Permit No. a—'2- t'3-303 Master Permit No. OWNER: Name (Fee Simple Titleholder): q C-. Phone#: City: State: Tenant/Lessee Name: Email: JOB ADDRESS: le., 0 s:', l 0 (0 QST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: i 111,3{, (70(o 0000 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone#: Address: City: State: *rL-C __-- Zip: Qualifier Name: i07W naKS VVPLYPhone#: State Certification or Registration #: L 11� 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 Description of Work: . — Submittal Fee $. ❑New ❑Repair/Replace ❑Demolition Permit Fee $ /0 0,W-10" CCF Scanning Fee $ 3.66Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 0 CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ � 3 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. Signature Owner or Agent Signature Contract The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before 7met 's day of , 20 _, by day of , 20 % by 4? �,(k IV 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: Sign: Sign: Q Print: Print: My Commission Expires: My Commission Exp' LUISSEIT@CASTRO MY COMMISSION # EE 147407 EXPIRES November 17, 2015 i ,�w � Bonded Thru Notery Pubec Undenv bm x�x�x�u��x�kxcx�x�x�x�x�x�x�x�x�x�ec,�k�xsx�x�x�d«�k APPROVED BY `S� Planes Examiner Zoning Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk r i*�VrV,3C3_3 " 73? 7/70 9 Miami Shores Village 1 �P gp Buildin 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 FBC 20 Permit No.� PERMIT APPLICATION Permit Type: Electrical 1� Master Permit No. JOB ADDRESS: GQ�l� l CO , ' City: Miami Shores County: Miami Dade Zip: c Folio/Parcel#: 1I C,(3(0 pp 7AW90 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee/e Simple Titleholder):''//(1 ,24 1e2 5/7`W Phone#:/dQ�1 %Jr// 73: Address: & /��1�� - City: /rl/4 91-99-ah[.1 State: Zip: C1%2V Tenant/Lessee Name: Email: CONTRACTOR: Company Name: /�LJ� ,� .L� Phone/ Address: 17211 -es City: /' ✓ State: Zipx„��l%�.� Qualifier Namc: State Certification or Registration #: Contact Phone#: a" Certificate of Competency #: Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 7Q ' �D Square/Linear Footage of Work: Type of Work: DAddressIteration ONew ORepair/Replace Description of Work: ❑Demolition %%%%%%%%%%%JC%%%%%%%%%%%%%%%%%%%%%%X%%%%Fees''••'Y..%%%%%%%%%%%%•.'<%%%%%%%%%%%%%%%'Y..%%"I..%%%%%%%%%% Submittal Fee $ Permit Fee $ `�7' 40 CCF $ CO/CC Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $_ Technology Fee $ TOTAL FEE NOW DUE $ -e , l0 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 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 attar ent. 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 a e building permit is issued. In the absence of such posted notice, the inspection will no proved and a reinspectio e willee charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this /,6- The foregoing instrument was packnowledged before me this day of ice -8 . 2o/3. by & %21G P�/'%� 14� 4rJ da of 20 U. by /t 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. NOTARY PUBLIC: Sign: �lLiY1'� Print:/%% My Commission Expires: Sl/r' w M INOW OE lONfo W OMISSION @ E 11 f02u EXPIRES: July 11.2%115 e«Wed 71w Nay Rft underwI6r as identification and who did take an oath. NOTARY PUBLIC: _ Sign: Print: My Commission Expir&S, /lji NN N, APPROVED BY P/L Plans Examinee Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Folio f t" 11-2136-006-0080 Property Address 6 NE 106 ST Owner Name(s) ERIC PIMIENTA ALEJANDRA ROCHA PIMIENTA Mailing Address 6 NE 106 ST MIAMI SHORES FL 33138 Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Use Code 0001 RESIDENTIAL -SINGLE FAMILY Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Adj. Sq. Footage 1,718 Lot Size 9,225 SQ FT Year Built 1948 Legal Description DUNNINGS MIAMI SHORES EXT NO 2 PB 41-78 LOT 8 BLK 202 LOT SIZE 75.000 X 123 COC 24557-0294 04 2006 5 OR 28431-1708 1212 01 Assessniprtt ttt�rmatfan, $0 Current Previous Year 2012 2011 Land Value $75,421 $83,801 Building Value $132,260 $132,260 Market Value $207,681 $216,061 Assessed Value $97,835 $94,986 Exemption Information: Current Previous Year 2012 2011 Homestead $25,000 $25,000 2nd Homestead $25,000 $25,000 Senior $0 $0 Veteran Disability $0 Civilian Disability $0 $0 Widower) $0 $0 Disclaimer. MIAMI-DADE COUNTY OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Carlos Lopez-Cantera Property Appraiser %\ Aerial Photography 2012 N Taxable Value Information: Current Previous Year 2012 2011 Exemption[Taxable Exemption/Taxable County $50,000 / $47,835 $50,000 / $44,986 School Board $25,0001$72,835 $25,000 / $69,986 City $50,000 / $47,835 $50,000 / $44,986 Regional $50,000 / $47,835 $50,000 / $44,986 Sale Information: Date Amount Recording Qualification Code Book -Page 12/2012 $330,000 28431-1708 Sales qualified as a result of examination of the deed 4/2006 $0 24557-0294 Sales which are disqualified as a result of examination of the deed 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.govriinfo/disciaimer.asp. Property information inquiries. comments, and suggestions email: pawebmail@miamidade.gov GIS inquires comments ani Suggestions email nis fJmiamirlarle gov Generated on Saturday February 16 2013 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 iWms 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: /C P `yn / C— /v 7-/f PERMIT ADDRESS: & AI & f Ota �S 7 -1Z -e C-7 FOLIO NUMBER: /I -Z 1 ��'�°®�v FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURfi?(atyach appraisal): t OWNERS SIGNA PLAN REVIEWER SIGNATURE: Created on June 2009 DATE: 2-14-13 TE: RESIDENTIAL SERVICES CONTRACT 111111111111 � 5401 UE00 Section 1. Customer Info ADT LLC ua Customer Name dba ADT Security Services ("ADT*) (•Customer' or'I' or "meor'my") Office Address r� Premises'1141 / Address J 95, City / ED State F' ZIP Tax Exempt No. Tax Expire Date E LE m www.MyADT.com 1.800.ADT.ASAP® I Protected Premises' O Traditional Phone ® Other (QuaMed) O Other (Non-Qaalifiecill (1.800.738.2727) _ i Telephone i Alternate O Home a Cell O Work Alternate ? O Home a Cell O Wotk Telephone 1 Telephone 2 O Fill in if billing address is the same wiling Address FT City El State m ZIP IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE see Paragraph 14 of the Terms and Conditions for explanation) r flfl EMAIL I +-Fc Communications Authorization: I authorize AD to provide me with information and updates about the security system and new ADT and third -party products and seryices to the contact inform p vlded by me. I may unsq�bscribe or opo by emailing donot/contad�adt.com or by calling 888.DNC4ADT (888.362.4238). Initial here •�5 Confirmation of Appointments: I authorize ADT to call me using an yutomated calling device to deliver a pre-recorded message to set/confi appointments and provide other information and notices about the alarm system at the telephone numbers) 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 1 manually test the alarm system monthly and any time I change telephone service, by calling 1.800.ADTASAP 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 I paid in advance. ADT Representative 01V�C �� GAlt Rep. License No. Rep. (if Required) ID No. Custom s proval: i inal Signature Requi ust match Customer Name in Section 1 above)] X NOTICE OF CANCELLATION THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY 4FTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION DF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION DF THIS CONTRACT AND RECEIPT OF THIS NOTICE. FINANCIAL DISCLOSURE STATEMENT THFRF IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATFD WITH THIS CONTRACT. A. NUMBER OF 4171"1 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 BILUCHARGE 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 S5 00 TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $ 17 2 9.6 y (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) PREPAYMENT — IF 1 PREPAY THE TOTAL OF PAYMENTS PRIOR TO 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. ©2012 ADT LLC dba ADT Security Services. 1 of 6 Administrative Copy All rights reserved. (06112) htsIQENTIAL SERVICES CONTRACT 0,3-e7,.-7oy �oibiWmi� Section 2. Services to be Provided of 6 (continued) Monthly Service Charge O Inkial/Annual Recurring Municipal Fee billed separately InitiaVAnnual Fee OD Standard Monthly Service, Burglary (Subject to change based on local law) � Customer to obtain and pay for initiallannual municipal Service includes: Customer Monitoring Center Signal Receiving ani] Notification Service for Burglary, alarm use permit Failure to obtain and provide ADT with Manual Fire and Manual Emergency the municipal alarm use permit registration number ond& 4-7,99 result irrno municipal firelpolice response to an alarm from the premises and/or a fine. =i O Statrdard, Monthly Service, Fire/Smoke Detection Service includes: Customer Monitoring Center Signal Receiving Notification Service for Fire, Manual 4t Municipal Electrical Pefmlt Fee and' Fire r O Customer to obtain electrical permit and Manual Police Emergency -" Installation Price � O Carbon Monoxide O Flood O Low Tem - O Medical Alert $ -- IJ _$ Taxable Amount Safewatch Cellguard® $ � Non-Taxable Amount ZS®® O SecurityLink® $ Connection Fee -------- ----------------- Admin Fee Extended Limited Warranty/Quality Service Plan (QSP) A�� O Guard Response Service $ -- Sales Tax on Installation*T — �- $ 60 O Monthly Recurring Municipal Fee (subjeetto change based on local law) $ — Total Installation Charge* O Customer to obtain and pay for municipal Alan use permit 7 -- 23 - 0 other $ Z.-4- Vc ----- ------------------ Deposit Received m G -4--7 Z l'. a -7 Total Monthly Service Charge $ ``t ;7 '7 f Balance Due upon Installation* *If applicable sales tax -not shown, it will be -added to the first Invoice. Sect ion 3. Equipment to be Installed Control Panelpa��J\S ,. � Comments Package Name: Includes: I , i Foyer Living Room i Family Room j i l - Office - Dining Room Kitchen --V, — - Laundry Room ! i - - T --- Hallway I �- Master Bedroom Master Bath i Bedroom 2 Bedroom 3 Bath 2 i L Basement i Garage - +-- -- - - —a — I l -- - - Price Per Piece Totals 4/ E=Existing Equipment Estimated Installation Start Date INSTALLER NOTES �CfC G'� tc PU(Si✓7ap f -A, ' IA -IA- 02012 ADT LLC All ght rights ds (06/12) w.. RESIDENTIAL SERVICES CONTRACT CONTRACT / CUSTOM@ DATE ACCb13NR1! 073471 -7oS O Check received for: O Installation: Check # Amount $111 ITM O Annual Service Charges Collected: Check # Amount authorise ADT: > To withdraw all (i) Service Charges and (fl) Con ract termination Charges &To charge my credhUdebit card for all () Charges anda Contract (see Paragraph 2. Early Termination of this Contract) from my bank account Termination Charges (see Parargrapi 2. EadyTermination of this Contract): O Annually O Semi -Annually O Quarterly O Monthly dFInstallation O 3 modthly credit/debit card payments of equal amounts Choose one: O Checking O SavG s (available only for telephone orders with an irisiaBation price c over $400 or field sales with an installation piice am $1,5W) lame of Baok(Credit Union :-*AlURecurring Service Charges i11111 X O Annually O Semi -Annually O Quarterly ®Monthly 9A Routing Number Bank Account Number O VISA 0 MasterCard O Discover O AMD( !; Credit/Debit Card Number ` Expiration Date recurring Service Charge Amount Plus tax M M Y Y lame as ft a ars on bank account Recurring Service Charge Amount Plus tax Cardholder's Name 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 idicated above. I 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 vriting 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. ervice charges will be withdrawn monthly. If no oval is filled above, my creditidebit card will be charged monthly. 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 ervices 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 +otify 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 in the next business day. Because this is an electronic transaction, these funds may be withdrawn from my acetum each month as early as the transaction date. If the date or amount A 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 nlfected. If an ACH transaction is rejected for non-sutfident funds (NSF), ADT may attempt to process the charge again within 30 days, and an NSF charge may apply. The origination of ACH ransactions to my account must comply with the provisions of U.S. law. l am an authorized user of this credit card or bank account, and I will not dispute the payment with my credit card :ompanyorbank, so-longas-theamount comes{wndsstothe temsirdfcaW-mtMi 1Cdntraktr'' D To send mea bill: O Annually O Quarterly O Other DOA Approval if no oval is filled, ADT will send bill quarterly. Authorized Account Si- -i,ection 5. Customerand Data Municipality Municipality Police Name Fire Name Municipality Medical Patrol Name Responder Name s, Number Cross Street Job Type 0 New Safe O Change Over O Upgrade Control Type O HW WRF Permit Affiliation Member # - Number _ _ Burglar Alarm: ® Yes O No Fire / Smoke: O Yes 1D No Two -Way Voice: O Yes 4"o Cellular Model: O Parallel OF Standard Section• Password This password must be issued to all users of the alarm system, including 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.ti00.ADT.ASAP. Section•eContact 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 fight I Qam identifying which of these individuals may be called prior to notification of the authorities. Customer/Emergency Contact #1 / ,e je �D�� /V �// %�6-.Z V --3'q 7t/' O O O Print First/Last Name cr Phone Home Cell Work Yes No O O O 00 (� Phone �-y' Home Cell Work Yes No 49 Customer/Emergency Contact #2 T^N b R� p',t� ILd� / 11 �rsfr -y 7„3�-(00 O ® O O L d _ Phone — Home Cell Work Yes No Prjr? fi�sUL aat Name ------ Phone -y (/}some Cell Woik Yes No AltematelEmergency Only Contact Qg/ C �O �L C_� -796 � / J � / Hoe el Work Ye No Print First1ast Name / / Phone O O O O O Phone Home Cell Work Yes No 3of6 ©2012 ADT LLC dba ADT Security Services. All rights reserved. (06/12)