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EL-13-516 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 No.ec- 5 S l p PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER:Name(Fee Simple Titleholder):l/� )C� Phone#: Address: k9L QE, q 35r City: State: zip: 3 Tenanta;ssee Name: Phone#: Email: JOB ADDRESS: 6 2— k —( -C City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: t�320 1-,3000 Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: Phone#: Address: ADT LLC 107t /�1� City: _ __ Zip: rFt,- Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phonek Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: ��x��xxxxx��x�x�x�xx��xx��xxxxx�xxFeesx�xxxxxxx�x��xx�x�xxx�xx��xxxxx�xx��x�� Submittal Fee$ Permit Fee$ 10 CP,1®d CCF$ CO/CC$ Scanning Fee$ 3 Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$.�C� « C� Bonding Corppany'SN Tame(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 /ontra7ctor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this-C9- day hisday of ,20_,by day of C P- QA ,20 (r;,by b Q MCWN 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: Print: Print: My Commission Expires: My Commissi 4,5 Pyr. LUISSEITECASTRO '•: :+= MY COMMISSION#EE 147407 ' •. -d EXPIRES:November 17,2015 APPROVED BY / 4: r Plans Examiner Zoning Structural Review Clerk (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 FBC 20 BUILDING Permit No.F u PERMIT APPLICATION Master Permit No. Permit Type:ElectricalcT�y A.JOB ADDRESS: &.2 AeW !P0 l,[ k 7 City: Miami Shores County: Miami Dade 7ip: �15 Folio/Parcel#: //-32007 69170 Is the Building Historically Designated:Yes NO Flood Zone: �y OWNER:Name(Fee Simple Titleholder): Phone#a �7d�—��! City: L�/1 f! State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: T• Zic, Phoncot4gg�� --4R-1) 3 Address: zD 74�3_ /rJl. l" OF City:�Lyvrr/�di'' ' State: 91-7 Zip:�� Qualifier Name:��Q /�G�r2 ,�et�%/ Phone#: — State Certification or Registration#: Certificate of Competency#: Contact Phone#:e6�Zg D-,W,?,.3 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit.$ / Y- ©O Square/Linear Footage of Work: Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: azze2 !2 &2z6z4M Submittal Fee '0C) Permit Fee$ lejP<&® CCF CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ r , 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. G Signatur Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day ofs��►a-rte ,20 L,by day of ,20 by 0l1� � , 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: Q®�� e � NOTARY PUBLIC: Sign:,, / ✓� Sign: G4�� Print: ata Print My Commission Expires: ,g;ewJ, ISSIK OEEG My o mission Expires: ATNALIE L.EDWARDLO MY ��/�� NOTARY PUBLIC IXPIRES:May 10 t)��tSwrRers STATE OF FLORIDA e Public Bonded Thru Notary ' � W�� rre*2/19/2017 ` APPROVED BY 11FAAA Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) J � � Notice to Building Official of Use of Private Provider Project Name: 6i'7Xho;iiaa1�4i, Parcel Tax ID: —4�91 70 Services to be provided: Plans Review Inspections X Note: If the notice applies to either private plans review or private inspection services the Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute. I, ,the fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: MTCI Private Provider Services Private Provider: Lester Triana Address: 97 N E 15th Street Homestead, Florida 33030 Telephone: (305)246-0696 Fax: (305)242-3716 Email Address(Optional): mtc mtcinspectors com Florida License, Registration, or Certificate#: PE65707 I have elected to use one or more private providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel,but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify,defend,and hold harmless the local government,the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect.to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans,make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I make any changes to the listed private providers or the services to be provided by those private providers, I shall,within 1 business day after any change, update this notice to reflect such changes. Hie building plans review and/or inspection services provided b) the private prop mcr a IIIIIILCd to buii1lin_ code compliance and does not include review for fire code,land use,environmental or other codes. 1 o f,2) i 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 S years subsequent to the performance of building code inspection services. Individual Corporations Partnership Print Corp tion Name Print Partnership Name C4't . atm B `—c B (signature) (signature) (signature) Print Print Print Name: ,h Y Zo Name _Z2?�iZrZ Name: A dress:G, �E ��' — Its: �— Its: -Aului ei Address: Address: Telephone ADT LLC No.: ?fir,— $tel 10785 MARKS WAY TelephorMIRAMR, FL 33025 Telephone No. No. Please use appropriate notary block. STATE OF COUNTY OF Individual Corporation Partnership Before me,this day of Before me,this day of Before me,this day ,20_,personally ,20,/3 of ,20_,personally appeared pp§onally 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 ;or Produced identification Type of identification produced Signature of Notary Print Name Notary Public:NOTARY STAMP BELOW My commission expires: 2 of 2 3/12113 M iami-Dade My Home F ac My Homepis " 4'Y ✓ D "9P- "f 'W r MIAM 1 I•C3J�C�E \ f Show Me: Properlyhtrmafion y ° i Legend Search By: �� ins � �t �� 'rt ��" Property �&YH 13 Boundary 3 Selected Property Text onlyLf sa ,' Property Appraiser Tax Estimator Street Property Appraiser Tax Comparison x f $ Highway » Miami-Dade Portability S.O.H.Calculator County Water Summary Details: g olio No.: 111- 206-013-017! Property: 621-93 ST , Mailing CHRISTIA E ALOU W ddress Z NE 93 STREET MIAMI ` SHORES FL 3138 vl - PropertyInformation: & , 1000 SGL FAMILY-2101 V Primary Zone: 300 SQ 001 RESIDENTIAL- LUC: SINGLE FAMILY BedslBaths /4 Floors 1 arial Photography-2012 0 113ft Living Units: 1 dj Sq Footage: 2,814 Lot Size: 9,600 SQ FT ear Built: 1942 My Home I ProgaMt Information I Property Taxes MIAMI SHORES SEC 1 I My Neighborhood I Property Appraiser MD PB 10-70 LOT 5& Home I using Our Site I Phone Directory I Privacy I Disciaimer egal Description: 1/2 LOT 4 BLK 2 LOT SIZE 75.000 X 128 OR 16316-0396 0294 1 OR 8398-1049 1112 01 you experience technical difficulties with the Property Information application, Assessment Information: or wish to send us your comments,questions or suggestions Year: 2012 2011 please email us at Webmaster. Land Value: $107,040 $82,339 Building Value: $221,471 222,206 Web Site Market Value: $328,511 304,545 ©2002 Miami-Dade County. Assessed Value: $171,454 166,461 All rights reserved. ExcempAlon Information: ear: 2012 2011 < H m d: $25,000 $25,000 YES YES Taxable Value Information: Year: 2012 2011 Taxing Applied Applied Authority:y: Exemption/ Exemption/ Taxable Value: Taxable Value: Regional: 50,000/$1211454 50,000/$116,461 County: 0/$121,4541$50,000/$116,4611 i 50,000/$121,454 50,000/$116,461 g isims2.Mamidade.g oy/myhome/propmap.asp 1/2 T, RESIDENTIAL SERVICES CONTRACT f��lllll�l l[�1111111�1 III�II III�� ® 5401 UE03 CONTRACT 'CUSDATE®�� LLL1J /ACCOUNT NO' ' C ` ,NO m 50 RCE Section • • FADT ADT LLC Customer Name Security Services("ADT') ('Customer'or'1'or"me"or'my') Office Address (l icy 3 303 ?�J APrdedmre' �a ,MU^ Jv/ pp� City State al ZIP C7i 11!i1�1 j www.MyADT.com lfa�Exempt No. Tax Expire Date 800.ADT.ASAP® Protected Premises' ®Traditional Phone O Other(Qualified) O Other(Non-Qualified) (800.238.2727) Telephone Alternate O Home r9 Cell O Work Alternate O Home O Cell O Work Telephone 1 Telephone 2 (Fill in if billing address is the same Billing Address City State[J] ZIP IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE 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.1 may unsubscribe or opt out by emailing donotcontact@adt.com or by calling 888.DNC4ADT(888.362.4238).Initial here If I have provided ADT with a phone number,including but not limited to a cell phone number or a number that I later convert to a cell phone number,I agree that ADT may contact me at this number.I also agree to receive calls and messages such as pre-recorded messages,calls and messages from automated dialing systems at the humber(s)provided. EQUIPMENT TO REMAIN THE PROPERTY OF ADT.All eggipment 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 he able to use the equipment for any purpose.See Paragraph 7 of the Terms and Conditions for more information. _pp I acknowledge an agree to each of the following:(A)This Contract consists of sic(�pages.Before signing this Contract,l Iia�yye�read,understand and agree to each and every term of this{ontract including but no#Aimft�d tD F!aragiaphs Sand 186f the Terms and QonditiorrtR(B)The initial term of this Contract is three(3)years.(C)ADT fs not a security consultant and cannot address all of my potential secufity 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.rh rovi`ie.complete,protection or guarantee prevention of loss or injury.Fires,floods,burglaries,robberies,medical problems and other incidents arUnpredictable and cannot always be detected or prevented by an alarm system.Human err6r`•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 recalftrgpnds�hat I manually test the alarm system monthly and any time 1 change telephone service,by calling 800.ADT.ASAP or by logging Into www.M ADT.com.(F)this Contract requires final approval by an ADT authorized manager before ADT may provide any equipment or services,anJf,3ipp)o I( den ed,then this Contract will be terminated,and ADT's only obligation will be to notify me of such termination and refund any amo6nts 1' I i adv ce. ADT Rep q�\sentative J/ Ck RepLicense �Requ red) o JID N . tyl V Cus=svah Original Signature Required(Must match Customer Name in Section 1 above) NOTICE OF ON I,THE CUSTOMER,MAY CANCEL THIS TRANSACTION AT AN, ' E116g.49 I (�i( NT OF TH€TF 1A BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NO E.O`F N 11i 61M FOR�Ill6 FOR°AN EXPLANATION OF THIS RIGHT.I ACIfNQ 1 CEQ EI(4f$,: 1114114]�1�,)1NFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RE�GEII TOP THI NOTICE. } a '> j) +; Section • be Provided FINANCIAL DISCLOSURE STA"ENIENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT(0°k APR)ASSOCIATED WITH TIiM40NTRACT. 1 A.NUI�fIBER OF TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $ PAYMENTS FOR THE B.AMOUNT OF EACH PAYMENT IS $ (A.TIMES B.)(EXCLUSIVE OF ANY APPLICABLE TAXES,FEES,FINES INITIAL TERM IS 36. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) AND RATE INCREASES) LATE.CHARGE-PAYMENT IS DUE PURSUANT TO MY'SELECTED BILLING p�pAYMENT—IF 1 PREPAY THE SEE PARAGRAPHS 2,7,15 AND. FREQUENCY,PRIOR TO THE ST O MY FIRST BILIJCHARGE WILL TOTAL OF PAYMENTS PRIOR TO. 19 OF THIS CONTRACT FOR BE SENT/MADE SHOffrixy1FrE MY. B GINS.ADT MAY IMPOSE A THE END OF THE INITIAL TERM ADDITIONAL INFORMATION ONE-TIME LATE CHARGE CIN 1kA PA T IS MORE THAN TEN(10) OF THIS CONTRACT,THERE IS NO ABOUT NONPAYMENT,DEFAULT DAYS PAST DUE,UP TO THE MAXIMUM AMOUNT PERMr TED BY LAW,BUT IN PENALTY OR REFUND. AND/ACCELERATION. NO EVENT WILL THIS AMOUNT EXCEED 15-00- @2012 ADT LLC dba-ADT Security Service 1 of 6 Administrative Copy All rights reserved:(10112 RESIDENTIAL SERVICES V _CONTRACT iIIIII�IIIIIIIIII�I�� 5401 UE03 CONTRA T CUSTOMER98E®l lda l LJ ACCOUNT NO. 14A l '!il . ,HO m SO RCE Section 2. Services to be Provided (continued) Monthly Service Charge q Initial/Annual Recurring Municipal Fee billed separately Initial/Annual Fee f (5object to change based on local law) 4�o Standard Monthly Service,Burglary II- -- - ---- ---- --- Service includes:Customer Monitoring Center Signal O Customer to obtain and pay for initial/annual municipal alarm use permit.Failure to obtain and provide ADT with Receiving and Notiticin n S.rvin,for Burglar✓ � - P P. * Manual Fire and Manu 'P,,-Einc;yency me rnomupal alarrn use permit registration number could result in no municipal fire/police response to an alar from the premises and/or a fine. a Standard MonthlyService,Fire(Smoke Detection ----_ -__ ----___-- Service includes:Customer MonitoringCenter Signal CMunicipal Electrical Permit Fee ReceMng,and Notification 5mvice for Fire,Manual Fire O Customer to obtain electrical permit and Manual Police Emergency O Carbon Monoxide O Flood O Low Temp $ Installation Price I - _- _- - ---- - O Medical Alert $ TaxableAmount $ ®Safewatch Cellguard® $ �` Non-Taxable Amount $ O SecurityLink® Connection Fee J i & ®Extended Limited Warranty/Quality Service Plan(QSP) $ Admin Fee $ O Guard Response Service $ Sales Tax on Installation* $ O Monthly Recurring Municipal Fee (Subject to change based on Ibcal law) $ Total Installation Charge* $ `� ®Customer to obtain and pay for municipal alarm use permit OOther Total Monthly Service Charge $ Deposit Received i I $ j $ . Balance Due upon Installation* 10 $ -- ---- ------- L ---- --- ------- --- -- --- *If applicable sales tax not shown,it will be added to the first invoice,if not collected at the time of installation. Section • • • be Installed Sodo/ve\aD`e`��ea� LaslOp/ca'l�yie3o/a \L°G,°A�Fpoe u/ri QOS,c��°\e°s�e oQsO\a� \s\�o°oteQCO��ao\ s/Ja`\ C° / /COntrOo �Panel (oC;o /mme/nt;so , Package Name: Includes: Foyer - Living Room ¢ Family Room ' Office Dining Room Kitchen e Room Hallway Master pfdroom Bedroom 2 Bedroom 3 1 nV t Bath 2 t Basement Garage Price Per Piece Totals E=Exlsft Equipment Estlinateid Installation Start 0,11111:Q MOS ©. b 0 02012 ADT LLC dba ADT Security Services 2 tG f 6 All rights reserved.(10712