EL-13-1998 Miami Shores Village IVED
Building Department artment SEP 0 4 2o13
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
1
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit NoZ-1 /3 •)W9
Permit Type:Electrical
JOB ADDRESS: /0-7A St -
City: Miami Shores County: Miami Dade Zip:
Folio/Parcelk // ` Z-®3 6 —00 7 — ®Od"
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): ® y � ."�'*2 Phone
Address: i /(0 , 12 Z
City: State: ';E e-J7W42
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: / e Phone#:
Address: F 107grn- Q
WAY
City: 1f l lZ(3�?�c'�7,L) State: Zip: 0 2� Q
Qualifier Name: /t4E A1,41Ys/`AIW(d Phone#: ` sq "26-4- Sol
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$C 5 Square/Linear Footage of Work:
Type of Work: ®'Address ❑Alteration ❑New ❑Rcpair/Replace ❑Demolition
Description of Work:
�mx��xx�xxxm�mn�����xxx��x��xm�xmmxm�m�Fees�xx�x���m�xmx�xamam��s.���xm�xx��mm�xs�xx�mmx
Submittal Fee$��• 00 Permit Fee$ /®® '00 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
. t
Bonding Company's Name(if applicable)
f
t 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. T understand that a separate permit must be secured for ELECTRTCAL WORK,PLUMBTNG, STGNS,
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 nut be appy ved and in ection fee will be charged.
Signa ,P Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged b fore me this The foregoing instrument was acknowledged before me this
day of Z� 120 ,by ?1Lyg0✓, day of ,20 by
4
who is personally known to me or who has produced 119 who is personally known to me or who has produced
�t'� As identification and who did ath. as identification and who did take an oath.
�( 0-fl.
NOT Y UB C: pO` TA�CGA, NOTARY PUBLIC:
7'ONo
.
Sign: v Sign:
• e �Pl Z�1� L`�f {
Print: 112636 .:XZ_ Print:
M Commission Ex ires: 9 �nded�N '''OQ
. �.�� My Commission Expires:
Y , y'�S Y NOTARY PUBLIC ARDS
STATE OF FLORIDA
x sx�s xx m� xx xx am xxx aaaa xmxxs« xx xx * � �E WAWAW& *
I Expires 2/19/2017
APPROVED B to/;'Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
8/21/13 Property Search-Report
I K
MIAMI-DARE COUNTY
OFFICE OF THE PROPERTY APPRAISER
•I PROPERTY SEARCH SUMMARY REPORT
Carlos Lopez-Cantera
J PropenY Appraiser
Property Information:
Folio 11-2136 007-0010 \ *e ti\\ . 3
Property Address 6 NW 107 ST " � � ��� mil�
p }moi
Owner Names ROBERTO MARTIN
Mailing Address 6 NW 107 ST
M1AMI SHORES FL
33168 a
PrimaryZone 0800 SGL FAMILY-1701-1900 SQ
rof'
Use Code 0001 RESK)SgML-SNVGLE FAMN-Y p
�F
Beds/Baths/Half 2/1/0
Floors 1 M,
Living Units 1 � \
Ad].Sq.Footage 1,274 ,
Lot Size 9,225 SQ FT
Year Built 1947
Aerial Photography 2012
Full Legal Description DUMVNVGS MIAMI SHORES EXT NO 3
PB 42-33
LOT 1 BLK 206 TaxWe Value Information:
LOT SIZE 75.000 X 123
OR 20821-3132 112002 1 Current Previous Previous 2
COC 25313-0223 012007 3 Year 2013 2012 2011
Assessment Information: Exemption/ Exemption/ Exemption/
Current Previous Previous 2 Taxable Taxable Taxable
Year 2013 2012 2011 County $0/$134,182 $0/$143,059 $0/$143,059
Land Value $45,979 $45,979 $45,979 School Board $0/$134,182 $0/$143,059 $0/$143,059
Building Value $88,203 $97,080 $97,080 City $0/$134,182 $0/$143,059 $0/$143,059
Market Value $134,182 $143,059 $143,059 Regional $0/$134,182 $0/$143,059 $0/$143,059
Assessed Value 1 $134,182 $143,059 $143,059 Sale Information:
Benefits Information: Date Amount ORBook-Page Qualification Code
Current Previous Previous 2 6/2008 $229,500 26615-1352 Other disqualified
Benefit Type 2013 2012 2011 1/2007 $0 25313-0223 Sales which are disqualified as a
result of examination of the deed
10/2005 $0 23996-0205 Sales which are disqualified as a
result of examination of the deed
10/2005 $450,000 23996-0334 Sales which are qualified
11/2004 $0 22830-4197 Sales which are disqualified as a
result of examination of the deed
11/2002 $190,000 20821-3132 Sales which are qualified
5/1993 $0 15911-4467 Sales which are disqualified as a
result of examination of the deed
11/1992 $0 15720-4242 Sales which are disqualified as a
result of examination of the deed
10/1992 $0 15702-1634 Sales which are disqualified as a
result of examination of the deed
6/1989 $59,900 14164-1484 Sales which are qualified
Disclaimer:
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
g isweb.mianidade.goWPropertjGearch/printMap.htm 1/2
III
X4M40-76-W09�(
5�{OR
Cl�rVED
...a aaaa�
SEP 0 4 2013
dew
�MTee I�
toaBY:
119,
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.
�(AA Copy of the Contract must be attached)
PROPERTY OWNER:
PERMIT#
ADDRESS: to Al2 /O 7 cS�
FOLIO NUMBER: // 4!5b FZOOD�ZONE:
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS(12 MONTHS): A3,949 00
COST OF PROPOSED IMPROVEMENTS:
(ATTACH COPY OF CONTRACT)
TOTAL CUMULATIVE COST OF IMPROVEMENTS(past and proposed):
VALUE OF PRINCIPAL STRUCTURE(attach appraisal):
/'(j Al
OWNERS SIGNATUR 11.x. DATE: °O 2,1/43
PLANREVIEWER:
PLAN REVIEWER SIGNATURE: DATE:
�I
Created on June 2009
r RESIDENTIAL SERVICES CONTRACT 07DS IIIIII IIII VIII II III VIII IIII
5401 UE05
CONTRACT CUSTOMER JOBm LEAD
DATE / �[�� I`1/_I"�'I ACCOUNT NO �� NO SOURCE
Section • •
ADT LLC Customer Name �'
dba'ADT Security Services("ADT")I ("Customer"or"I"or"me"or"my") FM
Office Address
�
Premises'/�,m�� �C Address
t I City R State ZIP !
i
i Tax Exempt No. ei Tax Expire Date EL1111111i]
www.MyADT.com [ ,
800.ADT.ASAP® [ Protected Premises' O Traditional Phone O Other(Qualified) :!O Other(Non-Qualified)
(800.238.2727) � Telephone
Alternate O Home O Cell O Work Alternate O Home O Cell O Work
Telephone 1 Telephone 2
O Fill in if billing address is the same
Billing Y
Address
City State m ZIP
IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation)
EMAIL 1 [ I j I I I 11J a
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 j
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 and other non-solicitation purposes, I agree that ADT may contact me at this/
these number(s).I also agree to receive calls and messages such as 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 1 will not tie 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
800.ADT.ASAP or by logging in to www.MyADT.com.(F) ontract requires final approval by an ADT authorized manager before ADT may provide
any equipment or services, and if approval is denied,thterminated, and ADT's only obligation will be to notify me of such
termination and refund any amounts I paid in advance. 'T
ADT Representative JCP Q 4 2013 I
Rep. License No. Rep.
� (If Required) ID No. /
Customer's Approval:Original Si tureequired(Must match Customer Name in Section 1 above)
m/m B
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.
Section • be Provided
FINANCIAL DISCLOSURE STATEMENT
THERE IS NO FINANCE CHARGE OR COST OF CREDIT(0% APR)ASSOCIATED WITH THIS CONTRACT.
A.NUMBER OF p^ "
PAYMENTS FOR THE j B.AMOUNT OF EACH PAYMENT IS $ 55� TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $
INITIAL TERM IS 36. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) ? (A.TIMES B.)(EXCLUSIVE OF ANY APPLICABLE TAXES,FEES,FINES
�I AND RATE INCREASES)
LATE CHARGE-PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING i PREPAYMENT—1F I PREPAY THE SEE PARAGRAPHS 2,7,15 AND
FREQUENCY,PRIOR TO THE START OF SERVICE.MY FIRST BILL/CHARGE WILL ;TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR
BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS.ADT MAY IMPOSE A THE END OF THE INITIAL TERM 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 i
PENALTY OR REFUND. AND ACCELERATION.
NO EVENT WILL THIS AMOUNT EXCEED$5.00.
Of 6 02013 ADT LLC dba ADT Security Services.
Administrative Copy All rights reserved.(07/13)
�
Important Terms and Conditions (condoued) �
�
feature,itmay not always beable tudetect ifmycommunication line bcut cninterrupted.ADT recommends that| �
test the alarm system mnnth|y,eventhoughasuceesfu|testofthma|annsyst m does not guarantee that ADT will
�
receive alarm signals from the system inthe future.
19.CANCELLATION.
A ADT may,at any time,cancel this Contract tits option if (1)ADT's CIVIC is destroyed or damadsnthvtiti,imp,acticalfo,ADTtpcontinuesemio*;
� (2)ADT cannot acquire o, retain the transmission connections orauthorization totransmit signals between my premises and its CMC orthe applicable
'
fire police department h between 4oTt[K4[and the applicablefire |i department other agency; (3) |fail tnfollow ADT's
recommendations to repair or replace any defective parts of the system not covered under the Limited Warranty or, if purchased,QSP; (4) 1 fail to�ollow
ADT's operating instructions for the alarm system;or(5)ADT determines that it is impractical to continue service due to the modification or alteration of
my premises after installation.If ADT cancels for any of the reasons stated immediately above,ADT will refund any advance payments made for ser\4ces to
be supplied after the date of such termination, less any amounts still due for the installation of the equipment,for services already rendered and for any
other charges due.Additionally,ADT will not assess contract termination charges, if any, as described in Paragraph 2 above.
B. ADT may cancel this Contract upon written notice to me it (1) \fail to pay any monies when due under this Contract, (2) | change to a telephone/
communications service not suitable for alarm signal transmission or(3)1 fail to comply with anyother term orcondition cfthis Contract. Upon receipt nf
written notice frnm ADT |will have ten(lm days to correct the defidency If|do not correct the defidency in a timely manner,and ADT does cancel this
|
Contract,ADT may assess contract termination charges, if any, as described in Paragraph 2 above.
|
20.ASSIGNMENT.I may not assign this Contract without prior written consent from ADT.ADT does have the right toassign this Contract o,tnsubcontract
any of its obligations under this Contract without my approval and without notice to me.
31.DELAYS.ADT HAS NO RESPONSIBILITY OR LIABILITY TO ME 0RANY OTHER PERSON FOR DELAYS IN THE INSTALLATION On REPAIR OFTHE 5Y5TEK4.
|
REGARDLESS OF THE REASON.ADT HAS NO RESPONSIBILITY OR LIABILITY FOR INTERRUPTIONS OF SERVICE OR ANY RESULTING CONSEQUENCES,WHETHER
�
DUE TO STRIKE, RIOT, FLOOD, FIRE, TERRDR|5/N, ACT OF GOD ORANY OTHER CAUSE WITHIN OR BEYOND ADT'5 CONTROL, IF THERE ARE SERVICE
|
INTERRUPTIONS,ADT HAS NOOBLIGATION T0SUPPLY*AEWITH SUBSTITUTE SERVICES.
otherwise22.ELECTRONIC MEDIA; PERSONAL INFORMATION. ADT may scan, image or hi Contract into an electronicformat of any nature. 4
copy of this Contract produced from such electronic format is legally equivalent to the original for any and all purposes,including litigation.ADT's receipt
by fax of the Contract signed by me legally binds me and such fax copy is legally equivalent to the original for any and all purposes, including litigation.
The personal information about me and third parties that I provided to ADT is true and complete. I will notify ADT without delay of any change to this
information. I consent to ADT's use of my personal information and that of third parties provided by me for the purpose of monitoring, setting up and
� -~''---- g''`'-----`-- (including
''`~' ^'` invoicing,collecting and providing'information
�x���fn,�equipment ' -s).I have obtained'
�
the consent m the third parties,wnv^ | "' m account with
disclose
� ._T_and_provided-this Contract.._ may conversations with representatives),use,
and transfer my personal information, and that of third parties provided affiliates, subsidiaries and successor corporations, any
subcontractor nrassignee ofthis Contract orany applicable authority having jurisdiction that requests such information to administer alarm monitoring
services oralarm system license, permit orsimilar programs.
23.PRIVACY POLICY. ADT maintains an online privacy policy atwww.ADT.cnm/privacythat is applicable to the terms, conditions and obligations of the
parties to this Contract.
24.ENTIRE AGREEMENT. THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN THE PARTIES. | AM NOT RELYING ON ADT'5 xov|[E OR
ADVERTISEMENTS. ADT IS NOT BOUND BY ANY REPRESENTATION, PR0W«|5E' CONDITION, INDUCEMENT 0RWARRANTY, ExpnBS OR |yNPUEn. THAT
|
IS NOT INCLUDED IN WRITING IN THIS CONTRACT. THE TERMS AND CONDITIONS OF THIS CONTRACT APPLY A6 PRINTED WITHOUT ALTERATION OR
�
QUALIFICATION, UNLESS A [HANGE IS APPROVED IN WRITING BY AN ADT AUTHORIZED REPRESENTATIVE. THE TERMS AND CONDITIONS OFTHIS
�
CONTRACT SHALL CONTROL AND GOVERN EVEN IF THERE ARE OTHER DOCUMENTS WITH INCONSISTENT OR ADDITIONAL TERMS AND [ONom0Nl IF
� ACOURT DETERMINES THAT ANY PROVISION OFTHIS CONTRACT IS INVALID OR UNENFORCEABLE,THAT PROVISION SHALL BE DEEMED AMENDED AND
ENFORCED TOTHE ;NAX|w)UrN EXTENT PERMITTED BY LAW. EACH AND EVERY OTHER PK0v|800 OF THIS CONTRACT SHALL CONTINUE TO BE VALID
AND ENFORCEABLE.
25.License Information:ALAlabama Electronic Security Board ofLinvnou,o'795OVaughn Rd.' Montgomery 36o1n' (334)28+980B;AK 3785V'552OLake
Otis Pkwy.,Anchorage,AK 99507;AR E12-041,Regulated by Arkansas Bd. of Private Investigators&Private Security Agencies,#1 State Police Plaza Dr.'
Little Ronk'AR 72208' (501) 018-8000; AZ ROC 279591; CAACO7155. alarm company operators are licensed and regulated by the Bureau of Security
' & Investigative Oen/i000 Dept. of Consumer Sacramento, CA 85814` 874443 PPO17�3z �T ELC01V00O9-L5� �� EC�902743� �� EFoOOn21�
| ' � ' ' ' � � ' ' '
GAU/A2O5295' -2O532O' '2O5572' '2O5079' -205O78' LVU405673' -004349; H/ CT32297; |QELE-GC2843; |L124001792; LA F1639, F1040' F1843 F1054
F1655; MA 172C; MI 3601206258, 5108208 4182 Pier North Ds Ste. D' Flint, /N| 48504 KxNTS85O25l; NC7535P2. 756lp2. 75U2P1O' 7503P7, 75O5Pl'
7566P8 Alarm Systems Licensing Bd,4881 Glenwood Ave, St*. 200, Raleigh, 27612 (319) 788-5320; NM �7483mV 0077105; NJ Bem/icmi Contractor
Uc. #t34FAO0 40500 179000' 7835 Browning Rd, Pennsauken, NJ 08109; NY 12000305615' Lice nmodbvNYS Dept. of State; OH 50-18-008.
50'25'0023' 50-29-0003' 50'31'00/4' 50-48-0008. 50-50-0005' 58'76-0008. 50-09g0/0. 53'89'1726/ 0K 1995; OR 196560; PA Pennsylvania Homo
|
Improvement Contractor Registration Number: PA090797;R{35683;TNACC'1888.-1589.'1090'-1V81''1692'-1OS3''1O94'-1O35''1O98;TX017g44'l40
Hoimn,Rd.Ste.1m0,San Antunio'TX7no32-Texas Private Security Bureau,58O5N.Lamar 8|vd,Austin 7nrs2;LIT 8289653;VA11-7345,11-7348,11-7351,
11-7354, 11-71598, 11-7900. M-820S' 27O514772OClass 8Contractor Classification ESC;VVAADTLLL8n1DO, n824NCreek Pkwy w105, Bothell,VVA8DV1;
WI 1210943;wox0497so -
MS 15019511
02O13ADT LLC dhaADT Security Services.All rights reserved.
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I
RESIDENTIAL SERVICES CONTRACT r)-7 & 361 OR I IIIIIIIIIIII VIII II IIIIIIIIIIIIII IIII
5401 U E05
t i CONTRACT CUSTOMER JOBLEAD
DATE ACCOUNT NO NO m SOURCE
Section 2. Services to be Provided (continued)
Monthly Service Charge O Initial/Annual Recurring Municipal Fee billed separately Initial/Annual Fee
(Subject to change based on local law)
O Standard Monthly Service, Burglary
Service includes:Customer Monitoring Center Signal O Customer to obtain and pay for initial/annual municipal
Receiving and Notification Service for Burglary, alarm use permit.Failure to obtain and provide ADT with
Manual Fire and Manual Police Emergency the municipal alarm use permit registration number could
�+ result in no municipal fire/police response to an alarm
from the premises and/or a fine.
O Standard Monthly Service,Fire/Smoke Detection
Service includes:Customer Monitoring Center Signal Municipal Electrical Permit Fee r od
Receiving and Notification Service for Fire,Manual Fire O Customer to obtain electrical permit `/t!"
and Manual Police Emergency f
O Carbon Monoxide O Flood O Low Temp Installation Price 0®
O Medical Alert Taxable Amount 9�
4PSafewatch Cellguard® Non-Taxable Amount
O Securityl-ink®Two-Way Voice $ Connection/Activation Fee $
0 Extended Limited Warranty/Quality Service Plan(QSP) Admin Fee
O Guard Service Response e Sales Tax on Installation* - !
P . _..._
O Monthly Recurring Municipal Fee * �a
Total Installation Char e
(Subject to change based on local law) � g $
O Customer to obtain and pay for Tri Charge Received $ � j
municipal alar P 9
use permit
®Other $ Deposit Received. $ ?c� BE
Total onthly Service Charge $ ,��. `� 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
Pa ne I
��� eta �as`'e�e% �o�,���sesl�e� ��e°O�l
d O ` C� O 0 O C O S t3` C P9 V P C�` P PQr P J Comments
ackag No
10
Includes: $ a 2
Foyer
.........
Living Room
Family Room
S i d;
I
Office j 1
Dining Room
j f
E
Kitchen I !'
Laundry Roome7
j l
Hallway
Master Bedroom T /n♦
I i i�
Master Bath
E 3
Bedroom 2
;
Bedroom 3
I
Bath 2 i C.AOIS 100i
l
Basement
Garage
IIj [ _
I k S w
Price Per Piece
Totals r' E=Existing Equipment
Estimated Installation Start Date m� W
NOTES
1
02013 ADT LLC dba ADT Securitiservices.
2 Of 6 All rights reserved.(07/13)
Important Terms and Conditions (continued) I IIIIIIIIIIII VIII II III�IIII rIlI�I
for ADT's installation of floor mats or wiring; (F)ADT may not be able to conceal any or all equipment or wiring;
(G)ADT will not be liable for property damage, personal injury, illness or other loss due to water intrusion, mold, 5401 UE05
fungi, wet or dry rot or bacteria that may result from the installation services; and (H) my premises complies with
all applicable codes, regulations and laws and will continue to comply with all applicable codes, regulations and
laws during the Initial term and any renewal terms of this Contract. {
9. LIMITED WARRANTY.During the first 90 days after installation,ADT will repair or,at its option,replace any defective part of the alarm system,including
wiring, and will make required mechanical adjustments, all at no charge to me. ADT will use new or functionally operative parts for replacements, This
limited warranty is for my benefit only and may not be enforced by any other person.This limited warranty gives me specific legal rights.The laws of the
state where this Contract was signed may also give me additional rights.To order service,call 800.ADT.ASAP(800.238.2727).
10.EXTENDED LIMITED WARRANTY/QUALITY SERVICE PLAN(QSP). If I purchase ADT's Extended Limited Warranty,which is called the Quality Servicf Plan
or QSP, ADT will repair or, at its option, replace any part of the alarm system installed by ADT that requires repair or replacement due to ordinary wear
and tear or malfunction, excluding batteries. ADT will use new or functionally operative parts for replacements. If I require services excluded from the
QSP(see Paragraph 11 below for exclusions),then ADT will provide the services at its current labor rate for each service call.The QSP and the billing for it
will commence on the date the alarm system is installed, operational and communicating with ADT's CMC and will continue for the term of this Contract.
The QSP will automatically renew for successive thirty(30)-day terms at ADT's then-current QSP rate unless terminated by either party's written notice at
least thirty(30)days before the end of the then-current term. If I purchase the QSP after the initial system installation,the alarm system must be in good
working condition at the time I purchase the QSP.To purchase the QSP;call 800.238.7085.
11.WARRANTY EXCLUSIONS. ADT performs warranty services only during normal working hours. IF I REQUEST ADT TO PERFORM WARRANTY SERVICES
OUTSIDE NORMAL WORKING HOURS, I WILL PAY FOR THE SERVICES AT ADT'S THEN-CURRENT RATES FOR LABOR AND PARTS. THE LIMITED WARRANTY
PROVIDED UNDER THIS CONTRACT AND, IF PURCHASED,THE QSP DO NOT APPLY IF ADT DETERMINES UPON INSPECTION THAT ANY OF THE FOLLOWING
CONDITIONS CAUSED THE NEED FOR SERVICE: (A) damage resulting from accidents, theft, Acts of God, natural disasters, labor disputes, war, terrorism,
civil strife,electrical surge,alterations or misuse; (B)I fail to properly close or secure a door,window or other point protected by an alarm device;(C) I fail
to properly follow the operating instructions; (D)trouble in a telephone line, use of non-traditional telephone line or service (including but not limited
to DSL, ADSL, VoIP, digital phone, internet-based phone, cellular, radio, etc.)or due to interruption of power; (E) repairs needed to window foil, security
screens,exterior mounted devices(except for outdoor cameras installed by ADT)or PROM (Programmable Read Only Memory); (F)ordinary maintenance
or wear and tear (not excluded from QSP); (G) alterations to my premises or failure of my premises to comply with any applicable codes, regulations or
laws;or(H) alterations or damage to the alarm system caused by me or by a cause beyond ADT's control.ADT will not perform warranty services on any
device not installed by ADT. Battery replacement is excluded from all warranties.
12.NO OTHER WARRANTIES, OTHER THAN THE LIMITED WARRANTY PROVIDED UNDER THIS CONTRACT AND, IF PURCHASED, THE QSP, I AGREE THAT
ADT MAKES NO GUARANTEE OR WARRANTY OF ANY KIND,INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE, WITH RESPECT TO THE SERVICES ADT PERFORMS OR THE EQUIPMENT IT PROVIDES. MY EXCLUSIVE WARRANTY REMEDY IS SET FORTH IN
PARAGRAPHS 9 AND 10 ABOVE, SOME STATES MAY NOT ALLOW THE PARTIES TO A CONTRACT TO LIMIT THE LENGTH OF AN IMPLIED WARRANTY.THE
LAWS OF THE STATE WHERE THIS CONTRACT WAS SIGNED WILL DETERMINE WHETHER THESE LIMITATIONS AND EXCLUSIONS APPLY.
13.ALARM MONITORING AND NOTIFICATION SERVICE. If I purchase service that includes response by police,fire department, guard, medical emergency
notification or two-way voice monitoring services and such an alarm is received at ADT's CMC,ADT may, at its sole discretion, attempt to contact me and/
or anyone on my Emergency Contact List to confirm that the alarm is not false.If ADT does not contact me and/or someone on my Emergency Contact List,
or if ADT questions the response it receives upon such contact,then (A)ADT will attempt to notify the appropriate police department or fire department
or, (B)if guard response service is provided and an alarm requires police response,ADT will attempt to dispatch a representative to make an investigation
of the exterior of the premises from his or her vehicle and, upon evidence of a crime, ADT will attempt to notify the appropriate police department. If
ADT provides supervisory alarm or trouble alarm monitoring services(or if such services are actively programmed into the alarm system)and ADT's CMC
receives an alarm,then ADT may attempt to notify my premises and/or the representative I designate.ADT may use an automated calling device to deliver
IC such notification. If medical emergency notification services are provided, I agree that the very nature of such services, regardless of any delay, involves
uncertainty,risk and possible serious injury,disability or death,for which I will not attempt to hold ADT responsible or liable;that the equipment furnished
for medical emergency notification services is not foolproof and may experience signal transmission failures or delays for any number of reasons; and
that the actual time required for medical emergency providers to arrive at my premises and/or to transport any person requiring medical attention is
unpredictable with many contributing factors, including telephone network operation, distance, weather, road and traffic conditions, alarm equipment
function and human factors both within and outside of ADT's control. ADT's performance of, delay in performance of or failure to perform medical
emergency notification services under the Contract are subject to and controlled by Paragraph 5 of this Contract.The person(s)identified on my Emergency
Contact List are authorized to act on my behalf.I understand that the equipment ADT provides may not operate with other companies'alarm monitoring
equipment and may prevent me from using such equipment in the event I terminate my services. I understand that local laws, ordinances or policies may
restrict ADT's ability to provide the alarm monitoring and notification services described in this Contract and/or necessitate modified or additional services
with additional charges to me.I understand that ADT employs a number of industry-recognized measures to help reduce occurrences of false alarms.These
measures include, but are not limited to, implementation of default settings on alarm panels and various procedures at ADT's CMC to determine when
and how to respond, if at all, to certain alarm events. I consent to ADT's use of these measures and agree that the alarm system has not been designed,
programmed or installed pursuant to any law, code or rule that may be applicable to my particular premises, including, but not limited to, any code
provisions of the National Fire Protection Association or the International Residential Code. I understand that, upon receiving notification that an alarm
signal has been received by ADT,the police department,fire department or other responding authority may forcibly enter my premises. I understand that
ADT will never arrest or detain any person for any reason. I agree that the equipment installed by ADT, including any outdoor camera, is not to be used
to monitor activity in or near any swimming pool or other body of water and that I alone am responsible for supervising the well being of any person in
or near any swimming pools or other bodies of water on the premises.
14.FAMILIARIZATION PERIOD.UNLESS 1 HAVE REJECTED THE FAMILIARIZATION PERIOD BY INITIALING THE APPROPRIATE LINE ON THE FIRST PAGE OF THIS
CONTRACT (EXCEPT WHERE FAMILIARIZATION IS REQUIRED BY LAW), I AGREE THAT, DURING A SEVEN (7)-DAY FAMILIARIZATION PERIOD, OR LONGER
PERIOD IF REQUIRED BY LAW, THAT FOLLOWS COMPLETION OF THE INSTALLATION AND THE COMMUNICATIONS CONNECTION TO ADT'S CMC (AND
DURING ANY APPLICABLE EXTENSIONS), ADT HAS NO OBLIGATION TO, AND WILL NOT, RESPOND TO ANY ALARM SIGNAL FROM MY PREMISES. I ALSO
li AGREE THAT DURING SUCH PERIOD ADT HAS NO OBLIGATION TO,AND WILL NOT, NOTIFY ANY AUTHORITIES, ME OR MY DESIGNATED REPRESENTATIVE
OR TAKE ANY OTHER ACTION WITH REGARD TO ANY ALARM SIGNAL ADT RECEIVES, EVEN IF DUE TO AN ACTUAL EMERGENCY.
15. FAILURE TO PAY CHARGES OR HONOR CONTRACT. If I fail to make any payment when due or to honor any other term or condition of this Contract,
ADT may stop providing the alarm monitoring and notification services and repossess or disable the equipment without notice. I will grant ADT access to
my premises and allow it to repossess or disable the equipment.ADT has no liability if it stops providing the alarm monitoring and notification services and
repossesses or disables the equipment.ADT is not required to redecorate or repair my premises as a result of repossessing or disabling the equipment. In
addition to these remedies,ADT does not waive, and retains the right to exercise,any other legal remedy, including the right to charge me a late fee for
each month that a payment is not received and/or interest on the unpaid amount and the right to report me to one or more consumer reporting agencies
if I become delinquent on my account(more than 90 days without a payment).
16.SMOKE AND CARBON MONOXIDE DETECTORS.IF THE ALARM SYSTEM INCLUDES SMOKE AND/OR CARBON MONOXIDE DETECTORS,I AGREE THAT.(A)
THE NUMBER AND PLACEMENT OF SUCH DETECTORS MAY NOT FULFILL THE REQUIREMENTS OR RECOMMENDATIONS IN CODES, LAWS OR STANDARDS
THAT APPLY IN MY JURISDICTION, INCLUDING THE CODE PROVISIONS OF THE NATIONAL FIRE PROTECTION ASSOCIATION AND THE INTERNATIONAL
RESIDENTIAL CODE; (B) I HAVE SOLE RESPONSIBILITY FOR COMPLYING WITH ANY AND ALL CODES, LAWS AND STANDARDS THAT MAY APPLY TO THE
INSTALLATION, PLACEMENT AND MAINTENANCE OF THE ALARM SYSTEM;AND(C)ANY SMOKE AND/OR CARBON MONOXIDE DETECTORS DESCRIBED IN
THIS CONTRACT ARE SUPPLEMENTAL DEVICES ONLY AND ARE NOT INTENDED TO BE PART OF A PRIMARY FIRE ALARM OR CARBON MONOXIDE DETECTION
SYSTEM.I understand that ADT's electrical smoke and carbon monoxide detectors,if installed in my premises,are designed to be connected to an electrical
power source.THESE DETECTORS WILL NOT OPERATE, THE ALARM WILL NOT SOUND AND THE ALARM SIGNAL WILL NOT BE TRANSMITTED WHEN:THE
ELECTRICITY IS CUT OFF;THE BACK-UP BATTERY, IF INCLUDED AS PART OF THE SYSTEM, IS LOW OR DEAD;OR FIRE CUTS OFF THE ELECTRICITY BEFORE THE
ALARM IS ACTIVATED, SOUNDS AND IS TRANSMITTED. Connecting these detectors to a separate dedicated electrical circuit may increase their reliability,
but even dedicated circuits can fail. I understand that these detectors all have limited useful lives, after which time they will not function. It is my sole
responsibility to monitor and replace all detectors before or at the end of their useful lives.
17.BATTERY-POWERED DEVICES. I understand that all battery-powered motion detectors, smoke detectors, door and window contact transmitters and
other detection sensors installed under this Contract are not connected to the electrical system of my premises and require batteries to operate.THESE
BATTERY-POWERED DETECTION SENSORS WILL NOT OPERATE, AND THE ALARM WILL NOT SOUND, IF THE BATTERIES ARE LOW OR DEAD. It is my sole
responsibility to maintain and replace these batteries.ADT recommends that I regularly inspect the sensors for dirt and dust buildup and test the sensors
weekly to help maintain continued operation.ADT also recommends that I carefully read and follow the owner's manual, instructions and warnings for
all equipment.
18.ALARM SYSTEM COMMUNICATION. I authorize ADT to request service from a telephone,wireless or other communication carrier under this Contract
(referred to as "Telephone Company")to transmit signals between my alarm system and ADT's CMC.The Telephone Company's liability is limited to the
same extent as ADT's liability in Paragraph 5 of this Contract. ADT will not receive alarm signals when the communication mode is not operating or has
been cut,interfered with or is otherwise damaged,or if the alarm system is unable to acquire,transmit or maintain an alarm signal over my communication
mode for any reason. If ADT determines in its sole discretion that my communication mode is or later becomes non-compatible,or if I change to another
communication mode that is not compatible, then ADT requires that i use an alternate mode of communication acceptable to ADT as the method to
connect the alarm system to ADT's CMC.Transmission of fire alarm signals by means other than a traditional telephone line may not be in compliance with
applicable fire alarm or other standards or codes,and it is solely my obligation to comply with such standards and codes.If the alarm system has a line-cut
Terms and Conditions continue on accompanying sheets.
� CIS (07/13)
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