EL-12-1615 R
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.
PERMIT APPLICATION Master Permit No.
FBC 20 �O
Permit Type: Electrical
OWNER:Name(Fee Simple Titleholder): / Phone#:
Address: 16 61'-7-z /4115' mo L
City: State: Zip:
Tenant/Ussee Name: Phone#:
Email: /
JOB ADDRESS: A0&/,z 7 A)WO le
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: d✓ /_`G
Phone#: 7J
Address: Z07rr 1/ 0'A�f dy
City: �- O"Y State: � Zip:
d�
Qualifier Name: Phone#:gs{����52-74__
State Certification or Registration#: 44 Certificate of Competency#:
Contact Phone#:� '.r�'7.r Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: DAddress DAlteratio ❑New r❑Repair/Replace ODemolition
Description of Work: �.e�'IP�[J�( — �L �'�Z ���✓
Submittal Fee$ Permit Fee$ r'-�0•C3 CCF$ CO/CC$
Scanning Fees C Radon Fee$ 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 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 Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowl ged before me this
day of ,20_,by day of V ,20��by
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: I I C1 -J-0 PI-Lc)
Print: Print:
My Commission Expires: My Commission Exp1 er. MARIA D.PERE?
(• 1�= Notary Public-State a Fbr,04,1
; •) My Comm. Expires ma; 7OF F 10
,
APPROVED BY �e / �.�'�Plans—74,617
miner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
1 -�
Miami Shores Village
Building Department AUG 2 8 2012
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 `�
Tel: (305)795.2204 Fax: (305)756.8972 3y'--
INSPECTION'S PHONE NUMBER: (305)762.4949
tb�Tl((2,--�' 9 r
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. i I
Permit Type: Electrical
JOB ADDRESS: 0077ICJ 'L
City: Miami Shores . County: Miami Dade Zip: 31.__A9
Folio/Parcel#: 0S`+7 0
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name(Fee Simple Titleholder): "o— Phone#:
Address: /'�7& :5z_- A"-O- /D /Q�-
City: AA& YYN State: �� Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ��� f ��-�� '/7 /�Y✓/�✓ Phone#: 7; -
Address: i(27T9 6_-jat•Ks lit/ 3
City: State: 1 Zip: "S 3
Qualifier Name:e 6L ��/7�%/ Phonew4�)4 �
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ -Square/Linear Footage of Work:
Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: �S
' o�
Submittal Fee Permit Fee$ � ®� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary $ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW Dt1E$ 1(110
Bonding Company's Name(if applicable)
Bonding Company's Address r
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 mast
promise in food faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose proper•q• is subject to attachment. Also, a certified copy of the recorded notice of commencement mast 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 gill not e up rn•ecl and a reinspection fee will he c•har,l ed.
Signature Af Si-nature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thiso2,54
day of��.20�,by JU n;or —d(Dol% 4 ).S�„ day of� ,20f�by
who isknown 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:
Iodmoo�
Sign: Sign:
Print: I IAP I/1 f' d 1�P^ �� I S Print: i ATOYA LCpRTER
MY&XMMISSION#EE 139bV4
My Commission Expires: My Commission Expire. _ - EXPIRES:Qcta�r19,2015
�ot►a'po%le ADEN.PIERRE-LOUIS wnuc
tA'IE tmee�wr s
# My COMMISSION#EE 041503
* EXPIRES:December 26,2014
PWOFVVI
>k 'n'I"•i�k :*:,-.x:k'k•:kok:k=k:K'k•-k:Y--Y->k:kH :g:g:e:g :y.:(::g:g:g:gac:gx:;c:kck:<:ckx:e-k:ic=gck >k>k-F-F-kX %kxk>k>kkk
APPROVED B Plans Examiner Zoning
Structural Review Clerk
IRe%I,Cd i/1_/_'012HRe\i<cd07/10/07i1Rc\i',ell06/1U/1-009)1Re\i.ed3/15/09)
MIAMI-DADE COUNTY
OFFICE OF THE PROPERTY APPRAISER
PROPERTY SEARCH SUMMARY REPORT
Honorable Pedro J. Garcia
Property Appraiser
Folio 11-2232-028-0570
Property Address '' 10627 NE 10 PL
Owner Name(s) THERMONFILS I JEAN-BAPTISTE&W
ROSELINE ` y
Mailing Address 10627 NE 10 PL (` r
MIAMI FL
33138-2103
Primary Zone 1000 SINGLE FAMILY RESIDENCE
Use Code 0001 RESIDENTIAL-SINGLE FAMILY
Beds/Baths/Half 2/2/0
Floors 1
Living Units 1
Adj.Sq.Footage 2,256
Lot Size 16,250 SQ FT
Year Built 1956 A
Aerial Photography 2010
Legal Description MIAMI SHORES ESTS PB 47-58 "
S45FT OF LOT 6&ALL LOT 7
BLK 4 _0 i"ble Vallue tnfi rmation:
LOT SIZE 125.000 X 130 '
OR 17714-4540 0697 1 Current Previous
OR 17714-4540 0697 00 Year 2011 2010
Assessmer►t Infprmaton:
Exemption/Taxable Exemption/Taxable
Current Previous
Year 2011 2010 County $50,000/$153,815 $50,000/$150,803
Land Value $163,185 $97,405 School Board $25,000/$178,815 $25,0001$175,803
Building Value $159,319 $160,364 City $50,000/$153,815 $50,000/$150,803
Market Value $322,504 $257,769 Regional $50,000/$153,815 $50,000/$150,803
Sale Information:
Assessed Value $203,815 $200,803
Date Amount Recording Qualification Code
Exemption Information: Book-Page
Current Previous 6/1997 $120,000 17714-4540 Sales which are qualified
Year 2011 2010 9/1996 $0 17355-4548 Sales which are disqualified as
a result of examination of the
Homestead $25,000 $25,000 deed
2nd Homestead $25,000 $25,000 8/1973 $56,600 00000-0000 Sales which are qualified
Senior $0 $0
Veteran Disability $0 $0
Civilian Disability $0 $0
Widow(er) $0 $0
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 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 hftp://www.miamidade.gov/info/disclaimer.asp.
Property information inquiries,comments,and suggestions email: pawebmail@miamidade.gov
GIS inquiries,comments,and suggestions email: gis@miamidade.gov Generated on:Tuesday,August 14,2012
• AESIDENrfIAL SERVICES CONTRACT
ms-V O 6a 6 3 8 7 0
5401UEOO
CONTRA"7rn/I F I d/I 1 F)1 ACCOUNT NO ` 'CUSTOMER ,NO m SOURCE
• • • Imo'
Secti
ADT LLC Customer
ustomer Name U i O.
dba ADT SecurityServices('ADT' Customor'I'or'me'or' 9 T
Office Address
i p785 mer K5 Loa/ 11111111111 11 111 -1
tn'►cz z+�� Fadores. 2
S-�eVl__ �kolo( city i s 1 State Q- 21P 1 3
Tax Exempt No. OEM Tax Expire Date
www.MyADT.com
1.800.ADT.ASAP• Protected Premises a 6
(1.800.7382727) Telephone g I O TraAtlonal Phone o Othe(t)uaONed) 'o other Mon Qualified)
Altemate O Home O Cell O Werk Alternate O Home O Cell O Work
Telephone 1 Telephone 2
O Fill 1n If billing address is the same
Billing
Address
qty TETIM state m zip
IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Tema and Conditions for explanation)
EMAIL u U 191 I 10 If
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 InformatfoA,provided by me.I may unsubscribe or opt out by emailing donotcontact®adtcom or by calling
888.DNC4ADT(888.362.4238).Initial here JJ UU
Confirmation of Appointments:I authorize ADT to call me using an automated calling device to deliver a pre-recorded message to set/confirm
appointments and provide other information and notices about the alarm system at the telephone number(s)provided by me.Initial here
EQUIPMENT TO REMAIN THE PROPERTY OF ADT.All equipment Installed by ADT pursuant to this Contract shall be owned by ADT unless ADT has
agreed to give me ownership of the equipment In a separate written agreement ADT has the right upon termination of this Contract to remove or
disable any or all of the equipment owned by ADT,in which case I will not be able to use the equipment for any purpose.See Paragraph 7 of the Terms
and Conditions for more information.
I acknowledge and agree to each of the following:(A)This Contract consists of six(6)pages.Before signing this Contract,I have read,understand and
agree to each and every term of this Contract,including but not limited to Paragraphs 5 and 18 of the Terms and Conditions.(B)The initial term of this
Contract Is three(3)years.(C)ADT is not a security consultant and cannot address all of my potential security needs.ADT has explained to me the full
range of equipment and services that ADT can provide me.Additional equipment and services over those Identified In this Contract are available and
may be purchased from ADT at an additional cost to me.I have selected and purchased only the equipment and services identified in this Contract(D)
No alarm system can provide complete protecjion or guarantee prevention of loss or injury.Fires,floods,burglaries,robberies,medical problems and
other incidents are unpredictable and cannot always be detected or prevented by an alarm system.Human error is always possible,and the response
time of police,fire and medical emergency personnel Is outside the control of ADT.ADT may not receive alarm signals if communications or power is
interrupted for any reason.(E)ADT recommends that I manually test the alarm system monthly and any time I change telephone service,by calling
1.800.ADT.ASAP or by logging in to www.MyADT.com.(F)this Contract requires final approval by an ADT authorized manager before ADT may provide
any equipment or services,and if approval is denied,then this Contract will be terminated,and ADTs only obligation will be to notify me of such
termination and refund any amounts I paid in advance.
ADT Representative
/ Rep.License No. Rep. P
E'✓2 (If Required)EFEM ID No.
Customer's Appro :Ori g Si t_ a ''d(Must match Customer Name in Section 1 above)
X LSV W�
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
PAYMENTS FOR THE B.AMOUNT OF EACH PAYMENT IS $ 36 - TOTAL OF PAYMENTS FOR THE INITIAL TERM IS
INITIAL TERM 15 36. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) (A.TIMES B.)(EXCLUSIVE OF ANY APPLICABLE TAXES, EES,FINES
AND RATE INCREASES)
LATE CHARGE-PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING PREPAYMENT-IF 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 I ABOUT NONPAYMENT,DEFAULT
DAYS PAST DUE,UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW,BUT IN PENALTY OR REFUND. AND ACCELERATION.
NO EVENT WILL THIS AMOUNT EXCEED$5.00.
@2012 ADT LLC dba ADT Security Services.
1 of 6 Administrative Copy All rights reserved.(06/12)
`'[ SIIlENTIAL SERVICES CONTRACT
CUSTOMER1E�
5401 UE00
OND TE i � t� ACCOUNTNOFF= =c Cl SOURCE
Section 2. Services to be Provided (continued)
Monthly Service Charge O initlal/Amoral Reaming Municipal Fee billed separately bh WAnnual Fee
0 Standard Monthly Service,Burglary (Sables m change based on local laud
Service Includes:Customer Monitoring Center Signal q q O Customer to obtain ami pay for initiabannual municipal
Receiving and Notification Service for Burglary, alarm use permit Failure to obtain and provide ADT with
Manual Fire and Manual Police Emergency 3 6 _I the muiddpal alarm use penmft registration number could
result m no municipal fire/pollce response m an alarm
from the premises and/or a fine.
O Statdard Monthly Service,WeSmoke Detection.
Service hndudes:Customer Monitoring Center Signal Municipal Electrical Permit Fee ' N C t
Receiving and Notification Service for Fire,Manual Fire $ i Customer to obtain electrical permit 11s.
and Manual Police Emergency
O Carbon Monoxide O Flood O Low Temp $ Installation Price $ 3Q� --
O Medical Alert Taxable Amount
O Safewatch Cellguard° $ Non-Taxable Amount
O SecurityUnk' $ Connection,Fee
®Exo;nded Limited Warranty/Quality Service Plan(QSP) $ ' U Admin F.- $
O Guard Response Service $ Sales Tax on Installation* $
O Monthly Recurring Municipal Fee
(Subj lR change based on.local law) $ Totall installation Charge* $
O Customer to obtai0 and pay for
municipal alartot•use:pennk
O other $ Deposit Received $
Total,Monthiy Service Charge $ 6 Balance Due upon Installation-
1
nstallation* $
*If applicable sales tax not shown,it will be added to the first Invoice.
Section • • to be Installed
Control
Panel °�\
�Qa
°s
S°J O° St3° 6�Oe� ��O¢ (P�Oe� Sa�CtO C Q9 V PO It PO PO Comments
t� ePackage l?O
Na
Includes:
Foyer
Living Room V 1
Family Room
Office ------- — — -- --- - j
Dining Room I I
Kitchen
Laundry Room r
Hallway
--
Master Bedroom
Master Bath i
Bedroom 2
Bedroom 3
Bath 2 j
Basement - -
L
Garage -- -- -- r I----
�
Price Per Piece f
i
Totals E=E/x�isting Equipment
Estimated Installation Start Date
INSTALLER NOTES
02012 ADT LLC dba ADT Security Services.
2 Of 6 All rights reserved.(06/12)