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ELC-13-519 r v ' � t Miami Shores Village Building Department 144 z, 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 ? BUILDING Permit No. PERMIT APPLICATION Master Permit No.-CA 3— S l Permit Type: Electrical may' JOB ADDRESS: �1� c�a `� 5 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: �1� �ZC'� G1?� . 4Z AC) Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): tel. ] Imo. Phone#: Address: %—CQ`J k_x; 1 l'2 City: 3� �_LSta e: VA Zip: Tenant/Lessee Name: i \ Phone#: Email- CONTRACTOR:Company Name: ` L�LCr Phone#: Address: City: 1 !��Qc State: Zip: ��� Qualifier Name: &ame H e129I!! 1-(lr Phone#: State Certification or Registration#: E�f"=12A Certificate of Competency#: Contact Phone#: a`�O6e� � Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ \`°'t`�'l ff�,� Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ®Newer ❑Repair/Rep lace ❑Demolition Description of Work: 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 DUE$ I � ° 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 ins tion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will 40t a approved'and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The forego' g i strument was acknowledged before me�Ithis"" The foregoing instrument was acknowledged before me this day of 20 I'�iy ►-nes A • rl day of 20_,by 8e%>cQe_ 1440-akaG1l; who is personally�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 td1 kemnnath NOTARY PUBLIC: NOTARY PUBLIC: °°°®g °1 .......h , Ole NOTARY e° "o 19-20 BONDED 70°; Sign: Sign: NOTARY PUBLIC c � Print: Print o UN tvs� WMMZUWAY My Commission Expires: ?° Mr GMSSW#EE88 0 My Commission Expires: 939y9�°°��� * * EXPIRES:February 23,207 "" ° � �ded gThN BudAe1Nagy ®®�'�gBC, c-r �®°'°°® ov c�� ��as<���sase�x�x�x�m��xsa�s<*�s<�s=��xsas=x��s«m>k���srs=se��s�sa���sesa�x�xs<msa����:s�:xis=sas=�x�x�x�x�x�x��x���ss��x:xs=saa�x��m�xs<�xsz�x�xs=:trsr�s=se���xse�xs=�sr*sr�x APPROVED BY l /��lans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) w`ww.sunbiz.org- Department of State Page 1 of 2 v Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search No Events No Name History FSubmit Detail by Entity Name Florida Limited Liability Company GATOR 9723 NE 2ND AVE,LLC This detail screen does not contain information about the 2013 Annual Report. Click the 'Search Now' button to determine if the 2013 Annual Report has been filed. Search Now Filing Information Document Number L12000146623 FEI/EIN Number NONE Date Filed 11/21/2012 State FL Status ACTIVE Effective Date 11/20/2012 Principal Address 1595 NE 163RD STREET NORTH MIAMI BEACH FL 33162 US Mailing Address 1595 NE 163RD STREET NORTH MIAMI BEACH FL 33162 US Registered Agent Name & Address GOLDSMITH,JAMES A 1595 NE 163RD STREET NORTH MIAMI BEACH FL 33162 US Manager/Member Detail Name&Address Title MGR GOLDSMITH,JAMES A 1595 NE 163RD STREET NORTH MIAMI BEACH FL US Annual Reports No Annual Reports Filed Document Images http://sunbiz.org/scripts/cordet.exe'?action=DETFIL&inq_doc_number=L 12000146623&in... 2/26/2013 www.sunbiz.org-Department of State Page 2 of 2 11/21/2012--Florida Limited Liabilitv View image in PDF,tormat; Previous on List Next on List Return To List Entity Name Search No Events No Name History Submit Home I Contact us I Document Searches I E-Filinq Services Forms Helo I Coi)vrightS;and Privacy Policies State of Florida,Department of State http://sunbiz.org/scripts/cordet.exe?action=DETFIL&inq_doc_number=L 12000146623&in... 2/26/2013 Property Information Map Page 1 of 1 My Home Miami-Dade County, Florida MIAMI-DADE w take � Property Information Map F � "f'1 +tY4 a Summary Details: Folio No.: 1-3206-01 210 723 NE 2 AVE ' '. Mailing ATOR 9723 NE 2ND AVE r Address: 11595 LC � r �a �y •. ) NE 163 ST NORTH [AM[BEACH FL 3162- � 0� ( i� Property Information: 100 COMMERCIAL- g Primary Zone: •-F t� R�T NEIGHBORHOOD y c .: � CLUC: 0011 RETAIL OUTLET 97 `° :° , 1" ., ° > ': Beds/Baths: 0/0 r � Floors: 1 �_� � �, ,� �� � _ �, �• • �^ra �, � Livinq Units: 0 r 1 dj Sq Footage: 9,459 rr Lot Size: 12,360 SQ FT & Year Built: 1948 E MIAMI SHORES SEC 1 :-- MD PB 10-70 LOTS 10 Legal &11 BLK 31 LOT SIZE M i Description: 95.000 X 130 OR 17437- mo 1378 1196 4(2)OR a ) 8412-2519 1212 01 Assessment Information: Year: 2012 2011 Land Value: $247,000 $247,000 Building Value: $347,740 $347,740 a � Market Value: $594,740 $594,740 Aerial Photography-2012 0 114 ft Assessed Value: $594,740 $594,740 Taxable Value Information: This map was created on 2/26/2013 4:41:10 PM for reference purposes only. Year: 2012 2011 Web Site©2002 Miami-Dade County.All rights reserved. Applied Applied Taxing Authority: Exemption/ Exemption/ Taxable Taxable Value: Value: Regional: $0/$594,740$0/$594,740 Count : $0/$594,740$0/$594,740 Cit : $0/$594,7401$0/$594,740 School Board: 1$0/$594,7401$0/$594 740 Sale Information: Sale Date: 12/2012 Sale Amount: $594,800 Sale O/R: 28412-2519 Sales Sales qualified as a result Qualification of examination of the Description: deed View Additional Sales http://gisims2.miamidade.gov/myhome/printmap.asp?mapurl=http://gisims2.miamidade.go... 2/26/2013 10 S11/IALL4BUSINESS CONTRACT �ry II�IIIIIIIIIIIIII��IIII�IIIII�II�IIIIIIIIIII�IIIII 0 ,\4 ®U J�� 54000E02 CONTRACT,�- .`'/ r� / ➢ CUSTOMERELMO JOB m LEAD DATE- ° �a. .� ACCOUNT NO NO SOURCE ADT LLC Business Name ` R j $$ i 1 } dba ADT Security Services("ADT")I ("Customer"or"I"or"me"or"my') Office Address �p Premises' 4�r)4.,fi y.• Address e^ MCity . t i . State ZIP Responsible www.MyADT.com Party Name 800.ADT.ASAP® Protected Premises` (800.238 2727) I ' _ �. O Traditional Phone 0 Other O Other(Non-Qualified) Phone(Required) ualified) W)Fill in if billing address is the same Billing Address Billing Phone City State m ZIP (Required) F FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE — (see Paragraph B3 of the Terms and Conditions for explanation) r EMAIL 11 Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third-party products and services to the contact information provided by me. I may unsubscribe or opt out by emailing donotcontact@adt.com or by calling 888.DNC4ADT(888.362.4238). Initial here If I have provided ADT with a phone number, including but not limited to a cell phone number ora 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 number(s) provided. Ownership of System and Equipment: O Customer-Owned O ADT-Owned Verticals (i Retail O Business Services O Personal Services O Automotive/Transportation O Grocery/Food O Health Services O Restaurants O Wholesale O Other 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 C and E of the important terms and conditions. (B)The initial term of this Contract is three(3)years. (C)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 ADI.ADT may not receive alarm signals if communications or power is interrupted for any reason.(D)ADT recommends that I manually test the alarm system monthly and any time I change telephone service, by calling 800.ADT.ASAP. (E)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 Rep.License No. Rep. (If Required) ID No. Customer's Approval:Original Signature Required NOTES (Special Instructions/Directions/Cross Street) I �y i f C2'12 ADT LLC c;ba -,DT S_—CL':.` Adrttinistrative Conn, 1� =i �111 SMALL BUSINESS CONTRACTIIIIIIiII540 r .. CONTRACT /I ? CUSTOMER JOBmLEAD DATE C ACCOUNT NO NO SOURCE Alarm Monitoring and Notification Services Monthly Service Charge ' Monthly Service Charge ,' O Burglary(BA) I ( ` On Site Services ` O Hold-up(HUA) is ' O Guard Response O Interior O Exterior '- _ O Other I O Duress O Two-way voice 1 Total Monthly Service Charge O Critical Condition Monitoring(CCM) ; Initial Fee w O Flood O Temperature }) is O Parallel Protection O Annual UL Certificate Fee is _......— O ADT DataSource �6 O ADT to obtain Electrical Permit 4$ ------------- O Open/Close Login is I O Municipal Electrical Permit. O Customer to obtain and pay for initial/annual municipal alarm use permit.Failure to O Supervised Scheduled Open/Close obtain and provide ADT with 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 ADT Entry Solutions i O Other Other Services a Installation Price v " O Quality Service Plan (QSP) { 1 Taxable Amount(Leave blank if ADT-Owned) __ is isO If Quality Service Plan (QSP)is Declined CustomerNon-Taxable Amount(Leave blank if ADT-Owned) must Initial here is O Preventative Maintenance/Inspections Per Year Connection Fee 01 02 03 04 06 012 I O Tra'ning Sales Tax on Installation* Tax Exempt No. I O Direct Connection Services i Tax Expiration Date O Monthly Recurring Municipal Fee i Total Installation Charge* ' (Subject to change based on local law) O Customer to obtain and pay for municipal I Deposit Received: 100% deposit required<$500 alarm use permit Minimum 50% deposit required$500+ O Money Order O Check O Credit/Debit Card *If applicable sales tax not shown,it will be added to the first invoice, if Balance Due* not collected at the time of installation. 1 Quantity Device Description Device Location � 1 - I t -- F-c.. , t t !; I .i Estimated Installation Start Date t ©2012 ADT LLC dba ADT Security Services. ,�-f r All rights reserved.(10/12) SMALL BUSINESS CONTRACT RACE II�IIIIIIIIIII�II��III��IIIII�IIIIIII��IIIII�IIIII ° 54000E02 CONTRACTLEAD DATE / -� 4 .J CUSTOMER-� )ACCOUN NO NO m SOURCE Check O Check received for: O Installation: Check# Amount Confirmation# Check O Annual Service Charges Collected: Check# Amount Confirmation# I authorize ADT: O To withdraw all(i)Service Charges and(ii)Contract Termination Charges q To charge my credit/debit card for all(i)Service Charges and(ii)Contract (see Paragraph C.2 Term and Payments)from my bank account: Termination Charges(see Paragraph C.2 Term and Payments): I` ......... ... O Annually O Semi-Annually O Quarterly O Monthly O Installation O Installation Deposit Only O Remaining Install Balance Only m 1, Choose one: O Checking O Savings Q All/Recurring Service Charges Name of Bank/Credit Union O Annually O Semi-Annually O Quarterly O Monthly g VISA O MasterCard O Discover O AMEX Credit/Debit Card Number Expiration Date-.'! ABA Routing Number Bank Account Number / A , t MM YY Recurring Service Charge Amount Plus tax Recurring Service Charge Amount C;1- LF Plu Name as it appears on bank accounts tax Cardholder's Name EMEMEM I 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 C.2 Term and Payments)indicated Recurring Service Charges and all Contract Termination Charges(see Paragraph C.2 Term above.I may revoke this authorization only by notifying ADT and my bank in writing at and Payments)indicated above.I may revoke this authorization only by notifying ADT and least 10 business days before the scheduled debit.If no oval is filled above,service charges my bank in writing at least 10 business days before the scheduled debit.If no oval is filled will be withdrawn monthly. above,my credit/debit card will be charged monthly. I 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 services 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 notify 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 on the next business day.Because this is an electronic transaction,these funds may be withdrawn from my account each month as early as the transaction date.If the date or amount of the withdrawal changes,or if Contract Termination Charges(see Paragraph C.2.Term and Payments)apply,ADT will notify me at least 10 days prior to the payment being collected.If an ACH transaction is rejected for non-sufficient funds(NSF),ADT may attempt to process the charge again within 30 days,and an NSF charge may apply.The origination of ACH transactions to my account must comply with the provisions of U.S.law.I am an authorized user of this credit card or bank account,and I will not dispute the payment with my credit card company or bank,so long as the amount corresponds to the terms indicated in this Contract. O To send me a bill: O Annually O Semi-Annually O Quarterly O Other DOA Approval If no oval is filled,ADT will send bill quarterly. Authorized Account Signature: Consolidated National Billing# Account# National Account Company f Manager ID Name )d h _dam ld `,-r 1.i '6 Cross Street 'J Municipality Municipality Police Name Fire Name Job Type O New Sale O Changeover O Resale O Upgrade Control Type �.O HW O RF Resale-Former Acct# Former CS# Resale Former Acct# Former CS# • • e • • This password must be issued to all users of the alarm system,including all people listed in Section 7.An optional,secondary password 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 calling ADT toll-free at 800.238.2727. • Epiprgency C.dintact 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, I the password,and the keypad code.By selecting the"Yes"designation on the right I am identifying which of these individuals may be called prior to notification of the authorities. Customer/Emergency Contact#1 , r 4 ? f O �O O 0 O Print First/Last Name '`) i i %-, Phone / rt b 't l !�i � � �ly Home Cell Work Yes No (` O O O O O Phone Home Cell Work Yes No d Customer/Emergency Contact#2 i� ) (t ) 7 _` {r'� 2` ,y O 0 O 'QP O Print FirstlLast Name V ?(. Dt.d b `� t - Phone ►E 1 l 1 1 Home Cell Work Yes No O O O O O Phone Home Cell Work Yes No 1 Alternate/Emergency Only Contact O O O O O Print First/Last Name Phone Home Cell Work Yes No O O O O O p Phone Home Cell Work Yes No V • 02012 ADT LLC dba ADT Security,Services. ,,.j All rights reserved.(10/12),