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Home My WebLink About13-14258 , CITY OF ZEPHYRHILLS ' S335-8th Street (813)780-0020 58 ELECTRICAL PERMIT Permit#:14258 Issued: 6/10/2013 Address: 37812 SR 54 Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL. Class of Work: ELECTRICAL MISC Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Sq. Feet: Est. Value: Book: Page: Cost: 99.00 Total Fees: 60.00 Subdivision: CITY OF ZEPHYRHILLS Amount Paid: 60.00 Date Paid: 6/10/2013 Parcel Number: 15-26-21-0030-00200-0010 Name: ADT LLC Name: ILLINOIS LT MANDER ALBERT R TST Addr: 5471 W. WATERS AVE STE 1000 Address: 14217 THIRD ST TAMPA, FL. 33634 DADE CITY FL 33523 Phone: (813)806-7000 Lic: Phone: Work Desc: INSTALL LOW VOLTAGE SERCURITY SYSTEM ELECTRICAL FEE 60.00 � lJ'�y� ROUGH ELECTRIC CONSTRUCTION POLE PRE-METER FINAL (�=-� �� REINSPECiION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one of the following reasons: a)wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspection called d)work not ready for inspection when called e) permit not posted on job site t� plans not at job site g)work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "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." Complete Plans, Specifications and Fee Must Accompany Application. Ail work shall be performed in accordance with City ..---�" Codes and Ordinances. �- CONTRACTOR PER OF I PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: �� 1-� Date Received: [� �-�'3 Site: �"7 �/�-- 5/� �� Permit Type: - v � Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sheet shall be kept,a�vith the permit and/or plans. ,� l�/� Kalvin S tz r- ans E Date Contractor and/or Homeowner ,°f (Required when comments are present) / 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received �j°s�13 � � _ � C � Phone Contact for Permittln Owner'sName `~��J � T��,,,� � 7�wner Phone Number tin �Owner's Address 7 `� ��E C�7 Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS � S Z ( � ^� 'S L T# �� SUBDIVISION . PARCEL ID# — — �� — _ O p� J (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED � NEW CONSTR 8 ADD/ALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR � COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK FRAME � STEEL Q DESCRIPTION OF WORK �~'� 7� ,S O w V� 7/� 6 E' , �Z v (7 y C,Ia./7 �f BUILDING SIZE SQ FOOTAGE O O HEIGHT QBUILDING $ VALUATION OF TOTAL CONSTRUCTION �ELECTRICAL $ .,p'� AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. �PLUMBING $ QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � j �fZS� .t"1 �GAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address ' License# ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# —� OTHER COMPANY " L L C I�(, "' V SIGNATUR REGISTERED Y/ N FEE CURRE� Y I N Address �/ "j^ , / 3 3 63 yt � P/a- icense# RESIDENTIAL Attach(2)Plot Pians;(2)sets of Building Plans;(1)set of Energy Fonns;R-O-W Permit for new construction, Minlmum ten(10)worlcing days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed, Sanitary FaaUties 8 1 dumpster;Site Work Permit for subdivisions/large projects COMMERCIAL Attach(3)complete sets of 8uilding Plans plus a life Safety Page;(1)set of Energy Forms.R-O-W Permit for new constructlon. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. '"'"PROPERTY SURVEY required for all NEW construcUon. 1T71PIf�i�r��tr��e �L11� W f Directions. Fill out application completely. Owner 8 Contractor sign back of application,notarized If over 52500,a Notice of Commencement is required. (A/C upgrades over E7500) " Agent(for the contractor)or Power of Attomey(for the owner)would be someone with nota►ized letter irom owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) �fteroofs'if slilri"gl'es� S�ewers ` 5ervice Upgrades A/C Fences(PIoUSurvey/Footage) J , Driveways-Not over Counter if on;public roadways..needs ROW , „ � NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions" which may be more �estrictive than County reguCations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPOhISIBiL•ITIES: If the owner has hir'ed a contractor or contractors to undertake work, they may be required to be license,d in accor.dance with state and l.ocal regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FE�ES: The undersigned understands that Transportation Impact Fess and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or�nal power release. If the project does not invoive a.certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTIUN �.kEN LAW(�hapt�r 713, Flarida Statptes, as.amended): Cf valuatiQFl of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Flo�ida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner"prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I unde�stand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health 8 Rehabititative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone"V"unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used onty to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent prope�ties. tf use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless th� work authorized by such permit�is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days:,and will•demonstrate justifiable cause for th�extension. If work ceases for ninety C90)�consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FO.E3aMPR0VEM O YOUR PROPERTY. IF�(.Dt��INTER� INANCING, CONSULT WITH YOUR�„I�L�FI6ER OR AN ATTOR�FORE RECORD YO NOTICE OF COMMEN NT. FLORIDAJ T�.03) ,__._..__._.-._..- y _.._ _ ...._.._�. OWNER OR �-�� CONT OR Subscribed and swom to(o irmed)before me this Subscribed an swom o rmed)be e me this �S�3.v,,�y �,✓A-,�' ,Q.e�,�n�.a- � ,i.. s o, by •Q��e � Who isl re personally k on w to me or has/have produced Who i /are personally knovm to me or has/have produced � L as idenUficaBon. L7L- as identlflcatlon. L:Gl,,..•..��`�-� Notary PubHc C.%'`"�"�7' Notary Public Commission No. Commission No. � ••�;: ROBERTARMBTRONQ o T r m S T o �7r �s�+-s�iGo.�.. '•: :«. MY COMA�SSION N EE 872714 Name of Notary ryped,printed , me of Notary typed,printed or stampe �...• ;. � ��» , ••��a'.r?•., ROBERT ARMSTRONG 12;�,tA• eonded T1w Noury Pubwc Unde�w�Mea �`�' ��'G�A�NiSSION�EE 872714 � ,a-' EXPIRES:Fehruary 10,2017 ='.�� 8onded Thru Notary PuWic Underwritea Pasco County Property Appraiser- Physical Address List for: 15-26-21-0030-00200-0010 Page 1 of 1 Welcome : Records Search : Parcel Details : Physical Addresses Physical Address List for Parcel: 15-26-21-0030-00200-0010 Displaying 11 records View in groups of: 10 25 50 100 500 Street Number Street Name w Unit 37800 STATE ROAD 54 37802 STATE ROAD 54 37804 STATE ROAD 54 37806 STATE ROAD 54 37808 STATE ROAD 54 37810 STATE ROAD 54 37812 STATE ROAD 54 37814 STATE ROAD 54 37816 STATE ROAD 54 37818 STATE ROAD 54 37820 STATE ROAD 54 Pasco County Property Appraiser Page Layout Modified: 2/17/2009 1:10.37 PM The Local Time Is: 6/3/2013 2:18:44 PM http://appraiser.pascogov.com/search/physadd.aspx?parce1=2126150030002000010&eas=140317 6/3/2013 I fteactivadon =Signals needed only � Eacisting=Eguipment alreac�j there 3wap/Replace=Replaceexistir�gequipment w Wireless=RF Install=New equipment needed , ��1� C�-�� t-� .S�C� "'�P AC Commercial Power E Added$efore code if existing equip KP Keypad ��v6 Sounder SM Smoke Detector FL� Flood Detector iR Llght Sriitch C Cootacts Telrn Telephone CATerminal HD Heet Detector M4 Motion Detec[or CAM Camera T}�1N1 Thermosiat GS Glassbrea& MOD Lamp qppliance Module COM Computer HS Hom Shohe TMP Temp Sensor �� m� CELL Cellu4ar Bac&u CU Controlllnit HU Hookup P PS PowerSupply CO Car6on Monoxlde Deteetor DVR Digital Video Recordee lii6 IHUB RF Added before code if Wireless equip . ......_.... ... . ...._. .. ......._._._. �CUStomer Name ' . .. - - ...._.._......_. . ,- - �---- �- _......... ... , ........_..._. ........ r�cc�.<>5 t-�-�;,Y- �lv- .... ..5� . .........— , >�> ; :Address: �� , , � ,.....t........ . ............... n , �...... t C n�,�r�.—....—.—�..., ................................_ �.........,........., �-r,�._d � y 4� � , �S uare F ,........... . � '_' ...A..�. . . . . .:.,....� �-�� 'S�r2 t ; [ct# . ....,...... 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'....f.._. . ...i.... .......�. ......1.........:.........: ......'. � 1 e • j ...L.. ..•... ........: ......:.........�.......�.......:. � • f : .......3........L........�.......3......�.� �� SOUND & SECURIlY CABI�S SOUND & SECURITY C �BLES 0 , CONDUCTOR COIOR CHART NON-PLENUM ASTM Bore Copper , igh Grode PVC Ins�lo��on wisied/Cobled Condodon er Roted Groy PVC locke� I � Blncic 1 Blotk 1 Block li�Brovm/Black 2 . Red 1 Whne 2 Red 12 Blak/Red 3 Whi�e 3 Red 3 Bluc 13 Blue/Red � � � � � � 4 Grcen 4 6reen 4 Oronge 14� 6ronge/Re� ADT SCN AWG H�'� $TRAHD ��K�g k POSSIBIE USE 5 erown 5 @�o.m S Ye9ow 1 S Yellow/Red Pd1GE PR COt.'D. FkCKkGE 0. . 8�'PPIICATIONS 6 Blue 6 Bioe 6 Biown 16 Brawn/Red 45460bSWHA 22 1• SOIID WNITE .) 3' Residentiol iur(oce 7 Oronge 1 Oronge 1 Red/Block 17 Block/Blue 4�� SDO"BX mounl;while irim. B Ydlow B Yellow 8 Blue/Block 18 Red/Blue 493I44 21 4• SOLID BEIGE 1 8" Residenlial Contocts 9 Pmple 9 Purple 9 Oronge/BI«k 14 Oronge/Blue 140089 SDO'CL Delectors ; � 481143 21 4• SOIID WHITE _� g' Heypod 10 Gioy 10 Groy 10 Yellow/61ock TO Yellow/Blue �4�5 11 Pnk I I Pink � 500'Cl �2 Ta� �1 Ta� 4546086BRU1 21 4' SOII� BROWN .1.6' � 4546088BR( S00'Cl 13 White/BMck • • ••• i 494461 22 10 SOIiD WNIIF I 4' Panel Inlerface PAIR/ Ist(OND/1nd(OND 140014 S00'RL 14 White/Red � � �'� 1 Block/Red � � 15 Whi�e/Green ; 494462 22 10 SOIID WHITE 0" 16 Whiie/Oronqe Poir Ist/2nd 2 Yellow/Green BE Beige • � 140015 500'Rl �7 �1e�B�� 1 Blotk/Red BR Black � ` 1 Blotk/While BL Blue �(ooduc�or colon ore RE,GN,YW,6K ond Aave a iondom hlitl. [ I 8 While/Brown • . ,,- • E 19 While/Yellow 3 Black/Green BR Brown � PAIR/ I st(OND/2nd(OND � � 20 Whi1e/Pur GN Green � � Block/Yeilow - - ---2 7s. IA • GR Gro �. 1 _ � Re�/�� I� y � 1 � 1• 1 r 1 22 Block/Red � � Block • 23 BIoJc/G�een P1( Pink 740016 1 B To )%16 GRAY ;90" Aiphone(olor Ydeo 1 Red . � • PR Purple 1000'BX 14 Block/YeRow 3 U.Blue � 4546)9AGk 14 2- 19 X 16 GRAY 15 Block/Blue PAIR! lst(OND/2nd(OND RE Red i . 39" Lock Power/Mog lock 4 Yellow : 1000'Rl 26 Blatk/Brown � Red/Whi�e w/Red VI Vide� 2� Blotk/Oronge � B�o�k/Whlle w/Black H ��e Condue Im rolor mde<ho�lt on poge 8.� 28 elak/Gror �� 3 Green/1Nhiie w/Green � Yello�� '(ode I o(ode 3 •Code)0 (ode 1! 29 Block/Purple 1 U.Blue 4 hde/Whi�e w/Yelbw 30 Red/G�een 7 Yellow � PAIR/ I st(OND/Tnd(OND � 1 Ornnge w/1Nhite White w/6�on e �— • � _ � ___ ? Btue w/While , Whi1e w/Blue DON'T SEE ITz FAX 908�87�8860 � 9 t' � � I r � _"-�--^----------� � � SMALL BUSiNE55 CONTRACT ��n ,�� Uj4 a�`'� II��I�IIIIII��Il�lnnllll I r��-G�i Sz.�� ss° I 5400UE03 I� I i CONTRqC7 �°-�.- ` f '� ACCOUNTNO � � y �D � I bqTE �C � O m SOURCE� I I � � I ADT LLC I I dba ADT Security Services("ADT'7 i Business Name n �. i! ; Office Address ,�Customer'or"I'or"me'or'my°) �� 7 � � �� 1.�i� j i I , ' ' _" ._ _.�.c�_ i f � I I ��r `'""1.,- ✓ I Premises' ^ I i Address ' �� ~ 5�' �s S � ,f'i C fq L1 �'..�' � � iV:� �� , ;� C m�_,{,�.� f' ��!�= . j Gty �`- '-i :r ;(? �-'r � ! l, State�L7 ZIP S 5 _1�7 I �Responsi6fe r� �+ � �Party Name � ''- � ��i i L � (2 7 �� r, I i�� Im� �/ � �Tax Exempt No. Tax Expire Date I I V m� I www.MyADT.com ; I 800.ADT./XSAP� �Protected Premises' �. � -� , i (800.238.2727) ;Phone(Required) t� � --' ; G�`� � O �Treditional Phone O Other(Quahfied) O Other(Non-Qualified) O Fill in if Billing address is the same , '-`7��'.��'-4`'O"�z I` Billing � Address � f (�'� I CiTy Billing Phone � _ State ZIP� (Required) � IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE � � ^ -�-- I _.__..___._____ (see Paragraph 83 of the Terms and Conditions for explanation) i �� . � � - �. , --------------------------------.�._-- ----- i EMAIL `� � �=� � � ��r '� v .� Fi L ^rS i. Y A }�G�G . L G � 1 _ � I 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 unsuburibe or opt out by emailing donotcontactQadt.com or by calling 888.DNC4qpT(888362.4238).Initial here � 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 I phone number,or any number that I subsequently provide for billing purposes,I agree that ADT may contact me at this/these number(s).I also agree � to receive calls and messages,including pre-recorded messages and calls and messa es from automated dialin I 9 g rystems,at the number(s)provided. Ownership of System'a'nd Equipment: O Customer-Owned 6ADT-Owned .� ,j ---- i Vertitals O Retail O Business Services O Personal Services O Automotive/Transportation � � O Grocery/FOOd O Health Services O Restaurants O Wholesale O Other i I acknowledge and agree to each of the following:(A)this Contract consists of six(6)pages.Before signing this Gontrect,I have read,understand and I agree to each and avery term of this Contract,includ'eng but not limitad to Paragraphs C and E of the important terms and conditions.(B)The inkial I 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, I burglaries,robberies,medical problems and other incidents are unpredictable and cannot always be defected or prevented by an alarm system.Human i error is always possible,and the responsetime of police,ftre and medical emergency personnel is outside the control of ADT.ADT may not receive alarm slgnals if communiwtions or power is intercupted for any reason.(D)ADT recommends that I manually test the alarm system morkhly and any time I change telephone service,by calling 800:ADT.ASAP.(E)This Contract requires flnal approval by an ADT authorized manager before ADT may I provide any equipment or services,and if epproval is denied,then this coMract will he te�minated,and ADT's only obligation wi[I be to notify me of I such termination and refund any amounts I paid in advance, � ADT Representative � �� i `"\ ` I '.'�.-.'?^ _�., �. "��""7- ti,• �,�. Rep License No. Rep � � , �� (If Required) ID No.�� Custome�s Approval:Original5ignature Required I �---. : X ' , __'�,� m/m , � ,� ;, �.� , :,�___—_ �j � W NOTES � � ~� }�� .�� '� ----- ---------- +''_ �=�'=— �� ---- - _�. I i -------------------- -------t.,t`G;� _;,� ::c tt �'�%-" r- I _ .�,Z--c�? -- --;4=------------- -- � ,.�_____ _. -- � ---�_.___----"-- a I � �- --------- -_._--�_LC_ �e i.c G', � T_--,_-.___ -_.__ � � I I __'________.___'_.___.__"'___'___-_____'__"".__-._- � � 1, _____'.________________'__.'.___.______�_____'___.____._'_.-.'___-_-'_.___'_".-________—'-_.___-' - � i I i 1 of 6 02073 AOT lLC dba ADT Security Services. � Administrative Copy All rights reserved.(02/13) � , ------�_._�.__�__---, _ � SMALL BUSINESS CONT�R N�I��II�IIIIIIIN�I�lII�IIIIIINI ' b400UE03 � CONTRACT � CUSTOMER DATE A6COi1NT NO ��B LEAD � NO SOURCE� � • • •'• � I A�artn Monkoring and Not'rfication Services _ � Monthfy Service Charqe � Monthty Service Charge I m Burglary�B,v -------��- �---- --------------------- � tU'� ` � Orl$Ft2 52rvi[25 � O Holdup(HU.� �)r � ____________ _ j� O Guard Response O Interior O Exterior � � • --------------L--.�.__ ,- ` I O Duress � �"—/--�"� f- --- -----� j-s I i�n` t �__"' ,� J.� I 1�l� �� ,� "` I O Two-way voice —� Tot,31 Monthly Strvice Charge� `'�T'j" � ------ ! � O Gitical Condition Monitoring(CGM) r �� ----"—� --- 1 -- ----_ I '-,�-T OFlood OTemperature i� �'� I i s�� Initial Fee O Paralle3 Protec[ion �� O Annual UL Cert'rficate Fee "� � 'a I - ----------------- ----- j•�+ I O ADT DataSource �--I---------- -'-- _._..-.-_-- i� '�ADTto obtain Electrical Permit � O Open/Close Login �� j C�Municipaf Electrical Permit ;� �;z� S�� ----� � O Supervised Scheduled Open/Close � �O Customerto obtain and pay for inkiaUannual munidpal alarm use permit.Failure to � _ � obtain and provide ADT with ihe municipal alartn use permit registration number could � i resuh in no municipal fire/police response m an aiarm from the premises and/ar a fine. � �ADT Ent Solutions - -- - ! ( �O Other ! -------ry-------- ------�� !�t� t � I Other Services --------------�--------------- � Instailation Price � � �.r � � I �Quality Service Plan(QSP) �� i,� ` j ;Taxable Amount(Leave blank'rfADT-Owned) ;� O If Quality Service Plan(QSP)is Declined Customer -"`-�------'------------- — I must Initial here Non-Faxable Amount(Leaveblan[c'rfADT-Owned) ;� � I O Preventative MaintenanceJlnspections Per Year !� I O 7 O 2 03 O q O 6`_O 12 _ _ _ Connection/Ac[rvarion Fee ,¢ I - ------- i.�r � O Training � Sales Tax on Installation* �� , `� ��, , O Direct Connection Services � -_----_-_ ------- �� I Total Installation Charge* -------- !� .�� ;�, 1 --`-------�--------- I C'-�"'� � O Monthly Recurring Municipaf Fee Trip Charge Received 1 ; (SubjeR to change based on local law} i ��. ,N�; - O Customer to obtain and pay for municipal �� Deposit Received:100%deposit required<5500 ; � alarm use permi# i I Minimum 50%deposit required f500+ � ��-' � �O Money Order O Check 0 GediVpebit Card,� `�'�' ""� "'If applicable sales tax not shown,it will be added to the first invoice,if I not collected at the time of installation. �Balance Due` i Q� � � • • • • •- ,•P Quantity � Device Descripti r � I --� -1--c--- „�y��--- I Device Lowtion i � '--i-_ ;�.��,��av� i �� - - � I � . - � - _.ti�,`-��i'" „-t;-,-ri-::�� i, ">�.� ;y-�.,, 1 I _ j1 i�` y -.f_"'1 c :.� S? ..�u , r w,. . ^ � --'-�- — t: cc�, _��-1-_�_�._.._�YJ� ��}�''�, CS F-E � f � -------`- _:��T � � j I I � �',i'°r� I __ �1.�L-:�Y_�-_—__- �!�' .��4_ � I � ---�— '�_- _-_-___ -___'- � t .__�..s-�_ � I ^ r`-l� t '• i ' I --- � � I � —€� ---- I -- -- ----- � i I � __'____ � � I � —�--______—____---�_—____�__ � �� y '_--.--�----------'--'--- ' � ��c,� i --- ------- i I ; i ----- + � __�� -- -_-_ � ___ I ' t � �__�" - ---- '_ 1 I f � I I � j � ___"—_ � _—.'__—_ i ' ' I i _�-- '_' ---_—__— __" __,._ —_' _. i I � � � Estimated Installation Start Date � I I 2 Of 6 02073 AD7 LLC dba ADT Security Services. � • �---� -- __ A!!riqhts reserved.(OL13) �