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Permit Security System 599 Atlantic Suite 5 2012 ,� � "r o CITY OF ATLANTIC BEACH j 800 MO :� =� ATLANTIC BEACH SE IN F L L E ROAD 32233 INSPECTION PHONE LINE 247 -5814 Jli Vii Application Number 12- 00000213 Date 2/22/12 Property Address 599 ATLANTIC BLVD UNIT 05 Application type description ELECTRIC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc low voltage security system Owner Contractor EAKIN, PAUL ADT SECURITY SERVICES INC 1745 BEACH AVENUE 5471 W WATERS AVE ATLANTIC BEACH FL 32233 TAMPA FL 33634 Permit ELECTRICAL PERMIT Additional desc . Permit Fee . . . 90.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 8/20/12 Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 90.00 90.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 94.00 94.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: a j 9c( 44(c-c j i VC-1( 34-Q S PERMIT # JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE Uo VALUE OF WORK $ 3 3 NEW SERVICE 1 1 Overhead 1 1 Underground nJ Underground up Pole ❑Residential (Main) Service ❑0 - 100 amps ❑ 101 150amps f l 151 200amps ❑ amps # of Meters 1 Commercial (Main) Service 1 0 -100 amps 101- 150amps 1_1151- 200amps ❑ amps ❑CT Service amps Conductor Type Size C i Multi- Family (Main) Service ❑ 0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters r- Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps 1150amps ❑ 200amps ❑ amps ❑CT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: 0- 30amps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑ Swimming Pool ❑ Sign ❑ Smoke Detectors Qty ❑ Transformers KVA _ l Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection C Panel Change f 1 OH to UG X Other: Installing low voltage security system 12 volts 2 amps Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name E c lc( Pau( El A L Phone Number 7 - 3 - ) 2 - 0 00 Electrical Company ADT Security Services Office Phone 904 - 732 -7100 Fax 904 - 732 -7760 Co. Address: 7818 Philips Hwy City Jacksonville State FL Zip 32256 License Holder (Print): c.1TSfi®/t/i4 , State Certification/Registration # EF2000413 Not/r' •i • •/ )'• 1 bier �S� /r� 7 411 ' 4N Notary Public State of Florida wo - '� f Keith DePew ' r d subscribed before me this 1 . My C ommion EE 165279 /I day of Fr? ��t��$ `1 20 2 of �► Exp ssi 02/01/2016 f / ignature of Notary Public 4 I q)) -�,,r; 7.,,,'5 . ?i/"'' 7 , / , (LAIC - 1�44� - , � 97 zY i s T . Co 7 r' , q , .r: '7,..--i c./> "N t17,-, DP c, P�'^ / \ / *011 SMALL BUSINESS CONTRACT II II III II II III III I II 3081UE05 \ / - CONTRACT I / /1, ACCOUNT NO lJ { I �4 JOB NO SOURCE DATE I vi - 17 � I - 1 ' Section 1. Customer Info ADT Security Services, Inc- ( "ADT ") Business Name ( "Customer" or "I" or "me" or "my ") Office Address , �l �f��l�r � NAli ( HAKkI E5QUI1 E V /l& (-- A ddress 3 3-sle 57 7 ,C1L.AOJ _7( a0(« VAkD ST s /015 ' - - / 92 YSl V Cis A Y L A lJ I Z C B A <- f/ State FL ZIP 3 2 2 3 3 Party Responsible A r^, G 4 I, U [ r l 5 O J Protected Premises' e mil es' ! & ' 3 7 2 c © O 0 Traditional Phone 0 Other (Qualified) 0 Other (Non - Qualified) www.MyADT.com 1.800.ADT.ASAP Alternate 9 0 L/ 8 Ci 1 gs �, O (1.800.238.2727) Telephone 1 O Home *Cell O Work IF FAMILIARIZATION PERIOD IS i Alternate 2 REJECTED INITIAL HERE O Home 0 Cell 0 Work (see Paragraph B3 of the Terms and 1 ' Conditions for explanation) i EMAIL k 4. J1 C y 1 1C - C'Af'"r I.I LO)v.) • 'R i Z. 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 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 or notices about the alarm system at the telephone number(s) provided by me. Initial here Ownership of System and Equipment: 0 Customer -Owned MP ADT-Owned Automotive/ Verticals Retail: Business Services: I Personal Services: Transportation: Grocery /Food: Health Services: Restaurants: Wholesale: Other: I ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, 1 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 15 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. (D) ADT RECOMMENDS THAT I MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME 1 CHANGE TELEPHONE SERVICE, BY CALLING 1.800.238.2727. (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 Name Rep. License No. Rep. L a i 5 /c ✓CCrZ (If Required) ID No. -' Customer's Approval: Original Signatu qui a x � �! ■ N - o® z.. or INSTALLER N • S (Special I r ctions /Directions Cross Street) 7 5>= -re- - 7 , -.0 /7rrSfC C7 Gf " 'f _ vm ptt/..J r . tic c- re e c tiff• - ---Q G_.i. 44-6-5' ,..-f /0.J1i Lk_ I / *\ SMALL BUSINESS CONTRACT II 11 III II 1 II III IIII 11 3081UE05 r ®u o® CONTRACT � 9.. CU570MER JOB LEAD DATE ACCOUNT NO - NO SOURCE Section 2. Services to be Provided Alarm Monitoring and Notification Services Monthly Service Charge Monthly Service Charge ® Burglary (BA) $ 2j ( - On Site Services —■ O Hold -up (HUA) $ 0 Guard Response 0 Interior 0 Exterior $ Duress $ .11-1,J _ 0 Other _ $ O Two -way voice $ Total Monthly Service Charge $ / y O Critical Condition Monitoring (CCM) Initial Fee O Flood 0 Temperature O Parallel Protection $ 0 Annual UL Certificate Fee i $ O ADT Select° DataSource $ 419 ADT to obtain electrical permit /O q o@ O Open /Close Login $ O Customer to obtain and pay for initial /annual municipal alarm use permit. Failure to 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 Supervised Scheduled Open /Close $ I 0 Other 1 $ O ADT Select Entry $ I Installation Price i $ 33').' Other Services Taxable Amount (Leave blank if ADT Owned) $ ■ 0 Quality Service Plan (QSP) ;77,--)C— Non- Taxable Amount (Leave blank if ADT - Owned) $ O If Quality Service Plan (QSP) is Declined Customer • must Initial here Connection Fee imill 0 Preventative Maintenance /Inspections Per Year $ 41 Sales Tax on Installation $ 01 02 03 04 06 012 _ ._. _. -- -- ----- - _ -. • Tax Exempt No. 0 Training $ Tax Expiration Date O Direct Connection Services $ Total Installation Charge $ it 8 7 0 Monthly Recurring Municipal Fee Deposit Received: 100% deposit required < $500 1 $ / � Q (Subject to change based on local law) $ Minimum 50% deposit required $500+ 7 v 0 Customer to obtain and pay for municipal alarm use permit 0 Money Order * Check 0 Credit/Debit Card -- 1 *If applicable sales tax not shown, it will be added to the first invoice. I Balance Due* $ • • • '. • •' • '• Quantity Device Description Device Location i�7 % �'I�1 �'r 1 / V-Sc- 7 47-74( tzle4,746— 79",-7-71.91=.14----- -i — 1 4 -- 77 — -- — °2 -- _Dove ( -a_ — ehInse,.f 1 fr 0,7,7 - -- — - -- — -- - - - - -- fi / ?At,h1-61 ,0 It' ek.1 44-7i I- ,-' 0 r - --7" --- 71 - 11 -7//'WV7 / e R SMALL BUSINESS CONTRACT 1111 111 11 11 III IIII 11 r ' 3081UE05 \ / e 111 ®© CONTRACT TOMER JOB I I I LEAD DATE , ACCOUNT CUS NO NO SOURCE Section 4. Billing - O Check received for: • Installation: Check # lk ,2 O Amount $ II(/ 8 Q 0 Annual Service Charges Collected: Check # Amount I authorize ADT: *To withdraw all Service Charges from my bank account: G To charge my credit/debit card for 0 Annually 0 Semi - Annually 0 Quarterly O Monthly • 0 Installation 0 Installation Deposit Only 0 Remaining Install Balance Only Choose one: 0 Checking 0 Savings 0 All /Recurring Service Charges Name of Bank/Credit Union 0 Annually. 0 Semi - Annually 0 Quarterly 0 Monthly 0 7 J Sjr O VISA O MasterCard O Discover O AMEX ABA Routing Number Bank Account Number Credit/Debit Card Number Expiration Date M M Y Y Recurring Service Charge Amount $ 1 7 1 .2 99 i Recurring Service Charge Amount $ Name as it appears on bank account Cardholder's Name NA /1a-1 C 17 L*4 /L - 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 indicated above. I may revoke this authorization only by notifying ADT and my bank in all Recurring Service Charges indicated above. I may revoke this authorization only by writing at least 10 business days before the scheduled debit. If no oval is filled above, I notifying ADT and my bank in writing at least 10 business days before the scheduled debit. service charges will be withdrawn monthly. I If no oval is filled above, my creditldebit 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, 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 compan or bank, so long as the amount corresponds to the terms indicated in this Contract. 0 To send me a b i l l : O Annuall� l • v '4111111 .r . , • 0 1 er DOA A roval If no oval is filled, ADT will send bill quarterly. Authorized Account Signature: _ _ - ,_ Section 5. Customer and System Data — Consolidated National Billing # Account # National Account Co Name �� 4 , �K CS �r J r ( Manager ID /) L - r . Y _ n - Billing i 4/ L 4fr /� c`1S)`E-V/9ld Address r // Apt. /Suite City 1 L /i- O1'S State ZIP � ^ Cross St. Premises' Phone 9 4 37.; 50 O Billing Phone (Required) (Required) Municipality Municipality Police Name Fire Name Job Type • New Sale 0 Changeover 0 Resale 0 Upgrade Control Type ® HW 0 RF - -- - --- - ---- --- - ---- -------------------------------- Proflle ` j q Preferred Monitoring Communication Account Management Q Codes: Ownership ` System 1 Service r_ Services / Method - Services / Guard / Market Resale - Former ELW /QSP 1 Service / Group Y Acct # _ Former CS # Profile Preferred Monitoring Communication Account Management Codes: Ownership / System Service Services Method Services Guard Market Resale- Former ELW /QSP Service Group Acct # Former CS # Section 6. Password r0 l c 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 old contacts by calling ADT toll -free at 1.800.238.2727. Section 7. Emergency Contact List _ 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, 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 , A ( q 6 [ [ e O • O • O Print First/Last Name /V A ! /S D/ Phone ! ' �9 g Hom Cell Wor Yes No O O O O O Phone Home Cell Work Yes No Customer /Emergency Contact #2 // Q p p Print First/Last Name K� / if �� Pho l V Y . "� / ( O Y D Ho Cell W � No 0 0 0 O O Phone Horne Cell Work Yes No Alternate /Emergency Only Contact L k!,,, gat/ -,7Y 6S • 0 0 0 •