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PW-16-1542 a s f 2 4,64.2 Miami Shores Village 10050 N.E.2nd Avenue NE r 0, Miami Shores,FL 33138-0000 '_ 3 � RO Phone: (305)795-220 "` P@ff�5�f �D 4 Expiration: 09/06/2016 Project Address Parcel Number Applicant 1551 NE 103 Street 1132050310210 ' Miami Shores, FL 33138- Block: Lot: MARGARITA DOSAL Owner Information Address Phone Cell MARGARITA DOSAL 1551 NE 103 ST MIAMI SHORES FL 33138-2627 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 00 E Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PW-6-16-60035 DBPR Fee $2.25 06/08/2016 Check#:10013 $ 115.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 06/02/2016 Check#:10143 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore,I authorize the above-named ntractor to do the work stated. June 08, 2016 Authorized Signature:Owner / Applicant / C n actor / Agent Date Building Department Copy June 08,2016 1 Miami Shores Village JUN 0 2 2016 Building Department o 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ILI ' BUILDING Master Permit No. Pwu — PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F—]PLUMBING ❑ MECHANICAL KPUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 1551 NE 103rd ST. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): RIGHT OF WAY Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954453-0806 Address: 5101 NW 21 AVE. STE. 460 City. FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA Phone#: 954453-0806 State Certification or Registration#: E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration R New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL A NEW 3/4" PLASTIC GAS SERVICE LINE LINE BY DIRECTIONAL DRILLING Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ -11;7> (L (Revised02/24/2014) c 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,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 acknowledged before me this day of 20 by day of oOe ;20 by who is personally known to 'A X"-Cyt_q q7;S ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identificat(ionho did take an oath. NOTARY PUBLIC: NOTARY P ,•SPRY Pia,, HUS (?T NJf4EZ , 10 S!tt to of Florida },. ° Ti e Sep 11,20i7f Sign: Sign: F 043679 i '+ n �il Print: Print: Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Construction i ra°c'B I Eying Board BUSINESS CERTIFICATE OF COMPETENCY ^^ ,� E1608 l--` PEOPLES GAS SYSTEM INC D.B.A.: VEGAJESUS Is certified under the provisions of Chapter 10 of Miami-Dade County DATE(MM/DD/YYYY) A�® CERTIFICATE OF LIABILITY INSURANCE 06/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MCGRIFF,SEIBELS&WILLIAMS,INC. NAME: P.O.Box 10265 A/C NNo Ext): 800-476-2211 aC No Birmingham,AL 35202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:Associated Electric&Gas Ins.Svcs. Peoples Gas System TECO Energy,Inc. INSURERC:LM Insurance Corporation 33600 702 North Franklin Street Tampa,FL 33602 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:KUPY3T4E REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY BX COMMERCIAL GENERAL LIABILITY XL5129405P 07/01/2015 07/01/2016 1 1,000,000 EACH OCCURRENCE $ Self-Insured Retention X CLAIMS-MADE FIOCCUR $1,000,000 AMAGETORENT PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 JECT POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY XL5129405P 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT 1,000,000 Self-Insured Retention Ea accident $ X ANY AUTO $250,000 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ 1HIRED AUTOS AUTOS Per accident B UMBRELLA LIAB OCCUR XL5129405P 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB Hx CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Excess Workers'Compensation: 07/01/2015 07/01/2016 X I PER oTH- B AND EMPLOYERS'LIABILITY Y/N EWS9318597-04(Statutory Limit is STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVEexcess of$35,000,000 insured by LM E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A Insurance Corporation) 1,000,000 (Mandatory in NH) Employer's Liability:XL5129405P E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Workers'Compensation EW5-64N-004918-125 07/01/2015 07/01/2016 Each Accident or Each Employee for Disease $ 35,000,000 $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excess Liability policy provides insurance in excess of Peoples Gas System's Self-Insured Retention as stated above. Jesus Vega is the qualifier for TECO Peoples Gas. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Miami Shores AUTHORIZED REPRESENTATIVE A4. Miami h 2nd AveMiami Shores,FL 33138 Page 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD es Village C_ I �fy B*_ I JUN 0 2 2016 SYMBOLS: Work 1% nnu ZOMN'G DEPS J,.(���. ROAD ORK DEPT ROAD 6001 P)L D C� DEPT AHEAD AHEAD LY Work A,ie vo Flagger T 1.0 C(_klpt. �J�J Automated Flagger Assistance Devices kSUUBJECT (0 C(-,NIP[. �IPSWJ_NaAll FEDERAL (AFAD),With Gate See Table 1 �250' A Lane Identification+Direction of Traffic L)C TATE ANCAA. AND REGU 10 qj .0 EO -----------------------------ff__ff_ff_ff_ ---- ------------------------------ c=* E1.1 0 Work Area A C Taper Length Tangen Device Spacing Taper t 50'to 100, 50'to 100'_/ May be omitted if ROAD WORK AHEAD sign is installed upstream within the project limits. ROAD BE GENERAL LAYOUT WORK ONE LANERpkD PREPARED AHEAD AHEAD TO STOP GENERAL NOTES: 1.Special Conditions may be required in accordance with these notes and 7,When Buffer Space cannot be attained due to geometric constraints,use TABLE I the following sheets. the greatest attainable length,not less than 200 ft. DEVICE SPACING 2.If the Work Area encroaches on the Centerline,use the Layout for B.RailroadCrossings: Distance Temporary Lane Shift to Shoulder on Sheet 2 only if the Existing Paved a.if an active railroad crossing is located closer to the Work Area Maximum Spacing Maximum Spacing of Shoulder width i s sufficient to provide for an IF lane between the than the queue length plus 300 feet,extend the Buffer Space as Posted of Cones or Type I ornr Type 11 Between Buffer Work Area and the Edge of Existing Paved Shoulder.Reduce the posted shown on Sheet 2. Speed Tubular Markers ..rricad.s1Pane1s1Drus Signs Space speed when appropriate. b.if the queuing of vehicles across an active railroad crossing cannot be avoided,provide a uniformed traffic control officer or On a On a On a On a T_ 3.Temporary Raised Rumble Strips: ,agger at the highway-rail grade crossing to prevent vehicles Taper Tangent Taper Tanoent A 8 CD a.Use when both of the following conditions are met concurrently: fr.m stopping within the highway-rail grade crossing,even if 25 201 5a 201 501 2001 1 200 200'1 1001 155' i. Existing Posted Speed is 50 mph or greater; automatic train warning devices are in place. 30 20' 501 201 501 2001 1 200' 2001 1001 200 il.Work duration is greater than 60 minutes. b.Use a consistent Strip color throughout the work zone. 9.ROAD WORK AHEAD and the BE PREPARED TO STOP signs may be 35 201 501 201 501 2061 2001 2001 1001 250' c.Place each Rumble Strip Set transversely across the lane at omitted If all of the Following conditions are met: 40 201 so, 20' 50' 200' 2001 2001 1001 305' 1 locations shown '.Work operations are 60 minutes or less. 45 201 50, 201 50, 350' 3501 350' 179 360' d.Use Option I or Option 2 a,shown on Sheet 2.Use only one option b.Speed limit is 45 mph or less. 7 throughout work zone. c.There are no sight obstructions to vehicles approaching the work 50 20' 50' 201 100' 500 5001 001 501 42" area for a distance equal to the Buffer Space shown in Table 1' 55 261 561 20' 100, 26401H 5001 49Y 4.Additional one-way control may be provided by the following means: d.Vehicles in the work area have high-intensity,rotating.flashing, 501 1001 2640' 5001 5701 a Flag-carrying vehicle; oscillating,or strobe lights operating. TJ b�Official vehicle; e.Volume and complexity of the roadway has been considered. 65 1 201 1 561 1001 2640' 50-01 64 c.P f I i Hot vehicles; f a railroad crossing is present,vehicles will not queue across 70 1 201 1 54Y 2640' .5001 730 d.Traffic signals. rail tracks. g.AFADs are not in use. When flaggers are the sole means of one-way control,the flaggers must be in sight of each other or in direct communication at a//times. 10.See Index 600 for general TCZ requirements and additional information 5.When a side road intersects the highway within the TTC zone,place CONDITIONS additional TTC devices in accordance with other applicable TCZ Indexes. 11.Automated Flagger Assistance Devices(AFADs)may be used in accordance with the Notes on Sheet 3. WHERE ANY VEHICLE,EQUIPMENT, 2 6.The two channehzing devices directly in front of the work area may be WORKERS OR THEIR ACTIVITIES omitted provided vehicles in the work area have high-intensity rotating, ENCROACH THE AREA BETWEEN flashing,oscillating,or strobe lights operating. THE CENTERLINE AND A LINE 2' 2 OUTSIDE THE EDGE OF TRAVEL WAY. 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