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PW-17-2168Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 241 NW 91 Street Miami Shores, FL 33150 - Permit Permit NO. PW -8-17-2168 Permit Type: Public Works Work Classification: Public Works Permit Status: APPROVED Issue Date: 8/29/2017 Expiration: 11/27/2017 Parcel Number 1131010331340 Block: Lot: Applicant LORI BRANDT Owner Information Address Phone Cell 241 NW 91 Street MIAMI FL 33150- Contractor(s) Phone Cell Phone TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Valuation: Total Sq Feet: $ 1,000.00 0 Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.00 $0.00 $0.00 $0.20 $100.00 $3.00 $0.80 $104.00 Pay Date Pay Type Invoice # PW -8-17-65004 08/29/2017 Credit Card 08/28/2017 Check #: 1592 Amt Paid Amt Due $ 54.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Excavation Review Public Works Final Public Works 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 informt construction and zoning. Futhermore, I authorize the above -n Authorized Signature: Owner / Applicant / Building Department Copy n is acc ate and that all work will be done in compliance with all applicable laws regulating ed o trtor to do the work stated. August 29, 2017 / Agent Date August 29, 2017 1 BUILDING PERMIT APPLICATION El BUILDING ❑ ELECTRIC ❑PLUMBING J MECHANICAL JOB ADDRESS: City: -Miami Shores Village RECEIVED Building Department pr�82011 S+� FBC 2014 G2 Master Permit No. rPINI 1_ 21 (o Sub Permit No. -PIA' 42 - 17 ._3 j 9 ❑ ROOFING ❑ REVISION LI EXTENSION RENEWAL El PUBLIC WORKS ❑ CHANGE OF n CANCELLATION SHOP CONTRACTOR DRAWINGS 9 � s; 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 - / Lv Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): RIGHT OF WAY Address: Phone#: FFE: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: TECO PEOPLES GAS Phone#: 954-453-0806 Address: 5101 NW 21 AVE. STE. 460 City: FT. LAUDERDALE Qualifier Name: JESUS VEGA State: FL Zip: 33309 Phone#: State Certification or Registration #: E1608 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1000 954-453-0806 Type of Work: ❑ Addition ❑ Alteration Square/Linear Footage of Work: ❑ New ❑ Repair/Replace El Demolition Description of Work: PERMIT RE -NEW FOR A GAS SERVICE LINE Specify color of color thru tile: Submittal Fee $ 5- , Permit Fee $ CCF $ CO/CC $ Scanning Fee $ �71 Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ q • W (Revised02/24/2014) 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 '2_ 3 day of 201 % , b ..- y who is personally known to ho is personally kng to 6,0-ak) me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: identifi NOTA Y tion a d who did take an oath. PUB IC: k Print: Seal: :-',•••••••":;!.%•HUBERT NUNEZ = MY COMMISSION # GG 104234 :;-7;_ EXPIRES: September 11, 2021 dry'*' ItAE9 p>p it f3 WANK* as ******** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACORD CERTIFICATE OF LIABILITY INSURANCE f`..---- DATE(MMIDDIYYYY) 1!18/2017 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 Marsh Canada Limited 120 Bremner Blvd, Suite 800 Toronto, ON M5J 0A8 CONTACT NAME: PHONE 1-866-616-0088 FAX (a/c, No, Ext): (A/c, No): 416-349-4564 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Associated Electric & Gas Ins. Svcs. AA -3190004 INSURED Peoples Gas System TECO Energy, Inc. 702 North Franklin Street Tampa, FL 33602 INSURER B: Associated Electric & Gas Ins. Svcs. AA -3190004 INSURER C: Associated Electric & Gas Ins. Svcs. AA -3190004 INSURER D: Everest National Insurance Company 10120 INSURER E: Associated Electric & Gas Ins. Svcs. AA -3190004 INSURER F: K CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 16-17-502- GAEW 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVO POLICY NUMBER POLICY EFF (MMIDDM/YY) POLICY EXP (MM/DDrYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY XL5692901P 12/01/2016 12/01/2017 EACH OCCURRENCE $1,000,000 K CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ X SIR $1,000,000 MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- JECT GENERAL AGGREGATE $1,000,000 POLICY LOC PRODUCTS-COMP/OP AGG $ OTHER $ B AUTOMOBILE LIABILITY ANY AUTO XL5692901P Self Insured Retention: $250,000 - 12/01/2016 12/01/2017(Eaaccident) COMBINED SINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS - - SCHEDULED AUTOS NON -OWNED AUTOS. BODILY INJURY (Per acddent) $ - PROPERTY DAMAGE (Per acddent) $ $ C UMBRELLA UAB OCCUR XL5692901P 12/01/2016 12/01/2017 EACH OCCURRENCE $1,000,000 X EXCESSLIAB X CLAIMS -MADE AGGREGATE $1,000,000 DED RETENTION$ $ D E WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y/N 4NY PROPRIETOR/PARTNER/EXECUTIVE NO OFFICER/MEMBER EXCLUDED? Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below N/A Employer's Liability: XL5692901 P Excess Wokers' Compensation: EN4GL00054-161 12/01/2016 07/01/2016 12/01/2017 07/01/2017 OTH- X STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1 OOO, OOO E.L. DISEASE - POUCY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 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. The above noted policy placements were made by Marsh USA Inc. Marsh Canada Limited has only acted in the role of a consultant to the client with respect to these placements, which are indicated here for your convenience. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg. Dept. 10050 NE 2nd Ave Miami Shores, FL 33138 �I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,,,�,e�/' ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CTQBBoard Construction Trades Qualifying BUSINESS CERTIFICATE OF COMPETENCY E1608 PEOPLES GAS SYSTEM INC D.B.A.: VEGA JESUS of Chapter 10 of Miami-Dade County Is certified under the provisions • •••• • • • ••• •• •• • • •• • •• •• • • • • • • •• • • • • • •• • • • •••• •• • •• • •• •• •• • • •• • • J L J L • • . • • • • •�• • -- . . • • ••• •• • • •• • • • • • • • • ••• zoo , 200' 400' �J ..• :: -• J•• • •�• •• • •• •• • • • C� • • •• •• •• lr lr Y+ • Work Area ' J J SYMBOLS ® Work Area • Channelizing Device (See Index No. 6001 LY Work Zone Sign 17. Flagger b Lane Identification + Direction of Traffic zoo' r ■ ■ ■■ • 50 200 More Than 2007 f/.`/l/1/i Work Area / •• GENERAL 1. Work operations shall be confined to one travel lane, leaving the opposing travel lane open to traffic. 2. When vehicles in a parking zone block the line of sight to TCZ signs or when TCZ signs encroach on a normal pedestrian walkway, the signs shall be post mounted and located in accordance with Index No. 17302. 3. If work area is confined to an outside auxiliary lane, the work area shall be barricaded and the FLAGGER signs replaced by ROAD WORK AHEAD signs. Flaggers are not required. 4. Flaggers shall be in sight of each other or in direct communication at all times. co JL b 1 NOTES 5. The FLAGGER legend sign may be substituted for the symbol sign. 6. The maximum spacing between devices shall be no greater than 25: 7 For general TCZ requirements and additional information, refer to Index No. 600. 8. The two channelizing devices directly in front and directly at the end of the work area may be omitted provided vehicles in the work area have high-intensity rotating. flashing, oscillating, or strobe lights operating. 9. Use Temporary Raised Rumble Strips in accordance with Index 603. Placement of Rumble Strips and additional signs should begin at FLAGGER Sign location. CONDITIONS WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE TRAFFIC LANE, FOR WORK AREAS LESS THAN 200' DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. CONDITIONS WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE TRAFFIC LANE, FOR WORK AREAS 200' OR MORE DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. DURATION NOTES 1 ROAD WORK AHEAD sign may be omitted if all of the following conditions are met: a. Work operations are 60 minutes or less. b. Speed is 45 mph or less. c. No sight obstructions to vehicles approaching the work area for a distance of 600 feet. d. Vehicles in the work area have high-intensity, rotating, flashing, oscillating, or strobe lights operating. e. Volume and complexity of the roadway has been considered. LAST REVISION 07/01/15 0 0 0 S 0 DESCRIPTION: FDOT FY 2017-18 DESIGN STANDARDS TWO-LANE, TWO-WAY, WORK NEAR IINTERSECTIION INDEX NO. 605 SHEET NO. 1 of 1 t • • • • • • • • • • • • • •••.•• • • • • • •••••• • • • • •• • • • ••• •••• • • •••• • JI • • • • • • • • • • • • •• •• • • •••• • • • •• WALK1.• • • • • • • • -•/W •, .VIDE N P/L 18.5' PROP NEW RISER METER SET LOCATION 35' wN 59' OCD iIT RECEIVED FB07 017 .2-7 '1 8-417( 11.1 PROP 3/4" P STIC GAS SVC DIREaa1IONAL BQRF. V - 21' SWALE m � 47' z N t — r 12' i LL E.O.P 70'18' --- E.O.P NW 91st STREET 26' SWALE S R/W SOD RESTORATION DETAIL SCALE: NOT TO SCALE GAS MAIN END CO 264' FROM CENTER LINE NW 2ND AVE XISTING 1 1/2" CS GAS MAIN \E TIE IN SVC TO GAS MAIN WITH T.T./E.F. V. RESTORE GRASS SWALE TO CITY SPEC. SURFACE REPLACEMENT RESTORATION OF ROAD CUT FOR UTILITY CROSSING SCALE: 1"=30' ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE CONSIDERED APPROXIMATE & SHOULD BK VERIFIED BY THE CONTRACTOR PRIOR TO THE START OF WORK OPERATIONS. J LEGEND MONUMENT LINE CENTER LINE RIGHT OF WAY PROPERTY LINE SEWER MAIN LINE WATER MAIN LINE TAPPING TEE EXCESS FLOW VALVE SERVICE LINE STEET PLASTIC COAT COATED STEEL EDGE OF PAVEMENT POLYETHELENE ELECTRONIC MARKER R/W P/L S/S W.M T/T EFV SVC SP CS E.O.P. PE EM GENERAL NOTES 1. REPLACE BASE MATERIAL OVER DITCH SHALL BE TWICE TH E THICKNESS OF THE BASE, MIN. 8" AND MAX. 18" 2. BASE MATERIAL SHALL BE PLACE IN 6" MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO T-180 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL 5. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS) 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES. PREP 3/4= PL*& h GAS .SVC. TO RE DIFIECTIONAL BORED 1 0 70' X. GRD. Z r 6"" MIN. 10 2 \EX.1/4"BSE. GAS MAIN 2 PROFILE CROSSING NW 91st STREET SCALE: N.T.S. 5 � A 01-31-2017 0 PROJECT ADDRESS: PROPOSED 3/4" P.E. GAS SERVICE REVISIONS 0 x NO. OF SHENTS:1 SHEET NO.: 1 Drawing File: \\browardfs\voll\users\stbxj\Documents\Marlen Cabrera\Marlen Cabrera\JOBS\241 NW 91st STREET, EL PORTAL\241 NW 91st STREET.dwg 02/02/2017