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PW-18-811 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-300415 Permit Number: PW-3-18-811 Scheduled Inspection Date: April 12,2018 Permit Type: Public Works Inspector: Miranda,Chris Inspection Type: Final Public Works Owner: STOBS, DONALD Work Classification: Public Works Job Address:9505 NE 5 Avenue Miami Shores, FL Phone Number (305)757-0950 Parcel Number` 1132060140710 Project: <NONE> k Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 i rr rrrr Building Department Comments TO INSTALL A NEW GAS SERVICE LINE (3/4" PLASTIC) BY DIRECTIONAL BORE Inspector Comments Passed 4 1141Y Failed 4/09 Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 11,2018 For Inspections please call: (305)762-4949 Page 16 of 36 - Permit NO. PW-3-18-811 Miami Shores Village Permit Type:Public Works 10050w.E.2nd Avenue ws WbitClassification:Public Works Miami Shores,FLou1u8-0000 Perl" IlmIt Petmit Status:APPROVED Phone: (305)795-220* Issue Date:414120 Fixpiration: 07/03/2018 Project Address Parcel Number Applicant" 9505 NE 5 Avenue 1132060140710 DONALDSTOBS Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DONALDSTOBS 9505 NE 5 Avenue (305)757-0950 MIAMI SHORES FL 33138-3161 9505 NE5Avenue ` MIAMI SHORES FL3313B' 161 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 2 Scanning:3 Available Inspections: Inspection Type: Excavation Review Public Works Review Plumbing Final Public Works ^ Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PW-3-18-66961 DBPR Fee $2.00 04/04/2018 Check#:2028 $64.60 $50.00 2 00 DCA Fee $2.00 Education S6rcharge $0.20 .03/28/2018 Check#:2023 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $1174.60 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,M HANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AF AVIT: rtify t all the f regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a d zo i g uth ore, uth ize the above-named contractor to do the work stated. uthorized?�Iature:Owner/ / Applicant I/ Contractor / Agent Date Building Depi _;Znt Copy April 04, 2018 1 /, P�� 7L2 Miami Shores VillageMAPublic Works Department (305)795-22101~2VPublic works forms are available from the building department, 10050 NE 2"dAve., Miami Shores, FLI33138--PUBLIC WORKS PERMIT APPLICATION Permit Type:Work in the Right-of-Way on Miami Shores Village or Miami-Dade Property Permit#: P W a — 1 1 Name of Applicant(if utility see below): Owner off the following described property: Legal Description: Lot 13&14 Block 54 Subdivision MIAMI SHORES SEC 2 Folio#; 11-3206-014-0710 Address: 9505 NE 5th AVE. UTILITY NAME: TECO PEOPLES GAS Qualifier/Authorized Agent: JESUS VEGA Address: 5101 NW 21 AVE. City. FT.LAUDERDALE State: FL ZIP: 33309 Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM State Certification or Registration#: E1608 Certificate of Competency# a CONTRACTOR NAME: Qualifier/Authorized Agent: Address: City: State: ZIP: 'Telephone: Email: State Certification or Registration#: Certificate of Competency#: Requests permission to install (describe work,attach separate page if necessary) in the adjoining right of way: TO INSTALL A NEW GAS SERVICE LINE(3/4"PLASTIC)BY DIRECTIONAL BORE i Type of Work: ❑ Paving N. Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape E] Antenna ❑ Other: t DESIGNER:Architect/Engineer: Address: City: State: ZIP: Telephone: Email: Registration#: Value of Work for this Permit: $1000 Square/Lineal Footage of Work: 2 LINEAL ***** Fees ***** Permit Fee$ 100.00 50 Notary$ Training/Education$0.20 Technology Fee$0.80 Scannin $ Bond $ (if required) Total Fee Now Due $ r Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding$2,500,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 the 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 public works permit is issued. In the absence of such posted notice,the inspection will not be approved and a reinspection will be charged. Signature Signature Applicant or Authorized Agent Company/Utilit gent The foregoing instrument was acknowledged before The foregoin instrument was a knowledged b fore me this day of 20 by me this day of ol� 20/ by who who is personally known to me or who has produced is ersonall n w to me or who has produced as as identification. identifi tion. HYP dio;�••I:s HUBERT NUNEZ MY COMMISSION#GG 104234 NOTARY PUBLIC: NOTA UB C: l EXPIRES:September 11,2021 %S...... Bonded Thru Notary Public underwriters Sign: Print: Print: SEAL: SEAL: 1 r APPROVED BY: 3 Public Works Director, or Designee' I 2017-04-15 > 3. '4���•'i►,1.�'` r'rnStruttionTrades QUa!i;AnnBra,r_ G CEPTIFICATE OF COMPETENCY El 608 PEOPLES OAS SYSTEM INC VEDA JESUS Is certified under the provisions of Chapter 10 of Miami-Dade County North Miami Contractor ID Number:.160800000 Town of Bay Harbor Island Contractor ID Number: CONT-0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS& DISTRI MIAMV— Ja—D Gascon,P.E. Secretary of the Board -1--d-de Mian-Dade Coaly retains a9 er property dgtds hein. A�!eo' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/7/2017 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 CONTACT NAME: Marsh Canada Limited PHONE 1-866-616-0088 FAX 416-349-4564 120 Bremner Blvd,Suite 800 A/C No,Ext): ac,No EMAIL , Toronto,ON M5J OA8 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Associated Electric&Gas Ins.Svcs. AA-3190004 INSURED INSURER s: Associated Electric&Gas Ins.Svcs. AA-3190004 INSURER C: Associated Electric&Gas Ins.Svcs. AA-3190004 Peoples Gas System INSURER D: Liberty Insurance Corporation 42404 702 North Franklin Street INSURER E: Tampa,FL 33602 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18-037-GAEW REVISION NUMBER:REV 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. INSF TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY XL5692901P 12/01/2017 12/01/2018 EACH OCCURRENCE $1,000,000 ADAMAGE X CLAIMS-MADE OCCUR PEM SES(E.=..) Ee occunence $ X SIR$1,000,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $11,000,000 PRO- PRODUCTS-COMP/OP AGG $ POLICY F—]PRO- ❑LOC OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB 1. BANY AUTO XL5692901P 12/01/2017 12/01/2018 Ea accident $1,000,000 X BODILY INJURY(Per person) $ ALL OWNED SCHEDULED Self Insured Retention: AUTOS AUTOS $250,000 130DILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR C XL5692901P 12/01/2017 12/01/2018 EACH OCCURRENCE $11,000,000 X EXCESS LIAB I X CLAIMS-MADE AGGREGATE $1,000,000 DED I RETENTION$ $ WORKERS COMPENSATIONER TH- AND EMPLOYERS'LIABILITY Y/N X TATUTE R �- ANY PROPRIETOR/PARTNER/EXECUTIVE Employers Liability: FFICER/MEMBER EXCLUDED? NO E.L.EACH ACCIDENT D $1,000,000 XL5692901P Mandatory in NH) - f yes,describe under N/A Excess Workers' E.L.DISEASE-EA EMPLOYEE $1,000,000 ESCRIPTION OF OPERATIONS below Compensation: 12/01/2017 12/01/2018 EW7-B7N-17272-27 12/01/2017 12/01/2018 E.L.DISEASE-POLICY LIMIT $1,000,000 SIR$1,000,000 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. 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. r CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg.Dept. 10050 NE 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Miami Shores FL 33138 EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD T - - Oki ap .r ROAD WORK AHEAD 200' 200' 400 CONDITIONS J J L 1 J l WHERE ANY VEHICLE,EQUIPMENT,WORKERS 13 OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE • • • •• ■ TRAFFIC LANE,FOR WORK AREAS LESS THAN • • Work Area • 200'DOWNSTREAM FROM AN INTERSECTION 1 FOR A PERIOD OF MORE THAN 60 MINUTES. 409 200' Le 70�han ROAD WORK ROAD AHEAD WORK AHEAD zoo 4001 J I I I CONDITIONS WHERE ANY VEHICLE,EQUIPMENT,WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE b • • • •• Work Area • b TRAFFIC LANE,FOR WORK AREAS 200'OR MORE DOWNSTREAM FROM AN INTERSECTION 401 FOR A PERIOD OF MORE THAN 60 MINUTES. � Sd zoo zoo ROAD More Than WORK 100' AHEAD DURATION NOTES SYMBOLS GENERAL NOTES ® Work Area 1.Work operations shall be confined to one travel lane,leaving 5.The FLAGGER legend sign may be substituted for the symbol sign. 1.ROAD WORK AHEAD sign may be omitted if all of the following the opposing travel lane open to traffic. conditions are met: ■ Channelizing Device(See Index No.600) 6.The maximum spacing between devices shall be no greater than 25.' 2.When vehicles in a parking zone block the line of sight to TCZ • • •■ a.Work operations are 60 minutes or less. Work Zone Sign signs or when TCZ signs encroach on a normal pedestrian 7.For general TCZ requi■e•entb§4 atl�iti mal i#for&ati•n,• r•ferto b.Speed is 45 mph or less. • walkway,the signs shall be post mountetl and located in Index No.600. • •• • • • • • C.No sight obstructions to vehicles approaching the work area for accordance with Index No.17302. • •• • • • • ••: •• a distance of 600 fee[. �• Flagger S.The two channelizing de•vr(es direly t fr9nt Snd;recsly tho• d.Vehicles in the work area have high-intensity,rotating, 3.If work area is confined to an outside auxiliary lane,the work end of the work area rrary.be•n•tftd prAiOed vehicles in the work flashing,oscillating,or strobe lights operating. b Lane Identification+Direction of Traffic area shall be barricaded and the FLAGGER signs replaced by area have high-intensity rotating,flashing,oscillating,or strobe e.Volume and complexity of the roadway has been considered. ROAD WORK AHEAD signs.Flaggers are not required, lights operating. 4 4.Flaggers shall be in sight of each other or in direct 9.Use Temporary Raid Rur#bjpitrips in AlcordAcl&i[h Indy 6Q?. • .• communicationat all times. Placemen[of Rumble Strips*no additiclal tgns sVould begiyat • • FLAGGER sign locaaions • • • • • • r • • • • • • • LAST 0 DESCRIPTION: IN SHEET REVISION vt FY 2017-�$ NO. NO. OTT TWO-LANE, TWO-WAY WORK NEAR IINTERSECTIION 07/01/15 W _a DESIGN STANDARDS z • • ••• + • 605 1of1 • • • • • • • • •• �• • s • s• 00 ORR wm� C RIW — --- —¢ ORR 7 •..1�� CHAINr:. � OWN �X���LINK FENCE P 9 ('n' 11 W E E�< 5?+[7+[7✓�i3+ U+ — , 1 41_ :•. '( r' a: = t— �.. . AR 2 2018 i r. 29' � PROP. GAS RISER BY:___- - _ I ___� S ' r'+ ^ •. . fl 1 SCALE :4: 1'=30' � o I I LEGEND CEN 60TER LINE � !y O 1= �r' - .M MONUMENT LINE w Z / - _ r R/W RIGHT OF,WAY auk � C! � PROP. 3'•" PLASTIC GAS SVC P/L PROPERTY LINE c3 Q TO BE DIRECTIONAL BORED. E.O.P. EDGE OF PAVEMENT 01 rq / ' T.T. TAPPING TEE O• F-] •�' I / TIE IN SVC TO GAS E.F.V. EXCESS FLOW VALVE •••• Z. I•r�l / MAIN WITH T.T/E.F.V. SVC. SERNCE UNE • • rn tJ-i / PE PLASTIC ••• •••• • • r*t. :. �. •• • • X STM. SEW.STORM SEWER • s • 0000•• •• •• •• o I #9505 GENERAL NOTES • • 0000•• • • 515 rn 1. REPLACED BASE MATERIAL OVER DITCH SHALL BE jV�CF• THE •• • D THICKNESS OF THE BASE, MIN. B" AND MAX. 18" • • • • a _ r I '.•. 1 EX. 2" PL GAS MAIN 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (L08S'L'RAEASURETviENT; •• • • LAYER AND EACH LAYER THOROUGHLY ROLLED OP)•TAMDE-D TO 9EWo OF •• •e• • MAX. DENSITY PER AASHTO T-180 • • • • 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE tI&CFiANICALLY •• • •• ••• ' SAWED 000000 • • • 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH 9URROUIdDING • • • • a • ••�••• SURFACE MATERIAL (1.5" MIN. THICKNESS) .••••• 5. BASE MATERIAL SHALL HAVE A'MIN. LBR. OF 100•AND A MIN. • v • CARBONATE CONTENT OF 70% (60% FOR LOCAL STf3EE�fS2 ••• • • a X e I X p L 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION F E (STING•••••• • '• UTILITIES •• •Em W `e6 v o a RNOR NOR • .. �,. a ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE CQIVCRE.I i .SIDEWALK CONSIDERED APPROXIMATE & SHOULD BE VERIFIED BY THE '5/GN "ICONTRACTOR PRIOR TO THE START OF WORK OPERATIONS. / EOP / 1 EDGE OF PAVEMENT M ami ShCTOS Village — ----- _ 95TH ST aP� �vEv BY DATE o . a I 60' . GRD. P ( y s a a J S' CT O Gc;