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PW-18-623Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-308157 Permit Number: PW-3-18-623 Scheduled Inspection Date: September 17, 2018 Inspector Miranda, Chris Owner: LUNA, MIGUEL & MAUREEN Job Address: 215 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Permit Type: Public Works Inspection Type: Final Public Works Work Classification: Public Works Phone Number Parcel Number 1132060450020 Phone: (305)957-3857 Building Department Comments INSTALL 2" PLASTIC GAS MAIN AND 1-114" PLASTIC SERVICE ALONG ALLEY EAST OF NE 2 AVE AND SOUTH OF NE 94 ST TO SERVE 215 GRAND CONCOURSE Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-302864. CREATED AS REINSPECTION FOR INSP-299070. 4/11I2018 FINAL REPAIR NOT COMPLETED ON ASPHALT IN ALLEY. 7/9/2018 PATCHES NOT ACCEPTABLE CONTACT PUBLIC WORKS FOR LIMITS OF RESTORATION et(lItt September 14, 2018 For Inspections please call: (305)762-4949 Page 14 of 34 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue Date: 3/12/2018 Permit NO. PW-3-18-623 Permit Type: Public Works Work Classification: Public Works Permit Status: APPROVED Expiration: 06/10/2018 Parcel Number Applicant 215 GRAND CONCOURSE Miami Shores, FL 1132060450020 Block: Lot: MIGUEL & MAUREEN LUNA Owner Information Address Phone Cell MIGUEL & MAUREEN LUNA 215 GRAND CONCOURSE MIAMI SHORES FL 33138- 215 GRAND CONCOURSE MIAMI SHORES FL 33138- Contractor(s) TECO PEOPLES GAS SYSTEM Phone Cell Phone (305)957-3857 (305)970-1783 Valuation: Total Sq Feet: Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $o.00 $o.00 $0.00 $0.20 $100.00 $9.00 $0.80 $110.00 Pay Date Pay Type Invoice # PW-3-18-66742 03/12/2018 Credit Card 03/09/2018 Check #: 2003 Amt Paid Amt Due $ 60.00 $ 50.00 $ 50.00 $ 0.00 $ 2,000.00 0 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 th- o and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting th ; rmit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for : RICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction - .. ' oning. Futhermore, I authorize the above -named contractor to do the work stated. uthon . Signature: Owner / Applicant / Contractor / Agent March 12, 2018 Date Building Department Copy March 12, 2018 1 RECEIVED Miami Shores Village Public Works Department MAR 0 9 2018 (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 33138O PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: pw i'8 c 23 Name of Applicant (if utility see below): RICO Di ULLA Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; Address: 2.15 arard aor-rc k ( ' UTILITY NAME: )CZ-) —PeTh S l��S , � Qualifier/Authorized Agent: �� � (J� // ,, Address: ntC)) JS ..��e---11`T &IP Sii'_Q0 City: State:l , ZIP: ,at Telephone: (--V ;YDAt I. Email: State Certification or Registration #: Ell oe(., Certificate of Competency # CONTRACTOR NAME: Qualifier/Authorized Agent: Address: City: State: Telephone: Email: State Certification or Registration #: Certificate of Competency #: ZIP: Requests permission to install (des rise work, attach separ.te ... a if necessary in the a•'• inin: ri• •t ofrOft. ii,�' it Type of Work: ❑ Paving Utility ❑ Sidewalk ❑ Electric ❑ 'Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: State: ZIP: Telephone: Email: Registration #: Value of Work for this Permit: • Square/Lineal Footage of Work: ***** Fees***** Permit Fee $100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning Bond $ (if required) Total Fee Now Due $ Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: N 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 ofcommencement 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 1> Applicant or Authorized Agent Company/Utill Agent The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this day of , 20 by me this .S 14" day of I11!}Q.6, , 20 I^ $ , by who neSL)S `k'5A SR.. who is personally known to me or who has produced is personally known to me or who has produced as as identification. identification. NOTARY PUBLIC: NOTARY PUBLIC. Sign: Sign: &et; ,40Gr/h . Print: Print: Aemej4 .b w• /J SEAL: SEAL: APPROVED BY: ARMETA D. WILSON Notary Public - State of Florida Commission 8 GG 148974 My Comm. Expires Jan 30, 2022 Bonded through National Notary Ass' Public Works Director, or Designee 2017-04-15 1.7 neiik t . ;;, ' Construction "Ira4ess QQua!ilying Board :�_ �1+ 5;' S CERTIFICATE OF COMPETENCY u 1606 • PEOPLES GAS SYSTEM INC acsL_ Jn, VEGA JESL�S Is certified under the provisions of Chapter 10 of Miami -Dade County North Miami Contractor ID Nurnber.160800000 Town of Bay Harbor island Contractor ID Number: CONT-0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS Q. DISTRI Jalme D. Gaston. P.E. •r Secretary of the Board .. •.. Maori -Dade Coady rata4,e al proporly dates Ivan. MIAM .DE ww.rri aa:dade. poHeaancmy I' A • ACORO' CERTIFICATE OF LIABILITY INSURANCE `ate- DATE(MM/DD/YYYY) I 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 Marsh Canada Limited 120 Bremner Blvd, Suite 800 Toronto, ON M5J 0A8 CONTACT NAME: PHONE 1-866-616-0088 FAX 416-349-4564 (A/c, No, EXt): (A/C, No): EMAIL I ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # I INSURER A: Associated Electric & Gas Ins. Svcs. AA-3190004 INSURED Peoples Gas System 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: Liberty Insurance Corporation 42404 1 INSURER E: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD!YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABIUTY XL5692901P 12/01/2017 12/01/2018 EACH OCCURRENCE $1,000,000 X CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ X SIR $1,000,000 MED EXP (Any one person) $ PERSONAL & ADV fNJURY $1 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- JECT LOC GENERAL AGGREGATE $1,000,000 PRODUCTS-COMP/OPAGG $ _ $ B AUTOMOBILE X LIABILITY ANY AUTO XL5692901 P Self Insured Retention: $250,000 12/01/2017 12/01/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ - ALL OWNED AUTOS HIRED AUTOS - SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C UMBRELLA LIAB OCCUR XL5692901P 12/01/2017 12/01/2018 EACH OCCURRENCE $1,000,000 i( EXCESS LIAB X CLAIMS -MADE AGGREGATE $1 ,000,000 DED 1- RETENTIONS $ D_ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below Y/N NO NIA Employer's Liability: XL5692901P Excess Workers' Compensation: EW7-B7N-17272-27 SIR $1,000,000 12/01/2017 12/01/2017 12/01/2018 12/01/2018 v PER STATUTE OTH- ER E.L. EACH ACCIDENT $1 ,000,000 E.L. DISEASE - EA EMPLOYEE $1 ,000,000 _ - E.L. DISEASE -POLICY LIMIT $1 Opp pOp 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. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg. Dept. 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH , THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE s ACORD 25 (2014/01) 101988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • • • NE 94 ST NE 93 ST T RAFFIC ONTROL LANS LLC. 3.140111/1 Date: 2-28-2018 Author: TOM FARNAN Project: MIAMI SHORES 2" MAIN ATSSA #: 2182 Comments: ALL EQUIPMENT TO BE PLACED AND COMPLY WITH FDOT DESIGN STANDARDS INDEX 600 SERIES 602 AND TA-20 OF MUTCD.PLAN TO BE SUBMITTED TO GOVERNING AGENCY FOR APPROVAL.PLAN NOT TO SCALE. O-SERVICE TIE IN -DIRECTIONAL BORE NOTE -CONTRACTOR TO MAINTAIN LOCAL RESIDENT ACCESS DURING DIRECTIONAL BORING. aoA0tt� ro naunAmc MIAMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION urn am utt uta This is to affirm thu/ Tom Faman hus satisfied the requireniCnt o bC designated as a CERTIFIED) TRAFFIC CONTROL SUPLRVISOR Ceti C. 2182 lace fate' 04212017 Fxparrm face: 64/12/2021 tntuwat w, iwrra NE 94 ST • • RAFFIC ONTROL LANS LLC. 0.013 Date: 2-28-2018 Author: TOM FARNAN Project: 215 GRAND CONCOURSE ATSSA #: 2182 Comments: ALL EQUIPMENT TO BE PLACED AND COMPLY WITH FDOT DESIGN STANDARDS INDEX 600 SERIES 602 AND TA-20 OF MUTCD.PLAN TO BE SUBMITTED TO GOVERNING AGENCY FOR APPROVAL.PLAN NOT TO SCALE. -DIRECTIONAL BORE NOTE -CONTRACTOR TO MAINTAIN LOCAL RESIDENT ACCESS DURING DIRECTIONAL BORING. AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION MI Mt ua rats This is to affirm that Tom Faman has sagad the requirements to be designated as a CERTIFIED TRAFFIC CO\7ROL SUPERVISOR Can r_ 2182 teat Door O421t2O17 F:pwawa now 04 12,2021 1 cum.:awn Lwow • • •••• • RERLACEMENT�ASE • (NEW MATERI • • FULL LANE SURFACE REPLACEMENT SAW CUT ASPHALT (TYPICAL) •••• • • • ••• • •• •• • • •••• •••• • • e • •••• a • • • • •• •• • • • • • • Ar DITCH MIDTH .: Iz 12 ••ILESTORATION OF ROAD CUT • •• FOR UTILITY CROSSING • • reV% NOTES • • •••• 1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE THICKNESS OF THE ORIGINAL BASE. MINIMUM 8•, MAXIMUM 18". 2. BASE MATERIAL SHALL BE PLACED IN 6" MAXIMUM (LOOSE MEASUREMENT) LAYERS AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF MAXIMUM DENSITY. PER AASHTO T-180. 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED. 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH THE SURROUNDING SURFACE MATERIAL 5. BASE MATERIAL SHALL HAVE A MINIMUM LBR OF 100 AND A MINIMUM CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS). PROP. 2" PE GAS MAIN AND 1-1/4" PE SERVICE TO SERVE 215 GRAND CONCOURSE ,15 z ▪ NE St p`rPt4 v NW 100th St �F rD NE 99th St NW 99th St NE 99th100th St Z NE 98th St " United Stotes Postal Service NW 98th St Proper Sausages NE 97th it cS� D NW 97th St o c.° O` NW 96th St NE 96th St aC° ° C a� O` (' NE 95th St Lai N A NW 95th St NE 95th St V am` ��`' ROJECT NE 94th St NW 94th St 1. NE 94th St Iron Sus Archdiocese of Miami LOCATION NE93ro NW 93rd St NW 93rd St NE 92r s NE 92nd St NW 91st St NE 91st St a` a a' • NE 90th St Z NE 90th St z Z NE 89th S7 °D Z Papa John's Pizza ? D N NE 88th St ro Z NE 88th St ▪ m a a Co NW 87th St NE 87th St T R St NE 86tnro D. ZW 86th St NW 86th St NESt BSth St E St C St Z A c. NOTES CONSTRUCTION 1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF CONSTRUCTION. SUNSHINE # 1-800-432-4770 2. RESTORE ALL AREAS TO PRIOR CONDITIONS 3. ALL CONSTRUCTION TO FOLLOW JURISDICTIONAL GOVERNMENT AND TPG STANDARDS. • s • • C • • C • • • • • • •• rrtvr. • •• •• • • • • • • • • • • •• • • • •• • • • • • X. 6" PE GAS MAIN ROP. 2" PE GAS (DIP. BORE) PROP. 6x2 PL. T/T, AND 2" PL. VLV. ALLEY 12 12 10 ROP. 1-1 /4" PE GAS 10 (DIR. BORE) EX. GRADE\ 8 — — 8 6 36"MIN. 6 4 4 t +,w I '4 :, iss , 2 ROP. 2' PE GAS 2 (DIR. BORE) 0 0 -2 -2 SgALE: 1 "=40' HOR. -4 1 "=4' VERT. SHEET NO. 1 of 1 a m a 0 a PROP. 2" PE GAS MAIN AND 1-1/4" PE SERVICE TO SERVE 215 GRAND CONCOURSE