PW-18-388Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Issue Date: 2/21/2018
Permit NO. PW-2-1' 8-388
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 05/22/2018
Parcel Number
Applicant
1053 NE 95 Street
Miami Shores, FL
1132060143600
Block: Lot:
SEAN SHEA
Owner Information
Address
Phone
Cell
ROSALIE SHEA
1053 NE 95 ST
MIAMI FL 33138-2547
Contractor(s)
Phone CeII Phone
TECO PEOPLES GAS SYSTEM (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
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW-2-1 8-66452
02/14/2018 Check #: 1936 $ 50.00 $ 54.00
02/21/2018 Check #: 1942 $ 54.00 $ 0.00
Amt Paid Amt Due
Available Inspe
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 certiall the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fu
e, I authorize the ab y�d contractor to do the work stated.
Authorized Sigrt turefOwner / Alplicant / Contractor / Agent
February 21, 2018
Date
Building Department Copy
February 21, 2018 1
4\I/ szo, . Miami Shores Village RECEIVED
- v Public Works Department
(305)795-2210 FEB 14 2018
Public works forms are available from the building department, 10050 NE 2' Ave., Miami Shores, FL 331 Ca I
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#: ? " 18' g8.
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot 23,24F. 1/2OF 22,25 Block 81 Subdivision MIAMI SHORES SEC 3
Folio #; 11-3206-014-3600
Address: 1053 NE 95th ST.
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 # Vsosor
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City: State:
Telephone: Email:
State Certification or Registration #:
ZIP:
Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoinin
way: TO INSTALL A NEW GAS SERVICE LINE (3/4" PLASTIC) BY DIRECTIONAL BORE
Type of Work: ❑ Paving ❑■ Utility ❑ Sidewalk ❑ Electric D Irrigation
❑ Landscape ❑ Antenna ❑ ,t'Other: `i
DESIGNER: Architect/Engineer:
Address:
City: State: ZIP:
Telephone: Email:
Registration #:
Value of Work for this Permit: $ woo
Square/Lineal Footage of Work: 4 LINEAL
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scann
Bond $ (if required) Total Fee Now Due $
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 XC_d\Da - j 1
Applicant or Authorized Agent Company/UtAgent
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this day of , 20 , by me this 1 ?—day o f ' 20 / F, by
who 'SOS v cl who
is personally known to me or who has produced i • ersonally kn • me or who has iiioduced
as
identification. identificati. n.
NOTARY PUBLIC:
Sign: Si
Print: Print:
SEAL: SEAL:
NOTARY
as
********k************************************
APPROVED BY: '%t, �� �'� V U, Public Works Director, or Designee
1
2017-04-15
V a `y r.
Ccnstruction Trades Quaffing Board
' S CERTIFICATE OF COMPETENCY
E1608
PEOPLES GAS SYSTEM INC
D.c.A.:
VEGA 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 TRADES)
0014 FUEL TRANS & DISTPI
AccoRD' 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
Marsh Canada Limited
120 Bremner Blvd, Suite 800
Toronto, ON M5J 0A8
CONTACT
NAME:
PHONE
H Nr o, Ext): 1-866-616-0088 (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
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
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
SUER
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDD/YYYY)
, LIMITS
A
X
COMMERCIAL GENERAL
LIABILITY
XL5692901P
12/01/2017
12/01/2018
EACH OCCURRENCE
$1,000,000
X
CLAIMS -MADE
OCCUR
DAMAGE TO RENTED
PREMISES (Ea ocarnence)
$
X
SIR $1,000,000
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$1 ,000,000
GEN'L
AGGREGATE LIMIT
APPLIES PER:
PRO-
JECT
LOC
GENERAL AGGREGATE
$1 ,000,000
POLICY
PRODUCTS - COMP/OP AGG
$
OTHER
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
XL5692901P
Self Insured Retention:
$250,000
12/01/2017
12/01/2018
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
BODILY INJURY (Per person)
$
ALL OWNED
AUTOS
HIRED AUTOS
-
SCHEDULED
AUTOS
NON -OWNED
AUTOS
BODILY INJURY (Per accident)
$
-
PROPERTY DAMAGE
(Per accident)
$
$
C
UMBRELLA DAB
OCCUR
XL5692901P
12/01/2017
12/01/2018
EACH OCCURRENCE
$1,000,000
X
EXCESSUAB
X
CLAIMS -MADE
AGGREGATE
$1,000,000
DED RETENTIONS
$
D
t
H
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? NO
(Mandatory In NH)
f yes, describe under I
DESCRIPTION OF OPERATIONS below ^)
N/A
•
Employers 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
ER OTH-
X TATUTE ER
E.L. EACH ACCIDENT
$1 ,000,000
E.L. DISEASE - EA EMPLOYEE
., )
$1 ,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 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
r/
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
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
• • ••• •
• •• •� • • • •• •� •�•
• • •
• • •• •••• •• • • •
• • •• •• •• • •
• • • • • • • • • •
SYMBOLS:
IM Work Area
• Channelizing Device (See Index No. 600)
[p Work Zone Sign
Er. Flagger
b Lane Identification + Direction of Traffic
LP
D
5
• •
• • • • ••
• • • • •
• • •
• • • •
• ••• •
•
•••
•• • • •
• • • • • • ••
•• • ••• • • •• ••
• • • • • •• •
•
��—•• ••c .�.•:•%/%///AV7//
♦• I • W4•Area
•
• • •
• 13Sifer
Sace
tee
Table 1
•
•e •
•
• • • 250
• •
••• •
•
LP
• ••
•••
C
41
a
8
0
D
4J
A
1'
0
A
—
GENERAL NOTES:
1. Special Conditions may be required in accordance with these notes
and the following sheets:
A. Railroad Crossings:
a. If an active railroad crossing is located closer to the Work Area than
the queue length plus 300 feet, extend the Buffer Space as shown on
Sheet 3.
b. If the queuing of vehicles across an active railroad crossing cannot be
avoided, provide a uniformed traffic control officer or flagger at the
highway -rail grade crossing to prevent vehicles from stopping within
the highway -rail grade crossing, even if automatic train warning
devices are in place.
B. If the Work Area encroaches on the Centerline, use the Layout for
Temporary Lane Shift to Shoulder on Sheet 3 only if the Existing
Paved Shoulder width is sufficient to provide for an 11' lane
between the Work Area and the Edge of Existing Paved Shoulder.
Reduce the posted speed when appropriate.
2. Temporary Raised Rumble Strips:
A. Use when both of the following conditions are met concurrently:
a. Existing Posted Speed is 55 mph or greater;
b. Work duration is greater than 60 minutes.
B. Use a consistent Strip color throughout the work zone.
C. Place each Rumble Strip Set transversely across the lane at locations
shown.
D. Use Option 1 or Option 2 as shown on Sheet 2. Use only one option
throughout work zone.
3. Additional one-way control may be provided by the following means:
A. Flag -carrying vehicle:
B. Official vehicle;
C. Pilot vehicles;
D. Traffic signals.
When flaggers are the sole means of one-way control, the flaggers
must be in sight of each other or in direct communication at all times.
Tangent
Taper Length
50 To 100
Device Spacing (See Table 1)
'0 May Be omitted if ROAD WORK AHEAD sign is installed upstream within the project limits.
WITHOUT TEMPORARY RAISED RUMBLE STRIPS
4. When a side road intersects the highway within the TTC zone, place
additional TTC devices in accordance with other applicable TCZ Indexes.
5. The two channelizing devices directly in front of the work area may be
omitted provided vehicles in the work area have high -intensity rotating.
"flashing, oscillating, or strobe lights operating.
6. When Buffer Space cannot be attained due to geometric constraints, use
the greatest attainable length, not less than 200 ft, for posted speeds
greater than 25 mph.
7. ROAD WORK AHEAD and the 8E PREPARED TO STOP signs may be omitted if
all of the following conditions are met:
A. Work operations are 60 minutes or less.
8. Speed limit is 45 mph or less.
C. There are no sight obstructions to vehicles approaching the work area for
a distance equal to the Buffer Space shown in Table 1.
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.
F. If a railroad crossing is present, vehicles will not queue across rail tracks.
G. AFADs are not in use.
8. See Index 600 for general TCZ requirements and additional information.
5.
9. Automated Flagger Assistance Devices (AFADS) may be used in accordance
with Specifications Section 102, 990 and the APL vendor drawings.
TABLE 1
-Posted
Speed
DEVICE SPACING
Distance
Between
Signs
Buffer
Space
Maximum Spacing
of -Cones or
Tubular Markers
Maximum Spacing of
Type 1 or Type /I
Barricades/Panels/Drums
Ona
Taper
On
Tangent
Ona
Taper
On a
Tangent
A
BCD
25
20
50
20'
50'
200
200'
200'
100'
155'
30
20
50'
20'
50'
200'
200'
200'
100'
200'
35
20'
50'
20'
50'
200
200'
200'
100'
250'
40
20'
50
20
50'
200
200
200'
100'
305'
45
20'
50'
20'
50'
350'
350'
350'
175'
360'
50
20'
50'
20'
100
500'
500'
500'
250'
425'
55
20'
50'
20'
100'
2640'
1500'
1000'
500'
495'
60
20'
50
20'
100'
2640'
1500'
1000'
500'
570'
65
20
50
20'
100
2640'
1500'
1000'
500'
645'
70
20'
50'
20'
100
2640'
1500'
1000'
500'
730'
CONDITIONS
WHERE ANY VEHICLE, EQUIPMENT,
WORKERS OR THEIR ACTIVITIES
ENCROACH THE AREA BETWEEN
THE CENTERLINE AND A LINE 2'
OUTSIDE THE EDGE OF TRAVEL WAY.
LAST
REVISION
01/01/16
0
0
DESCRIPTION:
Fir v DESIGN STANDARDS
FY 2017-18
TWO-LANE, TWO-WAY,
WORK WIITHIIN THE TRAVEL WAY
INDEX
NO.
603
SHEET
NO.
1 of 3
000000 1'
• •
•••
• 2.
00000
• •
▪ 00000
•
.
LEGEND
Q CENTER LINE
M MONUMENT LINE
R/W RIGHT OF WAY
P/L PROPERTY LINE
E.O.P. EDGE OF PAVEMENT
T.T. TAPPING TEE
E.F.V. EXCESS FLOW VALVE
SVC. SERVICE LINE
PE. PLASTIC
STM. SEW. STORM SEWER
S
SCALE: 1 "1=50'
ALL EXISTING UTILITIES SHOWN ON
THESE PLANS ARE TO BE
CONSIDERED APPROXIMATE Sc
SHOULD BE VERIFIED BY THE
CONTRACTOR PRIOR TO THE
START OF WORK OPERATIONS.
Z
• r•
• • • •
• • s•
• • • • •o •
06004.4
•0000000000PtL NGTFS. •
• •
REPLACED BASE Y Ai L OVER DITCH SHALL BE TWICE THE
THICRI9L•93 OF THE•69S, MIN. 8" AND MAX. 18"
BA6E•4ATERIAL 1-IAL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT)
LAYER AND EACH•LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF
MAX• A C,SITY PE ei4SHTO T-180
3. ASFV-IALT XONCReTE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED
4. SURFACE MATERIA•S•rfALL BE CONSISTENT WITH SURROUNDING SURFACE
MATERIAL (1.5e') M.• WHICKNESS)
5. BA55 MATERIAL 4 HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE
•C.ONITF 1T OF 0 . K60% FOR LOCAL STREETS)
6. CONTRACTOR SI-ALL•90FT DIG TO VERIFY LOCATION OF EXISTING UTILITIES
• •
• • • •
• k •
•••
15'—
_.
�`Z I
—---
--y
ROP. /" PLASTIC
4
I
r -GAS SVC. TO BE
DIRECTIONAL BORE
4
36"
MIN.
1
1oAd-
I
0
EXT.2" BSE.
GAS MAIN
�
_
(
I
PROFILE CROSSING AN ALLEY.
SCALE: (V) 1:5' (H) NTS.
OM MO
nxi LANE
TIE IN SVC TO GAS A
WITH T.T. /E. F. V.
PROP. 3/4" PLASTIC
GAS SVC. TO BE
DIRECTIONAL BORED
SURFACE REPLACEMENT
SURFACE
bLD
DEPT
ALLEY WAY
DEB 14 20$�
ANL
SUB CT TO COMPLIA1dCTH ALL FED
STATE AND COUNTY RULES AND REGULATIONS
SAW CUT ASPNALT
(TYPICAL)
REPLACEMENT BASE -
(NEW MATERIAL)
ift
452.,
W
` A
lr
IT'
I7•
RESTORATION OF ROAD CUT
FOR UTILITY CROSSING
SOD RESTORATION DETAIL
SCALE: NOT TO SCALE
F
02-05-2018
wa
cz leg
w
a
U
z
0
en
Z �
PROJECT ADDRESS:
REVISIONS
a
Z
NO. OF SETS:
SHEET NO.: 1
Drawing File: \\browardfs\voll\users\PGMXC\Documents\RESIDENTIAL\2017\NE 95 ST. 1053, MIAMI SHORES, FL\1053 NE 95 ST.MIAMI SHORES, FL.dwg 02/05/2018