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PW-18-874Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Issue Date: 4/10/201';
Permit NO. PW-4-18-874
Permit Type: Public Works
Work Classification: Public Works
Permit Status: APPROVED
Expiration: 07/09/2018
Parcel Number
Applicant
9100 N BAYSHORE Drive
Miami Shores, FL 33138-
1132050010560
Block: Lot:
ROBERT HUNDERVADT
Owner Information
Address
Phone
Cell
ROBERT HUNDERVADT
9100 N BAYSHORE Drive
MIAMI SHORES FL 33138-3408
(305)759-1765
Contractor(s) Phone Cell Phone
TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783
Valuation:
Total Sq Feet:
$ 1,000.00
4
Scanning: 1
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-4-18-67038
04/10/2018 Check #: 2033
04/04/2018 Check #: 2028
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 responsibilit for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBIN , CH ICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF
construction
IDAVIT: certi
Futh
Bui ding
at all the fo
mo -, I autho
d "�� ature: •wner / Applicant /
epartment Copy
egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ize the above -nod contractor to do the work stated.
L -s (0,^rPs
Contractor / Agent
April 10, 2018
Date
April 10, 2018 1
Miami Shores Village
g
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
APR 0 41018
Permit#: l8 8R \
Name of Applicant (if utility see below):
Owner off the following described property:
Legal Description: Lot 33 & 2oft of 32 Block 2 Subdivision WATERSEDGE
Folio #; 11-3206-001-0560
Address: 9100 N BAYSHORE DR.
UTILITY NAME: TECO PEOPLES GAS
Qualifier/Authorized Agent: JESUS VEGA
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE
Telephone: 954-453-0806
State: FL
Email: MCABRERA@TECOENERGY.COM
State Certification or Registration #: E1608
ZIP: 33309
Certificate of Competency #
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
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: $ woo
Square/Lineal Footage of Work: 4 LINEAL
*****Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scannin $
Bond $ (if required) Total Fee Now Due $ Q�
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 Signatures �f
Applicant or Authorized Agent Company/Utilit • gent
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged bfore
me this day of , 20 , by me this 4- day of 20) e by
who who
is personally known to me or who has produced • ersonally known t•• or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
**
APPROVED BY:
2017-04-15
identificat
NOTARY P
Print:.
SEAL: 1
as
;io:'"="' I;• HUBERT NUNEZ
! .�= MY COMMISSION # GG 104234
� EXPIRES: September 11, 2021
Bonded Thru Notary Public Undorwriters
* * * *1k***********************************
, Public Works Director, or Designee
ACORo• CERTIFICATE OF LIABILITY INSURANCE
koix/"--
DATE(MMIDD/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 1-866-616-0088 FAX 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
(MM/DDIYYYY)
POLICY EXP
(MM/DD/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
PREMISES (Ea occurrence)
nce)
$
X
SIR $1,000,000
MEDEXP (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 LIAB
OCCUR
XL5692901P
12/01/2017
12/01/2018
EACH OCCURRENCE
$1 ,000,000
X
EXCESSUAB X
CLAIMS -MADE
AGGREGATE
$1,000,000
DED (RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? NO
(Mandatory in NH)
f yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
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
PER TH-
X STATUTE R
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 l 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.
ERTIFICATE 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.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2014/01)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Ccnstruction Trades Qualifying Board
' E; S CERTIFICATE OF COMPETENCY
E1608
• PEOPLES GAS SYSTEM INC
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-06.13-2004-o.5
QUALIFYING TRADE(S)
0014 FUEL TRANS R DISTR.!
JL JL
1 I Work Area '
200' I I Less Than
200'
J L J L
SYMBOLS
MWork Area
• Channelizing Device (See Index No. 600)
ft Work Zone Sign
• Flagger
b Lane Identification + Direction of Traffic
f/.%l/f//
/ Work Area /
J L
1 r
GENERAL NOTES
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.
JL
lr
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
W
DESCRIPTION:
Fir DESIGN STANDARDS
FY 2017-18
TWO-LANE, TWO-WAY, WORK NEAR IINTERSECTIION
INDEX
NO.
605
SHEET
NO.
1 of 1
8
40
8
a o
e�,,,,,,
3
L.I I
��.�P.
i "�
w
120'
'�
36" MIN.
_
4
4
EXT. 2'
PROP. 3/i" PLASTIC)
CAS
STEEL
MAIN
ECT VL. IO tit
DIRECTIONAL BORED
TIE TO E�C GAS
N9 I T T
E.
MAI
0
AI /L
'
. .
0
I
PROFILE CROSSING N BAYSHORE DR
SCALE: (V) 1:5' (H) NTS
REPLACEMENT BASE
(NEW MATERIAL)
PLASTIC GAS SVC
ECTIONAL BORED.
FULL LANE
SURFACE REPLACEMENT
SURFACE
SAW CUT ASPHALT
(TYPICAL)
Ktragemst
kgmearmy Ar
rimemwitti
12'
VARIES
12'
RESTORATION OF ROAD CUT
FOR UTILITY CROSSING
S
SCALE: 1"= 30'
LEGEND
Ct CENTER LINE
ILL MONUMENT UNE
R/W RIGHT OF WAY
P/L PROPERTY UNE
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
GENERAL NOTES
RECEIVED
APR 0 4 7018
1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE
THICKNESS OF THE BASE, MIN. 8" AND MAX. 18"
2. BASE MATERIAL SHALL BE PLACED 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 (1.5" MIN. THICKNESS)
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
ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE
CONSIDERED APPROXIMATE & SHOULD BE VERIFIED BY THE
CONTRACTOR PRIOR TO THE START OF WORK OPERATIONS.
J
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG
L�
FEDE`�A'.\'
tD�EPT (tom
SUBu d' TO C:OMPI IA�OF KITH ALL
STATE AND COUNTY RULES AND REGULATIONS
SOD RESTORATION DETAIL
SCALE: NOT TO SCALE
r-A'Acq
NO. OF SHEET& 1
Pv4 q-E3i*ct