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