PW-18-3135Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PW-10-18-313S Permit IVR Number: 100378
[1 r� r1 Permit Type: Public Works
_t � Work Classification: Public Works
Permit Status: Approved
Issue Date:10/12/2018 1 Expiration: 04/08/2019
Location Address Parcel Number
9632 NE 5TH AVENUE RD, Miami Shores, FL 33138 1132060170140
Contacts
DAVID ELIAS HALABU Owner TECO PEOPLES GAS SYSTEM Contractor
9632 NE 5 AVE, MIAMI SHORES, FL 33138 JESUS VEGA
Other: 3052137625 15779 W DIXIE HWY, MIAMI, FL 33162
Business:
305957385777247
Other:3059701783
Description: TO INSTALL A NEW GAS SERVICE LINE (3/A" Valuation: $ 1,000.00 Inspection Requests:
PLASTIC) BY DIRECTIONAL BORE. 305-762-4949
Total Sq Feet: 5.00
COMMENT BY PUBLIC WORKS: ANY DAMAGE TO ASPHALT
REQUIRES FULL WIDTH RESTORATION.
Fees
Amount
Education Surcharge
$0.20
Public Works Permit Fee
$100.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$111.70
Payments
Date Paid Amt Paid
Total Fees
$111.70
Check# 3081
10/12/2018 $111.70
Amount Due:
$0.00
Building Department Copy
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.
PIS AFFIj�AVIT: 1' certify th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
ng c uctio �n Zoning. uthermore, I authorize the above named contractor to do the work stated.
/ Applicant / Contractor / Agent
Date
October 12, 2018 Page 2 of 4
w RECEIVI
Miami Shores Village �T 1 2018
Public Works Department
(305)795-2210 BY
Public works forms are available from the building department, 10050 NE 2nd Ave., Miami Shores, FL 3A38
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property V\11�
Permit#: ' 313S
Name of Applicant (if utility see below): TECO PEOPLES GAS
Owner off the following described property:
Legal Description: Lot 21 Block 86 Subdivision AMD PL OF MIAMI SHORES SEC 4
Folio #; 11-3206-017-0140
Address: 9632 NE 5 AVENUE RD.
UTILITY NAME: TECO PEOPLES GAS
Qualifier/Authorized Agent: JESUS VEGA
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE State: FL
Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM
State Certification or Registration #: E1608 Certificate of Competency #
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
Citv:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP: 33309
ZIP:
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
❑ Landscape ❑ Antenna
DESIGNER: Architect/Engineer:
Address:
City: State:
Telephone: Email:
Registration #:
Value of Work for this Permit: $1000
❑ Sidewalk ❑ Electric ❑ Irrigation
❑ Other:
ZIP:
Square/Lineal Footage of Work: 5 LINEAL
***** 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:
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
Applicant or Authorized Agent
The foregoing instrument was acknowledged before
me this day of 20, by
who
is personally known to me or who has produced
as
identification.
NOTARY PUBLIC:
Sign:
Print:
SEAL:
Signature �
Company/Ut64 Agent
The foregoing instrument was acknowledged b fore
me this of li'� ' 20, by
�_�Esws ca A who
ly
NOTARY PUBLIC:
Print:
SEAL:
or who has produced
as
HUBERTNUNtG
MY COMMISSION # GG 104234
Bonded Thru Notary Public Underwrltera
APPROVED BY: 4 �O , Public Works Director, or Designee
2017-04-15
r%C11SifU.:1l0I1 Trades Ci lidiif19nCt boa,,_
c CERTIFICATE OF COMPETENCY
-1008
ES GAS SYSTEM INC
VEGA uEStIS
Is ceitined 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-06-13-2004-0.5
QUALIFYING TRADE(S)
0014 FUEL TRANS & DIFTPI
MIAML�
Jawne D. Gaston. P.E. 2::...
Secretary Meta Board '� -
Wemi-Dada Carty retaim at property Agts herein. amioaoe pwlecr—my
A161 CERTIFICATE OF LIABILITY INSURANCE
DAT12/7/20DD17
oRo'
12n/
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
120 Bremner Blvd, Suite 800
Toronto, ON M5J OA8
PHONE 1-866-616-0088
a/c, No, Ext :
FAX 416-349-4564
(A/C, No
EMAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Associated Electric & Gas Ins. Svcs.
AA-3190004
INSURED
INSURER B: 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
INSURER E:
702 North Franklin Street
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
LTR
TYPE OF INSURANCE
ADDL
INSR
SUB
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
�(
CLAIMS -MADE OCCUR
XL5692901 P
12/01 /2017
12/01 /2018
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occu ..
$
X
MED EXP(Any one person)
$
SIR $1,000,000
PERSONAL &ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$1,000,000
JECTPRODUCTS
POLICY PRO- PRO- LOC
- COMP/OP AGG
$
$
OTHER
B
AUTOMOBILE LIABILITY
XL5692901 P
12/01 /2017
12/01 /2018
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
Self Insured Retention:
--..
$250,000
ALL OWNED
AUTOS
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS
NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
$
$
C
UMBRELLA LIAB
OCCUR
XL5692901 P
12/01 /2017
12/01 /2018
EACH OCCURRENCE
$1,000,000
X
EXCESS LIAB I
X
I CLAIMS -MADE
AGGREGATE
$1 ,000,000
DED I I RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YM
NY PROPRIETOR/PARTNER/EXECUTIVE
FFICER/MEMBER EXCLUDED NO
Mandatory in NH)
Employers Liability:
XL5692901P
ER OTH-
X TATUTE ER
E.L. EACH ACCIDENT
$1,000,000
f yes, describe under
ESCRIPTION OF OPERATIONS below
N/A
Excess Workers'
Compensation:
12/01 /2017
12/01 /2018
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
EW7-B7N-17272-27
12/01 /2017
12/01 /2018
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.
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
91988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
SYMBOLS:
® work Area
• Channetiling Device (See Index 102-600)
Work Zone Sign Buffer
Space
Q' Flagger See
�D Lane Identification + Direction of Traffic Table I
— — — — — — — — — — — — — — — — — — — — — — b — — — — 4 -----
D
A
Z
250' C
D
� 1 1 v v I
b . a 41 0• • +••••• :•••4i
— — — — — b----—---
• •
Device Spacing (See Table 11
•
•
•
Tangent
• • • • • •
Taper Length
• • • •
• •
•
50 To 100' * May Be omitted if ROAD WORK AHEAD sign
is installed upset V% •iol the
projK•l it • •
• • • • •
C
••••••
••••
•
•••••
• •
• •
•• ••
••••
•••••
•
WITHOUT TEMPORARY RAISED RUMBLE STRIPS
• • • • • •
•• •
•• •
•
•• •
GENERAL NOTES:
TABLE
1
]. Special Conditions may be required in accordance with these notes
. Whenside road intersects the highway
49 y within the TTC zone, plate
and the following sheets:
,a
additional TTC devices in accordance with other applicable TCZ Indexes.
DEVICE SPACING
A. Railroad
f Crossings:
5. The two Channelizing devices directly in front of the work area may be
Maximum Spacing
Maximum Spacing
of
Distance
a.
a. If an active railroad crossing is located closer to the Work Area than
omitted provided vehicles in the work area have high -intensity rotating,
Posted
of Cones
or
Type 1 or Type !!
Between
Buffer
the queue length plus 300 fee[, extend the Buffer Space as shown on
flashing, oscillating, or strobe lights operating.
Speed
Tubular
Markers
Barricades/Panels/Drums
Signs
Space
Sheet 3.
b. l/ the queuing of vehicles across an active railroad crossing cannot
6. When Buffer Space cannot be attained due to geometric constraints, use
On
On
avoided, provide a uniformed traffic control officer or flogger a[ the
a
the greatest attainable length, not less than 200 It, for posted speeds
a
a
On a
On a
highway -rail grade crossing to prevent vehicles from stopping within
greater than 25 mph.
Ta er
Tan en[
is er
Tan ent
A
e
C
D
the highway -rail grade crossing, even if automatic train warning
25
20
50
20'
50'
200'
200'
200'
100'
155'
devices are in lace.
p
7. ROAD WORK AHEAD and the BE PREPARED TO STOP signs may be omitted if
30
20'
50
20'
50,
200'
200,
200'
100'
200'
B. If the Work Area encroaches on the Centerline, use the Layout for
all of the following conditions are met:
35
20'
50'
20
50
200
200
200
100
250'
Temporary Lane Shift to Shoulder on Sheet 3 only if the Existing
q, Work operations are 60 minutes or less.
Paved Shoulder width is sufficient to provide for an ]1' lane
B. Speed limit is 45 mph or less.
40
20
50'
20'
50'
200'
200'
200'
100,
305'
between the Work Area and the Edge of Existing Paved Shoulder.
C. There are no sight obstructions to vehicles approaching the work area for
45
20
50'
20'
50'
350'
350'
350'
175'
360'
Reduce the posted speed when appropriate.
a distance equal to the Buffer Space shown in Table 1.
2. Temporary Raised Rumble Strips:
p
D. Vehicles in the work area have high -intensity, rotating, flashing, oscillating,
50
20
50'
20
IOU
500,
500'
500'
250'
425'
y p
or strobe lights operating.
55
20'
5D
20
IOU
2640'
1500'
1000'
500'
495'
A. Use when both o/ the following conditions are met concurrently:
E. Volume and complexity of the roadway has been considered.
60
20'
S0'
20
100'
2640'
1500'
1000
500
510,
a. Existing Posted Speed is 55 mph or greater;
F. If a railroad crossing is present, vehicles will not queue across rail tracks.
65
20
50'
20'
100
2640'
1500'
1000
SOO'
645'
b. Work duration is greater than 60 minutes.
G. AFADs are not in use.
B. Use a consistent Strip color throughout the work zone.
70
20'
50'
20'
100'
2640'
1500'
IOOD
500'
730'
C. Place each Rumble Strip Set transversely across the lane at locations
8. See Index 701-600 for general TCZ requirements and additional information.
shown.
D. Use Option 1 or Option 2 as shown on Sheet 2. Use only one option
9. Automated Flagger Assistance Devices (AFADs) may be used in accordance
throughout work zone.
with Specifications Section 102. 990 and the APL vendor drawings.
3. Additional one-way control may be provided by the following means:
CONDITIONS
A. Flag -carrying vehicle:
B. Official vehicle;
WHERE ANY VEHICLE, EQUIPMENT,
C. Pilot vehicles;
WORKERS OR THEIR ACTIVITIES
D. Traffic signals.
ENCROACH THE AREA BETWEEN
When /loggers are the sole means of one-way control, the loggers
THE CENTERLINE AND A LINE 2'
must be in sight of each other or in direct communication oftall times.
OUTSIDE THE EDGE OF TRAVEL WAY.
LAST ZO Ut�CHlYI1VN:
REVISION FY 2018-19 TWO-LANE, TWO-WAY, INDEX SHEET
11101117lid
STANDARD PLANS WORK WITHIN THE TRAVEL WAY ]02-603 1 of 3
ALLEY
• • ••• • • • • •••
w_•_. ... . • • 73' •
/EX• • ••• • ••• • . GRD.
3
8
8
D-
1•• • • • ••
••• •
PROP. 1 Y" PLASTI • • • • •
•
GAS SVC. TO BE -� • -: A;
Litz •—•�i
DIRECTIONAL BORED • • • • • •
•
—I AS
us
4
0
a
4
I
XT.2" PE.
0
I 7I111�
0
PROFILE CROSSING NE 5TH AVE RD.
SCALE: (V) 1:5' (H) NTS.
aygL I�� iF �•A.i. t.< 1. � .,�. � '1� .rill"'; '�faiT is
1 � � �L �`��� � � ` r' •l' _ � ,ifl'' Y' ice`
A
. `r1
uslwo,.n\,ecr,x"cew.0 N 41'32'38•E 191.01' _
D%wAy
1 1
-------------------------- -------------------------- 7 ------ — — -------------------- i---
i I I
I i
♦
♦ LOT 21
BLK 96 ntw cdgao —
o------------
♦ o. PROI
z
♦ GAS RISE
�' ` �' ') RESIDENCE
#9632
EXI31'9VG 2 STORY
RESIDENCE
/SCALE:=30' ♦
GENERAL NOTES ♦ 'YL�
3 O19'
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
c+ovc wt
6 1
8'
1
y I : S.
T I.
1 1
1
PROP. 1 Y4" PLASTIC
GAS SVC. TO BE
DIRECTIONAL BORED
�A A-
I1 t
1 2'?A,Ogc
� 1
93
1
i 1
"ei8r.unA... v'h w J
1 �
1 1
1 1 C, 1
1 y
1 I y
mi o- 1 I
1 1 1
1
-_t--J- -1(PROP. 1 Y4" PLASTIC
GAS SVC. TO BE
I 1 DIRECTIONAL BORED
MAX. DENSITY PER AASHTO T-180 ♦ a+ NESTNAVE14UE RO
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
I
LEGEND
rE CENTER LINE oQ.
ALL EXISTING UTILITIES SHOWN ON Id MONUMENT LINE �S
R/K RIGHT OF WAY
THESE PLANS ARE TO BE /
i
5 O
31.#W o Au
m
.-1
M
N
SIDEWALK
SWALES
vi
37.5'pnp
agi
o
qq
6
rn
65' In
co
-
o
NE. 5th AVE RD.
CONSIDERED APPROXIMATE & P/L PROPERTY LINE 0.
SHOULD BE VERIFIED BY THE E.O.P. EDGE OF PAVEMENT
CONTRACTOR PRIOR TO THE T.T. TAPPING TEE 75' j
E.F.U. EXCESS FLOW VALVE
SVC. SERVICE LINE
PE. PLASTIC
STM. SEW. STOR�
START OF WORK OPERATIONS.
FULL LANE
1 1.5 'R DITCH WIDTH R 1.5' 1
12"
RESTORATION OF ROAD
FOR UTILITY CROSSI
Drawing File: \\browarl
SAW CUT ASPHALT
(TYPICAL)
_ 10.5'
T 10 2018
SWALES
XIST.2" PE. GAS MAIN > a
(1-3) C ` LL
3' oo=�
KIW
Miami Shores Villaqe
I
APPROVED BY
i�
"' 7Cn"LING DEPT
GAS MAIN
O 'a DEPT
SOD RESTORATION DETAIL I, C;OMPLI (�E WITH ALL
SCALE NOT TO SCALE
NTIAL\2018\NE 5th AVE RD. 9 1 9MFs
DATE
waW��
r OW��
Y�•I a Z
L < �z
z
rn
� a
x
NO. of BE ►s:l
sir NO.: 1
EMI SHOOES, FLdwg 10/04/2018