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PW-19-2180Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date:10/09/2019 Parcel Number 431 NE 94TH ST, Miami Shores, FL 33138 1132060140500 Contacts Permit No.. PW-09-19-2180 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 04/06/2020 LUIS ARIAS Owner 790 NE 72 ST, MIAMI SHORES, FL 33138 TECO PEOPLES GAS SYSTEM Contractor JESUS VEGA 15779 West Dixie Hwy, North Miami Beach, FL 33162 Business: 305957385777247 Other:3059701783 Re Description: TO INSTALL A NEW GAS SERVICE LINE 3/4 Valuation: $ 1,000.00 Inspection quests: tion Re PLASTTIC BY DIRECTIONAL BORE 762-4940 Total Sq Feet: 8.00 .j Fees Amount Education Surcharge $0.20 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $105.70 Payments Date Paid Amt Paid Total Fees $105.70 Check # 3570 09/19/2019 $50.00 Check # 3577 10/08/2019 $55.70 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named contractor to do the wor stated. Authorized Signature: Owner / Applicant / Contractor / Agent / Date October 08, 2019 Page 2 of 2 • '' �� RECEIVED \� Miami Shores Village Public Works Department SEP 19 2019 (305)795-2210 Public works forms are available from the building department, 10050 NE 211 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 Permit#: I w p" 1 �, Z Name of Applicant (if utility see below): TECO PEOPLES GAS Owner off the following described property: Legal Description: Lot 16 & 17 Block 52 Subdivision MIAMI SHORES SEC 2 Folio #; 11-3206-014-0500 Address: 431 NE 94TH 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 # -i CONTRACTOR NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: Email: State Certification or Registration M State: 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 ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration #: State: Email: Value of Work for this Permit: $1000 Permit Fee $ 100.00 Notary $ Bond $ ZIP: Square/Lineal Footage of Work: 8 LINEAL *****Fees***** —Train ing/Education $ 0.20 Technology Fee $ 0.80 Scanning $ _ (if required) Total Fee Now Due $ R- 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 X ��4X+� � �^ Company/Utility ent The foregoing instrumenywas acknowledged before me this day of �'i" 20) 4 , by - ES ,t vlE a A who Print: SEAL: to me or who has produced lion. HUBERT NUNEZ MY COMM SSION "' `;'. EXP RES:�Sep ember 11, 2021 PUB C: ... . LE*m APPROVED BY: , Public Works Director, or Designee 2017-04-15 Construction Trades ua i!,�ru� 8oaii S CERTIFICATE OF COMPETENCY r. t ;1608 PEOPLES GAS SYSTEM INC D.B.A.: . V -J4. VEGAJESUS IS certified under the provisions of Chapter 10 of Miami -Dade County North Miarni Contractor 10 Number:.160800000 Town of Bay Harbor Island Contractor ID Number: CONT-0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS & DISTRI LMne D. Geuon, P.E. � M' Secretary of the Board ' PA -Dade County relama et propeAy ngN, twain. """""'-miemidade.pw/economy A� o' CERTIFICATE OF LIABILITY INSURANCE DAT //2018 Y) 11/22/22018 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: Canada Limited 120 Bremner Blvd, Suite 800 HONE A/,Exc : 1-416-868-2600 FAX c No): 416 EMAIL Toronto, ON M5J OA8 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 702 N. Franklin St. Tampa, FL 33602 INSURER D: Associated Electric & Gas Ins. Svcs. AA-3190004 INSURERE: Liberty Insurance Corporation 42404 INSURER F: COVERAGES CERTIFICATE NUMBER: 18119-037- GAEW REVISION NUMBER: 1 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. INSH LTR TYPE OF INSURANCE ADDL INSR SUBR VIVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE OCCUR XL5692903P 12/01/2018 12/01/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ X MED EXP(Any one person) $ SIR$1,000,000 PERSONAL& ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 PRO- POLICY JECT LOC PRODUCTS -COMP/OPAGG $ $ OTHER B AUTOMOBILE LIABILITY XL5692903P 12/01/2018 12/01/2019 COMBINED SINGLE LIMIT Ea accident $1 000,000 BODILY INJURY (Per person) $ X ANY AUTO Self Insured Retention: ,$25Q,000 OS ALL UTOS AU SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ C UMBRELLA LIAR OCCUR XL5692903P 12/1/2018 12/1/2019 EACH OCCURRENCE $1,000,000 X EXCESS LIAR X CLAIMS -MADE AGGREGATE $1,000,000 DED I RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X ER STATUTE OTH- R E.L. EACH ACCIDENT $1,000,000 NY PROPRIETOR/PARTNER/EXECUTrVE NO FFICER/MEMBER EXCLUDED? Employer's Liability: Mandatory In NH) XL5692903P E f yes, describe under ESCRIPTION OF OPERATIONS below NIA Excess Workers' E.L. DISEASE - FA EMPLOYEE $1,000,000 Compensation: 12/01/2018 12/01 /2619 EW7-B7N-171272-028 12/01/2018 12/01/2019 E.L. DISEASE -POLICY LIMIT $1,000,000 SIR $1,000,000 DESCRIPTION OF OPERATIONS I 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 �`"�'''� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD RDAD WDRK AHEAD 209 1 200' 400' CONDITIONS .0 WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REOUIRING THE CLOSURE OF ONE b ■ • • • •� b TRAFFIC LANE, FOR WORK AREAS LESS THAN Work Area 200' DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. 400' 200' Le 20anan RDAD WORK RMAD AHEAD WORK AHEAD 1001 400' CONDITIONS WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE b • ■ • ■ • Work Area ■ b TRAFFIC LANE, FOR WORK AREAS 100' OR MORE DOWNSTREAM FROM AN INTERSECTION 400' FOR A PERIOD OF MORE THAN 60 MINUTES. � zoo Sd 2oa RDAD More Than WDRK AHEAD DURATION NOTES SYMBOLS GENERAL NOTES ® Work Area 1. Work operations shall be confined to one travel lane, leaving 5. The FLAGGER legend sign may be substituted for the symbol sign. 1. ROAD WORK AHEAD sign may be omitted if all of the following the opposing travel lane open to traffic. conditions are met: ■ Channelizing Device (See Index 102-600) 6. The maximum spacing between devices shall be no greater than 15.' 7. When vehicles in a parking zone block the line of sight to TCZ a. Work operations are 60 minutes or less. D Work Zone Sign signs or when TCZ signs encroach on a normal pedestrian 7. For general TCZ requirements and additional information, refer to b. Speed is 45 mph or less. walkway, the signs shall be post mounted and located in Index 102-600. C No sight obstructions to vehicles approaching the work area for accordance with Index 700-101. a distance of 600 feet. Flogger S. The two channelizing devices directly in front and directly at the d. Vehicles in the work area have high -intensity, rotating, 3. If work area is confined to an outside auxiliary lane, the work end of the work area may be omitted provided vehicles in the work flashing, oscillating, or strobe lights operating. b Lane Identification + Direction of Traffic area shall be barricaded and the FLAGGER signs replaced by area have high -intensity rotating, flashing, oscillating, or strobe e. Volume and complexity of the roadway has been considered. ROAD WORK AHEAD signs. Flaggers are not required. lights operating. 4. Flaggers shall be in sight of each other or in direct 9. Use Temporary Raised Rumble Strips in accordance with Index communication at all times. - 102-603. Placement of Rumble Strips and additional signs should begin at FLAGGER sign location. LAST - DESCRIPTION: REVISION FY 2019-20 INDEX SHEET 11101117 STANDARD PLANS TRIO -LANE, TWO-WAY, WORK NEAR INTERSECTION 102 605 1 of 1 tin --------- __-_NE I 1 402 d20 434 460 9454 ; `p � I 1379 4 I 1 I 419 443 , 446 1 I 1 I g.94TKS-T------- ----------------- 410 420 � 41 1 440 GENERAL NOTES 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 450 SWAM N W E s LEGEND C CENTER LINE M MONUMENT LINE RIW 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 RU LAW RESFORAUTIILITYECROSSING T 3' "I z 6" GAS AWN SOD RESTORATION DETAIL SCALE: NOT TO SOME TIE INSVCTOGAS MAI - RECEIVED ►sT.2"C.S.GAS MAIN WITH T.T./E.F.V. 1-3 a N R W ---SE° _�' --------�� S R /2 V5' PROP. 3/4" PE.GAS SVC. LINE BY DIRECTIONAL BORE 36" MINIM COVER PROP. RISER ALT PAWM/£NT:.......: .... P—Mo—.- .• '.':: _ :'.'::.'.'..'..'.'..'.'. 1' 46' I S I v 3.O:o ,c o i5.10' �111.40• # 3; SW CK ,SPH&T 0.7 SCRMNM . 419 io ENM0WRE a 0.7Vll ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE. CONSIDERED APPROXIMATE do SHOULD BE VERIFIED BY THE CONTRACTOR PRIOR TO THE START OF WORK OPERATIONS. 15' n . GR%� 8 o ui T w 8 PROP. 3 4' PLASTI L_ --- -----__ _- _ W DIRECTIONAL BORED 36" MIN. 4 ' •�` 1 4 1MA1111 1 1-3 1 0 0 PROFILE CROSSING ALLEY SCALE: (V) 1:5' (H) NTS. A (BASIS OF 6EARNG PER PLAT) 0. 150.00' 16.0' /7540'. TWO STORY RES. #431 I % r�-. vw- 7' V'-' .4' 1 41 CONC AMI SH 5uAic v ...... .... �••• • • I Sys••• aN Wrm N ES ILLAC Ki EW D T6�� s SCALE:1'=20' F:iP. 1/2' % F.LP. w 5' CSW 00. ,•' . . .... ............ , .. : ........:.:. ;^ .........10.0' ASpyAL T�PAWING' .. _ .:... - - : - P. '• ......... ... .. .. . ' ' '.... ... :........ .... ... . .. . , ' 75'-RMCWT--W—WAY (BY PLAT),. ::. - '.......................... .. .. .. ,•;.` ..20'f ASPHALT PAWUENT.'..............'-: . e •db C o w E z ol OF ur No.: 1 Drawing File: G:\Documents\MIAMI SHORES\431 NE 94TH ST MIAMI SHORES FL 33138 —IN PROGRESS\431 NE 94TH ST MIAMI SHORES.dwg 09/10/2019