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PW-19-2677Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1234 NE 94TH ST, Miami Shores, FL 33138 Contacts r�G"iiul�[� Issue Date:11/19/2019 Parcel Number 1132050100210 Permit NO.: PW-11-19-2677 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 05/06/2020 ELI BRAVO Owner 1200 NE 97 ST, MIAMI SHORES, FL 33138 Other: 3054942371 TECO PEOPLES GAS SYSTEM Contractor 1ESUS VEGA 15779 West Dixie Hwy, North Miami Beach, FL 33162 Business: 305957385777247 Other:3059701783 Description: TO INSTALL A NEW GAS SERVICE LINE (1 1/4 Valuation: $ 1,000.00 Inspection Requests: PLASTIC) BY DIRECTIONAL BORE TotalSq Feet: 4.00 1305-762-4949 Fees Amount Education Surcharge $0.20 Public Works Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $105.70 Building Department Copy Payments Date Paid Amt Paid Total Fees $105.70 Check # 3596 11/08/2019 $105.70 Amount Due: $0.00 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 ELECTRICA ,PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDA IT: cert' thathe foregoiDg information is accurate and that all work will be done in compliance with all applicable laws regulating constructs nd ing. F e more,, I a h nzefthe_ ve named contractor to do the wgrk stated. X-L �2W Authorized Signature: Ow er / Applicant / Contractor / Agent Date November 19, 2019 LV Page 2 of 2 ENTERED -�� Miami Shores Village Public Works Department NOV 0 7 2019 (305)795-2210 Public works forms are available from the building department, 10050 NE 21' Ave., Miami Shor(8''033138 __�k PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: TVJ-" ti—Iq' 20 -- - Name of Applicant (if utility see below): TECO PEOPLES GAS Owner off the following described property: Legal Description: Lot 23 & 24 Block IRREGULAR Subdivision MIAMI SHORES BAY VIEW Folio #; 11-3205-010-0210 Address: 1234 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 # CONTRACTOR NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: Email: 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 (1 1/4" PLASTIC) BY DIRECTIONAL BORE Type of Work: ❑ Paving ❑■ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: Telephone: Registration M State: Email: Value of Work for this Permit: $1000 Permit Fee $ 100.00 Notary $ Bond $ ZIP: Square/Lineal Footage of Work: 4 LINEAL *****Fees***** -Train ing/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (if required) Total Fee Now Due $ i 005. 10 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: APPROVED BY: 2017-04-15 Signature Cz3� Company/Uti Agent The foregoing instrument was acknowledged before me this � day of c 'f 20) � , by �i rfkS ce A who is personally known to me or who has produced as jntifica' n. TA PUBLIC•n: Print: SEAL: Z : `r;w , ••. :'• My COMMISSION fl GG 104234 .,.•.1•;, EXPIRES: Seplamber 11, 2021 ,CF ; •',i; Oondcd Thai tdotary Public Undorwrilors _ ********************************************** Public Works Director, or Designee A`CORUe CERTIFICATE OF LIABILITY INSURANCE DAT 22/o1a 11/v2v2018 Y) 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 HONE A/C, , Ext : 1-416-868-2600 FAX No : 416 349-4564 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 INSURER D: Associated Electric & Gas Ins. Svcs. AA-3190004 702 N. Franklin St. Tampa, FL 33602 INSURER E: Liberty Insurance Corporation 42404 INSURER F: COVPRAGFS CFRTIFICATF NUMBER: 1R/19-n37-GREW REVISION NUMBER: 7 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 SUB WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY 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 (Anyone Person) $ SIR $1,000,000 PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY ❑ JECT LOC GENERAL AGGREGATE $1,000,000 PRODUCTS •COMPK)P AGG $ JOTHER $ 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: $250,000 ALLOW NEO AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ C UMBRELLALIAB OCCUR XL5692903P 12/1/2018 12/1/2019 EACH OCCURRENCE $1 �000�000 X EXCESS LIAR I X CLAIMS -MADE AGGREGATE $1,000,000 DED I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ERSTATUTE DTH- X R E.L. EACH ACCIDENT $1,000,000 NY PROPRIETORIPARTNERJEXECUTIVE NO FFICER(MEMBER EXCLUDED? Employer's Liability: Mandatory in NH) XL5692903P E ( yes, describe under ESCRIPTION OF OPERATIONS below N/A Excess Workers' E.L. DISEASE • EA EMPLOYEE $1,000,000 Compensation: 12/01/2018 12/01/2019 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 / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Liability policy provides insurance in excess of Peoples Gas Systems 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 W20-7A MOT-18-10 (See Note 1) W20-4 (See Note 3) MOT-13-06 W20-IF G20-2 (See Note 4) (See Note 4) 9PEE—OEI LAGGE � UMBLROAD END AHEAD ROAD STRIPS WORK AHEAD AHEAD PREAHEAD Temporary Raised Rumble Strip Set (See Note 3) I 250' X -i X _ I X I X X _ ——Z.L--------7/�_--------�-L--------�Z------ �Z--------��--------�Z X X x x X U Temporary Raised Rumble Strip Set (See Note 31 50'-IOU 501-1001 END ROAD ool■IFd O�AZ WORKAHEAD p� AFIEM AHEAD G20-2 (See Note 4) MOT-13-06 W20-IF (See Note 4) MOT-18-10 W20-4 W20-7A (See Note 3) (See Note 2) SYMBOLS: ® Work Space ■ Channelizing Device (See Index 102-000) D Work Zone Sign ­10- Lane Identification and Direction of Traffic Cr Flagger NOTES: 1. L = Taper Length U = Buffer Length X = Work Zone Sign Distance See Index 101-000 for "L", "U", "X", and channelizing device spacing values. 2. Optionally, use "Flagger Ahead" sign with symbol (W20-7) instead of "Flagger Ahead" sign with text (W20-7A). 3. Use temporary raised rumble strips in accordance with the Plans. If temporary raised rumble strips are not used, omit "Rumble Strips Ahead" signs (MOT-18-10) and associated work zone sign distance. See Index 101-000 for temporary raised rumble strip details. 4. The "Speeding Fines Doubled When Workers Present" signs (MOT-13-06) and "End Road Work" signs (G20-2). along with associated work zone sign distances, may be omitted when the work zone will be in place for 14 hours or less. LAST o DESCRIPTION: FDOT FY 2020 21REVISION INDEX SHEET 11101119 �� STANDARD PLANS TWO-LANE ROAD FLAGGE RS CLOSURE USING 102-025 1 of 1 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY E1808 PEOPLES GAS SYSTEM INC a D.B.A.: CJ� vgt Jn. VEGAJESUS Is certified under the provisions of ChWer 10 of Miami -Dade Carat QUALIFYING TRADE(S) 0014 FUEL TRANS & DISTRI Jayne D. Gasoorl P.E. Secrefiryoldie Board ..a•..-8.•:'`� Miami Dade Couty rely- as property dgMs herein. vnvw.piani0ade.Gow� N W E S N R/W _ o TIE IN SVC TO GAS MAIN N WITH T.T./E.F.V. XIST .2" P.E. GAS MAIN 1-3 0 g O E.O.P. € —50'- — 15" S R/W PROP. 314" PE.GAS SVC. LINE BY DIRECTIONAL BORE 36" MINIM COVER PROP. GAS RISER LOCATION MAP 1--T -r LEGEND CENTER LINE ALL EXISTING UTILITIES SHOWN ON M I A M I SHORES V I L LAC IL1 MONUMENT LIN R/W RIGHT OF WAY THESE PLANS ARE TO BE PUBLIC WORKS REVIEW CONSIDERED APPROXIMATE & P/L PROPERTY LINE SHOULD BE VERIFIED BY THE E.O.P. EDGE OF PAVEMENT CONTRACTOR PRIOR TO THE LT. TAPPING TEE A PROVED C �"' DATE � START OF WORK OPERATIONS. E.F.V. EXCESS FLOW A SVC. SERVICE LINE PE. PLASTIC GENERAL NOTES STM. SEW. STORM SEWER 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 50 0- - a 14 - - - PROP. MAIL 2" P.E.1 I-3 12 'ROFILE CROSSING NE 94 ST. BORED ------------- -- MIN. - MIN. n 15'WM i 1 14 12 1 SCALE: (V) 1:5' (H) NTS N tE S SCALER'=31 NE 94th STREET V E.O.P. r I N 4 -- j1---------- — — -- ------ 15 — —� W 220 1 ..' r... • One story , ••• RESIDENCE #1234 • • •' . " • • i rid �� -... ,� ,��-..' -... "�a • • • SOD RESTORATION DETAIL SCALE NOT TO SCALE REPLACEMENT BASE (MEW MATERIAL) 17d. I.T. RESTORATION OF ROAD CUT FOR UTILITY CROSSING la rn w C] z zQ v Q a=LL uWUw¢ W6 QXm wEE p Gz ^z 9 z NO. OF SFI]MTS: 1 SFWM NO.: 1. • Drawing File: C:\Users\lkrupinski\appdata\local\temp\AcPublish-1316\1234 NE 94TH ST, MIAMI SHORES.dwg 10/28/2019