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PL-03-20-457
Miami Shores Village 10050 NE 2 Ave Miami Shores Fl- 33138 305-795-2204 Location Address 330 NE 93RD ST, Miami Shores, FL 33138 Contacts Issue Date: 03/i Parcel Number 1132060136340 Permit NO.: PL-03-20-457 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: Approved D I Expiration: 09/21/2020 TASSO RUMELIOTIS Owner TECO PEOPLES GAS SYSTEM Contractor 330 NE 93 ST, MIAMI SHORES, FL 331382828 JESUS VEGA 15779 West Dixie Hwy, North Miami Beach, FL 33162 Business: bertnunez2@aol.com 305957385777247 Other: 3059701783 ;.:c Description: INSTALL 3/4 PLASTIC GAS SERVICE Inspection Requests: LINE Valuation: $ 1,000.00 DIRECTIONAL BORE 305 762-4949 Total SLFeet 0.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $116.30 Payments Date Paid Amt Paid Total Fees $116.30 Check # 3818 03/25/2020 $116.30 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 tha all the foregoing infor do is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin uther ore, I authorize t a co ve named actor do the work stated. LfL� � Authorized Signature: Owner Applicant / Co tractor / Agent Date March 25, 2020 Page 2 of 2 L.O w '�,p p� ✓� �` L� Miami Shores Village , Public Works Department -� (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores;, Yi PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property �-7t Permit#: l �'"r ' b -�4 J Name of Applicant (if utility see below): SEE BELOW Owner off the following described property: Legal Description: Lot 8. 9 & 112 or 10 Block 47 Folio #; 11-3206-013-6340 Address: 330 NE 93RD ST. UTILITY NAME: TECO-PEOPLES GAS Qualifier/Authorized Agent: JESUS VEGA Address: 5101 NW 21st AVE. Subdivision Miami Shores Sec. 1 City: FT. LAUDERDALE State: FL Zip: 33309 Telephone: 954-453-0811 Entail: ARROCHE@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: INSTALL 3/4" PLASTIC GAS SERVICE LINE VIA DIRECTIONAL BORE Type of Work: ❑ Paving ® Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: City: Telephone: Registration #: State: Email: Value of Work for this Permit: 8 1,000 Permit Fee $ 100.00 Notary $ Bond $ ZIP: Square/Lineal Footage of Work: 49 FT. ***** Fees***** -Train ing/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (if required) Total Fee Now Due $ � I Co • 3 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. 1 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 Signature Applicant or Authorized Agent Company/Utili Agent The foregoing instrument was acknowledged before The foregoing instrument was. acknowledged before me this day of 20 by me this -.;2-7 day of 20� , by who who is personally known to me or who has produced _is_personal y known_10 me or who has produced as as identification. identificatia . HUBERTNUNEZ MY COMMISSION # GG 104234 NOTARY PUBLIC: NOTARY;I?UBLIC.' '"' - r:. �/ C,, ,<{= EXPIRES: September 11, 2021 Bonded Thru Nolar Public Underwriters Sign: Sign: Print: Print: SEAL: SEAL: t Tt 12� � v�T3 APPROVED BY: \ .' Public Works Dire ctor, or Designee 2017-04-15 CTQB t ..y, •' Construction Trades Qualifying Board '• BUSINESS CERTIFICATE OF COMPETENCY E1808 PEOPLES GAS SYSTEM INC •, 'D.B.A.. VEGA JES S Is certified under the provisions of Cfupter 10 of Miami -Dade Counlyt QUALIFYING TRADE(S) 0014 FUEL TRANS & DISTRI "1 MrAMtD Jaime D. Gauon, P.E. ; _ :.2 Secretary of the Board Mam4Dade County re hire as property rights herein. www.mlamidade.gwfecmgmy CERTIFICATE OF LIABILITY INSURANCE Y) DATE(11 /29//2019 019 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 1-416-868-2600 A/c, IN Exe : 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 702 N. Franklin St. Tampa, FL 33602 INSURER D: Associated Electric & Gas Ins. Svcs. AA-3190004 INSURER E: LM Insurance Corporation 42404 INSURER F: COVERAGES CERTIFICATE NUMBER: 19/20-037- GAEW REVISION NUMBER: 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 SUBI POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS.MADE F—IOCCUR XL5692904P 12/01/2019 06/01/2021 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 D JECT LOC PRODUCTS-COMP/OP AGG $ $ OTHER B AUTOMOBILE LIABILITY XL5692904P 12/01/2019 06/01/2021 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO Self Insured Retention. $250,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ HIREDAUTOS NON -OWNED AUTOS $ C UMBRELLA LIAR OCCUR XL5692904P 12/01/2019 0610112021 EACH OCCURRENCE $1,000,000 X EXCESS LIAB X CLAIMS -MADE AGGREGATE $1,000,000 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X ER STATUTE OTH- R E.L. EACH ACCIDENT $1,000,000 Y PROPRIETOR/PARTNER/EXECUTIVE NO OFFICER/MEMBER EXCLUDED? EmployeYs Liability: E Mandatory in NH) f yes, describe under ESCRIPTION OF OPERATIONS below N/A XL5692904P Excess Workers' Compensation: E.L. DISEASE - EA EMPLOYEE $1,000,000 EW5-B7N-171272-029 12/01/2019 06/01/2021 SIR$1.000,000 12/01/2019 12/01/2020 E.L. DISEASE -POLICY LIMIT $1,000,000 Fn I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License #E1608 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 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD f E c II c r � rr w� �`� hNNrOry�NgNOM - m P c r f 1 O O O O O O O O O O W C f .,3 a � E Gah oG ti ca o C m a�.�+ m LLLI c v W Zvi � Eo o � va O R hH Q 3 rn i Fwwi K O ti °w ? QmQo O O z W ti W 2 W O Q m Q w o OU 3 k w ti 0 _ y o N v L= E� no ono a m 3� ti o� 3�a ¢A daiu o w�iu �n Q'3 � 3 _ w o� — .c in Hai n ovvi m cc `w E Oc 30 Nww .�n�mvQ`ma�n °i t�mhz �3 30`." vL C mPu Oj �a�o o'G.,L Q U� w.. W3�w 3oa Z is ¢m �tiaas � �m6�a h�� a�ioo1= 3E LV vni cm ¢ co ii o .1 lz , BIOZM. i11 I rt25 1 335 1 341 ----Y,----------- r- ---------- NF 8 : r d • • ••• • • e •ee e• •• f • . ..• . e Al. r r • • R • e e e ® e . e • e ! ° e e woo e 366 LOCATION MAP �N.T.s.� GENERAL NOTES 1. REPLACE4,AASE MATERIAL OVER DITCH SHALL BE TWICE THE N W rc E S SCALER'=20' N R/W #301 L #325 _ _ _ _ _ #335 _ _ _ _ _ _ _ - CD -- o— - - _ -_._- _ SIDEWALK ' 5 O Existing 2" P.E. GAS MAIN € m TIE IN SVC. TO GAS MAIN (DIR. BORE) - 26' WIT TTIE FV 811 W M o ° 2 d � 1 ' a a °d ,a ° a FROM EOP °d a ao d � d ° ° ° � ° I�.�. 93rd ° St. ° a° ,(FCTJy�4 z ,(arJy4] d a d _ e a a ° d ° d ° V] Q E- U 0 14 THICKNESS OF THE BASE, MIN. 8" AND MAX. 18" _ _N P/L 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) SIDEWALK 0 _ _ _ _ _ _ _ LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF ALL EXISTING UTILITIES SHOWN ON TO BE S' R/W - - - a MAX. DENSITY PER AASHTO T-180 THESE PLANS ARE 1 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED CONSIDERED APPROXIMATE & 1 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE SHOULD BE VERIFIED BY THE , MATERIAL (1.5" MIN. THICKNESS) I 5. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE CONTRACTOR PRIOR TO THE 25' CONTENT OF 70% (60% FOR LOCAL STREETS) START OF WORK OPERATIONS. 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES PROP.--' f 3' --� f 6" M -GAS MAIN 0 SOD RESTORATION DETAIL SCALE: NOT TO SCALE FULL LANE SURFACE REPLACETAENT BASE —�- (NEW MATERIAL) 1.5' DITCH WIDTH LEGEND q CENTER LINE %ye M MONUMENT LINE R/W 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 8" W M ° E.0ePa D — 75' -7— — 14 m °E.O.P.° d ° D d 49' I Gi D 1010' I 314" P.E. --j GAS SVC. cn SAW -1 ASPHALT (TYPICAL) TO BE DIRECTIONAL #346 BORED \ E- IAMT SHORES VILLAC:- I 25' a PUBLIC WORKS REVIEW I� ' PPROVEr) C«- DATE 3 �� U ao E" z� z} RESTORATION OF ROAD CUT PROP.------ n F LD I 1 I o FOR UTILITY CROSSING GAS RESIDENCE , , , W W �. W ; a x m I 12• 75' — — 3 12 _ 12 -------------- ----- ------ -------------------- 8 I 36" MI _ PRO 1 MAIN 2" P.E.----- �dS IAAIN . ' CAS — GAS — I' T --CXS--GAS-�CA --• — C 1 , -PROP. 3/4" PLASTICrAS SVC RF --.._.._....—I "SRN ---1— I' TO DIRECTIONAL BORED I 4 —....... ... -.......--- - -- -1 - 4 1 1-1 ILL VI\VJJIIVV IVC zjJ JI. RISER I e W a 1 ` #330 I e W m 2: a Z N z I 1 7 ZO 1 � 1 I 1 I 1 1 - SCALE: V 1:5' H NTS. ---J- -- —-- -- TMW- 8 T)=AN3 '"No. OF%H=S: SHEEP NO.: 1 Drawing File: C:\Users\lkrupinskl\appdata\local\temp\AcPubI Disapproved