PW-05-22-1305Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
530 GRAND CONC, Miami Shores, FL 33138 1132060171420
Contacts
Robert Paul Roberts TRS Owner PEOPLES GAS SYSTEM INC Contractor
530 Grand CONC, Miami Shores, FL 33138 ANGEL QUANT
5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309
Business: 9545580876 bertnunez2@aol.com
Mobile: 9544530811
Inspection Requests:
Description: GAS SERVICE REPLACEMENT Valuation: $ 1,000.00
Tota15 Feet: 11.00��
q � urr.6E INN �tr
Fees
Amount
Education Surcharge
$0.30
Public Works Permit Fee
$100.00
Technology Fee
$10.00
Total:
$110.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
05/02/2023 $110.30
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 ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI VIT: I certify that all the foregoin formation is accurate and that all work will be done in compliance with all applicable laws
regulating cow ion d zoning. Futhermore orize the abo n ed contractor to do the work stated.
G✓� � 3 0CPA
Authorized Signature:
May 02, 2023
Contractor / Agent
Date
Page 2 of 2
=4. Miami Shores Village {�a
Public Works Department `j i02
(305)795-2210�'�
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 333.38
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#VI) o
Narne of Applicant (if utility see below): PEOPLES GAS SYSTEM
Owner off the following described property:
Legal Description: Lot 5 ^� Block 97 _ Subdivision MIAMI SHORES SEC 4
Folio #; 11-3206-017-1420
Address: 530 GRAND CONCOURSE MIAMI SHORES, FL 33138
UTILITY NAME: PEOPLES GAS SYSTEM
Qualifier/Authorized Agent: Angel Quant
Address: 5101 NW 21 AVE. SUITE. 460
City: FT. LAUDERDALE State: FL
Telephone: 954-558-0876 Email: BERTNUNE:Z2@AOL.COM
ZIP: 33309
State Certification or Registration #: E2100068 _ Certificate of Competency #
CONTRACTOR NAME: PEOPLES, GAS SYSTEM
Qualifier/Authorized Agent: Angel Quent —
Address: 5101 NW 21 AVE. SUITE, 460
City: FT. LAUDERDALE State: FL ZIP: 33309
Telephone: 954-558-0876 Email: BERTNUNE:Z2@AOL.COM
State Certification or Registration #: E2100068 Certificate of Competency
Requesl:s permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: GAS SERVICE REPLACEMENT
Type of Work: ❑ Paving ■❑ Utility
❑ Landscape ❑ Antenna
❑ Sidewalk ❑ Electric ❑ Irrigation
[] Other:
DESIGNER: Architect/Engineer: TECO PEOPLES GAS
Address: 5101 NW 21 AVE..
City: FT. LAUDERDALE State: FL ZIP: 33309
Telephone: 954-558-0876 Email: BERTNUNEZ2@AOL.COM
Registration #:
Value of Work for this Permit: $1000
Permit Fee $100.00
Notary $
Bond $ _
Square/Lineal Footage of Work: 11
***** Fees*****
_ Training,/Education $ 030 Technology Fee $4�.80 Scanning $__
(if required) Total Fee Now Due $ i L�� •:�v _._
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 th
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 � Signatur
Applicant or Authorized Agent Company/Utility Agent
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this day of 20 by me this _,Z_o day of A . . 20Z Z , by
_ who A }.OJ—IQ0/A F __who
is personally known to me or who has produced is person III y known to me or who has produced
_ as _ as
identification. identification.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: _ Sign: 61
Print: _ _ Print: ! ! UAl, ,4 f U /1 e,
SEAL: `,TEAL:
HUBERTNUNEZ
MY COMMISSION # HH 128865
;�oF�opo EXPIRES: September 11, 202E
Bonded Thru Notary Public Underwriters
APPROVED BY:?�, Public Works Director, or Designee
2017-04-15
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NOTE: THE RESTORATION OF THE NEW ASPHALT MUST BE RESTORED BY THE STANDARDS OF
CITY OF MIAMI SHORES 10' ON EACH SIDE OF THE OPEN CUT AND FULL ALLEY. G�
\PR 2 4 2023
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CENTER LINE
G` ' PC) M MONUMENT LINE
�`e� Q�Q Q� C>�G \ �'\ • / �• / • • ��G\�C ` W RIGHT OF WAY
P/L PROPERTY LINE
E.O.T. TAPPING
TEEVEMENT
E.F.V. EXCESS FLOW VALVE
SVC T.F. TRANS17� IO IFIrnNG
I J •• +
•• ALL EXISTING UTILITIES SHOWN
G ! ./ ON THESE PLANS ARE TO BE
` v- S ../� /' �• , ti �F, CONSIDERED APPROXIMATE &
CAP G. / p\� SHOULD BE VERIFIED BY THE
/ • ` P\J �`� CONTRACTOR PRIOR TO THE
/•. ../� �, ���Q�P �Q G\ START OF WORK OPERATIONS.
• ••/ / •/• 5� �G.
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/
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se
EXISTING U77LI77ES SHOWN ON THIS
_
— --"— 1 6. 5 —
I
PLAN ARE FROM GPR INFORMATION
PROVIDED BY Mt —TECH an EQu0t tympany
3
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1 X. GRID.
Ix
ZIFEX.3/4"
IN
GENERAL
NOTES
$1.
CUT &
_�_
;AP
I
REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE
7
AT
AIN
7
THE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18"
I
2.
BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE
6
.36"
E
I
MIN.
1 6
MEASUREMENT) LAYER AND EACH LAYER THOROUGHLY
1
ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER
5
WM
5
AASHTO T-180
I
3.
ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE
MECHANICALLY SAWED
4
1
1 4
I
4.
SURFACE MATERIAL SHALL BE CONSISTENT WITH
3
2"
X.STEEL
SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS)
3
,
5.
BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A
\'Xl
( GAS MAIN
MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL
2 1
I
I`
1 2
1
STREETS)
1 2.5
OPEN CUTI
Y'ROP. 314"
' PLASTIC
1
6.
CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF
EXISTING UTILITIES
GAS SVC. TO a
I OPEN CUT _
PROFILE CROSSING ALLEY SCALE: 1:40 (V) 1 "= I' (H) 1 "=2'
5
J
VAIN
SOD RESTORATION DETAIL
SCALE: NOT TO SCALE
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SHM No.: 1
c1gi
Construction Trades ualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
111 r,i
PEOPLES GAS SYSTEM INC
7
QUANT, ANGEL
Is certified under the provisions of Chapter 10 of Miami -Dade County
AC"R19' CERTIFICATE OF LIABILITY INSURANCE r DATE(MM/DD/YYYY)
5/21 /2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RICIHTS 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 �i
CONTACT
NAME:
Marsh Canada Limited
120 Bremner Blvd, Suite 800
Toronto, ON M5J OA8
PHONE
1-416-888-281)0
(A/C, No, Ext):
A/(a, No): 416-349-4564
C
EMAIL
ADDRESS:
_
INSURER(S) AFFORDING COVERAGE
NAIC tl
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 33802
INSURERD: Associated Electric & Gas Ins. Svcs.
AA-3190004
INSURERE: LM Insurance Corporation
42404
INSURER F:
U-sioYlXI:491aLey—it _4U,01it1:1=10111 ] 1151]4Qt7_\NAV6'1If] kiI'!ill di1:14:0
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
SUBR
WVD
POLICY NUMBER
_-
POLICY EFF
MM/DDIYYYY
POLICS'EXP
MI MIDDiYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X
CLAIMS -MADE OCCUR
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1,000,000
_.
DAMAGE TO RENTED
PREMISES Ee occurrence
$
X
.
MED EXP (Any one person)
$
SIR $1,000,000
PERSONAL &ADV INJURY
$
GEN'L AGGREGATI= LIMIT APPLIES PER:
PRO- POLICY1:1 PRO- LOC
JECTPRODUCTS
GENERAL AGGREGATE
$1,000,000
- COMP/OP AGO
$
_!.
$
OTHER
B
AUTOMOBILE LIABILITY
XL5692905P
06/01/2021
06/01%2022
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
X ANY AUTO
Self Insured Retention:
$250,000
BODILY INJURY (Per person)
$
ALL OWNED
AUTOS
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
$
HIREDAUTCS
NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
$
.
UMBRELLA I.IAB
OCCUR
C
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1,000,000
CC
X
EXCE39 LIAI#
X
CLAIMS -MADE
AGGREGATE
$1,000,000
DED
RETENTION $
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
Employer's Liability:
X
PER STATUTE
TH-
R
E.L. EACH ACCIDENT
$1,000,000
NY PROPRIETORWARTNER/EXECUTIVE NO
FFICERIMEMBER EXCLUDED?
XL5692905P
E
Mandatory In
F yes, describe ndo•
unc
DESCRIPTION OF OPERATIONS below
WA
Excess Workers'
Compensation:
06/01 /2021
06/01 % 2022
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE. POLICY LIMIT
$1,000,000
EW5-B7N-171272-020
SIR $1,000,000
12/01/2020
12/01/2021
DESCRIPTION OF OPI=RATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
License #E1608
Excess Liability policy provides insurance in excess of Peop as Gas System's Self -Insured Retention as stated above.
The above noted poltoy placements were made by Marsh USA Inc. Marsh Canada Limited has onhl acted in the role of a consultant to the client with respect to these placements, which are Indicated here
for yourconventence.
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:
01988-2014 ACORD CORPORATION. All rights reserved.