PW-02-22-383Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
9535 BISCAYNE BLVD, Miami Shores, FL 33138 1132060143050
Contacts
FRANK BLANCO Owner PEOPLES GAS SYSTEM INC Contractor
9535 BISCAYNE BLVD, MIAMI SHORES, FL 331382536 ANGEL QUANT
Other: 7862511500 5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309
Mobile: 9544530811 arroche@tecoenergy.com
Inspection Requests:
Description: TO INSTALL A NEW GAS SERVICE LINE (1 1/4" Valuation. $ 1,000.00
PLASTIC) BY DIRECTIONAL BORE 305"762 4949,;
Total Sc Feet: 3.00
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 # 4473
02/23/2022 $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.
OWNERS AFFIDAVIT: I certify that all the foregoing information. -is accurate and that all work will be done in compliance ,nvith all applicable laws
regulating construction and zoning. Futhermore, I authorize the ab6ve naMed contractor toA the work stated, ,
Authorized Signature: Owner / Applicant /
Agent
•xJ
February 23, 2022
Page 2 of 2
nT R � U T T
-a—� Miami Shores Village
``cam Public Works Department r �_ ]_ 2012
(305)795-2210 LJ
Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, L 33138
3;
PUBLIC WORKS PERMIT APPLICATION
Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property
Permit#:
Name of Applicant (if utility see below): TECO PEOPLES GAS
Owner off the following described property:
Legal Description: Lot 12&13 Block 76 Subdivision MIAMI SHORES SEC 3
Folio #; 11-3206-014-3050
Address: 9535 BISCAYNE BLVD
UTILITY NAME: TECO PEOPLES GAS
Qualifier/Authorized Agent: Angel Quant
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE State: FL ZIP: 33309
Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM
State Certification or Registration #: E2100068 Certificate of Competency #
CONTRACTOR NAME: TECO PEOPLES GAS
Qualifier/Authorized Agent: Angel Quant
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE State: FL
Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM
State Certification or Registration #: E2100068 Certificate of Competency #:
ZIP: 33309
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: TECO PEOPLES GAS
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE State: FL ZIP: 33309
Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM
Registration #: .* 119rLT.v0 .4 C_z a Q f(o 1—
Value of Work for this Permit: $1000
Permit Fee $ 100.00
Notary $
Bond $
Square/Lineal Footage of Work: 3
***** Fees *****
_ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $
(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 Signature
Applicant or Authorized Agent Company/Utility Agent
The foregoing instrument was acknowledged before The foregoi g instrument was acknowledged before
me this day of 20 by me this day of Pit 20_Z by
who 4 c , ,,� who
is personally known to me or who has produced is personally known to me or who has produced
as as
identification.
NOTARY PUBLIC:
Sign:
identification.
NOTARY PUBLI
Sign:
Print: Print:
SEAL: SEAL:
;.4... HUBERT NUNEZ
*; MY COMMISSION # HH 128865
="a•'o EXPIRES: September 11, 2025
''FOF '."• Bonded Thru Notary Public Underwriters .
C&*�*
APPROVED BY:', Public Works Director, or Designee
2017-04-15
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CENTER LINE
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E.O. P. T
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T.TAPPINGTEE
T. FITTING
E.F.V. EXCESS FLOW VALVE
SVC SERVICE LINE
ALL EXISTING UTILITIES SHOWN
ON THESE PLANS ARE TO BE
CONSIDERED APPROXIMATE &
SHOULD BE VERIFIED BY THE
CONTRACTOR PRIOR TO THE
START OF WORK OPERATIONS.
CITY
GENERAL NO OP
1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE
`a,
3.
4.
5.
6.
THE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18"
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
ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE
r
MECHANICALLY SAWED
SURFACE MATERIAL SHALL BE CONSISTENT WITH
SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS)
BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A
MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL
STREETS)
I
I
I ! �
LOCATION MAG (N.T.S.)
[mo— .3' ---]
m
MAIN
CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF SOD RESTORATION DETAIL
EXISTING UTILITIES SCALE: NOT TO SCALE
I AG
PUBLIC WORKS RL'` t E
8 PPRC10 �i Al
w
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6 I-------t`_�_—� 6
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1 36" MIN.
4 Ir6" iV✓.M. I 4
3 I j�p�J I 3
� AS 1 _ L
I 1
1 I ROP. 1 1/4" PLASTIC GAS FAIN 1
1 GAS SV�. TO BE 1-3
0 I DIRECTIONAL BORED i 0
I
—2
PROFILE CROSSING ALLEY SCALE: 1:40 (V) 1"=l' (H) 1"=2'
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ry
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SHEET NO.: 1
Construction Trades uall(yinct [bard
OUSINESS CERTIFICATE OF COMPETENCY
ES GAS SYSTEAR INC
B.A„
QUANT, ANGEL
Is certified under the provisions of Chapter 10 of Miaml-Dade County
MI .. mm t, t zk. f
QUALIFYING TRADE(S)
0014 FUEL TRANS & DISTRI
-Wme D. Gaston, P.E. MtAM
Seactory of the Board �"�-'� �' ion
am
htiamFDade CnuMy relatns aA property dghls herein. +*`Aw•mianadade.gev/oconomY
A� �' CERTIFICATE OF LIABILITY INSURANCE
DAT5/21/2D/YYYY)
5/21 /2021
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
(AIC, No Ext :
jAAic, No): 416-349-4564
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: 20/21-037- 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MM/DD
LIMITS
A
XCOMMERCIAL
GENERAL LIABILITY
X CLAIMS -MADE OCCUR
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1,000,000
To
PREM SE S Ea oocu D nce
$
X
MED EXP (Any one person)
$
SIR $1,000,000
PERSONAL &ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
PRO-
POLICY JECT LOC
GENERAL AGGREGATE
$1,000,000
PRODUCTS - COMP/OP AGG
$
]OTHER
B
AUTOMOBILE LIABILITY
XL5692905P
06/01/2021
06/01/2022
COMBINED SINGLE LIMIT
Ea accident
$1'000'000
BODILY INJURY (Per person)
$
X ANY AUTO
Sett Insured Retention:
$250,000
ALL OWNED
AUTOS
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS
NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
C
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1 ,OQQ,QQQ
CC
X
EXCESS LIAB
X
CLAIMS -MADE
AGGREGATE
$1,000,000
DED RETENTION $
$
D
WORKERS COMPENSATION
X
PER STATUTE
OTH-
=R
AND EMPLOYERS' LIABILITY YIN
Employees Liability:
E.L. EACH ACCIDENT
$1 ,D00,000
Y PROPRIETORIPARTNER/EXECUTIVE NO
FFICER/MEMBER EXCLUDED?
XL5692905P
E
Mandatory in NH)
(yes describe under
ESCRIPTION OF OPERATIONS below
NIA
Excess Workers'
Compensation:
06/01/2021
06/01/2022
E.L. DISEASE - EA EMPLOYEE
$1,000,000
EW5-B7N-171272-020
SIR $1,000,000
12/01/2020
12/01/2021
E.L. DISEASE -POLICY LIMIT
$1,000,000
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 PROV,
SIONS.
AUTHORIZED REPRESENTATIVE
CORPORATION. All rights reserved