PW-11-23-2982Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date-11/29/2023
Location Address Parcel Number
10561 NE 2ND PL, Miami Shores, FL 33138 1122310130470
:ontacts
Permit NO.: PW-1 1 -23-2982
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 05/27/2024
M BROOKS Owner PEOPLES GAS SYSTEM INC Contractor
10561 NE 2 PL, Miami Shores, FL 331382004 ANGEL QUANT
5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309
Business:9545580876 bertnunez2@aol.com
Mobile: 9544530811
Inspection Requests.
Description: REPLACING PW-04-22-926 GAS SERVICE
Valuation:
$ 1,000.00
REPLACEMENT£
Total Sq Feet:
11.00
�k
s
Fees Amount
Payments
Date Paid
Amt Paid
Public Works Permit Fee $100.00
Total Fees
$100.00
Check # 4995
11/29/2023
$100.00
Total: $100.00
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 f regoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constr ction and zoning. Futhermor , I authorize above named contractor to do the work stated.
7�'l6� <// '"� 0 r ;_0 Z � .
Authorized Signature: Owner / Applicant / Contractor / Agent Date
November 29, 2023 Page 2 of 2
Miami Shores Village
NOV 2 9 6.]
Public Works Department
(305)795-2210
Public works forms are available from the building department, 10050 NE 2"d 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 ��EiJE�Jfi �-
`
Permit#: Q�—
��� - ' —c
Name of Applicant (if utility see below): PEOPLES GAS SYSTEM INC. PIN
Owner off the following described property:
Legal Description: Lot 12 & 1/2 OF 13 Block 13 Subdivision FIRST ADD TO PASADENA PARK
Folio #; 11-2231-013-0470
Address: 10561 NE 2nd PL, MIAMI SHORES, FL.
UTILITY NAME: TECO PEOPLES GAS
Qualifier/Authorized Agent: ANGEL QUANT
Address: 5101 NW 21 AVE.
City: FT. LAUDERDALE State: FL
Telephone: 954-453-0806 Email: BERTNUNEZ2@AOL.COM
State Certification or Registration #:
CONTRACTOR NAME:
Qualifier/Authorized Agent:
Address:
City:
Telephone:
State Certification or Registration #:
Email:
State:
ZIP: 33309
Certificate of Competency # E2100068
ZIP:
Certificate of Competency #:
Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of
way: ,J �c ivc� fly Szv�cc'A-)Z04L -�02
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: $1000
ZIP:
Square/Lineal Footage of Work: 5
***** Fees*****
Permit Fee $ 100.00
Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $_
Bond $ (if required) Total Fee Now Due $ 4 I . tiC7
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.
Sign
The foregoing instrument was acknowl dged. before
me this ?'? day of ,coo v. 0 Z3 , by
I )!J Z L a ►L A .J i who
is personally known tome or who has produced
as
identificati
NOTARY PUBLIC: NOTARYI'UBLIC:
Sign:
Print: Print:
SEAL: SEAL:
APPROVED BY:
2017-04-15
**********************************************
HUBERT NUNEZ
my COrWAISSIOIN # HI 1128865
EXPIRES: Septermber 11, 2025
Bonded T hru Notary Public Undeo.Witei
Public Works Director, or Designee
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Subject to compliance with all Federal, State PUBLIC WORKS REVIEW C e z
and County rules and regulations. ° N
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U N M O v U b ri N O JJ V U V
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I I
TIE—IN SVC. TO GAS,
MAIN WITH
T.T./T.F./E.F.V.
I J I
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17i 0'
401.0' -
I
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,--EX. 1 /2" S.P.PROP.
I I I
NEW RISER
GAS LINE
WITH 1 1 /4" GAS
4'
SVC. (END OF BORE) --
- -Z=_PROP.
I
1 1 /4" PLASTIC
GAS SVC. FROM EX.
— --- I
2" STEEL S.P. GAS
MAIN TO RISER
_—�
LOCAT{ON ® 10561 NE
5'
2ND PL, MIAMI
SHORES (TO BE
�- F�2ND PL,
DIRECTIONAL BORED) ,
MIAMI SHCR 1
M SOFT DIG TO FIND
\
EXISTING SERVICE i
AND CUT AND CAP
\ -
-- AT THE MAIN ;
I
XIST. 2" S.P. GAS
---------MAIN (1-3)
4'x4' OPEN CUT FOR
BORE PIT
(BEGINNING OF BORE)
DRIVEWAY AND
SWALE TO BE
RESTORED TO CITY
S P /L _ - OF MIAMI SHORES
REQUIREMENTS
\ 40' --...
ry1
X. GRD.
(w
1 PROP. 9 3/4" PLASTIC
8 I I GAS SVC TO BE I $
71
I
6
W.M
51
1
4�
31
I
2
1 _
PROFILE CRGSSII',,G NE 2ND PL
36" MIN. DIRECTIONAL BORED
17
cas — cns — cis I 6
IEX.2" S.P
!GAS MAIN I 5
1(1-3)
4
I
CUT & CAPFX1P 13
AT MAIN GAS LINE 1
12
I— I i
SCAI_ _: ' :AC (V) 1 '='(11) 1 `=2
N
W r F;
5�
SCALE:1 '-20'
(4,
NF 1077H ST
- RE
i -:.. —..I 4 A C 0
c.cmunmiV � 9 .R mv..
LOCATION MAP (N.T.S.)
a
P.
LEGEND
i CENTER LINE
M MONUMENT LINE
GENERAL
1.
NOTES
REPLACED BASE MATERIAL OVER DITCH SHALT. PF TWICE
' R/►'ti' RIGHT OF WAY
THE THICKNESS OF THE BASE, MIN. 8" AND MAX. '8"
1 P/L PROPERTY LINE
2.
BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE
E.O.P. EDGE OF PAVEMENT
MEASUREMENT LAYER AND EACH LAYER THOROUGHLY
{ T.T. TAPPING TEE
ROLLED OR TAMPED TO 98% OF MAX. DENSsT ( ?ZR
50
L� E.F. V. EXCESS FLOW VALVE
3.
AASHTO T-180
ASPHALT CONCRETE PAVEMENT JOINTS SHAD L EE
coSVC
SERVICE LINE
MECHANICALLY SAWED
4.
SURFACE MATERIAL SHALL BE CONSISTENT MTH
p"
ALL EXISTING UTILITIES SHOWN
SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS)
6i
ON THESE PLANS ARE TO BE
CONSIDERED
5.
BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A
o
APPROXIMATE &
MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL
A
SHOULD BE VERIFIED BY THE
STREETS)'
CONTRACTOR PRIOR TO THE
START OF WORK OPERATIONS.
6.
CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF
ro
o
EXISTING UTILITIES
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SOD RESTORATION DETAIL
SCALE: NOT TO SCALE
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.HEFT NO.: 1_
CTQB
;onstruction Trades Qualifying Board
NESS CERTIFICATE OF COMPETENCY
E2100068
OPLES GAS SYSTEM INC
.A.:
QUANT. NGEL
Is certified under the provisions of Chapter 10 of Miami -Dade County
AC"R"' CERTIFICATE OF LIABILITY INSURANCE
DATE
5/21/2D/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
A/C, No Ext ;
FAX
�v, No): 416-349 4564
(c
EMAIL
ADDRESS:
INSURER 5 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. 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.
INS
LTR
TYPE OF INSURANCE
ADDL
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MM/DD/VYYY
LIMITS
A
XCOMMERCIAL
GENERAL LIABILITY
X
CLAIMS -MADE F—IOCCUR
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occumence
$
X
MED EXP(Any one person)
$
SIR$1,000,000
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER;
PRO -
POLICY F—IJECT LOC
GENERAL AGGREGATE
$1,000,000
PRODUCTS-COMP/OP AGO
$
$
OTHER
B
AUTOMOBILE LIABILITY
XL5692905P
06/01/2021
06/01/2022
COMBINED SINGLE LIMIT
Ea accident
$1'000000
X ANY AUTO
Self Insured Retention:
$250,000
BODILY INJURY (Per person)
$
ALL OWNED
AUTOS
SCHEDULED
AUTOS
BODILY INJURY (Per accltlenl)
$
HIRED AUTOS
NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAR
OCCUR
C
XL5692905P
06/01/2021
06/01/2022
EACH OCCURRENCE
$1,000,000
CC
X
EXCESS LIAR
X
CLAIMS -MADE
AGGREGATE
$1,000,000
DED I RETENTION S
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
Employer's Liability:
X
ER STATUTE
ORTH-
E.L. EACH ACCIDENT
_
$1 ,000,000
NY PROPRIETORIPARTNERIEXECUTIVE ND
FFICER/MEMBER EXCLUDED?
XL5692905P
E
Mandatory In and
under
f yes, DESCRIPTION
ESCRIPTION OF OPERATIONS below
N/A
Excess Workers'
Compensation:
06/01/2021
06/01/2022
E.L. DISEASE•EA EMPLOYEE
$1 ,000,QOO
E.L. DISEASE• POLICY LIMIT
$1,000,000
EW5-B7N-171272-020
SIR $1,000,000
12/01/2020
12/01/2021
1 -7-
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
License #E 1606
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.
<R" LI Us 104- .L J1 A" 9L1\\-I'1S9L1a\ I\
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
reserved.