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PW-11-23-2742Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 801 NE 91ST TER, Miami Shores, FL 33138 1132060050220 Contacts 801 NE 91 Owner PEOPLES GAS SYSTEM INC Contractor 801 ANGELQUANT 5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309 Business: 9545580876 bertnunez2@aol.com Mobile: 9544530811 Description: TO INATALL A NEW GAS LINE (1 1/4" PLASTIC)VIA Valuation: $ 1,000.00 Inspection Requests: � sx 5, DIRECTIONAL BORE FROM GRASS SWALE Total Sq Feet: 11.00 Fees Amount Education Surcharge $0.30 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $119.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $119.30 Check # 4993 11/20/2023 $119.30 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futherghore, I authorize the above named contractor to do the work stated. /-I 91 nt / Contractor / Agent Date I November20, 2023 Page 2 of 2 s• t,� T Miami Shores Village Public Works Departmentg I� (305)795-2210 Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shores, FL 33138 .1 �h PUBLIC WORKS PERMIT APPLICATION 96)b Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property a� 111 Permit#: N - 11—� �� I Name of Applicant (if utility see below): PEOPLES GAS SYSTEM Owner off the following described property: Legal Description: Lot 14 Block 2 Folio #; 11-3206-005-0220 Address: 801 NE. 91st. TERRACE MIAMI SHORES FL 33138 UTILITY NAME: PEOPLES GAS SYSTEM Subdivision GOLDEN GATE PARK ADDN PB 6-130 Qualifier/Authorized Agent: Angel Quart Address: 5101 NW 21 AVE. SUITE. 460 City: FT. LAUDERDALE State: FL Telephone: 954-453-0806 Email: MCABRERA@TECOENERGY.COM State Certification or Registration #: E2100068 Certificate of Competency # CONTRACTOR NAME: PEOPLES GAS SYSTEM Qualifier/Authorized Agent: Angel Quart Address: 5101 NW 21 AVE. SUITE. 460 City: FT. LAUDERDALE Telephone: 954-453-0806 Email: State Certification or Registration #: E2100068 State: FL MCABRERA@TECOENERGY.COM ZIP: 33309 ZIP: 33309 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) VIA DIRECTIONAL BORE FROM GRASS SWALE 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 #: Value of Work for this Permit: $1000 Permit Fee $ 100.00 Notary $ Bond $ Square/Lineal Footage of Work: 11 *****Fees***** -Train ing/Education $ 0.20 Technology Fee $ 0.80 Scanning $ (if required) Total Fee Now Due $ � 1 1 tee, 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 Sig re 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 S day of Ajoy1 20 Z 3 , by who Ok Jgc e, Q — M,-J ; who is personally known to me or who has produced is personally known to me or who has produced as as identification. identificatio . NOTARY PUBLIC: NOTARY PU LIC: Sign: Sign: Print: Print: SEAL: SEAL: ` `crnt� t F HUBERT NUNEZ MY COMMISSION # HH 128865 EXPIRES: September 11, 7.025 Bonded Thru Ncbary f uh+: :;rde rrri!ers **** *** * ******************************* APPROVED BY: G Z� , Public Works Director, or Designee 2017-04-15 I I PROP. 1 1/4" PLASTIC GAS SVC. VI A DIRECTIONAL ' BORE NE. 92nd. ST ' I 1 2 4' GAS TEST I POINT I I P ARKI i G I SWALE ' -OPEN CUT (START OF BORE) L TIE—IN TO EXISTING. GAS MAIN WITH 5'i�' T. T. /T. F. /E. F. V. .1 I RESTORATION I I Q AREA AS PER MIAMI SHORES II REQUIREMENTS. I �c II EXISTING. II 2" CS.GAS I MAIN (1-3) I I L 30.7' M l.Il 2' ' j J�p5lp •,-18' 30' �I W J' �a I � ul I z I i 5.� 1 4' PROP. RISER LOCATION WITH 1 1 /4" PLASTIC GAS SVC. N P /L ROP. BOLLARDS I 39' J d. W Residence # 801 I I I I LEGEND (K CENTER LINE ALL EXISTING UTILITIES SHOWN M MONUMENT LINE ON THESE PLANS ARE TO BE R/W RIGHT OF WAY CONSIDERED APPROXIMATE & EXISTING UTILITIES SHOWN ON THIS P/L PROPERTY LINE SHOULD BE VERIFIED BY THE PLAN ARE FROM GPR INFORMATION CONTRACTOR PRIOR TO THE PROVIDED BY MI —TECH E.O.P. EDGE OF PAVEMENT START OF WORK OPERATIONS. T. T. TAPPING TEE E.F.V. EXCESS FLOW VALVE SVC SERVICE LINE V' SCALER "-20' TT1 . r,D i �-- 3' --� 0 MAIN SOD RESTORATION DETAIL SCALE: NOT TO SCALE , C� E. 92nd. wm - � �---�-- , soy � x o CQ NE.91 st.TERR�►CE ffk��]]] c o W_- Ell- � N PZ N pqRIII �z Z U � LOCATION MAP (N.T.S.) a GENERAL NOTES 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) co LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF w MAX. DENSITY PER AASHTO T-180 c0 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED .wa 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS) y 5. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE �a CONTENT OF 70% (60% FOR LOCAL STREETS)q 00 x 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES w ro a a. \ 30' � /SEX. GIRD.. I 5 I W.M. --- -- ROP 1 1,14" PLASTIC 15 36" MIN GAS SVC. TO BE 4 I Z1 DIRECTIONAL BORED 14 I I EXISTING. 2" CS-3 12" 1 I3 GAS MAIN (I-3) 2 I GAS S — GAS � I � --Q ! -- - ---- — --- _ I 0 I � I —GI PROFILE CROSSING NE. 8th. AVE. SCALE: 1:40 (V) 1"=1' (H) 1"=2' 620-2 (See General Note 7) END ROAD WORK a NE 92 ST. W20-IF W20-4 SYMBOLS: 801 NE 91 st. TERRACE ® Work Area A W20-1 F j Q ROAD WORK AHEAD G20-2 W 20-4 Q (See General Note 7) ONE LAN k END ROAD AHEAD ROAD WORK Q v8 W 20-7 x W20-7 W20-4 W20-IF 11 ■ I ONE LAN ROAD ROAD WORK 0 • AHEAD AHEAD o • •� Ln `7 X X X - - - - 777 - 7�l — - • _ 7/7 - a Cp i I 1 ■ I o END � ROAD WORK ■ � o ■ G20-2 (See General ■ Note 7) Lj W20-7 w Q`` w 8 W20-7 Qg� Z ONE LAN MI MI SHORES FL 33138 G20-2 Q ROAD ■ Channelizing Device (See Index 102-600) (See General 123— [p Work Zone Sign Note 7) W20-4 ® Type III Barricade X pm— Stop Bar ET' FlaFla ROAD '18 WORK --<AHEAD Lane Identification and Direction of Traffic BRED NOV 0 3 2023 A�Se W20-IF WORK IN INTERSECTION OF TWO-LANE ROADWAY LAST Z DESCRIPTION: FY 2023-24 INDEX SHEET REVISION FDOT TWO-LANE, TWO-WAY, I[NTIERS ECTIION WOIE K 11101122 W �- STANDARD PLANScc 102-604 2 of 2 44F \ i 1 ' F y ZEWA"'L�kl :TQB i Trades Qualifying Board ZTIFICATE OF COMPETENCY i GAS SYSTEM INC -- --- -- --- C, UANT, ANGEL Is certified under the provisions of Chapter 10 of Miami -Dade County QUALIFYING TRADE(S) 0014 FUEL TRAINS $ DISTRI Joime D. aaswrt P.E. VA".manideda.9ovfecorom/ secretary of iTe Bond Aerotn. Miane-Dada -LOY retains at propadY " AFRO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 5/21 /2023 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 have ADDITIONAL INSURED provisions or 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). Marsh Canada Limited 120 Bremner Blvd Suite 800 r PHONE 1-866-616 0088 (A/C, No Ext FAX No): 416-349 4564 Toronto, ON M5J OA8 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: INSURER E: LM Insurance Corporation 42404 INSURER F: COVEKAGE5 CERTIFICATE NUMBER: 23/24-035-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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE ❑OCCUR XL5692907P 06/01/2023 06/01/2024 EACH OCCURRENCE $1,000,000 PREM SESTO Ea ocurD $ 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 - COMPIOP AGG $ $ OTHER B AUTOMOBILE LIABILITY AS1-B71-171271-013 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ C UMBRELLA LIAB OCCUR XL5692907P 06/01/2023 06/01/2024 EACH OCCURRENCE $1,000,000 X EXCESS LIAB X CLAIMS -MADE AGGREGATE $1,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Employer's Liability: ER OTH. X TATUTE I JER Y PROPRIETORIPARTNERIEXECUTIVE FFICER/MEMBER EXCLUDED? NO XL5692907P E.L. EACH ACCIDENT $ 1,000,000 E Mandatory in f yes, describeaunder ESCRIPTION OF OPERATIONS below NIA Excess Workers' Compensation: p 06/01/2023 06/01/2024 E.L. DISEASE - EA EMPLOYEE $1,000,000 EW5-B7N-171272-023 06/01/2023 06/01/2024 E.L. DISEASE -POLICY LIMIT $1,000,000 SIR $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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 10050 NE 2nd Ave EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Miami Shores FL 33138 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. FDOT� This Certifies that l ` ORLANDO DAGER Has Completed a Florida Department of Transportation Approved Temporary Traffic Control (TTC) Advanced Course. Date Expires: 11/12/2024 Certificate it 67357 Instructor: Juan Morales FOOT Provider It 37 ATSSA� Phone: 540-368-1701 15 Riverside Parkway Ste.100 Fredericksburg, VA, www.atssa.com jessica.scheyder@atssa.com SAFER ROAOS SAVE LIVES