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PW-10-23-2578Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 138 NW 107TH ST, Miami Shores, FL 33168 1121360080200 Contacts PEOPLES GAS SYSTEM INC Owner PEOPLES GAS SYSTEM INC Contractor ANGEL QUANT ANGEL QUANT 5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309 5101 NW 21 AVE 460, FORT LAUDERDALE, FL 33309 Business:9545580876 bertnunez2@aol.com Business:9545580876 bertnunez2@aol.com Mobile: 9544530811 Mobile: 9544530811 Description: cut and cap service line at the main Valuation: $ 2,000.00 Inspection Requests: Total Sq Feet: 0.00 Fees Amount Education Surcharge $0.60 Public Works Permit Fee $100.00 Scanning Fee (Manual) $9.00 Technology Fee $10.00 Total: $119.60 Building Department Copy Payments Date Paid Amt Paid Total Fees $119.60 Check # 4981 10/31/2023 $119.60 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 co struct' and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized %naore: Owner / Applicant / Contractor / Agent Date October 31, 2023 Page 2 of 2 Telephone: 954-558-0876 Email: State Certification or Registration #: E2100068 sQ9.�ra r Miami Shores Village Public Works Department BY: (305)795-2210 Public works forms are available from the building department, 10050 NE 2nd 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 �1 Permit#:q W _ `3_1�_ Name of Applicant (if utility see below): PEOPLES GAS SYSTEM Owner off the following described property: Legal Description: Lot 4 Block 205 Folio #; 11-2136-008-0200 Address: 138 NW 107th. ST. MIAMI SHORES Subdivision DUNNINGS MIAMI SHORES EXT 4 UTILITY NAME: PEOPLES GAS SYSTEM wG 2 JG i nJ A" F (4 ) Qualifier/Authorized Agent: Ansel Quant Address: 5101 NW 21 AVE. SUITE.460 City: FT. LAUDERDALE State: FL ZIP: 33309 Telephone: 954-558-0876 Email: bertnunez2@aol.com State Certification or Registration #: E2100068 Certificate of Competency # CONTRACTOR NAME: PEOPLES GAS SYSTEM Qualifier/Authorized Agent: Angel Quant Address: 5101 NW 21 AVE. SUITE. 460 City: FT. LAUDERDALE State: FL bertnunez2@aol.com ZIP: 33309 Certificate of Competency #: ,4aj vao 62 Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of Way: CUT AND CAP SERVICE LINE AT THE MAIN Type of Work: ❑ Paving x Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna ❑ Other: DESIGNER: Architect/Engineer: Address: 5101 NW 21 AVE. City: FT. LAUDERDALE Telephone: 954-558-0876 Registration #: _ PEOPLES GAS SYSTEM State: FL Email: bertnunez2@aol.com Value of Work for this Permit: $1000 Permit Fee $ 100.00 Notary $ Bond $ ZIP: 33309 Square/Lineal Footage of Work: 11 ***** 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 Sign ure _ Applicant or Authorized Agent Company/Utility A ent The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this day of 20, by me this 1L day of e7e--,1 20 73, by who a,aRE� Gw-, 4 ^), who is personally known to me or who has produced is personally known to me or who has produced as as identification. identificat' NOTARY PUBLIC: NOT Y PUBLI . Sign: Print: Print: SEAL: SEAL: HUBEP,T NUE7.MY COMMISSION#HH 128865 EXPiRE5: September 11, 2.025 L''m Bonded Thru Notary Public Underwriterss ******************************************* APPROVED BY: �-� �� , Public Works Director, or Designee 2017-04-15 w = o 0 k o w � p ? N vi O o W O ° o^vh use wv� �W vomtH� gz ` E t� ° aai ° `minkrV4o ,O w U C tip a c VI m V a '°vco mya��a °' �yvvm Uh ^`mot •'°o aDm c a dam _ U `t�tiw N C � ;°�'u e��pa ®tea 21 Eomv H QV1 O t iO om y `o w .. ` `opacww h ? wpX Z W e m s N c m N v W m m O E N J Uv� av oo3�„c a � G va wa z uj �a�`i i�a c c '"ca>NEmN mNv W^ \ Z c vn-N y o o g Q " oN�E Vl 3 m3 wRi O W ¢ ¢` z d' Q N 00 � N O M N Q M p W V) LL z 0� MIn 2 O_ K U H W NOJs�A3a 0 ti O N h h � g � O o � J N W c W J W Cp ac¢ 3�N ti� C E I I tl W x�, v v 3 �n Q `ov � 3 v4i 3 Nmn ao�nbn � c � W � Q J ,`awmrnc co �no�no�nm�no corm =l `a °n N MVOulhbbn�i ONO � o z..1. arc' N 3 c H a Z O a W k o N m W J N m o°� w c w W W N M v h b n m m �ro arsc�z uorrzzio� t' 0� 'W - I 0 CT 2 o 2 u � 3 NW 107th, ST. I--, " i I IJ 1 1 138 NW 107th. ST. MIAMI SHORES 1"GUN BARREL EX.GAS SERV. 38' Imp F- 2' rwM --------------- RESTORE ALLEY ASPHALT AS PER CITY OF MIAMI SHORES REQUIREMENTS 75' S R/W EX. 2" C.S. GAS MAIN 1-3 4.0' N R/W A L L rr_-- 151 OPEN 2'X2' TO S R/W CUT & CAP SERVICE LINE AT THE MAIN IV L SCALE:1"-20' *4 xeaa LOCATION MAP (N.T.S.) 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) LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO T-180 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED 4, SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL (1.5- MIN. THICKNESS) 5. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS) 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES SWA= RMACOOff j/— T LEGEND q CENTER LINE td MONUMENT LINE RIW RIGHT OF WAY AW 7�'n � SVC SERVICE LINE IV go%" vm 10 P/L PROPERTY LINE E.O.P. EDGE OF PAVEMENT TEE AMI SHII 0 R F� S I LU =T;V v OW VALVE BI IC WORKS REVIEW REST FOR ,�,ft F-e ON DA 1, N WED OL LjvtlZY I ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE CONSIDERED APPROXIMATE & SHOULD BE VERIFIED BY THE E. XtS77NG U71LITIES SHOWN ON THIS rn CONTRACTOR PRIOR I'D THE PLAN ARE FROM GPR INFORMATION z P START OF WORK OPERATIONS. OWDED BY MI —TECH NOTE: -THE REST0R_AL10_N­OF THE NEW ASPHALT MUST ERESTORED BY THE STANDARDS OF MIAMI SHORES -�LI—LLAGE.!Q'DE ")--j C? -FljLt.--ALLEY WIDTH. �7 3 1: 0 co 0 0 D M X DETOUR 11111110* ROADCLOSED TO THRU TRAFFIC 1NWW.1IwarIVIMul11 0 SIDEWALK SWALE SWALE SIDEWALK END DETOUR 138 SWALE L�� _ SWALE Wv ROAD CLOSED DET©UR END DETOURlk ` SIDEWALK �./ SWALE FIDOTI,,) This Certifies that ORLANDO DAGER Has Completed a Florida Department of Transportation Approved Temporary Traffic Control (TTC) Advanced Course. Date Expires: 11//212024 Certificate 9 67357 Instructor: Juan Morales FDOT Provider # 37 ATS.SA Phone: 540-366-1701 16 Riverside Pwk.vay Ste.100 Fredericksburg, VA, www.atssa.corn jessica.scheyder@atssza,com SAFER ROADS SAYE LIHS END DETOUR ROAD CLOSED TO THRU TRAFFIC DETOUR WA+ N M� * N_ wa' * v xr" fix SPEED LIMIT y U Driveway Apron Fire hydrant :- r Flagger i Sign Stand Y^:•j SWALE Work Area Note- Flaggers to assist local traffic. Work Truck SWALE Date: 10/17/2023 Author: Orlando Dager Project: 138 NW 107 ST Miami Shores FDOT#: 67357 rEcH Comments: Temporary traffic control must comply with FDOT Standards Plans Index 600 Series TA-20 and the Manual on Uniform Traffic Control Devices (MUTCD). Plan to be submitted to governing agency for approval. PLAN IS NOT TO SCALE. Legend Cone • Cut and Capped n o� ^� S O� O CQ pip C6.9 Q N � W V t i}6fl. 1 � 1 .-7 'X. FF n a, ((QQ f0 - WORK AREA WORK AREA Wi z IL A 0 G7 � z 01 O V] o NO. OF : sHm NO.: 2 d o a a y a N n In o C 3 M 0 0 e o fD M O 0 a U C N > w > W O > �a C o a En Q O m U �-+ O o Z F LL �j E o do HO o� E O N W O O CD N LL m� N Co > m O N `o Y > oo'm 6E y a E w o UDa O T �� u E 2 02 w OU W u N �! a;> m 0 m m N O W d In LL.d, ruction Clq ualifying Board 3 CERTIFICATE OF COMPETENCY E2100068 _ES GAS SYSTEM INC D.B.A.: �7 QUANT, ANGEL Is certified under the provisions of Chapter 10 of QUALIFYING TRADE(S) 0014 FUEL TRANS & DISTRI Jaim a Gascon P.E. Secretary of the Board I wwv.rtiarridade.govleconom� pAw&oade covty retains at property rV is herein. unicipal Contractor's Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY CC NO: E2100068 BUSINESS NAME/LOCATION PEOPLES GAS SYSTEM INC 15779 W DIXIE HWY NORTH MIAMI BEACH, FL 33162-6037 OWNER PEOPLES GAS SYSTEM INC RECEIPT NO. EXPIRES 7667153 SEPTEMBER 30, 2024 Pursuant to County Code Sec 10-24 TYPE OF BUSINESS SPECIALTY ENGINEERING PAYMENT RECEIVED CONTRACTOR BY TAX COLLECTOR 175.00 10/03/2023 0225-24-000032 3. i This receipt is not valid in the following Municipalities: Aventura, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. For more information, visit www.miamidade.govAaxcollector Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 4773363 BUSINESS NAME&OCATION PEOPLES GAS SYSTEM INC MUNICIPALITIES LOC COMMERCIAL LESSORS, FL 33888 RECEIPT NO. RENEWAL 4983202 EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Ifflil� ' 0 Pursuant to County Code Chapter 8A — Art. 9 & 10 �a J � QI 13 N OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED PEOPLES GAS SYSTEM INC 192 COMMERCL/INDUST/OF BY TAX COLLECTOR ATTN: PGS ACCOUNTING P7 FICE SPACE 75.00 08/15/2023 ` Aggregate sq. ft. 3304 INT-23-426980 k This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0, above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-276. MIA ; For more information, visit www.miamidade goy/taxcollector Local Business Tax Receipt Miami —Dade County, State of Florida L 13 Ir -THIS IS NOT ABILL - DO NOT PAY 113324$ RECEIPT NO. RENEWAL BUSINESS NAME&OCATION 1133248 EXPIRES PEOPLES GAS SYSTEM INC SEPTEMBER 30, 2024 15779 W DIXIE HWY NORTH MIAMI BEACH, FL Must be displayed at place of business Pursuant to County Code 33162-6037 Chapter 8A — Art. 9 & 10 a � OWNER PEOPLES GAS SY, TEM INC SEC. TYPE OF BUSINESS 196 SPECIALTY PAYMENT RECEIVED BY TAX COLLECTOR ENGINEERING 214.50 10/03/2023 E2100068CONTRACT Workers �) 60 0225-24-000032 This Local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-276. For more information, visit www.mia idade.gov/taxpoIlector ACORO' CERTIFICATE OF LIABILITY INSURANCE DAT 5/21/2DrrYYY) 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 PHONE A, No, Ext : 1-866-616-0088 rc FAX (A/Cc No): 416-349 4564 EMAIL ADDRESS: Toronto, ON MW OA8 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: COVERAGES 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 Ml 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 DAMAGE TO RENTED PREMISES Ea occurrence $ X MED EXP(Any one person) $ SIR$1,000,000 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT F1 LOC GENERAL AGGREGATE $ 1,000,000 PRODUCTS-COMP/OP AGG $ $ OTHER B AUTOMOBILE LIABILITY AS 1-B71-171271-013 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT Ea acc dent $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ C UMBRELLALIAB OCCUR XL5692907P 06/01/2023 06/01/2024 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 Employers Liability: ER TH- X rTATUITE ER E.L. EACH ACCIDENT $ 1,000,000 NY PROPRIETOR/PARTNER/EXECUTIVE NO FFICERIMEMBER EXCLUDED? XL5692907P E Mandatory In NH) yes, describe under ESCRIPTION OF OPERATIONS below N/A Excess Workers' Compensation: EW5-B7N-171272-023 06/01/2023 06/01/2023 06/01/2024 06/01/2024 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 SIR $1,000,000 DESCRIPTION OF OPERATIONS I 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 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 ©19BB-2015 ACORD CORPORATION. All rights reserved.