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PL-10-2090Inspection Number: INSP- 153681 Permit Number: PL -11 -10 -2090 Scheduled Inspection Date: March 02, 2011 Inspector: Hernandez, Rafael Owner: CASTRO, MARIA INES Job Address: 5 NW 107 Street Miami Shores, FL 33138- Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)773 -6608 Parcel Number 1121360070480 Phone: (305)957 -3857 GAS SERIVCE 12/15/2010 -STOP WORK: MUST REPAIR ALLEY Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 01, 2011 For Inspections please call: (305)762 - 4949 Page 16 of 44 Public Works Permit Application FBC 2004 NOV 2 4 2010 Miami Shores Village. ,., Public Works Department Pemdt Type: Public Works WATER Owners Name (Fee Simple Titleholder) J.v.e S L. Srco Owners Address -S h' w ( / n 7 ?71 '5? E ;— Cit V'"G Job Address (where the work is being done) N• NI /G 7 m Contractor's Company Name ors' 66 pecpies e5 Contractors Address /5 - 7 -7 1 VP''Sr ,c of 'e E City Architect/Engineer's Name (if appfita' ble) $ Value of Work For this Permit 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ,v/o4 - /e Type of Work Ltd "�ihon Describe Work: /lo" Lk peep /C'5 ` 3 4' Ago-- state G/ Tenant/Lessee Name Phone #: V a ' CEcT City Miami Shores Wage County Miami Dade Is Sutlding Historically Designated: YES NO Stabs «.. • Fees .�...«,�...,...,. Submittal Fee $ Pemdt Fore $ -- Notary $ Training/Education Fee $ Scanning $ Radom $ Code Enforcement $ Structural Plan Review $ Total Fee Now Due $ (Continued on opposite aide) Phone #: /1+ /OTAf:SI - s - CCF$ Permit No.. Phone#: 305 75 - 4 ,-46 Z3 ❑ Alteration ❑ New ❑ Repair/Replace Xvsmu Nog, 3/ 4e ,'M(n.. fs1 Antoci:, •f « s 0-200 3 fe8` zip zip .33 /6 !' g - t' ?c1373 ?3 Z rip p hone #: 3e r 5' 7a / p. 73 Lineal Footage Of Work: V 5--- ❑ oemot6on arr Technology Fee $ Zordng Band $ Bonding Company's Name (if applicable) Bonding CoAipany's Address N/A City State ZIP Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address City State ZIP Application is hereby made to obtain a permit to do the work 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 regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC .... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applcable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 this issuance of a Public Works permit with an estimated value exceeding $2500, the appL'cant must promise in good faith thata copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the fast inspection which occurs seven (7) days after the building pemrit is issued In the absence of such posted notice, the inspect on will not be approved and a reinspection fee will be charged. Signature Y Owner or Agent The foregoing instrument was acknowledged before me this /t The foregoing instrument was acknowledged before me this 2 ,ti- e rr M.' day of /V/OV 20 /0 , by--S who is personally known to me or who has produced o is personally know to me or has produced NOTARY PUBLIC: Sign: Print My Commission Expires: APPLICATION APPROVED BY: 11/17/2005 as identification and who did tak Signature x sr Contractor Sign: Print My Commission Expires: as identification and who did take Public Works Director or his designee. /+ p Avon ® CERTIFICATE OF /� /► CERTIFICA E OF INSURANCE ISSUE DATE 07/02/2010 PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC. 0. Box 10265 rmingham, AL 35202 800 - 476-2211 This certificate is Issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. COMPANIES AFFORDING COVERAGE Company Associated Electric & Gas Ins. Svcs. INSURED Peoples Gas System TECO Energy, Inc. P.O. Box 111 Tampa, FL 33601 Company B Company C • Company D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO LT TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY A GENERAL LIABILITY ❑ Commercial General Liability Claims Made ❑ Occurrence ❑ Owners' and Contractors' Protection ❑ ❑ General Ag regate Limit �aplles per: ❑ Policy Project ❑ Location X0521A1A10 Self- Insured Retention $1,000,000 07/01/2010 07/01/2011 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE $ MEDICAL EXPENSE $ PERS. AND ADVERTISING INJURY $ GENERAL AGGREGATE $ 1,000,000 PRODUCTS AND COMP. OPER. AGG. $ A AUTOMOBILE LIABILITY ❑ ny A m le ❑ al owned automobuas X0521A1A10 Self- Insured Retention $250,000 07/01/2010 07/01/2011 COMBINED SINGLE UMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ ❑ Scheduled Automobiles ❑ Hhed Automobiles PROPERTY DAMAGE (Per accident $ ❑ Non -owned Automobiles ❑ COMPREHENSIVE COLLISION WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY WC Statutory Umit I 1 Other 1 EL EACH ACCIDENT $ EL DISEASE (Each employee) $ EL DISEASE (Policy Limit) $ A EXCESS UABIUTY ❑ Occurrence to Claims Made X0521A1A10 07/01/2010 07/01/2011 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS WC Excess workers' Compensation CO521A1A10 07/01/2010 07/01 /2011 Each Accident or Each $ Employee for Disease $ 1,000,000 $ Excess liability policy provides insurance in excess of Peoples Gas System's Self- Insured Retention as stated above. CERTIFICATE HOLDER City of Miami Shores 0050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. Authorized Representative . --- F p r °— t '- l G . .6.:- "^ S' "— i Page 1 of 1 Certificate ID If TRMMEWYD NOTES CONSTRUCTION 1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF CONSTRUCTION. SUNSHINE # 1- 800 - 432 -4770 2. RESTORE ALL AREAS TO PRIOR CONDITIONS 3. ALL CONSTRUCTION TO FOLLOW JURISDICTIONAL GOVERNMENT AND TPG STANDARDS. •••••• • • • • •�• •••• PER.COFTL • •'• 4. NO 'N •• :••• • • 5. Na WM, AIR'VF�6FILES. � ••••: 6. IVO • ©�FAINA� •• • •••• ••••• • • •••• •••••• •1••• • • • • .•r ••• NO APPL'ICATIO;L•LIBMITTED FOR: • rr 6. DEOATERING; ('ABOVE W TABLE). •;L••• 7. TatfiF•I§ STRIPS OR LOOPS. • • • • • • •• • • LEGEND R/W RIGHT OF WAY P/L PROPERTY LINE T/T TAPPING TEE EFV EXCESS FLOW VALVE SVC SERVICE LINE SP STEEL PLASTIC COAT PE POLYETHELENE 0 4'GRASS SWALE RESTORATION SCALE: NOT TO SCALE GRASS SWALE RESTORATION DETAIL T.T/T.F/E.F/E.MO GAS MAIN PROP BORE 3/4" PLASTIC GAS SERVICE FROM EXISTING 2 "CS GAS MAIN TO RISER LOCATION 0 5 N.W. 107TH Sitttk.i MIAMI SHORES WORKING IN ALLERWAY IN REAR OF HOUSE PROPOSED RISER METER SET LOCATION FO P GAS RESTORE GRASS SWALE TO CITY SPECS WORKING IN GRASS SWALE 0 -- --- --- --- --- -- --- --- ----------------------------------- 5 N GXS - GAS -GAS -- GAS - GAS GAS SOD _.] 5 N.W.107TH STREET MIAMI SHORES N.W.107TH STREET Na LANE OF TRAFFIC TO BE BLOCCKED OR DISTURBED 1- CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTIUTIES. 2- MAINTAIN A MINIMUN HORIZONTAL SEPARATION OF 5' FROM ANY aTY UTIUTIES. 3- MAINTAIN A MINIMUN VERTICAL SEPARATION OF 18" OF ANY CITY UTIUTIES. -ALLEY-WAY — r — - — - ! EXISTING 2 "CS GAS MAIN APPROVED DATE ZONING DEPT BLDG DEPT Ira" _ STMEANOCOUIMSONOSECW PEOPLES GAS mwaw SLM • \c) - zcr ) Miami SW • • •••• i• • TECO / PEOPLES GAS - N. MIAMI OPERATIONS 5 N.W.107TH STREET MIAMI SHORE WORKING IN ALLEY WAY PROPOSED 3/4" P.E. GAS SERVICE SCALE: 1° = 50' I DATE 11/16/10 I SHEET 1 of 1 • • • • • •••••• • • ••••• • • ••••• OOO • • • OO OOOO • • •••••• • •