PW-10-1207Protect Address
441 GRAND CONCOURSE
Miami Shores, FL
1132060170310
Block: Lot:
PRISCILLA BEATTY
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
441 GRAND CONCOURSE
MIAMI SHORES FL 33138 -2462
Contractor(s)
Phone Cell Phone
TECO PEOPLES GAS SYSTEM (305)957 -3857 (305)970 -1783
Scanning: 3
Fees Due
CCF
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$150.00
$9.00
$0.80
$160.60
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. Futhermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Pay Date Pay Type Amt Paid Amt Due
Invoice # PW -7 -10 -38320
07/01/2010 Check #: 5997 $ 50.00 $ 110.60
07/09/2010 Check #: 6007 $ 110.60 $ 0.00
Applicant
Valuation:
Total Sq Feet:
$ 900.00
20
1
July 09, 2010
Date
Available Inspections:
Inspection Type:
Final
Excavation
1
July 09, 2010 1
Scheduled Inspection Date: July 28, 2010
Inspector: Hernandez, Rafael
Owner: BEATTY, PRISCILLA
Job Address: 441 GRAND CONCOURSE
Miami Shores, FL
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM
Building Department Comments
July 27, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 147577 Permit Number: PW -7 -10 -1207
For Inspections please call: (305)762 -4949
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number
Parcel Number 1132060170310
Phone: (305)957 -3857
PROPOSED 20 OF 3/4 PLASTIC GAS SERVICE BORE TO
GET TO RISER LOCATION WORKING ALLEY WAY.
RESTORE ASPHALT TO CITY SPECIFICATIONS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 13 of 31
Public Works
Permit Application
FBC 2004
Owner's Type: Public Works WATER 15 /YAP ��
^
rs Name (Fee Simple Titleholder) 'A7 ,o ��/� fit- �
Owners ` O I.CJ/SS/�� -5.
cit / eddi F State r�
Tenant/Lessee Name
Job Address (where the work is being done) / ` / �/� t 7 7/ ly l✓(✓ C,U O U �
City Miami Shores Village County Miami Dade Zip ) 33 � �J
Is Building Historically Designated:
Contractors Company Name
Contractors Address /5 779
city
Architect/Engineers Name (if appli able)
$ Value of Work For this Permit
Submittal Fee i
Notary:
Scanning $
ct
Code Enforcement $
Total Fee Now Due
(Continued on opposite side)
JUL WS?)
0 9 2010 gli
Miami Shores Village BY'
Public Works Department
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax (305) 756.8972
YES
,..,amn- Fees It**It.1111**.1111..11..
Permit Fee $
NO
f
Phone d:
Phase t
Phone d:
PenultNo. 10_ I20—)
Zip 33 /3 g
17S,0 in (AS) tlitACIAA„
305- 970 -1373
zip 3340
Phone S:
Lineal Footage O/ Work l() '07s / a c4
Type of Work ❑ Addition ❑ New ❑ Repair/Replace ❑ Demolition
Describe Watt <),/0,5e70 0 OF 3 9 &Vie G/vc &O c( &Re /V 6ET •s✓\.
d l lfIMIINNlf ll MlWl .(
Training/Education Fee $ 070
Radon $
Structural Plan Review $
CCF$
Zoning
c <De CO/CC
Technology Fee $ lv' • lTO
Bard $
Bonding Company% Name (if applicable)
Bonding Coinpanys Address
City , State
Mortgage Lender's Name (if applicable)
Mortgage Lenders Address
City
Signature
The foregoing Instrument was acknowledged before me this 3C
My Commission Expires:
APPLICATION APPROVED BY:
11/172005
Owner or Agent
as identification and who did take an oath.
LW)
1
State
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 applicable
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 appfrcant 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
properly is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job she for the first
inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be
approved and a reinspeclion fee wit be charged
ARY PUBLIC:
My Commission Expires:
Contractor •
The foregoing instrument was acknowledged before me this 3 c)
_ by 65 64 4-5 day of , 20,/ 6 by F.s •tom VE'C
me or who has produced to me or has produced
as identification and who did take an oath.
Sign: Sig
Print: Print
Public Works Director or
his designee.
0014
Hemrtdrtio Gonzalez P. E. t•y.
Secretary of the Board ; 9t ' s-- •
M and-Dede Caady retairo ®A property darts heredl
CTQB
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
E1608
PEOPLES GAS SYSTEM INC
DBA•
J n,
VEGAJESUS
Is certified under the provisions of Chapter 10 of Mlaml -Dade County
VALID FOR CONTRACTING UNTIL 09/30/2011
QUALIFYING TRADE(S)
FUEL TRANS & DISTRI
MI
wrer.odaaddade.
PRODUCER
MCGRIFF, SEIBELS & WILUAMS. INC.
P.O. Box 10265
Birmingham, AL 35202
800-476-2211
INSURED
Peoples Gas System
TECO Energy, Inc.
PO. Box 111
Tampa. FL 33601
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
-CO 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.
TYPE OF INSURAN POUCY NUMBER EFFECTIVE
— —
LT
A
A
ACORD„,
GENERAL UABtLITY X0521A1A09
D Commercial General Liability Self-Insured Retention
D Ciattris Made D Occurrence 1,000,000
D Owners: and Connectors: Protection
0
Genemi Aggregate Limit applies per:
0 Polio/ D Project DI-oration
AUTOMOBILE UABILITY
D Any Automobile
D All Owned Automobiles
0 Scheduled Automobiles
rj Hired Automobiles
D Non.owned Automobiles
LJ
WORKERS COMPENSATION
AND EMPLOYERS° LIABILITY
A EXCESS LIABILITY
[I occurrence 123cretme Made
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2nd Ave
Miami Shores, FL 33138
CERTIFICATE OF INSURANCE
X0521A1A09
Selt-Insured Retention
$250,000
X0521A1A09
This certificate is issued as a matter of information only and ccarfers no rights
upon the Certificate Holder. This Certificate does not amend, extend or after the
coverage afforded by the policies below
CornPanY Associated Etectrk & Gas Ins Svcs.
A
Company
B
Company
C
Company
D
Company
E
EXPIRATION
07/01/2009
07/01/2010
COMPANES AFFORDING COVERAGE
EACH OCCURRENCE
FIRE DAMAGE
MEDICAL EXPENSE
PERS. AND ADVERTISING INJURY
GENERAL AGGREGATE
PRODUCTS AND COMP. OPER. AGG.
07101/2009 COMBINED SINGLE LIMIT
07/01/2010 BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
COMPREHENSIVE
COLLISION
WC Statutory umit ottier F f
EL EACH ACCIDENT
EL DISEASE (Each employee)
_ELOBEASE_BticyliM4
07/01/2009 EACH OCCURRENCE
07/01/2010 AGGREGATE
Excess Liability policy provides insurance in excess of Peoples Gas System's Self-Insured Retention as stated above.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 REPRESENWIVES.
Authorized Representative
.•
LOUTS OF LIABILITY
ISSUE DATE
06/30P2009
1,000,000
Page 1 of 1 Certiftede ID # NXSPUN61
ACORD. CERTIFICATE OF INSURANCE
PRODUCER
Associated Electric & Gas Insurance Semites Limbed
1 Meadowlands Rama
East Rultierlonl„ N107073
INSURED
Peoples Gas System
Teco Energy. Inc.
PO. Box 111
Tampa, FL 33601
-----
This is to certify that the poticies of insurance described herein have been issued to the brewed named herein for tive policy period indicated. Nribehdancting
any requirement term or condition of conked Or other docurrterd with respect tu adds td* certificate new be Waled or raw pertain, the insurance afforded by
the pinkies described herek subied to al the terms, conditions wad exclusions el such policies. Limits shown may have been ireduCed by paid claims.
CO
LT
TYPE OF INSURANCE POLICY NUMBER EFFECTIVE
EXPIRATION
GENERAL LIABILITY
Ceencerciai Genoa! Uablfty
o Mims undo Occserenee
o Owes' and Cententrs Protect=
0
0
Gertend Amass*, Lend appals per
D Optzosti Dutra=
AUTO/608�.B LIABILITY
Ll Any duEnnolde
o AE Owned Aseconables
o
o o ScitedstedAlitornades
Wed tedernenges
N...-emed Aummetees
WORKERS" COMPENSATION
AND EMPLOYERS' LABILITY
EXCESS UM:WTI(
°Mamma DIataints Meta
EXCESS WC
Excess Wfwere C.ornsersidien
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2nd Ave
Miami Shores, FL 33138
CO52/A1M9
Tlds certificate is issued as a matter of Inlomudien only and confers no rights
upon the Cerifficatie Holtler. This Certdcate does not amend, extend or after the
coverage afforded by the paces below.
emPanY Associat' ed Electric & Gas Ins Svcs ltd
A
Company
Corry
D
Cornpany
Company
E
07/0
07/0112010
Authorized Representable
a 9e 1 of I
EACH OCCURRENCE
ARE DAMAGE
MEDICAL EXPENSE
PERS. AND ADVERTISING INJURY
GENERAL AGGREGATE
PRODUCTS AND COMP. OPER, AGG.
12 LL
COMBINED SINGLE Il
PROPERTY DAMAGE (Per accident/
COMPREHENSNE
COLLISION
WC Standoni Um& I 1 Other
EL EACH ACCIDENT
EL DISEASE (Each email:Ir
EL
EACH OCCURRENCE
AGGREGATE
Each Accident or Each
Employee for Disease
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAIKER TO
MAIL 30 DAYS WRITTEN NOTICE TO TEE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO 00 50 SHALL IMPOSE NO OBLIGATION OR UABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
CORWAPMES AFFORDRIG COVERAGE
LIMITS OF LIABIUTY
fLY LiJ L» moo)
ISSUE DATE
06f30f2009
A
IDS
Ft. Lauderdale, FL
*.'zaio'''...,cgn.a'FwgP.:=>nanrcdnnns
e rican rya Sa
has aft- --, ded th
Florida Advanced Refresher
Trai • Cours
ereby recognizes t
MAN TRAFFIC SAFETY
VICES ASS*CIATION
SAFER ROHS SHE LIVES This is to affirm that
rD #37
Mr. Steven Mitchell
has satisfactorily completed the
Florida Advanced Work
Zone Traffic Control Refresher Course
Date Completed:9/10/2009 Status:Passed Final
Location:Ft. Lauderdale, FL Instructor:Ms. Catherine G. Witt
Date Refresher Course Required:9/10/2013
.;:n a4 4;n14.VM•in1 •
•
" " • • '•4
14: ad—E5
Executive Director
Training & Products Dept.
e41 Sea WES WI
44 Rights fiasenert
7
— ,
-
LITHO. IN U.S.A
4'XFULL LANE RESTORATION
SCALE: NOT TO SCALE
SOD RESTORATION DETAIL
YST_ PtCv -Al
PA1401ET3i
TRENCH EA EFT1.L€D
114 6" COMPACTED LIFTS
TO DO% OE MAT,LESUM
DEDEFF1 PER AAS4TO
T -140
i iErFrALITC 4`ERE:R1',1G TAPES SlT. 26
NOTAITED 24' s3Evie, FSt T A 'T, yr °. E 40 t
REEE E RPECTEICARON 2320 r r _^; 3 F c R E€LE T IEEE
!'1I_ESS OT ;;%E i t D :£LE D TER;AL
:.L 6 FR OE �'" STC C LAE€CEi 1 3 /6` ETA
5.RITELEOE ALL 2 61E tEPREADES A' U 1-464 Fr(T€EFOREE R EEs.
k L €'[.T 1111181:
F^,.,1Yt
iESTC 2 € O:at7 DF, 61 TWO 11r12S
Ulti +;!p.SSL "i'r {; #iS•;kl421 _ 10" FAY.
.1b!0 'I 2 6!1 -6ED Bd
4 1 6 1 1 1- 4 1 0 CCF1PRCC D TO 9(,E4 02
EVERIMUPA DENSITY PER AFSE110
RIGHT OF WAY
TRENCH REPAIR, MILLING, AND OVERLAY
TYPICAL TRENCH AND PAVEMENT
RESTORATION FOR TRANSVERSE
CROSSING
1€€ €Y€3 . I FL
r,F P46)4ED SEDUM
\ MAMMAL UP TO
4PF@I061 —LIEGE Of PIPE
T
1-RPI€WEER CACKEIL(.
!1- 061PACTLD Ili 1
46. 1R441'D3%4TIE %1REE S
=I<< 1 STREETS
.P.ECT ( _ "..
SURFACE RESTORATION
IN R/W ABOVE THE PIPE ZONE
SAW CUT & APPLY
TARR COAT TO ALL
`:0 1114 AND EGt,2',
IE.O.P
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 FM
5. NO WM, AIR PROFILES.
6. NO DRAINAGE.
NO APPLICATIONS SUBMITTED FOR:
6. DEWATERING ( ABOVE W TABLE).
7. TRAFFIC STRIPS OR LOOPS.
PROP BORE 3/4" PLASTIC GAS SERVICE
FROM EXISTING 2 "B.S.E GAS MAIN TO
RISER LOCATION 0 41.1 GRAND CONCOURSE
MIAMI SHORES/WORKING IN ALLEYWAY
PROP RISER METER
NO LANE OF TRAFFIC TO BE BLOCCKED OR DISTURBED
1— CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION
OF EXISTING UTILITIES.
2— MAINTAIN A MINIMUN HORIZONTAL SEPARATION OF
5' FROM ANY CITY UTIUTIES.
3— MAINTAIN A MINIMUN VERTICAL SEPARATION OF 18"
OF ANY CITY UTIUTIES.
T.T/T.F/E.F/E.M0 GAS MAIN
—,--MIAMI SHORES
441 GRAND CONCOURSE
GRRMB£9N@6tiR3E
PEOPLES GAS
m
r
L
N R/W
S R/W
GRASS SWALE
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
STING 2 "C.S GAS MAIN
TECO / PEOPLES GAS - N. MIAMI OPERATIONS
441 GRAND CONCOURSE MIAMI SHORES
WORKING IN ALLEYWAY
PROPOSED 3/4" P.E. GAS SERVICE
am � 1 SCALE: 1° = 50' I DATE 6/29/10 I SHEET 1 of 1
' --' - - ' P •
MHami Shiores Village
APPRC)VED
ZONING DEPT
RI.. DG DEPT
BY
DATE
nLII Cr_ UAJCL !TH ALL FEDERAL
L27 F""
LEAF CD L1L
Diameter 2
alerial: C3
Pressure Type: I -3
LocationDescription- 4 14 RW
CC'S Located?: NO
Job Name:
Tuesday, Jun 29, 2010 01:35 PM
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