PW-11-680Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 158515 Permit Number: PW -4 -11 -680
Scheduled Inspection Date: May 18, 2011 Permit Type: Public Works
Inspection Type: Final
Owner: NESTOR, MARCEL Work Classification: Public Works
Job Address: 50 NW 109 Street
Miami Shores, FL 33168 -4315
Inspector: Hernandez, Rafael
Project <NONE>
Contractor: TECO PEOPLES GAS SYSTEM
Phone Number
Parcel Number 1121360110210
Phone: (305)957 -3857
Building Department Comments
PROPOSED GAS LINE FROM GAS MAIN TO RISER IN
ALLY WAY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 17, 2011
For Inspections please call: (305)762 -4949
Page 12 of 27
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,
11 APR 1 8 2011 IL
Miami Shores Village Es''
Public Works Department
Public Works
Permit Application
FBC 2004
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax (305) 756.8972
(0Ai72k3r pm* No. PC() 1 GK)
75.(0 F2 6L151
Penult Type: Public Works WATER
Owners Name (Fee Simple Titleholder) _JU arez/
menet 345- 3&' 26157
Owners Address 5.0 Ai ((,,tr /D M SP2-tr;r:
City State p/ zip
Teruud/Lessee Name Phone II:
,5e), 4ipt,
Job Address (where the work is behm done)
City Miami Shores Wane County Warni Dade
Is Building Histimitudiy Designated YES NO .
ap3316t
Contractor's Company Name j.26401/E5 4d Phonet 29 ."3
Contractor's Address 677, btl:27"
City W04/7"-- State I Zip 331(;20
Architect/F_righwer's Name (if nook:able)
$ Value of Work For this Permit .
Type of Work
Describe Work:
7e0
phone ,..;(3 99e / $ 7,-
Limit Footage Of Woric
El Addition pAtteralion ErNew 0 Repak/Replace El DemoWon
ATvas 51, yz, ,,Av`:,,2 -;74061e,-,,_//e3A4E Alas,' •-?4, 1',/9/1; f2,'-' fr'S
, ;---;:-,,,,-,'; -7:•77,--d , , 1 .,' .., --4.-LZ rzi 47.1,4,,: 1-4
V eX1 , 0 - e ,,--7-i sm-&7--..7- g 4, -0 , /2.,,,,,- ,,-f 4,,- ci-
-Jr r
A
F
..,,,
?or), 0 Permit Fee $ CCF S' COiCC
Submittal Fee 8
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review $
Total Fee Now Due $ \
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address N/A
City State Zp
Mortgage Lenders Name (if applicable)
Mortgage Lenders Address
City
N/A
rip
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 thet.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 afl 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 WITii YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
!Notice to Applicant As a condition to this Issuance of a PubIC Works permit with an estimated value exceeding $2500, the applicant must
promise in goad fakir that a copy of the notice of commencement and construction Hen taw brochure will be ,red to the person whose
property is subject to attachment Also, a certified copy of the recorded notice of commencernent be ' + : , at the job site fiorthe first
inspection which occurs seven (7) days after the building penult is issued in the absence of suth posted notice, the inspection will not be
approved and a reinspection fee will be charged
Signature
Owner or Agent
Signature ®)
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was admowdedged before me this
ex day of l , 20!t, by
who is personally known to me or who has produced Who is personally knowjo -me or has roduced
day of
, 2Q., by
My Commission Expires:
APPLICATION APPROVED BY:
11/17/21105
My Commission Expires:
•
.4fro) It
'91 --//
Public Works Director or
his designee.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Job Name
PLUMBING CRITIQUE SHEET
/l @ 140/(c, y `) Lo
� v
■
END I�
pp ROAD WORK
4]
50'
Buffer Space
/ 250'I
See Table
`1 b
C
SPEEDING FINES
G
MEN ESKERS
PRESENT
1
4
8
(a
I
Device Spacing - Tangent 500'
DISTANCE BETWEEN SIGNS
Speed
Spacing (ft.)
(mph)
A
8
C
0
40 or less
200
200
200
100
45
350
350
350
175
50
500
500
500
250
55 or greater
2640
1640
1000
500
x The ROAD WORK 1 MILE s'gn may be used
as an alternate to the ROAD WORK AHEAD
sign.
at at 500' beyond the ROAD WORK AHEAD
sign or midway between signs whichever
is less.
4'44 BE PREPARED TO STOP sign may be
omitted for speeds of 45 MPH or less.
SYMBOLS
® Work Areo
v 0 Sign With 18" x 18" (Min.)
Orange Flag And Type 8 Light
• Chonnelizing Device (See Index No. 600)
[p Work Zone Sign
13-. Flogger
,♦ Automated Flogger Assistance Devices
(AFAR), With Gate
ca Lone Identification + Direction of Traffic
y
See Table 1
Device Spacing -Taper
See Table 1
TABLE I DEVICE SPACING
Speed
(mph)
Max. Distance Between Devices (ft.)
Cones or
Tubular Markers
Type I or Type II
Barricades or Vertical
panels or Drums
Toper
Tangent
Toper
Tangent
25 to 45
20
50
20
50
50 to 70
20
50
20
100
GENERAL
1. Work operations shall be confined to one traffic
lone, leaving the opposite lane open to traffic.
2. Additionolone -woy controlmoy be effected by the
following means,
(1) Flog - carrying vehicle: (2) Official vehicle:
(3) Pilot vehicles: (4) Traffic signals.
When f/aggers are the sole means of one -way
control, the floggers shollbe in sight of each other
or in direct communication at o/l times.
3. The ONE -LANE ROAD signs are to be fully covered
and the FLAGGER signs either removed or fully
covered when no work is being performed and the
highway is open to two -way traffic.
4. When a side road intersects the highway within the
TTC zone, additional TTC devices sholibe placed in
accordance with other applicable TCZ Indexes.
END
ROAD WORK
NOTES
5. The two chonnelizing devices directly in front of the
work area and the one chonnelizing device directly
of the end of the work area may be omitted provided
vehicles in the work area have high- intensity rotating,
flashing, oscillating, or strobe lights operating.
6. For general TCZ requirements and addition/ information,
refer to Index No. 600.
DURATION NOTES
1. ROAD WORK AHEAD and the BE PREPARED TO STOP signs may
be omitted if allot the following conditions are net
a) Work operations are 60 minutes or less.
b) Speed limit is 45 mph or less.
c) No sight obstructions to vehicles approaching the
work area for o distance equal to the buffer space.
d) Vehicles in the work area have high- intensity, rotating,
flashing, oscillating, or strobe lights operating.
e1 Volume and complexity of the roadway hos been considered.
w /094
BUFFER SPACE
Speed
(mph)
Dist.
(it.)
25
155
30
200
25
250
40
305
45
360
50
425
55
495
60
570
65
645
70
730
When Buffer Space cannot
be attained due to geometric
constraints, the greotest
attainable length shall be
used, but not less lhon 200 t t.
CONDITIONS
WHERE ANY VEHICLE, EQUIPMENT,
WORKERS OR THEIR ACTIVITIES
ENCROACH THE AREA BETWEEN
THE CENTERLINE AND A LINE 2•
OUTSI06 THE EDGE OF TRAVEL WAY.
hoe
0 TWO -LANE TWO -WAY, WORK WITHIN THE TRAVEL WAY
2010 FOOT Design Standards
Last
Resist= heet No.
y
07/01/09 1 of 2
603
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.
LEGEND
R/W RIGHT OF WAY
PA PROPERTY LINE
T/T TAPPING TEE
EFV EXCESS FLOW VALVE
SVC SERVICE LINE
SP STEEL PLASTIC COAT
Uri ,PPL Y
PE POLYETHELENE C,CA. f TO ALL
c■:'EF ED.SES
PROPOSED RISER METER SET LOCATION
PROP BORE 3/4" PLASTIC GAS SERVICE
FROM EXISTING 2"B.S.E GAS MAIN TO
RISER LOCATION 050 N.W 109114 STREET
MIMI SHORES WORKING IN ALLERWAY IN REAR OF HOUSE
;..ELEOT
ASPHALTIC CONCRET AS REQU1000
Eri sPEcincAnols 010141/00 TO
0001-1 EXtSTINC,
1i1LLING, 0/P;io1TlC
CONCRETE RE0001-,000
AS REQUIRED 1/30
SP 001,1CP110
EXIST RQ!,...D
•
/
0-1031/0 00
/01-1-100
SURFM.7.0
SURFACE RESTORATION
IN R/W ABOVE THE PIPE ZONE
..
. Ea$0. RO-
,, PAVE.? 'ENT
. ....-
4-41,X4s,
CIKIST
RESTORE 0 :;;; rik/Ls
oRiGloAL
rz ,! PLOCED
▪ 01D COVPAC TEA') TO P.`;::".
▪ 0000 000
; fir-.2•0FILLEC;
SI'
`.:X.100
USE
1:0EE 7,.0/0
00g..;000000
jSTiLi I.;
.,PP00,fi.13
01/01 :if' 30
RIGHT OF WAY
TRENCH REPAIR, MIWNG, AND OVERLAY
& PO-
0,7..7.0 0:0AT TO ALL
0'0000003 01-1-3 ENES.
•1SN 0 T r; (4- -;
(SEE EFEC.W,Ci-T,:,.. SECT!C F-2r o
2 S C04EF: sPEC'FIE0 Tr71'..!
00 '377 !I if. Li,.
TYPICAL TRENCH AND PAVEMENT
RESTORATION FOR TRANSVERSE
CROSSING
N.W109TH STREET
50 N.W 109TH STREET
MIAMI SHORES
r
16)1 c,-7s77,tt-)A-
APR 1 6 /Oil
BY:
oedoomeee;oo
'gas —ear
--------------
T.T/T.F/E.F/E-M0 GAS MA
4
2
—2
GAS GAS
GAS
--arAt:12EY MAW.
/�C®iJ
�;� b B`C n"
CERTIFICATE OF INSURANCE
ISSUE DATE
07/02/2010
PRODUCER
MCGRIFF, SEIBELS & WILLIAMS, INC.
O. Box 10265
rmingham, AL 35202
600- 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
■.1 Claims Made ❑ Occurrence
❑ Owners' and Contractors' Protection
❑
❑
General Ag regate limit applies per:
El Poltcy 11 li 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
$ 1900,000
PRODUCTS AND COMP. OPER. AGG.
$
A
AUTOMOBILE LIABILITY
o Any Automobile
❑ All Owned Automobiles
❑ scheduled Automobiles
X0521A1A10
Self- Insured Retention
$250,000
07/01/2010
07/01/2011
COMBINED SINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per nerson)
$
BODILY INJURY (Per accident)
$
❑ Hired Automobiles
PROPERTY DAMAGE (Per accident)
$
❑ Non -owned Automobiles
❑
COMPREHENSIVE'
COLLISION
WORKERS' COMPENSATION
AND EMPLOYERS° LIABILITY
WC Statutory Limit 1 1 Other 1
EL EACH ACCIDENT
$
EL DISEASE (Each employee)
$
EL DISEASE (Policy Limit)
$
A
EXCESS LIABILITY
❑ Occurrence M Claims Made
X0521A1A10
07/01/2010
07/01/2011
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESS WC
Excess Workers' Compensation
C0521A1A10
07/01/2010
07/01/2011
Each Ac cidenf 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
:)050 NE 2nd Ave
Jliami Shores, FL 33138
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 REPRESENTATIVES.
Authorized Representative
f
__ re.' 4: ° '-^h
Page 1 of 1 CertiocateID# TRMMEWYD
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A M IC 4I TRAM SAFETY
SERVICES ASSOCIATION
is to r rm.tha
Steven Mitchell
has satis,�actorii. completed the
_Florida Advanced Work
Zone raffic.Cont 0,1cRefresher Cour
Date Completed,9110/2009 Status: Passed Tina
Locati 1�1 t I twit erdal � 'ctbr:M . Ca 4e ne VYl
Date Refresher Course Require*d:9/1072013
:0:0:0:0:0:0:0:0:0:0:0
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0:0:0:0:0:0:0:0:0:0