PW-11-2228I
f
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167232 Permit Number: PW -11 -11 -2228
Scheduled Inspection Date: January 25, 2012
Inspector: Hernandez, Rafael
Owner: SOTOLONGO, SERGIO
Job Address: 1249 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number (305)206 -1767
Parcel Number 1132050080060
Phone: (305)957 -3857
Building Department Comments
PROP DIRECTIONAL BORE 3/4" PLASTIC GAS SERVICE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
January 24, 2012
For Inspections please call: (305)762 -4949
Page 11 of 30
q3—' B4600 6—m/
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ueo p
Miami Shares Village
Public Works Department
ki,\51(\--tvoic,
Public Works
Permit Application
FBC 2004
Permit Type: Public Works WATER (� / �'`�
Owners Name (Fes simple Titleholder) ✓°e J 1) D/d /O/1 0
RECEIVEr
NOV 302011
BY-
10050 N.E. 2nd Avenue, Miami Shores. Florida 33138
Tel: (305) 7952204 For (305) 756.8972
Owners Address / Q.1/9 /14E /00 mar
City , it i /'a'fJlas
Phones: 3o5 539 yy /2
State; ,944. •
TetaanWLessata Nwiie;
Job Address (whets the work is being done)
City
Miami Shores Village
Phones:
N.E /®® tri-s?'!2 ': 200,1-A. °es
zip 3/33
is Building Htatw rally Designated:
YES
County
Contractors Company Name ."C-0) %JLVie; 4
Miami Dade
NO .
•°v is✓d4rBS .Sur
zip 3 2 for
Contractors Address ?g Zr/C-Sr. ®I•/c- /17-4
City N wiz /14° .as so % -
ArchfteWErrgineers Name (if applicable) ° Cwt °V) k5 C8
$ VON of Work For tills Permit
Type of Work
Describe Work
Submittal Fee $
Notary $
Scanning $
Prone #: Gar 76 - "3 73 -5'/Z-✓C
❑ Addition ['Alteration New
,410t9er5 ®//fed T /®/lec / C /(/tom+
7.02- Rs;,.
%4.0°P
J3 13,x'
ZIP
Pte* 305-52b /373
Lhreel.Footage Of Work / 01 / DtX// f8 iN /thy
❑ Demotition
die 220,••
20 rm F . 0®C
5
710 � °, f --
5.z)
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
• Fees
Pemdt Fee $ CCF $
CO/CC
Training/Education Fee $ Technology Fee $
Radon $ Zoning Bond $
Structural Flan Review $
Bonding Company's Name (lf applicable)
Bonding.Corppany's Address N/A
City State ZrE►
• Mortgage Lenders Name (if applicable) WA
Mortgage Lenders 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 MI be performed to meet the standards of all laws regulating conefLuction in
this jurisdiction. I understand that a separate pemrfi must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC ....
. OWNER'S AFRDAVIT: 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 e condition to this Issuance of a Public Works permit with an estimated va(ue exceeding $2500, the applicant must
promise In good faith that a copy of the notice of commencement and construction Gen taw brochure will be deviled to the person whose
property is subject to attachment Also, a certified copy of the recorded notice of commencementmust be pasted at the job site for the first
Inspec libn which occurs seven (7) days after the building permit is issued In the absence of such posted notice. Ure hrspecton will rat be
approved and a rebion fee wul be charged
Signature
Owner or Agent
Signature
Contractor
The foregoing Instrument was acknowledged before me this The foregoing instrument was adcnowtedged before me this
day of g
2027_, by ',Joe _
who Is personally known to me has'praduced % Who is personally know to me or has produced .
day of
20 by Oft',(d 0/
as identificatkin and who did take an oath.
NOTARY PUBLIC:
Zrolitr
Sign:
Print:
My Commission Expires:
( Sign:
-as identification and who did take an oath.
NOTA - Y PUBLI
My Commission Expires:
APPLICATION APPROVED BY:
11117/2005
Public Works Director or
his designee.
®
A� O CERTIFICATE OF LIABILITY INSURANCE
DATE 1"'
/2 01
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 POUCIES
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 pollcy(Ies) must 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).
PRODUCER
MCGRIFF, SEIBELS & WILLIAMS, INC.
P.O. Box 10265
Birmingham, AL 35202
CONTACT
NAME:
INC. No. EA): 800-476 -2211 L (Wc, No):
E -MAIL
ADDRESS:
INSURERS) AFFORDING COVERAGE
NAIC #
INSURER A :Associated Electric & Gas Ins. Svcs.
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURED
Peoples Gas System
TECO Energy, Inc.
P.O. Box 111
Tampa, FL 33601
INSURER B :Liberty Insurance Corp.
X0521A1A11
Self- Insured Retention
$1,000,000
INSURER C :Zurich American Insurance Company
16535
INSURER D :
$ 1,000 ,000
INSURER E :
$
INSURER F :
$
COVERAGES
CERTIFICATE NUMBER:EE74Y5HU
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.
USSR
LTR
TYPE OF INSURANCE
ADLICSUBR
INSR
INVD
POLICY NUMBER
POLICY EFF
LMMIDD/YYYY)
POLICY EXP
(MMNDNYYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
X0521A1A11
Self- Insured Retention
$1,000,000
07/01/2011
07/01/2012
EACH OCCURRENCE
$ 1,000 ,000
PREMISES (Ea occurrence)
$
MED EXP (My one person)
$
X I CLAIMS -MADE
OCCUR
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$ 1,000,000
PRODUCTS - COMP /OP AGG
$
GFNL AGGREGATE LIMIT APPLIES PER:
—1 POLICY n JPECCT- n LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
� OOSWNED
AUTOS
—
SCHEDULED
ED
AUTOS
X0521A1A11
Self- Insured Retention
$250,000
07/01/2011
07/01/2012
COMBINED SINGLE
accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY GE
(aant
$
$
A
X
UMBRELLA IJAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
X0521A1A11
07/01/2011
07/01/2012
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
DED 1 1 RETENTION $
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
EWS931859700
X0521A1A11
07/01/2011
07/01/2012
WC STATU OTH-
X 1 TORY LIMITS I I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
B
EXCESS WC
Excess Workers' Compensation
EW564N004918121
07/01/2011
07/01/2012
Each Accident or Each
Employee for Disease
$
$ 35,000,000
$
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I more space Is required)
Excess Liability policy provides Insurance In excess of Peoples Gas System's Self- Insured Retention as stated above.
WC Statutory Limit Is excess of $35,000,000 (Insured by Liberty Insurance Corporation)
CERTIFICATE HOLDER
CANCELLATION
City of Miami Shores
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
Page 1 of 1 @ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
0'
&fir Sono
hi Tonto
I DISTANCF BETWEEN SIGNS
(mph)
x, ? tan +I 8rlwean Devices fft.1
A
a
0
WEIN
40 or less
200
g0 90 X30
50
50 to 70
5
l► inti
TLlrn
0
o
.+
or , adter
.. , ,
it
IP
"r
r The ROAD WORK 1 M114 sign may ba used
as on otternala to the ROA0 WORK AHEAD
sign,
sr 500' beyond the ROAD WORK Al4£A5
9(pr) Or mIIWOy 6etwoom signs ',Wallow
is Joao,
FE RRERARti'a ra sraP in may be
Wed for speeds of 45 OW or lass,
SYMIKILS
Work Alen
?!C Sion with 16" x 18"' (ro1n,1
�s arango Fiop ,4nd TYpe B (dont
e Chenna/l• gaWWOO (See Index No. 6001
131 Work Zone Sign
Flogger
Automotod Flogger Assistance Osvioes
(11 Q1, rrltn ate
mo .Lone Identification 4• DJreotion of Trees
too cable 1
[soviets 8oe tng•Tooer
ag
TWO
TALE 1 DEVICE SPACING
Swab
(mph)
x, ? tan +I 8rlwean Devices fft.1
Comes or
rv8ular
Mryorklri
Typo 1 or Type 11
Vortical
�rma
Renoir or Oru
� u41
3 .i +
Tppor
Tangent.
25 to 48
g0 90 X30
50
50 to 70
RO 50 r 20
100
OENIRA`
1. Work operptIon8 ehaab* confirm(' 10 ens fPOMRO
lotto,
leaving the opposite lone open 10 frOffkl.
Z. Additlonaiono -wey 0ontre/mgy bI'ffeotca ay Use
following moons,
(1) Flagmcorrying vehlchit (2) 0ff101e1 vehlplli
(3) Pnot vohfchmi.fel Trafryo eiarnis,
When. 'faggots pre the solo nicer!, of ene.ocy
aontrel, the Ruggers 8hollbo to sight of Roan other
or in erect 00m+riunfa*UOn of 011 ,imam
3, The ONE-LArig N0.40 signs ore It) be folly oovared
ono Ma RLAGQER *iris ,/thee: removed or luny
savored whon no work to boat; oorf0rmed RIO the
highway is coon to two -way tr0fflo,
4. Whom a g/de rood Interseatg the highway within th1
rro sone, edeitfonal.!TC devloee.eheabe Pleaed !m
eooerdene0 with ether OPPROOblo TQZ 1md000*.
N 1TS
a. The two ohonno11*Jng dovlaoo directly el front of the
work grog and the one 0nonn0Asing desk, direpey
at the and of the work prep may be ornate; provided
veM010* in tee ware area -hove h11,11- n(an*lty rotating,
floating. overacting, or dfrobo 11ght0 *perms,
Or Par ganoro( TCZ requk'emantp ono' bddltkinoiinfarmaeon,
rotor to index No: 600.
TICN NOTES
1, NW WORK MEV and the BE RRBPorco TO STOP signs may
00 Omitted If ollof the follorn4 apndlNong arc met?
*) Work operations ere 60 (miming or lase,
8) Speed emit 1s 45 mph or less. -
p) a sight -ebstruo1gns to vaMdfos approaching Me
work ono for a -atoned ,quo/ to the buffor space,
Vihl¢1ae tt the wank crag have high,intenslty, rotating,
Rashing..oaBQloHng, or strobe lights opere7rtg,
o) Vplumo and eomplesity of th0 raodwey hag born eonsidorse.
a cif AV.eioo'
-Cr ..ail tea,
BUFFER SPACE
Speed I Dist.
(mph(, (ft.)
25 i 155
30 i 200
35 250
40 ' 305
45 360
50 i425
405
70
65 ,545
70 I 730
• Wi917 5lt!er Space sonnot
be ottoinad aye to geornetrla
oon4trotnts, the progtast
.ottekaa6lo length 9110006
udad, but not /goo anon 200 (t.
CQNDITIANS
0/67£8(, ANY. veHioL . 80U(0UENT,
WORKERS OR r6E/R ,4 T /VIT /ES
FNQROACH AREA BETW��N
TH£ oew r£Rl. iNe Tl8 AND
OUTSIDE THE FPCE OF TRAVEL wax
.M0 MOT ,c_ . s BtrAnd®ttle
TWOL..ANE .TWOWAY, WORK WITHIN THE TRAVEL. WAY
1
AMERICAN TRAFFIC j },;FEW
SERVICES OCIATION
SEMI 88868 WE UYEB This 13 tO that ID #37
Mr. Steven Mitchell
has satiJactorlly comphated the
Florida Advance Work
Zone Traffic Control Refresher Course
Date Completed :9 /1O/2009 S :Passed Final
Location:Ft. Lauderdale, FL InrUetar au._c t Brine G. Witt
Date Refresher Course Required:9Y1O /2013
3 ,000, o,o,o o,o.o�' o.o.00.0o,:o,00 op,00b.0000,9'oy,o„ o00.0o.o.o,.b. 9,ii.
l.Y ` ,.draeA:.i is' _Z�' : , _f#1 ' 0' \ . r. � T�.o, ..ivv P(•aG.. 2*:.'S F .. /,T '7J� ..� -.s' -r
rU i t]_n1, F} L;UES S4$
1
UM*. IN U 00
a
a•
s
SAW CUT & APPLY
TACK COAT TO ALL
SURFACES AND EDGES
EXIST. ROAD
PAVEMENT
EXIST.
BASE
4° TOP SOIL
SAI FCT NATIVE
MATERIAL.
ASPHALTIC CONCRETE AS REQUIRED
BY SPECIFICATIONS THICKNESS TO
TCH EXISTING.
MIWNG, ASPHALTIC
CONCRETE RESURFACING
AS REQUIRED BY
SPECIFICATIONS.
or
REMOVE OLD
ASPHALT
SURFACE
EXIST. ROAD
PAVEMENT
SOD
SURFACE RESTORATION
IN R/W ABOVE THE PIPE ZONE
RESTORE ROAD BED TWO TIMES
ORIGINAL THICKNESS 18` MAX.
AND 12° MIN. PLACED IN 6°
LAYERS AND COMPACTED TO 98% OF
MAXIMUM DENSITY PER AASHTO T -180
LEGEND
TRENCH BACKFILLED
IN 6° COMPACTED UFTS
TO 985 OF MAXIMUM
DENSITY PER AASHTO
T -180
METALLIC WARNING
TAPE (SEE NOTE 1)
SAW CUT & APPLY
TACK COAT TO ALL
SURFACES AND EDGES
GRANULAR BACKFIU.
COMPACTED IN 6°
LIFTS
APPROVED BEDDING
MATERIAL UP TO
SPRING —UNE OF PIPE
RIGHT OF WAY
TRENCH REPAIR, MIWNG, AND OVERLAY
MILT
1...6° PARKING
1.METAWC WARNING TAPES SHALL BE Tm8° RESIDENTIAL STREETS
INSTALLED 24' BELOW FINISH GRADE ABOVE MAIN. T ®10° MAJOR STREETS (4 LANE)
(SEE SPECIFICATION 2320 SECTION 3.8 FOR MARKING 1YPE) T'12° MAJOR STREETS (6 LANE)
2.UNLESS OTHERWISE SPECIFIED SELECTED MATERIAL
SMALL. BE FREE OF STONES LARGER THAN 3 /B° DLA 2Tm1S° MAX. 12 MIN.
3. REPLACE ALL LANE MARKINGS AN0 REFLECTIVE MARKERS.
TYPICAL TRENCH AND PAVEMENT
RESTORATION FOR TRANSVERSE
CROSSING
R/W RIGHT OF WAY
P/L PROPERTY LINE
T/T TAPPING TEE.
EFV EXCESS FLOW VALVE
SVC SERVICE UNE
SP STEEL PLASTIC COAT
PE POLYETHELENE
60'
20' H
N.E.100TH STREET
GRAss
3I
PROR RISER /METER SET LOCATION
PROP DIRECTIONAL BORE 3/4" PLASTIC GAS SERVICE
FROM EXISTING 2'B.S.E.W GAS MAIN TO
RISER LOCATION 0 12149 N.E.100TH STREET
MIAMI SHORES /WORKING GRASS SWALE
DIRECTIONAL BORE PIT
_ N R/W
NO SIDE WALK
GRASS SWALE ja
1249 N.E.100THSTREET
MIAMI SHORES
-- 1
NO SIDE WALK
GRASS SWALE
1
18' MINIMUM
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.
NO SIDE WALK
2 "GAS MAIN
SR/W
T.T /T.F /E.F /E.M® GAS MAIN
N
• NOV_ 3 O..2O11
GRASS SWALE
f� F 6 6 3ZS' .. ,�t�� �+ p _ if
Miami Shores Village
APPROVED
BY
DATE
teNING DEPT
DG DEPT
1/2._ Z,,-/1
SUBJECT i0 CCMPUANCE WI m ALL FEDERAL
.STATE AND eC,IJN IY MULES AND REGULATIONS
NO LANE OF TRAFFIC TO BE BLOCOCED OR DISTURBED
1- CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION
OF EXISTING UTIUTIES.
2- MAINTAIN A MINIMUN HORIZONTAL SEPARATION OF
5' FROM ANY aTY unuTIES.
3- MAINTAIN A MINIMUN VERTICAL SEPARATION OF 18"
OF ANY OTT UTIUTIES.
PEOPLLIN GAIN
TECO / PEOPLES GAS - N. MIAMI OPERATIONS
1249 N.E.100TH STREET MIAMI SHORES
WORKING IN GRASS SWALE
PROPOSED 3/4' P.E. GAS SERVICE
suu II I SCALE: 1" = 50' 1 DATE 11/223 /11 1 SHEET 1011