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PW-11-2229
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 167234 Permit Number: PW -11 -11 -2229 Scheduled Inspection Date: January 25, 2012 Inspector: Hernandez, Rafael Owner: BANICH, ROSEMARIE Job Address: 521 NE 105 Street Miami Shores, FL Project: <NONE> Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number Parcel Number 1122310140240 Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957 -3857 Building Department Comments PROP BORE 3/4" PLASTIC GAS SERVICE Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 24, 2012 For Inspections please call: (305)762.4949 Page 13 of 30 r4\-3‘61(,, RECE k'�T E NOV 30 Z91) IVhami Shores ViiIageBY:_-i. Public Works Department 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Public Works Permit Application FBC 2004 Permit Type: Mac Works WATER O p/% wne?a Name (Fee Simple Titleholder) eat /10 f C A 4 r 4CC. Owner's Address S2 /� >N • E 10 8i8 �"r City . �//�s/3 -r> o sJ�iusm+EV TenanULessee Nano. /1 r Pe[nitttt1 912%Pc1 Phone S: (20g 25 — 37'7.1r- Phone t zip 3.3s3� Job Address (iMieke the oak Is betn9 done) ' / N E t't 3 �...o � / "..� .N s City Miami Shores VEage County Wand Dada zip 3/3/! it Is Building Itlstorkelly Designated: YES NO . Contractor's Company Name 6/i ,PeatiC Contractor's Address 0t771 Architect/Engineer's Name (if applicable) Cd-r). °p `- f5��79 lards'^ 2i iLr �[1 $ Vakse of Work For this Pemdt Phatee; _Par -v t, /.37 . d iO Type of Work ❑ Additka ei ❑ Alteration New Repair/Replace ❑ Demolition Describe Work �l °Ci m 4.4 a ,w® /i e: 4®? — r ✓ icy' "!I0r r® 4,74-1 fr) aria,- $ / !/0 s c"- , de1-r7QJ#.3 e✓c Pf ave.a 6t a®u estolea..65 444l .ee. 4: No ra. e•y Zip j3.3/f° Phone * 70 /3 7% lineal Footage Of Wodc Submittal Fee $ Notary $ Scanning $ Fees '"'..""""«""" Permit Fee $ CCF $ CO/CC Training/Education Fee $ Technology Fee $ Radon $ Zoning Bond $ Code Enforcement $ Total Fee Now Due E (Continued on opposite side) Structural Plan Review $ Bonding Company's Name (if applicable) Bonding.Corppany's Address N/A • City ' State ZIP • Mortgage Lenders Name (if applicable) WA Mortgage tenders Address City 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 pernit and theta(' work will be performed to meet the standards of ail laws regulating constejctlon 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 .... . dWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done iq 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 Appli cant: As a condition to Bds issuance ofa Public Works permit with an estimated value exceeding $2800, the applicant must pmn?lse b► good faith that a copy of the notice of cormnencement and construction Bah taw brochure will be' to the person whose pmpertyls subject to attachment Also, a certified copy of the recorded notice of commencement must be p at the job site for the fast inspection which occurs seven (7) days afterthe building pemdtIs. issued kr the absence of such posted notice, The Inspection will not be approved and a retnspection fee will be charged Signature Owner or Agent Signature Contractor The foregoing instrument was acknowledged before me this . Atr The foregoing instrument was adknowtedged before me this Z J' day of A(C) , 20 0Q , by v .adE� . /4,7 day of Ado'✓ , 20 who is personally n6wn to me o w o has produced - as iden ' ti n and who did take an oath. as identifi •, . and who did take an oath. Who is personally know to ai rodu NOTARY PUBLIC: Sign: I/ Print: ARY PUBLI Sign: Print: My Commission Exp My Co air arlry MY COMMISSION # DD831 +91 irJ'IRES: November 29, 2012 op 1.800. 4-NOTARY F1. Notary Discount Assoc. Co. A Ark-A-1.11-11-111111 APPLICATION APPROVED BY: 11/17/2005 Public Works Director or his designee. A EP CERTIFICATE OF LIABILITY INSURANCE DATE "` Y' 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 BYTHE 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 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: (A/C No. Extb 800 476-2211 FAX No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A Associated Electric & Gas Ins. Svcs. UAAIUTY 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 a :Zurich American Insurance Company 16535 INSURER 0 : $ 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POUCY NUMBER POLICY EFF (MM/DDIYYYY) POUCY EXP (MM/DDIYYYY) UMITS A GENERAL — UAAIUTY COMMERCIAL GENERAL LIABILITY X0521A1A11 Self-Insured Retention $1,000,000 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (My one person) $ X I CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGO $ GEN'I. AGGREGATE LIMIT APPLIES PER POLICY n ERCTT n LOC $ A AUTOMOBILE — — — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUT NON -OWNED AUTOS X0521A1A11 Self- Insured Retention $250,000 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT (Ea accident) _S 1 000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB _ X OCCUR CLAIMS -MADE X0521A1A11 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED IN $ A C WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N yes, describe under DESCRIPTION OF OPERATIONS below N / A EWS931859700 X0521A1A11 07/01/2011 07/01/2012 X I TOW TATU- I IG R EL. EACH ACCIDENT $ 1,000,000 EL. 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 I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If 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. AUTHORED 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 s rho ROAD WORK 1 M11.E Sign may 48 u4ed ae an alternate to Cho ROAD WORK MEAD sign. ss 500' P4yona the 9040 WORK AWAO .sign or mldwgy batw44n 819ne whichever love. - �xyr ‘RE PREP4RrD r0 $TOR elfin may 94 emitted for woods of 45 MPN or lees. SYM8OL S Work Are4 Sion with 18" x 18" (Mln.) Orange flog And Typo 0 Light o Cngn l4li,Zng Device. (Sao 1n8* No, 600) work 2on4 Sign Flogger Automated Flogger As8lotano4 Devices (4F401, .w.im 6rite off. ,Lone Identification + Dbeotlon of ?yarn rA®LE 1 1:1EVJCE SPACING _ .. SPOOd OW) .: °r,Mil':e,• Q9lw,gn 00 (004 tft.) Coma or rubuloa Ifato dO 1111dff Tyoa 1 er Type 11 d d s Or �00i �8 To r Tangent 25 to d" 20 55 20 50 50 0 70 ;0 90 30 100 NAVAL 1. Wore opgrpl /one 41181 /b4 eenfinid to One 9430,19 lone, leaving th8 09090/10 tans o9in t0 09(19, 2. Addltlonalono -way c4ntrolmgy b9 effoot8d ay the following moonst (1) Fid9- carrying veldetot (2) Offlolcivohlelel (3) Rot 8417181897 (4J rrafflo ef9nal®. Whom fl0ggaro. ore the 0014 mono Of ORe®w8y control, Cho flagon ah0llbe in sight of eon agar Or in dboot oammunld4tlon of all Woe, J. No ONE -LANE ROAD elgna are to be fW/y oovirq¢ ono t17o RLA00E0 sire e/utar:removed or fully owed whom 170 work is doing� p9//rrforted end She hi9hwoy /8 op4n to twowwey frallla, 4, Whon 0 oid4 read 1ntarie0t4 tint WghNay. wlthh tee rrc rang, 9dditlonol.170 davi6ae•ehQNbe Pined to 08car00n8c with plher 009901A T02 lttdeeee, S a9, rho rwb onannoli8ing dd81484 dlroctly in front of the pore grim and 3179 one ph08n4A8(ng 948109 41898(17 fit Ihi and of Cho work or89 frtay 00 online(' 989v10'8d vdhl9tis 117 tna work (woo nave ntgh- 1ntenelty rotating, (+9101179, QOClliall9, or 8troba ((9hte eporeting, 0, Per 9e/oral TCd requir4montp and bddiH3nalhformation, refer to 1nd41 No. 600, DURATION N©= 1. 11411 f 740! following I Oore 3TDf7 slgnl may ge of W9re 040+0114178 -aro 80 talnot99 or lase, BJ *9eod limit t9 45 mph or top, pJ NNo eght•obstrwolIOni to veletas a9Progeh(ng the Mere area for 0 diit8n04. 4quol to t/te Puffer ppawe. d) V4hlalos et Cho work drop hove fighwhtensfty. rotanhg. 4890!179. walla/kg, or strobe i(9hts b9eroling. a) Velum! One aompl8Xity of Cho rocdWOy h09 1100n o0n4 /d4r4d. 4UFFER SPACE 50843 Dist. lenpnl (0,1 25 155 30 i 200 , IS 250 40 "' .305 45 1 360 50 425 55 495 0....... 57o 65 645 • NOW? fivrf0r 99804 cannot Dd 0114;080 duo to goontetrio eenetralrts, 1370 grept451 011o41017l4 length 5001180 114061 Oat not lags Mon 200 It. CQN41T!QNS WHIM ANY vvh1c4E: EOurPNENT, WORA'£t?5 OR T'H£iR ,40 ri vows E4ROAC#1 THE AR£A BETWEEN THE CENTERLINE AND A LiNE Z' //�� 0UT510E PHE EDO,tOF TRAVEL WAY. •59/ 11/"& /� S -- 3 19 !! n t3rtAr>der94 7WOLANE. TWO.WAY, WORK WITHIN THE TRAVEL. WAY &A t* POW No. 07/01/08 1 oft Indott No. 603 0.4.u,0,0.0,0,0 :0":000.0.0 0.0:0,0,0:0 ;oip O, O O:O g0:0:0.0:< SO tee er 10, 2009 . Da e Ft. Lauderdale, FL LOcailon AMERICAN TRAFFIC wert SERVICES ASSOCIATION This is to gffirm that . SAFER RAM WE LIVER �` ID #37 ,y Mr. Steven Mitchell has satisfactorily completed the Florida Advanced Work Zone Traffic Control Refresher Course Date Completed:9 /1012009 St tus:Passi Final Location:R. Lauderdale, 1111, Inatructor:MA. Cp*bwiroe G. Witt Date Refresher Curse Required9 /10/2013 SAW CUT & APPLY TACK COAT TO ALL SURFACES AND EDGES EXIST. ROW PATUXENT TOP 5011. SELECT NATIVE PATEFML,_. -- ASP&0,EIC CONCRETE 05 REOl11F.ED 65 SPECIFICATIONS THICK NESS TO MATCH EXISTING. MILLING, ASPHALTIC CONCRETE RESURFACING AS REQUIRED BY SPECIFICATIONS. SOU FACE RESTORATION IN R/W ABOVE THE PIPE ZONE REMOVE OLD ASPHALT ,_SURFACE SURFACE f EXIST. ROAD PAVEMEHIT EXIST. BASE,. RESTORE ROAD BED TWO TINES ORIGINAL THICKNESS 18° MAX. AND 12' MIN. PLACED IN 6' LAYERS AND COMPACTED TO 98% OF MAXIMUM DENSITY PER PASHTO T -180 EXIST. BASE TRENCH BALKFILLEO 10 6' COMPACTED UFTS TO 960 OF MAXIMUM DENSITY PEP ATSHTO T -t8A_f METALLIC WARNING TAPE (SEE NOTE 1) SAW CUT & APPLY TALK COAT 10 N.I. SURFACES AND EDGES GRANULAR ELACKFI.L C OMPACTED IN 6" APPROVED BEDDING MATERIAL UP TO SPRING -UNE OF PIPE RIGHT OF WAY TRENCH REPAIR, MILLING, AND OVERLAY tctE: 7,6° PARKING r.METAWC WARNING TAPES St7Al1 BE Tm8` RESIDENTIAL STREETS INSTALLED 24° BELOW FINISH GRADE ABOVE MAIN. T =10° MAIM STREETS (4 LANE) 1 1 D EL G TYPE) Tm12° MAJOR STREETS (6 TARE) a 66655 OIHERASE 2520 SECTION 3.6 MATER SHALL. BE FREE OF STONES LARGER THAN 3J8' DIA. 27=18' MAX. i2° M16. 3.6601.656 ALL LANE MARKINGS AND REFLECTIVE MARKERS. TYPICAL TRENCH AND PAVEMENT RESTORATION FOR TRANSVERSE CROSSING 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. 2 "CI GAS MAI 964 0 PROPOSED RISER METER SET LOCATION PROP BORE 3/4 " PLASTIC GAS SERVICE FROM EXISDNGG 2 "C.S GAS MAIN RISER LOCATION 15 521 N.E 105TH STREET MIAMI SHORES m 521 N.E.105TH STREET MIAMI SHORES r O 1 1 N /RW —5_' _sTDEWAE GRASS SWALE E.O.P E.O.P AASgs SALE EXISTING 2"CS GAS MA(1I 75' 55' S R/W W GRASS SWALE IstE- t65T#SREET E.O.P M E.O.P PA kINT LOT T.T/T.F/E.F/E.MO GAS MAIN N.E.105TH STREET SWALE a (y� • SWALE W 0 � E. lJ o PROP 3/4 PE BORE I— GAS I 1 1 1 1 ■�I III 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 NO LANE OF TRAFFIC TO BE BLOCaCED OR DISTURBED 1— CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTUJI1ES. 2— MAINTAIN A MINIMUN HORIZONTAL SEPARATION OF 5 FROM ANY STY unUTIES. 3- MAINTAIN A MINIMUN VERTICAL SEPARATION OF 18" OF ANY art UTIUTIES r au OS au aW se au au as--14 RESTORE GRASS TO QTY SPECS SIDEWAI K pgR,70,7 NOV 3 0 .20n 1 . 5 )ores Village APPRO'''ED B BY D DAIS ZONING DEP1- BLDG DEPT / /Z- Z J1i SUBJECT CO CCMPI,IANCE fri ALL FEDERAL STATE AND CCIJN 1Y RULES AND REGULATIONS 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 NO LANE OF TRAFFIC TO BE BLOCaCED OR DISTURBED 1— CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTUJI1ES. 2— MAINTAIN A MINIMUN HORIZONTAL SEPARATION OF 5 FROM ANY STY unUTIES. 3- MAINTAIN A MINIMUN VERTICAL SEPARATION OF 18" OF ANY art UTIUTIES r au OS au aW se au au as--14 RESTORE GRASS TO QTY SPECS SIDEWAI K pgR,70,7 NOV 3 0 .20n 1 . ..... _ _�. , J 4 ` ) 5 )ores Village APPRO'''ED B BY D DAIS ZONING DEP1- BLDG DEPT / /Z- Z J1i SUBJECT CO CCMPI,IANCE fri ALL FEDERAL STATE AND CCIJN 1Y RULES AND REGULATIONS PEOPLES GAS TECO / PEOPLES GAS - N. MIAMI OPERATIONS 521.N.E 105TH STREET MIAMI SHORES WORKING IN PARKING LANE PROPOSED 3 /4 " P.E. GAS SERVICE S I SCALE: 1' = 50' I DATE 11/17/10 I SHEET 1 of 1