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PW-12-1669Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 181392 Permit Number: PW -9 -12 -1669 Scheduled Inspection Date: December 17, 2012 Inspector: Hernandez, Rafael Owner: ROBINSON, JOHN Job Address: 1239 NE 100 Street Miami Shores, FL 33138 -2603 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Permit Type: Public Works Inspection Ty be: Final Work Classification: Public Works Phone Number Parcel Number 1132050080050 Phone: (305)957 -3857 Building Department Comments Gas line Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-181384. CREATED AS REINSPECTION FOR INSP- 178207. no pe it on site 11/8/12 No permit or plan posted. Sprinkler damaged at boring hol ;x1240 E 100 St. December 14, 2012 For Inspections please call: (305)762 -4949 Page 21 of 41 I Id-) Public Works Permit Application FBC 20,04 gOtO Miami Shores Village Public Works Department 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 (mss Penult Type: Public Works 9MAIZIN Owners Name (Fee Simple Titleholder) J *Ai t 'it" a vi S L' C. Owner's Address 4.73 Zr" /De 44 sr". City 11:44..x, tJAb e Cs Permit No. -/6IF cis) 743 - /1529 Tenantll.essee Name Phone Job Address (where the wok is being dote) JDQ cf>l ZIP 427/ 3e9 City Miami Shores Village County Miami Dark: Is Building HIstuically Designated: YES NO x �..?3/3d' Contractor's Company Name I "Pit ili6rJ a � t' / s Phone t 6,04) V 3- 077V Si 4 54 Y6 D Cotractors Add.. S/O cur 0C•1 �a ti �.-eie% rkp 331'0 9 Architect/Engineers Name (if appaeable) Pion d: S Value or Wok For this Permit f � .11 ©Dd Of Work_ ocra Type of Worts ❑ Addition DAtteralian New ❑ Repah Replace ❑ Demo Describe Wok • s mew „1' /n +°1 c ' ST( o:' ” c it..,h'c w�R'vr t'�. s „Sew..,. e4. a-i d 4/4. *poi moss fdt��y 4rsa w.q,iv� �•/ Submittal Fee $ Notary $ TralafrglEducatton Fee 5 Technology Fee $ Scanning S Radon i Zoning Code Enforcement $ Structwni Plan Review $ .m.....+..,...,... Fees Permit Fee $ // i° CCP $ CO/CC Total Fee Now Due E Bond S (Continued on opposite side) inU Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 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 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 the issuance of a building permit with an estimated value exceeding $2500, the applicant 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 property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site 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 reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: T: p���% MAX CH4MORR0 _* : Commission # DD 930875 "JA`PO Expirec. Cctoner 6, 2013 - 4,ex °.0 Boded Thm Tilly Fein Insurarce MOMS APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: —11" '1 Examiner Structural Review (Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign Print: My Commission Expires lid AI O J Commission # DD 930875 Expires October 6, 2013 F�`+ of Sanded 7luu Troy Feln Insurance BOO-3115.7019 �k sk d: sk H� sk �k �k �k � �+F Zoning Clerk CJP.T!.t1 ;tX 60t1 'POPLES, aySTEry VEcip-% iEC er 61,4 DfrAti:4101i ■I;tAa n>, 0.014 UL TRANS e, Owl§ lopkg RA, .,ivatistr, et Ito kiwi Ai ED CERTIFICATE OF LIABILITY INSURANCE DATE 2 0"2 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(les) 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: PHONE 800- 476 -2211 FAX (A/c. No. ExU: (ac, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED Peoples Gas System TECO Energy, Inc. 702 North Franklin Street Tampa, FL 33601 INSURER B :Associated Electric & Gas Ins. Svcs. XL5129401P Self- Insured Retention $1,000,000 INSURER a :LM Insurance Corporation 33600 INSURER D : $ 1,000,000 INSURER E : $ INSURER F : $ GES CERTIFICATE NUMBER:YL5N7YFU 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD)YYYY) LIMITS B GENERAL UABILITY COMMERCIAL GENERAL LIABILITY XL5129401P Self- Insured Retention $1,000,000 07/01/2012 07/01 /2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ X CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP /OP AGG $ GENII AGGREGATE LIMIT APPLIES PER: 7 POLICY n JET n LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED HIRED SCHEDULED AUTOS AUTOS XL5129401P Self- Insured Retention $250,000 07/01/2012 07/01/2013 COMBINED i t) SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ $ B X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE XL5129401P Self- Insured Retention $1,000,000 07/01/2012 07/01 /2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED RETENTION $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Nei N N /A EWS9318593-01* XL5129401P 07/01/2012 07/01/2013 X ITORYTATU- I RR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C EXCESS WC Excess Workers' Compensation EW5 -64N- 004918 -122 07/01/2012 07/01/2013 Each Accident or Each Employee for Disease $ $ 35,000,000 $ $ $ DESCRIPTION OF OPERATIONS / 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) ELLATION Clty 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, NOTICEWILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .AUTHORIZED REPRESENTATIVE ``` °"'r ‘140‘.1. .fr s "`e ti ACORD 25 (2010/05) Page 1 of 1 @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P/L P/L 60' R/W LEGEND: WATER — NE 100TH ST WATER Seal --- TIE IN SVC TO GAS MAIN WITH T.T. / E.F.Y. R/W — RIGHT OF WAY P/L — PROPERTY LINE C/L — CENTERLINE E.O.P. — EDGE OF PAVEMENT E.O.B. — EDGE OF BUILDING T.T. — TAPPING TEE E.F.V. — EXCESS FLOW VALVE SVC — SERVICE LINE GENERAL NOTES: EXIST. 2" CS 15' W OF C/L 1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18" 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO T -180 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL 5. BASE MATERIAL SHALL HAVE A MIN. LBR OF 100 AND A MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS) PROP. 85' OF 3/4" PLASTIC GAS SVC TO BE DIRECTIONAL BORED — R/W C/L R/W ADDITIONAL NOTES: 0 NE 100TH ST 25 Feet 50 60' R/W EAS1 5 BO ND WESTBOUND D C/L 15' `j ta 0 5 1 WATER PROP 3/4 ", PE BO RE 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES 7. MAINTAIN A MINIMUM HORIZONTAL SEPARATION OF 5' FROM ANY CITY UTILITIES 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" FROM ANY CITY UTILITIES SCALE: 1"= 20' HORIZONTAL 1 "= 5' VERTICAL RESTORATION OF ROAD CUT FOR UTILITY CROSSING FULL LANE SURFACE REPLACEMENT SURFACE SAW CUT ASPHALT (TYPICAL) vb:;,,,,,„....0.4„:„ magmater A AmmrAm...1:11.4■AlLwi. 1.5' REPLACEMENT BASE (NEW MATERIAL) 1.5' DITCH WIDTH (W) 12" VARIES 12" 1 5101 NW 21sf AVE. STE 460 FORT LAUDERDALE, EC41—J FLORIDA 33309 PHONE 954- 453 -0794 G'• FAX 954- 453 -0804 WWW.PEOPLESGAS.COM I END ROAD WORK 50 WORK ) \HEAD / 8 OOUa FOSS OIIFRESE. D LANE ate. \ BE � / �. PREPARED \// TO STOP 7/ DISTANCE BETWEEN SIGNS Speed Spacing (ft.) (mph) A B 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 The ROAD WORK 1 MILE sign may be used as an alternate to the ROAD WORK AHEAD sign. "* 500 beyond the ROAD WORK AHEAD sign or midway between signs whichever is less. "*! BE PREPARED TO STOP sign may be omitted for speeds of 45 MPH or less. SYMBOLS Work Area Sign With it x 18° (Min.) Orange Flag And Type 8 Light • Channelizing Device (See Index No. 600) _) Work Zone Sign IT. Flogger --I.. Automated Flogger Assistance Devices MEAD), With Gate i=J Lane Identification + Direction of Traffic Buffer Spate See Table Device Spacing- Tangent See Table I Device Spacing -Taper See Table / TABLE 1 DEVICE SPACING Speed (mph) Max. Distance Between Devices (ft.) Cones or .Tubular Markers Type I on Type 11 barricades or Vertical barricades Phials or Drums Taper Tangent Taper Tangent 25 to 45 20 50 20 50 50 to 70 20 50 20 100 GENERAL NOTES 1. Work operations shall be confined to one traffic lane. leaving the opposite lane open to traffic. 2. Additional one -way control may be effected by the foHowing means: 1. Flag - carrying vehicle; 2. Official vehicle 3. Pilot vehicles: 4. Traffic signals. When naggers are the sole means of one -way control, the naggers shall be in sight of each other or in direct communication at all times. 3. The ONE -LANE ROAD signs are to be fully covered and the FLOGGER signs either removed or fully covered when no. work Is being performed and the highway is open to two -way traffic. 4. When aside road intersects the highway within the TTC zone, additional 1TC devices shall be placed in accordance with other applicable TC2 Indexes: 5. The two channelizing devices directly in front of the work area and the one channelizing device directly at 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 additional information. refer to Index No. 600. END ROAD WORK 4=. i;a DURATION NOTES 1. ROAD WORK AHEAD and the 8E PREPARED TO STOP signs may be omitted 11 all of the following conditions are met: a. Work operations are 80 minutes or less. b. Speed limit is 45 mph or less. c. No sight obstructions to vehicles approaching the work area for a distance equal to the buffer space. d. Vehicles in the work area have high - intensity, rotating, flashing, oscillating, or strobe lights operating. e. Volume and complexity of the roadway has been considered. BUFFER SPACE Speed (mph) Dist. (ft.) 25 155 30 200 35 250 40 305 45 360 50 425 55 495 570 65 645 70 730 When Suffer Space cannot be attained due to geometric constraints. the greatest attainable length shall be used, but not less than 200 ft. CONDITIONS WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACTNITIES ENCROACH THE AREA BETWEEN THE .CENTERLINE AND A UNE 2' OUTSIDE THE EDGE OF TRAVEL WAY. LAST REVISION 07/01/09 DESCRIPTION: e FDOT DESIGN STANDARDS FY 2012/2013 TWO -LANE, TWO -WAY, WORK WITHIN THE TRAVEL WAY INDEX NO. 603 SHEET NO. 1 60' R/W LEGEND: — - R/W WATER —— NE 100TH ST tom c/L TIE IN SVC TO GAS MAIN WITH T.T. / E.F.V. R/W - RIGHT OF WAY P/L - PROPERTY LINE C/L - CENTERLINE E.O.P. - EDGE OF PAVEMENT E.O.B. - EDGE OF BUILDING T.T. - TAPPING TEE E.F.V. - EXCESS FLOW VALVE SVC - SERVICE LINE GENERAL NOTES: EXIST. 2" CS 15' W OF C/L 1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18" 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO T -180 3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL 5. BASE MATERIAL SHALL HAVE A MIN. LBR OF 100 AND A MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS) PROP. 85' OF 3/4" PLASTIC GAS SVC TO BE DIRECTIONAL BORED ADDITIONAL NOTES: 0 NE 100TH ST 25 Feet 50 60' w EAS1 LANE ND WE STB FUND 5 o, W C/L IZ p Z W 15' .J 0 5 • WA TER ROP 4" PE BO RE 2" C S GAS MA N SAN 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES 7. MAINTAIN A MINIMUM HORIZONTAL SEPARATION OF 5' FROM ANY CITY UTILITIES 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" FROM ANY CITY UTILITIES SCALE: 1"= 20' HORIZONTAL 1 "= 5' VERTICAL RESTORATION OF ROAD CUT FOR UTILITY CROSSING FULL LANE SURFACE REPLACEMENT SURFACE SAW CUT ASPHALT (TYPICAL) T•1 I(��7i•T • /((.�7�;•�({�7�;�7f�� �i� %•��L.�7i'_�I`li•�({,� ?il iwn REPLACEMENT BASE (NEW MATERIAL) 1.5' DITCH WIDTH (W) 1.5' 12" r7 VARIES 12" I 5101 NW 21st AVE. STE 460 FORT LAUDERDALE, 9ALE PHONE 954- 453 -0794 ° FAX 954- 453 -0804 WWW.PEOPLESGAS.COM WORK AHEAD/ ENO ROAD WORK 4] f Buffer Space See Table 50 • ) ,,,,, ONE LAE ' fU1EAp \y/ DISTANCE BETWEEN SIGNS Speed Spec ng (ft.) (mph) - A a C D 40 or less 200 200 200 100 45 350 350 350 175 50. 500 500 500 250 55 or greater 2640 1640 1000 500 w The. ROAD WORK 1 MILE sign may be used as an alternate to the ROAD WORK AHEAD sign. ° 500 beyond the ROAD WORK AHEAD sign or midway between signs whichever is 1e55. �*+ BE PREPARED TO STOP sign may be omitted for speeds of 45 MPH or less. SYMBOLS Work Area 9^� - Sign With /8" x t8° (Min.) Orange Flag And Type 8 Light • Channelizing Device (See Index No. 600) Work Zone Sign ET. Flagger Automated Flagger Assistance Devices WAD), . With Gate ■'j Lane Identification + Direction of Traffic PREPARED \TO STOP uy` Device Spacing- Tangent See Table 1 Device Spacing -Taper See Table I 500 SPEEDING PINES DOUBLED WEN aORKERS PRESENT sy TABLE I DEVICE SPACING Speed (mph) Max. Distance Between Devices (ft.) Cones or Tubular Markers Type 1 or Type N Barricades or Vertical Panels or Drums Taper Tangent Taper Tangent 25 to 45 20 50 20 50 50 to 70 20 50 20 100 GENERAL NOTES 1. Work operations shall be confined to one traffic tare. leaving the opposite lane open to traffic. 2. Additional one -way control may be effected by the following oceans: 1. Flag-carrying vehicle; 2. Official vehicle; 3. Pilot vehicles; 4. Traffic signals. When flaggers are the sole means of one -way control, the flaggers shall be in sight of each other or in direct communication at all 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 ITC devices shall be placed in accordance with other applicable TCZ Indexes. 5. The two channelizing devices directly in front -of the work area and the one channelizing device directly at the end of the work area nun be omitted provided vehicles in the work area have high - intensity rotating, . flashing, oscillating, or strobe lights operating. 6. For general TCZ requirements and additional information. refer to Index No. 600. END ROAD WORK DURATION NOTES 1. ROAD WORK AHEAD and the BE PREPARED TO STOP signs may be omitted if all of the following conditions are met 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 a distance equal to the buffer space. d. Vehicles In the work area have high - intensity. rotating, flashing, oscillating, or strobe lights operating. e. Volume and complexity of the roadway has been considered. BUFFER SPACE Speed (mph) Dist. (ft.) 25 155 30 35 250 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 greatest attainable length shall be used, but not less than 200 ft. CONDITIONS WHERE ANY VEHICLE, EQUIPMENT, WORKERS OR THEIR ACT1V1T155 ENCROACH THE AREA BETWEEN THE CENTERLINE AND A LINE Z OUTSIDE THE EDGE OF TRAVEL WAY. LAST REVISION 07/01/09 DESCRIPTION: FDOT DESIGN STANDARDS FY 2012/2013 TWO -LANE, TWO -WAY, WORK WITHIN THE TRAVEL WAY INDEX NO. 603 SHEET NO. 1