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PW-13-1427 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-198783 Permit Number: PW-6-13-1427 Scheduled Inspection Date: September 17,2013 Permit Type: Public Works Inspector: Diaz,Osvaldo Inspection Type: Final Owner: KAWACHIKA,JON&CYNTHIA Work Classification. Public Works Job Address: 179 NE 94 Street Miami Shores, FL 33138- Phone Number (305)758-0927 Parcel Number 1132060132930 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments PUBLIC WORKS FOR GAS LINE IN RIGTH OF WAY Infractio Passed Comments INSPECTOR COMMENTS False �--� Inspector Comments Passed o / CREATED AS REINSPECTION FOR INSP-194162. cancelled by home owner Failed Correction _ I Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 17,2013 For Inspections please call: (305)762-4949 Page 22 of 39 r JUN 9 4 201.3 iami Shores Villa ubtic Works Department. 10050 N.E.2nd Avenue,Miami Shores,F16rida 33138 Ted(305)785.2204 Fax:(305)756.8972 � , Public works Penmk�c�-�`� i ��-- Permit Application FBC 2004 pemrR Type: Pubic works' /Qr/�>J o e It/ y,y Ownwe Name(Fee Simple TiNafiolder)�!J t�i^ /K c(w yys,r G Q. Rhnne# �5� 6 ownees Address CtiY /"t�s.v►e 5�.�s State /"L ZIP Tenanf/Lessae Name Phone z: Job Address(where the work Is being dome) Mr "ve e 4- city &Alarm shores Masse county Miaod Dade / zip is BWkft Historically Designated: YES No ContracWs Company Name 22�'O A r��.t 6Q--y Phane* ) �/ .?—(/�Q S/ Cont..W.Address .�/D/ .�/�✓��' s� 04.'.e sF'.4 AGO CRY Grp .�t...a/�.e1 a/�. Sm. XAC zip i.?330 ArcittecftEingineefs Nam(d applicable) Phi IV $Value.Of Work For We Pmmit /OG7[)a•� Footage Of vvork: Type of Work: 0 Aditw QAt n � New FIRepairlRoplepe 0 Demolillion Describe Work: SubmKW Fee$ '57 L r Permit Fee i CCF$ CO= tau"$ Trat Fee$ Technology Fee$ Scanning i Radon$ zoning Bunt$ Cede Entanwmeat$ Shuetrand Plan RwAaw$ Total Fee Now pug$ � (Continued on opposite side) Bonding Company's Name(if applicable) Bonding Cc,wpanys Address N/A City �_. State Zip . Mortgage Lenders Name(if applicable) NIA. Mortgage Lender's Address City State Zip. Application is hereby made to obtain a pemrit to do the work and installations as indicated.l oerfify that no work or installation has oommenc�d prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulafarg 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:1 certify that all the foregoing information is accurate and that all work will be done In comptiance.wkh at[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 Notice to AppNcani:As a condition to fMs issuance of a Pn4ft Works permit with an aslinuded value exceadmg 52500,the appocant must promise in goad fain;Ural a copy of the notice of ant and construction ban taw brochure wNbe delivered to do person whose property is subject to affachoerrt Alsrx a certified copy of Me racomW notice of commexcernent must be posted at the Job sQe for the W inspection which occurs seven M days after the bufidkrg perrrdt is issued In Ure absence of such posted notice,the hupachm wX not be approved and a reinspection fee wX be charged r/ Signature nature Owner or Agent The foregoing Instrumend was acknowledged before me this The f Instrument was aftowledged before me clay of./)74,V_20_31 by day of 20 L3 by W r who is personally known b me or who has produced Who Is personalty know tome or has produced =. as Identification and Who.did take an oath. as motion and who did take an oath. NOTARY PtIBLiC: NO Y PUBLIC Sign: . Sign: print; print: A aG MAX C owzo My Commission Expires: wry Commission _: Commission#DD 9=75 Expires O toter 6,2013 f f=TloyFzbfi 58010 APPLICATION APPROVED BY: Public Works Director or his designee. 11117=05 A� CERTIFICATE OF LIABILITY INSURANCE DA 6TE 12920112m 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 ALTERTHE 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 - O - - MCGRIFF,SEIBELS$WILLIAMS,INC. NAME. P.O.Box 10265 A/c No Ext:800-476-2211 FA C No): Birmingham,AL 35202 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A Zurich American Insurance Company 16535 INSURED INSURER B Associated Electric 8r Gas Ins.Svcs. Peoples Gas System TECO Energy,Inc. INSURERC:LM Insurance.Corporation 33600 702 North Franklin Street Tampa,FL 33601 INSURER D: - INSURER E INSURER F: I COVERAGES 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR R WVD POLICY NUMBER M/DD MM/DD B GENERAL LIABILITY XL5129401P 07/01/2012 07/01/2013 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention COMMERCIAL GENERAL LIABILITY $1,000,000 PREMISES Ea occurrence $ X CLAIMS-MADE F—I OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JEC- LOC $ B AUTOMOBILE LIABILITY XL5129401P- 07/0112012 07/01/2013 COMBINED SINGLE LIMIT -1,000,000 Self-insured Retention Ea accident X ANY AUTO $250,000 BODILY INJURY(Per person) $ - - ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS- AUTOS $ _ NON-OWNED... PROPERTY DAMAGE- - - HIREDAUTOS AUTOS - B UMBRELLA LIAB XL5129401P 07/01/2012 . 07/0112013 EACH OCCURRENCE $ 1,000,000 OCCUR Self-Insured Retention X EXCESSUA13 X CLAIMS-MADE $1,000,000 AGGREGATE "$ - 1,000,000 DED RETENTION$ $ A WORKERS COMPENSATION EWS9318593-01* - 07/01/2012,. 07/01/2013. X TORY IM TS O B AND EMPLOYERS'LIABILITY YIN XL5129401 P R 1,000,000 ANY PROPRiETORIPARTNER/EXECUTIVE F-1 A-N/ E.L.EACH ACCIDENT -. $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $ 1,000,000 If yea,describe under 1,000,000 .DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C EXCESS WC EW5-64N-004918-122 07/01/2012 07/01/2013 Each Accident or Each Excess Workers'Compensation 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$35,000,000(insured by Liberty Insurance Corporation) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE.EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Miami Shores AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave 1 Miami Shores,FL 33138 {""r O r 4 Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD a BE� e O �� PREPARED;q % ' ROAD l LANE"'- SPEEDING FINS fj!( \� ROAD 0+910 E un AHEAD_ �. `'•AHEAD PRESSNI END I �,' '•:, x. ROAQ'WORk.. �1 Buffer Space D See Table 50 250 C 8 A Work Area N1 4� A B C END RDAD� D Device Spaclrtg-Tangent 500 n WORK '�'� - See Table 1 ROAD WORK a 1 _ _ Device Spacing-Taper AHEA DSee Table I ORE IAN ROAD i ess AHEAD/ it�pREp�AREp Y\ p DISTANCE BETWEEN SIGNS TABLE I DEVICE SPACING BUFFER SPACE Speed Spacing(ft.) - Max.Distance Between Devices(ft.) Speed (mph) A I B I C I D Type I or Type 11 (mph) (ft.) 40 or less 200 200 200 100 Speed Cones or Barricades or Vertical 25 )$a 45 350 350 350 175 lmph) Tubular Markers Panels or Drums 30 200 50 500 500 500 250 Taper Tangent Taper Tangent 35 - 750 55 or greater 2640 1640 1000 500 25 to 45 20 50 20 SD - 410 305 e The ROAD WORK 1 Nuz sign may be used as 50 to 70 20 50. 20 100 -45 360 an alternate to the ROAD WORK AHEAD sign. yg. 425 500 beyond the ROAD WORK AHEAD sign or GENERAL NOTES- DURATION. NOTES 55 495 midway between signs whichever Is less. 60 570 I.Work operations snarl be confined to one[raffle lane,leaving the opposite lane I.ROAD WORK AHEAD-and the 8E PREPARED TO STOP signs may BE PREPARED TO STOP sign may be omitted open to traffic be omitted If all of the following conditions are met: 65 645 3 BE speeds of 45 MPH or less a.Work operations are 6a minutes or less. 70 730 y 2.Additional one-way control may be effected by the following means: b.Speed limit Is 45 mph or less: 1.Flag-carryMg vehicle; c.No sight obstructions to vehicles approaching the work area When Bliffer Space cannot 2.Official vehicle; - for a distance equal to the buffer space.. be attained due to geometric 3.Pilot vehicles; d.Vehicles In the work area have high-intensity,rotating, -constraints,the greatest. 4.Traffic signals: flashing,oscillating,or Strobe lights operating. attainable length shall be E SYMBOLS e.Volume and complexity of the roadway has been considered. used,but not les's than 200 ft. Y9 When flaggers are the sole means of one-way control.the flaggers shall be in .Work,Area 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 Sign.With 18°x IE' (Min.) removed or fully covered when no work Is being performed and the highway Is f Orange Flag And Type B Light open to two-way traffic. CONDITIONS ■ Channelizing Device(See Index No.600) 4.when a side road intersects the highway within the TTC zone,additional TTC E - devices.shall be placed in accordance with other applicable TCZ Indexes. WHERE ANY VEHICLE,EQUIPMENT, [p Work zone sign - wORKERs QR rurtx ACTIVITIES S.The two channellzing devices directly in front of the work area and the one - ENCROACH THE AREA BETWEEN [r' Flogger channeilzing device directly at the end of the work area may be omitted provided - THE CENTERUNE AND A LINE 2' Automated Fiagger Assistance Devices vehicles In the work area have high-Intensity.rotating,;flashing,oscillating,or OIR'S108 THE EDGE OF TRAVEL WAY. (AFADi,With Gate strobe lights operating. ab Lane.Identification+Direction of Traffic 6.For general TCZ requirements and additional information,refer to Index No.600. .LAST 2 DESCRIPTION: INDEX SHEET ~ REVISION �, FOOT.DESIGN STANDARDS TWO-LANE, TWO-WAY, NO. NO. 0101109 FY 201212013 WORK WITHIN THE TRAVEL WAY 603 1 it 242013 0 25 ae c v#" a sr-'` �' Z Feet Is, !n �,• . " �a`= *� a r `. kN + PROP. 103' OF 3/4" PLASTIC GAS SVC TO BE DIRECTIONAL BORED J, r 4 'y 4 6 m � s C NE 94TH S 1 R W . 4 OU. D �W WE OU40 cr _ . ; CAL S4' to f � R W � r { C L Yll s r e ? ' t .,.,. Aft 3 4" PE BORE bb11 WD*4 d t w 6" P GAS M&IN TIE IN SVC TO.CAS MAIN EXIST. 6 PE A94M OS-18-2013 WITH T.T. / E.F.V. 26' S OF CA SCALE: 1" '20' HORIZONTAL 1"= 5' VERTICAL - RESTORATION OF ROAD CUT RfY/S/ONE LEGEND. FOR UTILITY CROSSING ciaL ue� �` R/W RIGHT OF .WAY MERA� NOTES: AownoNA�. NoTESr susvac� aEau►ce rr ?.• SUfW'AM SA*CWT ASPHALT PA PROPERTY LINE ("P=L) .Z• 1 REPLACE BASE. MATERIAL OVER DITCH SHALE BE TWICLV THE 6. CONTRACTOR SHALL: SOFT DIG TO VERIFY 'LOCATION C L - CENTERUNE THiCICNESS OF THE BASE, SCALE.' / MIN. 8" AND MAX. 18' AF EXISTING UTILITIES 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) 7. MAINTAIN'A MINIMUM HORIZANTAL SEPARATION OF 2T "_ ' E.O.P. EDGE OF PAVEMENT 1 50 LAYER'AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF 5' FROM ANY CITY UTILITIES (Kw MAnUL) ice. M+ t v E.O.B. — EDGE. OF BUILDING MAX. DENSITY PER AASHTO T-180 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18° T.T. TAPPING TE.E 3• ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED OF ANY CITY UTILITIES Aix 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE 1 �F 1 E.F.V. — EXCESS FLOW VALVE MATERIAL 5. BASE MATERIAL SHALL HAVE A MIN. LBR Of 100 AND A MIN. CARBONATE SVC — SERVICE LINE CONTENT OF 70% (BOX FOR LOCAL STREETS) VAs