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PW-12-2237 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-183087 Permit Number: PW-11-12-2237 Scheduled Inspection Date: March 18,2013 Permit Type: Public Works Inspector: Hernandez, Rafael Inspection Type: Final Owner: MICHELLE CANERO, PENN DAVIS Work Classification: Public Works Job Address:384 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132060136140 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments INSTALL 12T OF 3/4" PLASTIC NATURAL GAS SERVICE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed El CREATED AS REINSPECTION FOR INSP-182040. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 15,2013 For Inspections please call: (305)762-4949 page 12 of 64 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-197253 Permit Number: PW-11-12-2237 Scheduled Inspection Date:August 14,2013 Permit Type: Public Works Inspector: Diaz,Osvaldo Inspection Type: Final Owner: MICHELLE CANERO, PENN DAVIS Work Classification: Public Works Job Address:384 NE 94 Street Miami Shores, FL Phone Number Parcel Number 1132060136140 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments INSTALL 127'OF 3/4" PLASTIC NATURAL GAS SERVICE Infractlo Passed Comments INSPECTOR COMMENTS False Extended for 60 days. NB Inspector Comments Passed J� Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 13,2013 For Inspections please call: (305)762-4949 Page 34 of 36 N- 11,�2-,222307 � UC pellit'? ��� t TM 4 14GV 2 7 2012; , Il Ry:. _-,--oemoaAOOs Miami.. Shores Village Pudic Works Department. 1M50 N.E.2nd Avenue,Miami Shores.FWWa 33138 Tel_(305)795.2204 Fax:(305)756.8972 Public Worsts Permit Application FBC 2004 Permit Type: Pa6Ts Works n 9 .r1 Owners Name(Fels S.-*T �iG f/1 rA � /./4y/o s Fhom t .iQJ/ Mine.Add.. 38V -V4r 9'y`'� S� City Aae4--- J, zip 3.sI.3e� T Name Fivxte f Job fie wask Is bft dww, 3Ay .dG' py sy Ow Cowdy Kwal Daft zip Is YES ,4o, X co lic—yam 7210 � r+a Pier S�S� �/S3 d7 f s!6 coraracWsA �7vi y� .>T.� { S4 sibs city �..ad1,� stars 1004 OR of > .d �..►t...d.. mane s� '! 3-,�7'9 S� i vakre of VYork For tfis Perms �J�p °^� Lb"w Footage ok vvaw- . Type of Work ❑AdMan Q num3um New ❑ °esoibeVVork i.o�.�, 127( e �f� y 04 c�✓G Am�ew. � 4 c�.o.. ,.�........�.....Fen.a. submittal Fee i PermH Fee i f S y CCF$ GO= Notary i TrainIngMducadon Fee t Tecturobgy Fee i Swarming$ Radon$ Zoning Bonds Code Enforearm a S Sbruedvai Plan Review Z Total Fee Now[bee i. l b (Continued an oppasita side) a Bonding CompWs Name(d applicable) Bonding Cc,.+parys Address. WA City State zip mortgage Landees;Name(d apptis ) N/A Mortgage Lenders Address City State zip Application is hereby made to Main a permit to do the work and Installations as intIlicated.1 cer6Ty Brit no wodc 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 rem awtshuction 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 afE the foregoing inforriation is accurate and that all wwk will be done in compliance with all appftable laws regutafmg construction and zooing: °WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF MAY RESULT IN YOUR PAYNG TvfiCE FOR NPROVEMENTS TO YOUR PROPERTY.IF YOU INTEND TO osuiN FfNANmG,CONSULT WITH YOUR LEmDER OR AN ATTORNEY BEFORE RECORD=YOUR NOTICE OF COMMENCEIIM T.° Abbbe to Applicant As a cordon to fins issuance of Pubft Waft permit wM an estimated value excee&V$2500,go applicaMrust PW Wse irm good faith Not a aW at 0se notice oftwnmervement and construction ban low brocfum w9 he doted to do person whoee properlyis subs to amoral.Afro;a eerldod copy of the recorded rofice ofca mmerrcmrw+d rmrstbe posted at Mew srft fordo fast btspection wtdch occurs sam m days after go bukft permit Is issued In On absence of sucb posted mdse,pre wapectien wN not be approved and a reftapection fee wX be dtarged Signature Signature � Orr or Agent Cordractor The foregoing Instrument was acknowledged before"'M V s The fad�e))ofng hafrt was before me ft�/ ✓ day of 20_,by day of/� e _,by � � . (/ who is personafiy known to rme.or who has produced Who is personally know to me or has produced as idermffication and who did take an oaM, as kleriffication and who(RU faire an oaft NOTARY PUBLIC. M)CAVV Sign: Sk,]n: Print Prink ® J� My Commission Expires: MY Cornet' MAX CHAMOM CWMdWolt#DD 930875 EWM Oftff 6,2D13 ftvm In win APPLICATION APPROVED BY: Public Works Dfrector or I his designee. P� 11!1712005 I V , CTQB Camfruntion Trades Ward BUSINESS CERTIFICATE OF Cc?'q?rT gti-''r E1608 PEOPLES GAS SYSTEM D.e.h.. VEGA JESUS is orvied under the pmvWons of Chapter 10 QllALIFY1i\i€_,T!-,ADE(Si 0014 FUEL TRANS g r)I CRl 8ea0tNetnry OYN,e BOard �.^-S ; .. .. vAva,eum+t**.gogiiarHGiW; I I ' II CERTIFICATE OF LIABILITY INSURANCE DATE 011=01"M Y' o�29izo12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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 NAME: MCGRIFF,SEIBELS&WILLIAMS,INC. PHONE 800-476 2211 (FAA A,Box 10265 C No A/C No: Birmingham,AL 35202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A Zurich American Insurance Company 16535 INSURED INSURER B:Associated Electric&Gas Ins.Svcs. Peoples Gas System TECO Energy,Inc. INSURER C:LM Insurance Co ration 33600 702 North Franklin Street Tampa,FL 33601 INSURER D: INSURER E.• - WSURERF: 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE Im WVD POLICY NUMBER M/DD MMD LIMITS B GENERALUABIUTY XL5129401P 07/01/2012 0710112013 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention DAMAGE TO RENTEff- COMMERCIAL GENERAL LIABILITY $1,000,000 PREMISES Me occurrence $ X CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 110001000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ B AUTOMOBILE UABIUTY XL5129401 P 07/01/2012 07/0112013 COMBINED SINGLE LIMIT Self-Insured Retention Ea accident 1,000,000 X ANY AUTO $250,000 BODILY INJURY(Per person) $ � OOSWNED SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acddent B UMBRELLA LIAR OCCUR X 129401 P 07/0112012 07/01/2013 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention X EXCESS UAS. X CLAIMS-MADE $1,000,000 AGGREGATE $ 11000,000 r.DED RETENTION$ $ A WORKERS COMPENSATION EWS9318593-01• 07/01/2012 07101/2013 X WC su s OTH-. B AND EMPLOYERS'LIABILITY YIN XL5129401 P ANY PROPRIETORJPARTNER/EXECUTNE- E-1.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,OOQ If yea describe under 1,000,000 DESCRIPTION OF OPERATION$below E.L.DISEASE-.POLICY LIMIT $ C EXCESS WC EW5 64N-00491&122 07/0'U2012 07/0112013 Each Accident or Each Excess Workers'Compensation Employee for Disease $ 35,000,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H 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 OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF;NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City.cf Miami Shores AUTHORIZED REPRESENTATIVE.. 10050 NE 2nd Ave ? Miami Shores,FL 33138 - t Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD TIE IN SVC TO GAS MAIN EXIST. 6" PE N WITH T T / E.F.V. 29' S OF CA W R/W CA R/W 0 25 SO g O N In w tr . .=i NE 94TH ST r, �R/W x 400 A AVER ' —__----WATER _ WATER sera------------CA 0' TU D s 70' SA ----r—— , .'te '. . W� �•f V � ;� .-- -=---- R/W eJ a : _ ' ♦ $ . a k ', S/ � .� S ' +Q PR P. 3/ " E R 1' € — � t a 7a z > W 'TE J ' r e JIM IIA r: ITI E N SCALE: 1 p= 20' HORIZONTAL W 1 $ VERTICAL . a D m . - PROP. 12T OF 3/4" PLASTIC a GAS SVC TO BE DIRECTIONAL 0.4TE.• BORED 11-09-2012 kw*r• 603 RESTORATION OF ROAD CUT LEGEND: FOR UTILITY CROSSING REi9S/ONS.• R/W — RIGHT OF WAY GENERAL NOTES: ADDITIONAL NOTES: ?.• Sa�Ace FULL LAW SAW CUT ASPHALT P/L — PROPERTY UNE. S 1._REPLACED .BASE .MATERIAL OVER DITCH SHALL BE..TWICE THE 6. CONTRACTOR SHALL SOFT" DIG TO VERIFY LOCATION. C/L - CENTERLINE THICKN ESS OF THE BASE, MIN. 8" AND MAX. I8" OF EXISTING UTILITIES 2T SCALE.• 2. BASE MATERIAL"SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) 7. MAINTAIN A MINIMUM HORIZONTAL SEPARATION OF 1 go= SO' E.O.P. — EDGE OF PAVEMENT LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF S' FROM ANY CITY UTILITIES qtr (NEW wTaVAL) t.s' turat ttlm (r) t.s' E.O.B.. - EDGE OF BUILDING MAX. DENSITY PER AASHTO T-180 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" T.T. - TAPPING TEE-3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED FROM ANY CITY UTILITIES 4. SURFACE MATERIAL.SHALL BE CONSISTENT WITH SURROUNDING SURFACE E.F.V. — EXCESS FLOW VALVE MATERIAL. 1 OF 1 5. BASE MATERIAL SHALL HAVE A MIN. LBR OF 100 AND A MIN. CARBONATE SVC — SERVICE UNE CONTENT OF 70% (60% FOR LOCAL STREETS) 12" V'� 12" � ROAD WORK AHEAp 200' 200 400 CONDITIONS J l J- l •./ l / l WHERE ANY VEHICLE,EQUIPMENT,WORKERS OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE [] • •••• ■ - TRAFFIC LANE,FOR WORK AREAS LESS THAN `� + ■- • Work MeA • 200 DOWNSTREAM.FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. 400' 200 Less Than �y 200 Y ROAD ( WORK ROAD AHEAD / j WORK i �\\ AHEAD 200 400 J J CONDITIONS WHERE ANY VEHICLE,EQUIPMENT,WORKERS OR THEIR ACTIVITIES-ENCROACH ON THE PAVEMENT REQUIRING.THE CLOSURE OF ONE `y' • • ■ ■ Work Area Q b TRAFFIC LANE,FOR WORK AREAS 200 OR MORE DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. 400 � 50 200' - 200 q More Than /ROAD WORK AHEAD / DURATION NOTES 9 SYMBOLS GENERAL NOTES p ® Work Area 1.Work operations shall be confined to am travel lane,leaving S.rho FL40GER legebd sign may be substituted for the symbol sign. 1.ROAD WORK AHEAD sign may omitted if all of the following the opposing travel Jane open to traffic. conditions are met: Sign With 18'x Is'(Min.) 6.The maximum spacing between devices shall be no greater than 25.' Orange Flag And Type 8 Light- 2.When vehicles in a parking zone block the line of sight to rCZ a.Work operations are 60 minutes or.less. signs or when TCZ signs encroach on a normal pedestrian 7.For general TCZ requirements and additional information,refer to b.Speed Is 45 mph or less. ■ Channelizing Device(See Index No.600) walkway,the signs shall be Pont mounted and located In Index No.600. c.No sight obstructions to vehicles approaching the work area for accordance with Index Not 17302. - a distance of 600 feet. D Work Zone.Sign - S.The two channOlzing devices directly in front and directly at the d.Vehicles in the work area have high-intensity,rotating, �. 3.If work area Is confined.to an outside auxiliary lane,the work end of the work area may be omitted provided vehicles in the work fleshing,oscillating,or strobe lights operating. Flagger area shalt be barricaded.and the FLAGGER signs replaced by area have high-intensity rotating,flashing,oscillating,or strobe e.Volume and complexity of the rotdway has been considered. ROAD WORK AHEAD signs.Flaggers are not required. lights operating. ' CJ Lane Identification+Direction of Traffic 4.Flaggers shall be in sight.of each other ar in direct communication at aft times.+ LAST x-t>FSCnrPrtoH: - FDOT DESIGN STANDARDS INDEX SHEET REDfsroN N TWO-LANE, TWO-WAY, WORK NEAR IINTERSEmoN NO. NO. �ioliog FY 201212013 605 1