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PW-13-1924Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-197880 Permit Number: PW -8-13-1924 Scheduled Inspection Date: October 31, 2014 Inspector: Rodriguez, Jorge Owner: CURZON, ANDREW Job Address: 10050 NE 12 Avenue Miami Shores, FL Project: <NONE> Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number Parcel Number 1132050190370 Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments NATURAL GAS LINE INSPECTOR COMMENTS False October 30, 2014 For Inspections please call: (305)762-4949 Page 2 of 24 Inspector Comments Passed tw_ Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 30, 2014 For Inspections please call: (305)762-4949 Page 2 of 24 V Miami Shores Village - 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 PannitType: PublicWorks perrolt NO. ownePs Name (Fite Simple Titleholder) Pphone S ��� y�� " 749800 Owners Address /�C�SD �G e2 s"` Ai . city �'i, 6 .,,_ : JLa..e s state �'C zip 3313 Tenant/Lessee Name Pltona r Jab Adder (whefe ft work is being date) /Od SO .tlE /2 At Ae� City Miami Shores Wage County Munni Dade zip J3/,300 -- Is Building Historkcaltp Designated: YES NO Contr ccs Company Name CoMracWs Address a7 /d / WW .�� T / V d. city 04e 4..Loif' .14 Architect/Engineer's Name (d applicable) S Value of Work For this Panni; Type or Work: Describe Work Submiffal Fee $ Notary $ Scanning $ Code Etrfomement S Total Fee Now Due $ (Continued an opposite side) State zip__�3a?'D� Lmeal Footage Of Work: ❑ Addition D AWration IC New ❑ Rq-i Meplace ❑ D..M. ♦ r / ,,t a Ytr, is r=r- K - e - Q_ ��G.•�v� �wr /A'G C .i►.r. " *ev c .......„,.....,„„ Fees "....'..'.."...," Peradt Fee $F $ TrAninglEdueatlon Fee $ Radon $ Toning St nlctural Plan Review $ CbtCC Technology Fee $ Bond $ Bonding Company's Name (if applicable) Bonding Cc,-apany's Address N/A City State Mortgage Lenders Name (if applicable) Mortgage Lenders Address City State N/A 0 zip Application is hereby made to obtain a permit to do the work and installations as indicated. l eertity 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 .... OWNEWS 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 this issuance of a Public Works permit with an estimated value exceeding $2500, the applicant must prorise in good fa#& that a copy of the notice of cornmermement and construction lien law broc hum wX be delivered to the perzon whose property is subject to attachment Alsoa certified copy of the recorded notice of commencement rust be posted at the job site for the first inspection whhxm occurs seven (7) days after the building permit is issued. In the absence of such posted notim, Bre inspection wN rot be approved and a reinspection fee will be charged. Signature Owner or Agent Signature °1 Contractor The foregoing instrument was acknowledged before me oft The foregoing instrument was adamowledged before me this— day of , 20_, by da;,4?. 2©1 � < Y =Q who is personally known to me or who has produced ow me or has produced_ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPLICATION APPROVED BY: 11/1712005 v —� Public Works Director or his designee_ CTQB Construction Trades Board BUSINESS CERTIFICATE OF COMPETr-NCY El 608 PEOPLES GAS SYSTEWN" r 1 ID.B.A.. VEGAJESUS Is artifled under the i*lw4 of Chapter 10 of Misr -m -Dace QUALIFYING TRADE(S" 0014 FUEL TRANS & DISTRI MIAM6 Gterles (7an5er P, E. � �•(/A Secrebry of the 0oard 1 ' � i• ' 1 wwa.mieMiWde.gov/buildinu. IIIIIII] A`OR" CERTIFICATE OF LIABILITY INSURANCE DA n CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 6/21/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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 (leu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 CO PHONE A/CNtY Ext): 800 478 2211 FAX No E-MAIL ADDRESS: Birmingham, AL 35202 INSURERS AFFORDING COVERAGE NAIC d 07/01/2013 INSURER A Zurich American Insurance Company 16535 EACH OCCURRENCE $ 1,000,000 INSURED Peoples Gas System INSURER B :Associated Electric & Gas Ins. Svcs. INSURER C :LM Insurance Corporation 33600 TECO Energy, Inc. 702 North Franklin Street $1,000,000 Tampa, FL 33602 INSURER D INSURER E: X CLAIMS -MADE F—I OCCUR INSURER F : COVERAGES CERTIFICATE NUMBER:N6LH82KL 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 CONTRACTOR 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 O AUTHORIZED REPRESENTATIVE POLICY NUMBER POLICY EFF M/DD POLICY EXP MM/DD LIMITS B GENERAL LIABILITY XL5129402P Self -Insured Retention 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ X COMMERCIAL GENERAL LIABILITY $1,000,000 X CLAIMS -MADE F—I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GEN'- AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY E LOC $ B AUTOMOBILE LIABILITY XL5129402P Self -Insured Retention 07/01/2013 07/01/2014 COMBINED SINGLE LIMIT 1,000,000 Ea accident BODILY INJURY (Per person) $ X ANY AUTO $250,000 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PerecddeM NON -OWNED HIRED AUTOS AUTOS $ B UMBRELLA LIAB OCCUR XL5129402P 07101/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X EXCESS LIAR Hx CLAIMS -MADE DED RETENTION$ $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A Excess Workers' Compensation: EWS9318597-02 (Statutory Limit isER excess of $35,000,000 Insured by LM Insurance Corporation) Employer's Liability: XL5129402P 07/01/2013 07101/2014 X WC SL TU OT E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Excess Workers' Compensation EW5-64N-004918-123 07/01/2013 07/01/2014 Each Accident or Each 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. CERTIFICATE HOLDER CANCELLATION 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 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 Miami Shores, FL 33138 d •�' 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 ago2M7 -�- Q0° I CONDITIONS I J \ l \ . / \ / WHERE ANT VEHICLE, EgHPMEMr, WORKERS 4� OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE • • • • •■ Work Are • b TRAFFIC LANE, FOR WORK AREAS LESS THAN 200 DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. 400 200 Less Than aorr ROAD WORK �� � ROAD AHEAD WORK AHEAD 200 400 CONDITIONS WHERE ANT VEHICLE, EQUIPMENT, WORKERS <' a OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE `� ■ • • • i i b TRAFFIC LANE, FOR WORK AREAS 200 OR Work Area MORE DOWNSTREAM FROM AN INTERSECTION 000 FOR A PERIOD OF MORE THAN 60 MINUTES. More Than DURATION NOTES LAST 2 DESCRIPTION: IVOEX SHEET REVISION ° IAWW&IFDOT DESIGN STANDARDS TWO-LANE, TWO-WAY, WORK NEAR INTERSECTION NOE ND' 107101109101FY 2012/2013 1605 1 SYMBOLS GENERAL NOTES ® Work Area 1. Work operations shall be confined to one travel lane, leaving S. The FLAGGER legend sign may be substituted for the symbol sign. 1. ROAD WORK AHEAD sign may be omitted if, all of the following the opposing travel lane open to traffic. conditions are met: Sign With 18' x 18' (HI") 6. The maximum spacing between devices shell be no greater than 25.' Orange Flag And Type B Light 2. When vehicles in a parking zone Mock the line of sigh to TCZ a. Work operations are 60 minutes or less. signs or when TCZ signs encroach on a normal pedestrian 7. For general TCZ requirements am! additional Information, refer to b. Speed is 45 mph or less. ■ Channelizing Device (See Index No. 600) walkway, the signs shall be post mounted and located In Index No. 600. c. No sight obstructions to vehicles approaching the work area for accordance with Index No. 17302. a distance of 600 feet. [ft Work Zone Sign 8. The two channelizing 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 flashing, oscillating, or strobe lights operating. Flogger area shall be barricaded and the FLAGGER signs replaced by area have high-intensity rotating, flashing, oscillating, or strobe e. Volume and complexity of the roadway has been considered. ROAD WORK AHEAD signs. Flaggers are not required. lights operating. Lane Identification + Direction of Traffic 4, Fiaggers shall be In sigh of each other or in direct communication at all times. LAST 2 DESCRIPTION: IVOEX SHEET REVISION ° IAWW&IFDOT DESIGN STANDARDS TWO-LANE, TWO-WAY, WORK NEAR INTERSECTION NOE ND' 107101109101FY 2012/2013 1605 1 loo, R/W LEGEND: P/L 10050 / P/L WATER NE 100TH ST _ 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 EXIST. 2" CS 15' S OF C/L WATER WATER R/W C/L GENERAL NOTES: 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) WATER / TIE IN SVC TO GAS MAIN WITH T.T. / E.F.V. PROP. 135' OF 3/4" PLASTIC GAS SVC TO BE DIRECTIONAL BORED I T iJL w._ Vami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT $•Z}j'7 SUBJECT 10 CC;NIPI.IPNCE WI rH ALL FEDERAL STATE ANL, Cc -UN I ( fiLLLS A`ID REGULATIONS NE 100TH ST SCALE: I"= 20' HORIZONTAL 1"= 5' VERTICAL 12' 0 25 50 Feet RESTORATION OF ROAD CUT H V1 O FOR UTILITY CROSSING - CL t0 /W L P L AME P&L A1E Q M < ADDITIONAL NOTES: SINKAGE EMf yr Clff AS�IIIILT �) ' ^ (J , 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION T M W 7 OF EXISTING UTILITIES 7. MAINTAIN A MINIMUM HORIZONTAL SEPARATION OF 2T rnov REIML 5' FROM ANY CITY UTILITIES (NEWnrqN, <� w olral rlmN (✓) Is• O y 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" < FROM ANY CITY UTILITIES J Q Of H � 12' 0 25 50 Feet U W H V1 O C CL t0 /W O Q M < _ w Q �. o ' ^ (J , W N U_ M W 7 Z W _ C L O x V7 N O O y < J J Q J Q Of H � ul z a z z UJ 0 z�Q J J VI J Q � l7 V1 Z 01 Y OpU W w I � O�opmv I Q. tOMYMo I �W NY�MYfJ =wm"Ol f 0 zI~Jlnow�a Q z ol.i�pox; �n<wwaw3 R R DATE.• 08-12-2013 A0107- 603 REV/S/ONS.• 1.- 2. 3.• SCALE.• 1 "— 50' SHEET NO. 1 OF 1 Miami Shores VillageLBY: Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION [f BUILDING M ELECTRIC M ROOFING OCT 24 2014 FBC 20 10 Master Permit No. & - 9- /3 ~ 19 Z ILt Sub Permit No. ❑ REVISION ❑ EXTENSION NEWAL []PLUMBING M MECHANICAL �j9PUBUC WORKS M CHANGE OF ❑ CANCELLATION ❑ SHOP �" CONTRACTOR DRAWINGS JOB ADDRESS: ��®�� -*0Z" /®Z� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -4 '�P eit. 2 >–®' Phone#: Address: /D D -S"® City: 1/1/i r A - Of a S14 d eZ ,9-S State: r • Zip: Tenant/Lessee Name: Phone#: Email: -or G6 CONTRACTOR: Company Name: Phone#: Address: Y 7% 9 14-1 9e City: W(' A' State: - Zip: -S-3 ) e. 2 - Qualifier Name: A- { 2 . Phone#• State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Or AbO, — CCF $ 0 ° ('00 CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ - Notary $ Technology Fee $ r) - Pa Training/Education Fee $ (1, a Double Fee $ Structural Reviews $91 Bond $ M_ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Norm f applicable) Bonding Company's Address (3ty aete Mortgage Lender's Mff e(ifapplicable)_ Mortgage Lender's Address 10 Sate ap Application is hereby made to obtain a permit to do the work and instal lations as indicated. I aertify that no work or installation Inas eon rented prior to the issuance of a pernit and that all work will be performed to mad the staidards of all laws regulating construction in this jurisdidion. I understand that a separate permit mst be secured for ELECFRG R -L A43NG 9Cs$ R3C1.9 RROCM 60L8;$ HFAIE $ TR41$ AIR0Cm-nCdNl3;;5 ETC.... OWNER'S AFFIDAVIT: I certify that all the foregoing infonTstion is accurate amd that all work will be done in oompliamce with all applicable lam regulating construction anizx ing "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY FESLLT IN Yt7UR PAYING TWICE F IOR IMPFUVE11AE WZ TO NCM PFuPER .. IF XXI INTEND MCBTAIN ANANC]NG; OONSLLTNTHMx RI.BVDBRCRANATR34g- ING YOUR NOTICE OF COMMENCEMENT." AbUce toAc dic nt: Asa aanoitian to the isz"wof a buldngpan# with an estimated Value cosedng $2MO, the alclo6idart nig t prrmw in goad farth that a owy of the notim of oarm m;e7Ed and m do dic n lien lawbroctuae wi// be oldhere/ to the pwsu7 woepriclocrtyissdjecttoa!tadnirt. Also, acertifiedaprofthanxrrdednatfimof mdbepostedatthejobste far the first irgoaction which coaos Sam 0 days after the buldngg p rnt is is ad In the absmm of such posh/ notion the irq%ticnwillrut beap rowdandarsrgoectionfeewi//bednUed 3gmature O N:RorAf3�TT Theforegoing instrument wasadgaMedgsd beforemethis who is personally knc ni to identification and Wm did tale an oath NOTi RYME IC SgrT Rint: ,%d: A9TUvE3DB1( f-1-�/1'2- i7°f (FLviMCKYJAW14) as 9g dura u , Qj Theforegoirig instru r�eryntwasadgnMedgedbeforen-ethis -21 e dayof zlo,r_ . 20 by sa.c s Vq_ 4A_ _J� Wm ispersonally (mown to me or vAmo has produced as identification and who did tale an oath RalsE m iner Mining aructurd FbAeN Qerk hµ r North Miami Contractor ID Number 160800000 Town of Bay Harbor Island Contractor ID Number: CONT -0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL. TRAMS & DISTRI nr - Charles Darper Secretary of the Boaro ` www mlamrdada WWkm1OV m Wfiidpm: tradDt, t. lax Miai;i -Dade,County, State of Florida m c —TOSISNOTABU—Q9 W.-TFAY CCNO-. o 6 PEOPLES INC ilev A 9011 15779'W ,,f DM NOM MWA tE" R. 3362 faysuw&t*Cw Code Chmptw$A? tAd.9&10 nS, k - OIAM TVMC�FVUI*� yo S GAS MTI SfEdA&64GINgMNql' FLER MPRY 1p"mw RYTAXC OR 'OT' 117500 lb 18/2914 -623-1 4. 4 73 07 U Ml I =WW Leval Business Tax Recelp Miami -Dade County, State of Flfaridi -TW8 19 NOTA BILL -'00 NOT PAY 1133248 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES PEOPLES GAS SYSTEM INC RENEWAL SEPTEMBER 30, 2015 15779 W DIXIE HW 113324 Must be displayed at place ofbusiness NORTHMlAIVit BEACH FL 33162 Pursuant to County Cade Chapter f1A - Am 9 & 10 OtNNER SEC. TYPE OF, BUSINESS PAYMENT RECEMP PEOPLES GIBS SYSTEM INC 196 SPECIALTY ENGINEERING CONTRACT BY TAX CQUACTOR ' 160sWorkers),6O 042 > OPPU08.tI4-0074$7 This local Ousinm Tax Receipt only aoaflrms payment of the fecal Business Tex The Recelptis note Room pemdt, or Q certificadan of the holder's gpeliiicotim to do business. Holder mud comply wild'airy governmental at mnlimmmental ragulrtory laws and requirements which apply to the businom TM RECEINT NO. *hove n u3t ho d1sployed on all commercial vehir4og- Mlaml4lads We Sec 88 -Vii. Far more Infogeation. visit w n mlamidod®. eollmcter r f L000i Business Tac "Reoept Miai4-Dade County, State a1 Florida MIS 19 N 0* A BILL OQ NOTPAY sem. 192 C 0 RSCBtPT [NO. EXPIRES MNEWAL SEPTEMBER 301 2015' 4983202 Must be digp*ed at place of business Purauatnt te,County Code Chapter 9A -Art. 9 & 16 i I 5