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PW-14-24540 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223033 Permit Number: PW -11-14-2454 Scheduled Inspection Date: February 04, 2015 Inspector: Diaz, Osvaldo Owner: LUDICKE, ROBERT & ALLISON Job Address: 526 NE 97 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM tsunaing Department comments INSTALLING A NEW GAS SERVICE LINE BY DIRECTIONAL DRILLING. Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number (305)754-2903 Parcel Number 1132060171530 INSPECTOR COMMENTS False Inspector Comments ?0i � ,IS Phone: (305)957-3857 February 03, 2015 For Inspections please call: (305)762-4949 Page 8 of 33 BUILDING PERMIT APPLICATION Miami Shores Village Building Department Nov 7 14 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 K) Master Permit No. v 1 q - BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING MECHANICAL KPUBLICWORKS JOB ADDRESS: 526 NE 97 ST. Sub Permit No. -' REVISION `❑ EXTENSION [—]RENEWAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): RIGHT OF WAY Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: TECO PEOPLES GAS Address: 5101 NW 21 AVE. STE. 460 954-453-0806 City: FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA Phone#: 954-453-0806 State Certification or Registration #: E1608 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1000 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLING A NEW GAS SERVICE LINE BY DIRECTIONAL DRILLING Specify color of color thru tile: Submittal Fee $ M ` ``W Permit Fee $ d� CCF Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of it70 J , 20 i -1,4 . by who ' ersonally know ' to me or who has produced as Print: Seal: who did take an oath. HUBERT NUNEZ Notary Public - State of Florida My Comm. Expires Sep 11, 2017 Bonded Through National Notary Assn. ############################################################################################################ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) North Miami Contractor 10 Number: 160600000 Town of Bay Harbor Island. Contractor Iii Number: CONT -0613-2004-05 QUALIFYING TRAOE(S) 0014 FUEL TRANS & DISTRI chwwa ftv& P.E. ; its. a A C?l t CERTIFICATE OF LIABILITY INSURANCE °Aoingg/201° 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. 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 terns 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 CONTACT NAME: MCGRIFF, SEIBELS 8 WILLIAMS, INC. P.O. BOX 10265 Birmingham, AL 35202 PHONE .800-476-2211 FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC S 07101/2014 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 . INSURERE: X CLAIMS -MADE FlOCCUR INSURER F COVERAGES CERTIFICATE NUMBER:LACEQQUC 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. INSLTR. TYPE OF INSURANCE D AUTHORIZED PEPPESENTATNE POLICY NUMBER POLICY EFF POLICY EXP LIMITS B GENERAL LIABILITY XL5129403 Self -Insured Retention 07101/2014 07/01/2015 EACH OCCURRENCE $ 1,000+000 PREMISES Me occurrence $ COMMERCIAL GENERAL LIABILITY $1,000,000 X CLAIMS -MADE FlOCCUR MED EXP (Any cm person) $ PERSONAL B ADV INJURY $ GENERALAGGREGATE $ 1,000,000 GEM AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY PRO LOC F]JECT $ B AUTOMOBILE LIABILITY XL5129403P Self -Insured Retention 07/01/2014 07/01/2015 COa SINSSI GLE LIMIT E 1'000'000 BODILY INJURY (Per person) $ X ANY AUTO $250,000 ALL OWNED SCHEDULED OS HIRED AUTO BODILY INJURY (Per acddeM) $ Par= DAMAGE $ B UMBRELLA LIAR OCCUR XL5129403P 07/01/2014 07/01/2015 EACH OCCURRENCE $ 110001000 AGGREGATE $ 11000,000 X EXCESS Ll"X CLAIMS -MADE DED I I RETENTION$ $ A B wORicERRs COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A Excess Workers' Compensation: EWS9318597-03 (Statutory Limit is excess of $35,000,000 insured by LM Insurance Corporation) Employer's Liability: XL5129403P 07/01/2014 07/01/2015 XWC SIITU OTH. I TORY LIMITS ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes,DESCRId PATIO OFOPERATIONSbelow E.L. DISEASE - POLICY LIMIT $ 1100010DO C Excess Workers' Compensation EW5-64N-M918-124 07/01/2014 07/01/2015 Each Accident or Each Employee for Disease $ 35,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Addidonel 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. Jesus Vega Is the qualifier for TECO Peoples Gas. CERTIFICATE HOLDER CANCELLATION Page 1 of 1 ©1 8 813-201 0 AGORD CORPORATION. All rignts reservea. 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 DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Miami Shores AUTHORIZED PEPPESENTATNE 10050 NE 2nd Ave Miami Shores, FL 33138 •• �S•� Page 1 of 1 ©1 8 813-201 0 AGORD CORPORATION. All rignts reservea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD I I. Flag -carrying vehicle: c. No sJght obstructions to vehicles approaching the work area When Buffer 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 SYMBOLS e. Volume and complexity of the roadway has been considered. used, but not less than 200 ft. When flaggers are the sole means of one-way control, the Baggers shall 6e in of each other or in direct communication at all times. ®sight Work Area 3. The ONE -LANE ROAD signs are to be fully covered and the FLAGGER signs either Sign With 18' x 18' (Mia) removed or fully covered when no work is being performed and the highway is Orange Flag And Type B Light open to two-way traffic. CONDITIONS ■ Channehzing Device (See Index Na 600) 4. When a side road intersects the highway within the TTC zone, additional TTC devices shall be placed In accordance with other applicable TCZ Indexes. WHERE ANY VEHICLE, EQUIPMENT, Qt Work Zone Sign WORKERS OR THEIR ACTIVITIES 5. The two channelizing devices directly In front of the work area and the one ENCROACH THE AREA BETWEEN Flogger channetizing device directly at the end of the work area may be omitted provided THE CENTERLINE AND A LINE Y vehicles In the work area have high -Intensity, rotating, flashing, oscillating, or OUTSIDE THE EDGE OF TRAVEL WAY. Automated Flogger Assistance Devices strobe lights operating. (AFAD), With Gate �J Lane Identification + Direction of Traffic 6. For Temporary Raised Rumble Strips, general TCZ requirements and additional information, refer to Index Na 600. LAST REVISION 1,2fl DESCRIPTION: N 2015 FO TWO-LANEt TWO-WAY, INDEX NO. SHEET NO. 07/01/14 DESIGN STANDARDS WORD WIITJ LT THE TRAVEL WAY 603 1 Of 2 N L RESTORATION YFROSSNTTIITCIG z g 6" SOD RESTORATION DETAIL SCALE: NOT TO SCALE r N W E S SCALE: 1"=30' PROFILE CROSSING ON ALLEY SCALE: (H) NTS.(V) 1:5' PROP. 34" PE: GAS SERV. UNE BY DIRECTIONAL BORE 0► et . ®0 -1a ® 1 r--- -----�--F e IT. 2" PE. GM 1 � 1 R/W 1 TIE—IN SVC TO GAS WITH T.T./E.F.V. LEGEND CENTER UNE M MONUMENT LINE R/W RIGHT OF WAY P/L PROPERTY LINE E.O.P. EDGE OF PAVEMENT T.T. TAPPING TEE E.F.V. EXCESS FLOW VALVE SVC SERVICE LINE B/L BUILDING LINE Drawing File: \ M� U JL IA . L16 In ®� Ln I- 0: 0 4 PLAM approved 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 W MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROU(* LY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO, T-180 3. ASPHALT CONCRETE PAVEMENT JOINTS MALL BE MECHANICALLY SAWED 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS) S. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE CONTENT OF 70% (80% FOR LOCAL STREETS) S. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EIUSTING UTILITIES R/W R/W ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE CONSIDERED APPROXIMATE & SHOULD BE VERIFIED BY THE CONTRACTOR PRIOR TO THE START OF WORK OPERATIONS. 97 ST. 526, MIAMI SHORES, FL a Q=aj W W W J 0° IL oas W a+ a 2i In In iSHM NO- 1 NE 97 ST.MIAMI MORES, FL.dwg 11/05/2014 15' O . GRD. p 8 1 IW — — 16 -- — ' 36 MIN. DIRECTMAL BORE 1 , 1 4 12 1 1 ' EX.2 PE. GAS MAI I 0 1 1 g 4 4 PROFILE CROSSING ON ALLEY SCALE: (H) NTS.(V) 1:5' PROP. 34" PE: GAS SERV. UNE BY DIRECTIONAL BORE 0► et . ®0 -1a ® 1 r--- -----�--F e IT. 2" PE. GM 1 � 1 R/W 1 TIE—IN SVC TO GAS WITH T.T./E.F.V. LEGEND CENTER UNE M MONUMENT LINE R/W RIGHT OF WAY P/L PROPERTY LINE E.O.P. EDGE OF PAVEMENT T.T. TAPPING TEE E.F.V. EXCESS FLOW VALVE SVC SERVICE LINE B/L BUILDING LINE Drawing File: \ M� U JL IA . L16 In ®� Ln I- 0: 0 4 PLAM approved 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 W MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROU(* LY ROLLED OR TAMPED TO 98% OF MAX. DENSITY PER AASHTO, T-180 3. ASPHALT CONCRETE PAVEMENT JOINTS MALL BE MECHANICALLY SAWED 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE MATERIAL (1.5" MIN. THICKNESS) S. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE CONTENT OF 70% (80% FOR LOCAL STREETS) S. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EIUSTING UTILITIES R/W R/W ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE CONSIDERED APPROXIMATE & SHOULD BE VERIFIED BY THE CONTRACTOR PRIOR TO THE START OF WORK OPERATIONS. 97 ST. 526, MIAMI SHORES, FL a Q=aj W W W J 0° IL oas W a+ a 2i In In iSHM NO- 1 NE 97 ST.MIAMI MORES, FL.dwg 11/05/2014