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PW-13-2103 r Miami Shores Village Public Works Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 �j Public Works permit NO. Permit Application FBC 2004 Permit Type: Public Works WATER Owners Name(Fee Simple Titleholder) r�.S �/ l�) / >;� �O 7�6- ®::�'fq. Owners Address IV 3e Ale b R�� city xjtrc-AP" �Iias2��' Slate -7Zip Tenant/Lessee Name Phoneg. 0� - /�� —09,f-5'. Job Address(where the work is being done) /Y!1 Cd9/�c>f City Miami Shores VNWge county Miami Dade Zip Is Bullding Historically Designated: YES J + NO x• Contractors company Name�^- �-G lO �Cl/�/ (Sr�f��_ _ Phone A: Contractors Addressy C®� i'�/ �O 4 , 1 / city 77-- I r-,q a�4W'q-1E' State ` Zip ArchitectlEngineers Name(d appiicable) /`C'i 7'/1 'L�r/ r� ' Phone S: WY— 5-3—1�(� $Value of Work For this Permit / 4✓®l✓ Lineal Footage Of Work: Type of Work: ❑Addition ❑ ® Now ❑Repairmaptace ❑ Demofition Describe Work: ......................Fees..............„,,.. Submittal Fee$ Perrrdt Fee$ CCF$ CO= Notary$ TrainhrglEducation Fee$ _Technology Fee$ Scanning$ Radon$ Z—Ing Bard$ Code Enforcement$ Structural Pian Review$ Total Fee Now Due$ 6L4 r v 0 0 (Continued on opposite side) //ff��11 n T Disapproved Date_ Bonding Company's Name(it applicable) Bonding Cc,apany's Address WA City _ State Zip Mortgage Lender's Name(if applicable) WA Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated.1 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 constriction 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:t 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 promise in good faith that a copy of the notice of commencement and construction den 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 fire job site for the first inspection which occurs seven(7)days after the building permit is issuedIn fire absence of such posted notice,the inspection will not be approved and a reinspection fee wh7 be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this • _ The forgoing instrument was acknowledged before me this 14 day of .20_,by day of P Tei 2 .J S c>tS UG C'(-} � who is personally known to me or who has produced Who is personally 1 Ro produced_._ as identification and who did take an oath. u n dwhrhQdid take an oath. NOTARY PUBLIC: NOTARY Sign: s Print: Print NORAA W LDM W 040618 EXPIRES:1Yolfe W 2l,2014 My Commission Expires: % My Commission Exp' •Af Banded 7 t N"Ptft U*ffl fers APPLICATION APPROVED BY: Public Works Director or his designee. 11117/2005 A CERTIFICATE OF LIABILITY INSURANCE DAT6/21/2013 1() 06/21/2013 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 CONTACT MCGRIFF,SEIBELS&WILLIAMS,INC. NAME: P.O.BOX 10265 AICNNo Ext): FAX a 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 Corporation 33600 702 North Franklin Street Tampa,FL 33602 INSURER D: INSURER E: 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 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 D BR POLICY NUMBER POLICY EFF POLICY M UD EXP LIMITS LTR B GENERAL LIABILITY XL5129402P 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention RENTED X COMMERCIAL GENERAL LIABILITY $1,000,000 PREMISES DAMAGE ToEa occurrence $ X CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY I I PE 7 LOC $ B AUTOMOBILE LIABILITY XL5129402P 07/01/2013 07/01/2014 Ee BINED SINGLE LIMIT 1,000,000 Self-Insured Retention X ANY AUTO $250,000 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ 1HIRED AUTOS AUTOS Per accident B UMBRELLA LIAR OCCUR XL5129402P 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR Hx CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION Excess Workers'Compensation: 07/01/2013 07/01/2014 XWC STATU- OTH- B AND EMPLOYERS'LIABILITY YIN EWS9318597-02(Statutory Limit is O ER ANY PROPRIETOR/PARTNER/EXECUTIVE excess of$35,000,000 Insured by LM E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A Insurance Corporation) 1,000,000 (Mandatory in NH) Employer's Liability:XL5129402P E.L.fASEASE-EA EMPLOYEE $ If yes describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 SHOULD ANY OF THE 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 s Miami Shores,FL 33138 .. /os• Page 1 of 1 ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD BE ROAD PREPARED STOP ONE LANE SPU=EOI�ES WORK ROAD on"■ME-115 AHEAD AHEAD PRESENT END RDAD WORK Buffer Space D •- Sea Table 547 250' C B A CO b ■■ // Ar ■ • Work Area T � D D D D is D A B C til ROAD p END Device Sparing-Tangen[ 500' WORK �� See Table/ ROAD WORK AHEAD Device Spacing-Taper sPEEDBIb ims ONE LANE See Table 1 ■ as ; BE PREPARED TO STOP DISTANCE BETWEEN SIGNS TABLE I DEVICE SPACING BUFFER SPACE SpeedSpacing(ft.) Max.Distance Between Devices(ft.) Speed Dist. (mph) A B C D (mph) (ft.) 40 or less 200 200 200 100 Speed Cones or Type I or Type 11 45Barricades or Vertical 25 155 350 1 350 350 175 (mph) iubu/ar Markers Panels of Dorms 30 200 50 500 1 500 500 250 55 or greater 1264011640 1000 500 Taper Tangent Taper TarWwt 35 250 25 to 45 20 50 20 50 40 305 ^The ROAD WORK l MILE sign may be used as 50 to 70 20 50 20 100 45 360 g$ an alternate to the ROAD WORK AHEAD sign. 50 425 i; 500'beyond the ROAD WORK AHEAD sign or GENERAL NOTES DURATION NOTES ss 495 midway between signs whichever is less. 1.Work operations shall be confined to one traffic lane.leaving the opposite lane 1.ROAD WORK AHEAD and the BE PREPARED TO STOP signs may 60 570 ^• BE PREPARED TO STOP sign may be omitted open to traffic. be omitted if all at the following conditions are met: 65 645 ea.Work operations are 60 minutes or less. for speeds of 45 MPH or less. 2.Additional one-way control may be effected by the following means- b.Speed limit is 45 mph or less. 70 730 3 1.Flag-carrying vehicle; C.No sight obstructions to vehicles approaching the work area When Buffer Space cannot d 2.Official vehicle; for a distance n' 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 `e 4.Traffic signals. flashing,oscillating,or strobe lights operating. attainable length shall be § SYMBOL'S e.Volume and complexity of the roadway has been considered. used,but not less than 200 rt. § When flappers 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 IB"x 16" (Min.) 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. ■ Channeiizing Device(See Index No.600) q,When a side road intersects the highway within the iTC zone,additional TTC CONDITIONS g devices shall be placed in accordance with other applicable TCZ indexes. WHERE ANY VEHICLE,EOUIPMENT, _ D Work Zone Sign WORKERS OR THEIR ACTIVITIES S.The two channelizing devices directly in front of the Work area and the one ENCROACH THE AREA BETWEEN 0- Flagger channelizing device directly at the end of the work area may be omitted provided THE CENTERLINE AND A UNE Y Automated Flagger Assistance Devices vehicles in the work area have high-intensity rotating,flashing,oscillating,or OUTSIDE THE EDGE OF TRAVEL WAY. R' fAFAD).With Gate strobe lights operating. ==t> Lane Identification g Direction of Traffic 6.For general TCZ requirements and additional information,refer to Index No.600. LAST2 DESCRIPTION; REVISION NjAe—%jFD0T DESIGN STANDARDS TWO-LANE, TWO-WAY, INOEx sNO. 07/01/09iiiFY 2012/2013 WORK WITHIN THE TRAVEL WAY 603 1 N og a W E [�y / 5 NtO S FILL LAW t a _ SWA6L suWAa�stAaoeDrt SAW art ASPII&T rA IMPLAceeff to am HgAI 1.6' t i i N.E. 95 ST. — — — — - --- 1::E- �- ,� VARES RESTORATI N OF ROA CUT R/W z p p I 'I r - o FOR UTILITY CROSSING ==77=7=77n,7 Is� lot I� �1 Lit 6" '' 9430 GAS MAIN �R4P' 28',3?4" i'05NIQ .GAS SV � T BE ,DIRE"CTI0aAL- B QED WIT ! in R0X. SOD RESTORATION DETAIL APP . X10 IN.T,HE A !�EY R/411 SCALE NOT TO SCALE m F Ft - EX.2uS.S.E (�ASX i R -` ir ��_ � -�• _. � � GASGAS GAS GAS �.^SAS , �LEYr�s R/W 3 'a ALL EXISTING UTILITIES SHOWN ON "��a W 4Q I a THESE PLANS ARE TO BE "�` �`.� ; : N IE IN SVC TO `�MINy UJ CONSIDERED APPROXIMATE & ^ _ WITH TyT./E-F.V 31 a (_ W 8 m SHOULD BE VERIFIED BY THE -� - t r _ 7 a CONTRACTOR PRIOR TO THE e ( '` 0 3 s START OF WORK OPERATIONS. - , `'�` :�. a z • F � J LEGEND GENERAL NOTES a z' CENTER UNE 1. REPLACE BASE MATERIAL OVER DITCH SHALL BE TMACE THE P. MONUMENT UNE THICWESS OF THE BASE, YIN. 8- AND MAX. fir 2. BASE MATERIAL SHALL BE PLACE IN 6' MAX. (LOOSE MEASUREMENT) R/W RIGHT OF WAY LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98%OF g� �♦ j ��* P/L PROPERTY UNE MAX DENSITY PER AASHTO T-180 ��V 1.S�V �A 3, ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAND va E.O.P. EDGE OF BUILDING 4. SURFACE MATERIAL SHALL BE CONSISTENT WIN SURROUNDING SURFACE T.T. TAPPING TEEMATERIAL Approved a BASE MATERIAL MALL HAVE A MIN. LEM OF 100 AND A MIN. CARBOLATE EF.N. EXCESS FLOW VALVE CONTENT OF 7=(60R FOR LOCAL STREETS) B SVC SERVICE LINE 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES Disapproved LRL Od s> UAL' Drawing File: \\browardfs\volt\USERS\PGMXC\Documents\RESIDENTIAL\2013\NE 6 AVE. 9430 MIAMI SHORES\9430 NE 6 AVE.dwg 09/13/2013