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PW-14-287 • �� t < ZREC ED FE EIV. 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 Foram No.-RAJ SLA Permit Application FBC 2004 Permit Type: Public Works WATER Ownefs Name(Fee Simple Trdeholder) Rhone Owner's Address city State Z1p TenanULessee Name phonet. Job Address(where the work is belag date) �1 ` Iy '9T V city Mimi Shares%nn— County Miami Dade Zip Is HuffdUtg Miataieapy Designated: YES NO canhactWsCompany Name %�co ?EOp/Fs 67e?s r Con"cWs Address II-10 I Sf ;too City F'e- 1'q a Oleo zip Slats 06 3 3 o A-Affect/Enginee'sName(dapplicable) G�/ e'y vfQi Phone C: Oe06 S Vakme of Work For tris Permit mC� Lineal Footage Of Work Type of Work: ❑Addition Now ❑Repair(Rplace ❑ D Describe Work: H C-��{ •^ 4 3 .SG.ta�s y C E ».."..""'..`.."Fees..""""..'..`•"' submlNsl Fee f Permit Fee$ CCF S CQ= Notary$ TralninglEducation Fee$ Technology Fee$ Scanning$ Radom$ Bond$ Code Enforcement Y Structural Plan Review S Total Fee Now Due i � V (Continued on opposite side) �..�..� ¢,, (11_� 2.t /Y Bonding Company's Name(if applicable) Bonding Cc-wparmy's Address N/A City �. State Zip Mortgage Lender's Name(if applicable) WA Mortgage Lenders Address City Stale 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 ELECTRICAL WORK,PLUMBING,SIGNS,WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS and 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 taws 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 apprmcant must promise in good faith that a copy of the notice of commencement and construction lien law brochure w8/be delivered to the person whose property is subject to ettachment 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 ft absence of such posted soft e,the inspecilon will not be approved and a rainspectton fee will be charged. Signature Signature Owner or Agent Contractor The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this G day of .20_,by day of iE&1j 201 ,by .,/ <_wS Y,C-9 A-s -r who is personally known to me or who has produced me or has produced as Identification and who did take an cath. ident'dkabon and who did take an oath. NOTARY PUBLIC: OTARY LIC: Sign: Z Y p66Q6 Print Prink Notary Pubk-State of]Florlda• .• y m. pre ep 1My Commission Expires: My Commission p°a• Cornmissio�ny#�r�FFA'0'4"......� p �ThroughM W tRR 111�� [N Rl6Y'1U{JU�11 APPLICATION APPROVED BY: Public Works Director or his designee. 11117/2005 A� CERTIFICATE OF LIABILITY INSURANCE DA06/21/2013m 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 ALTER THE COVERAGE AFFORDED BY THE 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 AIC No Ext):800 476 2211 aC No: Birmingham,AL 35202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER 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. INSRLTR ADDLTYPE OF INSURANCE INSR SUER POLICY NUMBER MMOIUDD EFF MOM/UDD EXP LIMITS LTR WVD B GENERAL LIABILITY XL5129402P 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention DAMAGE TO RENTED- X COMMERCIAL GENERAL LIABILITY $1,000,000 PREMISES Ea occurrence $ X CLAIMS-MADE F1 OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PEQ LOC $ B AUTOMOBILE UABIUTY XL5129402P 07/01/2013 07/01/2014 COMBa aBINED 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 LIAB OCCUR XL5129402P 07/01/2013 07/01/2014 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ 1 1 $ A WORKERS COMPENSATION Excess workers'Compensation: 07/01/2013 07/01/2014 X WC STATU- OTH- B AND EMPLOYERS'LIABILITY Y/N EWS9318597-02(Statutory Limit is TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE excess Of$35,000,000 insured by LM E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA Insurance Corporation) 1,000,000 (Mandatory in NH) Employer's Liability.XL5129402P E.L.DISEASE-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 n Miami Shores,FL 33138J,. 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 r CTQB Construction Trades Qualltyfng Board _ BUSINESS CERTIFICATE OF COMPETENCY � E1608 ;. PEOPLES GAS SYSTEM INC J12. VEGA JOS Is certified under the provisions of Chapter 10 of Miami-Dade County VALIb POR CC014 RACTING UNTIL 09/30/2015 North Miami Contractor ID Number: 160800000 Town of Bay Harbor Island Contractor ID dumber: CONT-0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS&DISTRI Charles 0an9ar P E r (�(„� fm Secretary dthe Board 1 arma.mlemidaft 9w10WIEin9 ROAD WORK AHEAD 2011 200 4011 CONDITIONS J \ l \ •l ( ) � WHERE ANY VEHICLE.EQUIPMENT,WORKERS OR THEIR ACTIVITIES ENCROACH DN THE ty PAVEMENT REQUIRING THE CLOSURE OF ONE b i •• •••• Work Area • c_y TRAFFIC LANE,FOR WORK AREAS LESS THAN 200'DOWNSTREAM FROM AN INTERSECTION 400 D 2011 L FOR A PERIOD OF MORE THAN 60 MINUTES. e�OPhan ROAD WORK ROAD AHEAD WORK AHEAD zoo 4011 CONDITIONS WHERE ANY VEHICLE,EQUIPMENT.WORKERS a a OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE • • • •• Work Area • J TRAFFIC LANE,FOR WORK AREAS 200'OR MORE DOWNSTREAM FROM AN INTERSECTION 4011 FOR A PERIOD OF MORE THAN 60 MINUTES. � 50 2011 zoo a ROAD More Than 9 WORK 2011 g AHEAD a ° DURATION NOTES e a 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. I.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"(Min.) 6.The maximum spacing between devices shall be no greater than 25.' v Orange Flag And Type B Light 2.When vehicles in a parking zone block the line of sight 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 and additional information,refer to b.Speed is 45 mph or less. 2 ■ 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. 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, 3.1f 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, fiarea 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. Flagger ROAD WORK AHEAD signs.Flaggers are not required. lights operating. c=> Lane Identification+Direction of Traffic 4,Flaggers shall be in sight of each other or in direct communication at all times. LAST Izel DESCRIPTION. FDOT 2014 INDEX SHEET REVISION 0 TWO-]LANE, TWO-WAY, WORK NEAR IINTERSECTIION NO. ND. 07/01/09 DESIGN STANDARDS 605 !01`1 ROAD WORK AHEAO 1001 zoa 4001 CONDITIONS J ` •/ \ / �_ WHERE ANY VEHICLE,EOUfPMENT.WORKERS OR THEIRACTIVITIES ENCROACH ON THE a G� PAVEMENT REQUIRING THE CLOSURE OF ONE Q ■■ ■■■� ■ TRAFFIC LANE,FOR WORK AREAS LESS THAN Area ■ b + Work 200'DOWNSTREAM FROM AN INTERSECTION FOR A PERIOD OF MORE THAN 60 MINUTES. 4001 2001 Les ROAD WORK ROAD AHEAD WORK AHEAD 209 4001 I CONDITIONS J l J l J WHERE ANY VEHICLE,EQUIPMENT,WORKERS C� 4� OR THEIR ACTIVITIES ENCROACH ON THE PAVEMENT REQUIRING THE CLOSURE OF ONE c_y ■ ■ ■ b TRAFFIC LANE,FOR WORK AREAS 200'OR ■ ■ ■■ Work Area MORE DOWNSTREAM FROM AN INTERSECTION 400' FOR A PERIOD OF MORE THAN 60 MINUTES. � 5d zod zoa ROAD More Than WORK 20d AHEAD 6 ' DURATION NOTES a SYMBOLS GENERAL NOTES ® Work Area 1.Work operations shall be confined to one travel lane.leaving 5.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 IS'(Min.1 6.The maximum spacing between devices shall 6e no greater than 15.' v Orange Flag And Type B Light 2.When vehicles in a parking zone block the line of sight 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 and additional information.refer to b.Speed is 45 mph or less. ■ Channel zing 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. 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 and of the work area may be omitted provided vehicles in the work flashing,oscillating,or strobe lights operating. 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. Flogger ROAD WORK AHEAD signs.Flaggers are not required. lights operating. b Lane Identification+Direction of Traffic 4.Flaggers shall be in sight of each other or in direct communication at all times. f� Lys 2O DESCRIPTION: FDOT 2014 INDEX SHEET REVISION ` TWO-LANE, TWO-WAY, WORK NEAR IINTERSECTI[ON NO. NO. 07/01/09 ¢ DESIGN STANDARDS 605 1 of 1 �a t FUu.LANE a ; t �gy R SURFACE -, I - _ _ 'i I .parr.k.�r--- ...._-. .:. — -i•wr..r. _----, ._ m /�+ SWAM EPLACEMENT SAW CUT ASPHALT ` i - rTP. ROP. 3/4" PLASTIC N .� I'` GAS SVC. DIRECTIONAL r 4-1 NZ aEPEACE�NraAs£�,,,.,, i-; I BORE. (r47 EIA,ERIAL) ,,6• pTCH wont 1.6' N i•� - I- '}# cp =- r 4p, .i I r I� 1' I o # 67 , E _ Al ,r V"� ,r w � E I RESTORATION OF ROAD CUT FOR UTILITY CROSSING W s ;, I =,r cC SIDEWALK - - - - - G GAS MAIN 95 + 1" _ r Z o zJ SWAL , ll _` `= I XI T. 6" PE. GAS MAIN SOD RESTORATION DETAIL SCALE: NOT TO SCALE 58' NE. 94 S�"� ------ — --- .----- 75 -- ---- ------- E'0.P14 a�: — ["ALL EXISTING UTILITIES SHOWN ON THESE PLANS ARE TO BE1,. CONSIDERED APPROXIMATE & G• $ SWALE' SHOULD BE VERIFIED BY THE CONTRACTOR PRIOR TO THE SIDEWALK START OF WORK OPERATIONS. �TII 14 INS 4—SVC TOG - ' E� WITH T.T. E.F r. ¢ a" g a . i! • : 75' J o 3 T " W n �z a i EX. GRD. w g F 8 3 w 8d , v o J W4 d LD CD PROP. " P S11C GAS SVC. BE V I �- 1 t LEGE1YD.a. h W ) I o DIRECTIONAL ORED CENTER UNE t. REPLACE-6A MATERIAL OV .MTQH.,SHALL.BE TWICE THE'" 4 THICKNESS OF THE BASE, MIN. 8" AND MAX 18 „s. 1 �_�� MONUMENT LINE 2. LAYER AND EACH LAYERAL THOROUGHLYTHOROUGHLY ROLLE6- MAXD OR TAMLOOSE PED MEASUREMENT)88OF R/W RIGHT OF WAY MAX. DENSITY PER AASHT0 T-180 P/L PROPERTY UNE 3. ASPHALT CONCRETE PAVEMENT JOINTS MALL BE MECHANICALLY SAWED E O.P. EDGE OF BUILDING 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE 6"1 PL GAS MAIN MATERIAL T.T. TAPPING TEE S. BASE MATERIAL SHALL HAVE A MIN. Ill OF 100 AND A MIN. CARBONATE c O O E.F.V. EXCESS FLOW VALVE 6, CONTRACTOR SH�`SOF FOR TOOVVEW�OCC TION OF EXISTING UTILITIES z SVC SERVICE UNE 7. ALL ROADWAY RESTORATION WITHIN F.D.O.T R/W SHALL COMPLY WITH INDEX NO.OF MUM: PROFILE CROSSING NE. 94 ST. SCALE: (V) 1:4' (H) 1:50' 310• sBM NO.: 1 Drawing File: \\browardfs\voll\USERS\PGMXC\Documents\RESIDENTIAL\2014\NE 94 ST. 67, MIAMI SHORES, FL\67 NE 94 ST.MIAMI SHORES, FL.dwg 02/06/2014