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PW-15-1914 i� Miami Shores Village ■ f�errrai7yjl `PuIt110oris 10050 N.E.2nd Avenue NE lcii Cfass catrer R ttii0 t,_ Miami Shores,FL 33138-0000 �� � �'1 Permit Status: sR0VE0`, Phone: (305)795-2204 R1°A g/4J201 Expiration: 11/02/2015 �r Project Address Parcel Number Applicant 2 NE 109 Street 1121360110400 BELINDA BOQUIN Miami Shores, FL Block: Lot: Owner Information Address Phone Celt BELINDA BOQUIN 2 NE 109 ST MIAMI FL 33161-7040 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 00 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Plumbing Ej� Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PW-7-15-56523 DBPR Fee $2.00 08/04/2015 Check#:5717 $64.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 07/29/2015 Check#:5716 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is acc ate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-namevYcontra or to doth o tated. August 04, 2015 Authorized Signature:Owner / Applican on or / Agent Date Building Department Copy August 04,2015 1 Miami Shores Village -� �- -- -- Building Department JUL 292015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972^ INSPECTION LINE PHONE NUMBER:(305)762-4949 F B C 20 s`0 BUILDING Master Permit NoWL5 ��l PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL OPUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2 NE. 109th STREET. City: Miami Shores County: Miami Dade Zip: 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 Phone#: 954-453-0806 Address: 5101 NW 21 AVE. STE. 460 city: FT. LAUDERDALE t 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/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition Description of Work: REPLACEING THE EXISTING GAS SERVICE DUE TO A LEAK AND BAD CONDITION,BY DIRECTIONAL DRILLING Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) M 1 1 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 Signature OWNERorAGENT CONTRACT R The foregoing instrument was acknowledged before me this i Tkie Foregoing instrument as ack wledged before/me this day of 20 by o day of 20 by who is personally known to jAlho isrso a�knn to me or who has produced as me or who has produced as identification and who did take an oath. identification and o did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: HUBERT NUNEZ 4PaY PLe�,i =ow * Notary Public-State of Fl 2 a Sign: Sign: ?.° My Comm. Expires Sep Sep 11,2017 Comm ssio Print: Print: %if : ''`' Pd Tn , h National I lotary Assn. Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) s ACCERTIFICATE OF LIABILITY INSURANCE DATE 0613020115 n V 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 -- PHONE IC No Exti:8 '476 2211 AIC 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:KUPY3T4E 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 ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR 1 POLICY NUMBER MM/DD MMMD B X COMMERCIAL GENERAL LIABILITY XL5129405P 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 Self-Insured Retention X CLAIMS-MADE F—I OCCUR $1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 RPOLICY❑jE 4 EILOC PRODUCTS-COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY XL5129405P 07/01/2015 07/01/2016 Ea aid D 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 XL5129405P 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR Hx CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Excess Workers'Compensation: 07/01/2015 07/01/2016 X I PER OTH- B AND EMPLOYERS'LIABILI Y Y/N EWS9318597-04(Statutory Limit is ANY PROPRIETORMARTNERIEXECUTIVE excess of$35,000,000 insured by LM E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? a NIA Insurance Corporation) 1,000,000 (Mandatory in NH) Employer's Liability:XL5129405P 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 EW5-04N-004918-125 07/01/2015 07/01/2016 Each Accident or Each Employee for Disease $ 35,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace 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 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 Miami Shores,FL 33138 A4. Page 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD f i C Construction radL%ailfying Baan BUSINESS CERTIFICATE OF COMPETENCY Mrs El 608 PEOPLES GAS SYSTEM INC � D,a.A.: VEGA JESUS Is ce tt'i Urldor ft Pmviftm Of ChaPter 10 Of Misrni=trade Ctwnty V AL ID ;--DF dbN--rRAC-T1NG LINTIL 09130/kOl 5 North Miami Contractor ICS Number: 160800000 Town of Bay Harbor Island Contractor I® Number: CONT-0613-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS& DISTRI gvrlac Baer P.E. ��(; MID Secretary of the Board wxw.rnlElNdatle.gavThinldlig MIT SYMOOLS: JUL 2 g 2095 ■ GPvaaxPizderyp ■fs�Dmddm W.cm T EY: c 0 ff" 4—� f4fADTA®oQfn e see TaWle D k.�e fdremfdfdnaf'iwm,W Ddne�dwm Tnaffdf 2w G A —————————————————————----—————— ■ ■ M-k arras ■ � I A � G ® Tames acv 4e s Taper A Tapen aea'fPo Ta�fe a `�:, di Nfay bre dnriOfed d RDS we".R1 cw op ds nvD.red eowrea wap..the cwajeaf PrBs1s. 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MERE AW VERX E,EDfMPMEW, is.aframm V"ml davnP ddveafhyr alga fvwaf of Clog rework area aray be V ERS OR THEM A1CfP4/➢4BE$ dmaIIIIed prwedded•<efma:fes-roe cnmfk saga fnsre ftp'-re-sly nauft-iT, flovw%er ikpximl,dr sfnd&v PdaAfs dp-ariral. • ••• •• ••• E■CENT THE AU A U EE/tl • • • • • T/�SEOPTEItkDtlE ArGD A aaME Y • • • • • DPOTSDDE THE EDGE D7 TRAVEL WAV. •• • • • • • • • • • 2 LAST ®DESCRPPT=.' •••2�6 • • ••• • dMDBF% s#EET REVBSfaff aw d TWO-LANZ, TWO-WAY, 071m115 DESIGN STANDARDS WORK WlTHUN THE TRAVEL WAY 603 I of 3 ••• • • • • ••• • • • • • • • • • • • • 0:0 • ••• •• • • • •• •• • ••• • • # s Ilk ,t e a - �" 1 y - �-, - • 6 b 3 wom s t . g r * OD 1 X.q._p. _ I 4 �. ,9th k71i1 .4, ' cx RILLIAlR I — ly A t 81l1lFAflE All QUT AST (V•�m�1Q�A1,)7 "b , w M�YA1 jr am� t.e_ N 4• ROP. NEW RISER WITH y .y •ii4.� n -& 314" i�° ,a' �. SERVICE AT THE N N ." •.,1 . SAME LO TIO ^ �r RES ® ATI®N ®F ® CIJT •�; r ;fi ���, x � � � ,� y e i :• '�'� •' .,I<r�`, ®� UTILITY C5®ARINC ppqq��yy��, �p •. I 1 SCALE: V-40' ����5• 4tl b# 'IA 1 peri x•,r rzt 1 ?R� rA •i• •�i, •iii ��� i •�•i_ s� � ••i•• I,a�' r €f� �• ROP.3/4- PE NEW GAS • R �' , ° , �.,;`" ` �,. ' 70' SERVICE BY 6" •••'•. b • t ,, �,e f, - ••• DIRECTIONAL BORE ••wa•Z ��F*1# ,'i # �i'r••MI ;Yt •••' Fi �, .'n ,�. ' "� « r �. .� : • ii,jir� s• • � c� j --^ nd m� r �. ii��`. �,1 c a _ r_ f. °p • ''C ^ w$*` °c. ° ' .,t„ +I .',it - 9 ,..a a �� MAIN '� t+•.,J} .` t�• tr•�r �� •• � w t.y �} �a• 1-• O ••�•f•� �- f _.. - �:. � ••,<�y'#�y i,�• `l�' � t` • • • • • +#_ _ k ST 314" STL. GAS SERV. ^' �� •�,- �� . e00 40 ,•� '•" '' �. i �r w> ,� TO CUT & CAP AT MAIN q y L • �1 'SWR-. . ,t * ,�, �,,, . �, „ _ :�• �1z� k , iiN# ° Y>.obi. �..�� ON SOD RESTORATION DETAIL ,a b,.+,- • a w� '�� a �, i, �A6Et NOT '.Iu im' �w� �ra� e i •••• ... J t_ ,�„_. .3f 20, E ,�_. - - .s.�- —�,—. .f Y ,. �L w •a-=,=-•--�7 • % 'r• t• s+ • • • ,='i i x�i Is�,�t _a .�,y��t�'IG:��°'a g�.T C "'�'�• q �# �At #:,+sr �, � x� k , , y � ®{ � � 1tia�a�� �.Ly��J "4 1 "�' t _ ' �' ►" ++ _ - a • y • Q EXIST. 2" BSE. GM. TIE IN SVC TO GAS �MAIN Approved f � WITH T T./E F V rn fi- Date ,. `, f ,, k, u s �. �v j r t J{'♦'f-L �' 4',y � ,4� , 1 � .i � � 't` '�ar y �£�{�i". �; '��.i W .°�`l ray �' -.,,ft`a r�++t#.} 4 *� a,:: "x`w -i • r:� y - �'an. +s -_ ,P '�. N .y - '" n J 5 r ` � I:��� � Q r 9 f a r N�.$� '�h.���.a 9ftt5 t _.ilial• i�... Irl ~� �s rc-.�%t �.4«*, 'i'�k t�.'4' ��`...e E L`t.M S, , era�L.-i �",. _ _ � 2y 20' 4 ROP. THREE J/" PE. 4 LHGRNL2 ORWRAL NOTES 36"MIN, TO BE DIRECTIONAL BORE t �� LINE 1. REPLACED ®ASE MA11�,RIA6 OVER DITCH SMALL� TNACE THE 1 1 ALL EXISTING UTILITIES SHOWN ON MONuA#ENT LIN€ THICKNESS OF THE BASE, MIN, b° AND MAX. 16° R�r RimT w wAy 2. OAK MATERIAL SHALL HE PLACED IN b' MAX. (LOOK MEASUREMENI)_ THESE PLANS ARE TO BE LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO NX DOFF CONSIDERED APPROXIMATE & P/L PROPERTY LINE MAX' DENSITY PER AASMTO T-180 9. ASPHALT CONCRETE PAVEMENT ANTS SHALL 99 MECHANICALLY SAWED 01 0 EX.2" BSE. GAS MAI ( 0 SHOULD BE VERIFIED BY THE E o.P. EDGE OF PAVEMENT 4. SURFACE MATERIAL MALL HE CM98TCNT WITH SURROUNDING SURFACE CONTRACTOR PRIOR TO THE T.T. TAPPING TEE MATERIAL St,b" MIN. THICKN6�-) START OF WORK OPERATIONS. EFV. EXCESS FLOW VALVE ®ASE MATER A6 MALL HAVE A MIDI. LHR. 100 AND A MIN. CARBONATE SVC SERVICE LINE CONTENT MAL7OX(Soak FOR Loco STREETS) LOC O. CONTRACTOR SMALL SOFT DIO TO VERIFY LOCATION OF EXISTING UTILITIES NO.OF mmm —4 IPROFILE CROSSINGY SCALE: H NTS. V 1:5' —4 bar Nat 1 Drawing File: \\braward%\voll\USERS\POMXC\Oocumente\SERVICE REPLACED 2010\NE 109 ST. 2, MIAMI MORES, FL\2 NE 109 ST.MIAMI SNORES, FL,dwg 07/24/2018