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PW-15-2810 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-247263 Permit Number: PW-11-15-2810 Inspection Date: February 16, 2016 Permit Type: Public Works Inspector: Hernandez, Rafael Inspection Type: Final Owner: IRAIMA FLORES, MICHELLE BATISTA Work Classification: Public Works Job Address:6 NW 107 Street Miami Shores, FL 33168-4307 Phone Number Project: <NONE> Parcel Number 1121360070010 Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments INSTALL A NEW GAS SERVICE LINE BY DIRECTIONAL Infractio Passed Comments DRILLING 3/4" PLASTIC INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 February 12,2016 Page 1 of 1 Permit NO. PW,-171-15-2,010 Miami Shores Village Permk.TPubllcWorks 10050 N.E.2nd Avenue NWW* ificabon,Public Works Miami Shores,FL 33138-0000 �— � Permit Status:'APl?Rf `EE3 Phone: (305)795-2204 `� Issue ante 1 lot 61 [ Expiration: 02104/2016 Project Address Parcel Number Applicant 6 NW 107 Street 1121360070010 Miami Shores, FL 33168-4307 Block: Lot: ROBERTO MARTIN Owner Information Address Phone Cell ROBERTO MARTIN 6 NW 107 Street MIAMI SHORES FL 33168-4307 6 NW 107 Street MIAMI SHORES FL 33168-4307 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Scl Feet: 00 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PW-11-15-57662 DBPR Fee $2.00 11/04/2015 Check#:5896 $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 11/06/2015 Check#:5899 $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.60 Total: $114.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,dr wings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work one by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRIC ,P UMBING,MECHANI AL, INDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFIDAVI I ce i hat all the for g in atio a ur a and that all work will be done in compliance with all applicable laws regulating constructio nd zoni F e t cv e c tra or to do the work stated. November 06, 2015 Authorized Signature:Own / A plicant / Contractor / Agent Date Building Depart ent opy November 06,2015 1 Miami Shores Village =NOBuildin De artment Zo Building p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20)� BUILDING Master Permit Nof� PERMIT APPLICATION Sub Permit No. F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 NW. 107th ST. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): RIGHT OF WAY Phone#: Address: City: State Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0806 Address: 5101 NW 21 AVE. STE. 460 City: FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA Phone#: 954-453-0806 State Certification or Registration#: E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL A NEW GAS SERVICE LINE LINE BY DIRECTIONAL DRILLING 3/4" PLASTIC Specify color of color thru tile: Submittal Fee$ Permit Fee$ U® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ [ ' TOTAL FEE NOW DUE$ ""1' (Revised02/24/2014) Banding Company's Name(if applicable) Banding 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 Signatures.-a OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by _day of A)y d 20 14 by who is personally known to If S&Ots J(ES of J who is personally known to me or who has produced as me or who has pr ce as identification and who did take an oath. identification a d who di take an oath. NOTARY PUBLIC: NOTARY PUB IC: ,`'SPRy PVe KUBERT NUNEZ Notary Public-State of Florida N* a My Comm.Expires Sep 11,2017 Sign: Sign:y . e ` Commission FF 043679 on ed Through National Not Assn, Print: Print: .y Seal: Seal: APPROVED BY t` I flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) TE o CERTIFICATE OF LIABILITY INSURANCE DA 6/3020115 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 IAIPHO No Ext):800-476 2211 A/C 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: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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER M/DD MMD LIMITS B X COMMERCIAL GENERAL LIABILITY XL5129405P 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 Self-insured Retention DAMAGE TO RENTEIT_ X CLAIMS-MADE FlOCCUR $1,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY❑jE 7 F-1 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY XL5129405P 07/01/2015 07/01/2016 Ea COMBINED 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 $ HIRED AUTOS AUTOS Per ac I I B UMBRELLA LIAR OCCUR XL5129405P 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR X 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'LIABILITY Y/N EWS9318597-04(Statutory Limit Is STAT TE ER ANY PROPRIETOR/PARTNERIEXECUTIVE 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:XL5129405P E.L.DISEASE-EA EMPLOYEE $ If descaibeunder 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Workers'Compensation EW5-64N-004918-125 07/01/2015 07/01/2016 Each Accident or Each Employee for Disease $ 35,000,000 $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K 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 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 + Page 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD C QB Const Tri"'Quil1"ng BUSINESS CERTIFICATE OF COMPETENCY, Ak 0608 PEOPLES GAS SYSTEM INC `t D.B.A.: f VEGA JESIJs t 90�i W&MI ► 'p is�titied d�itta� s® Chapter' { 0 R��AAir #- MiarN �115� APFROyElS �v <.- SYMBOLS: ZONING SEPT . MF m Py ® Work Area BLDG DEPT _ ■ ehoomlizong novae &See Work zamd signSUBJECT I p LTw flogger Crhl}��.�°P! � � C U (AF�I rt (. r 1J�11 t f r,L, % ioel i 2 A �_ Lan&IdefdNitatidn t 0frectron a REGI y �J�„A ——————————————————————————— ——————————————————————————————————- E1.0 ■ Werk Ar&a ■ '� D ■ I � IaMyFdnt 0ewico S aci Taper 48rp11i yam„L�tor Ta9l&D 36 to 166 56'90 1G4" Hay&V amefted i!MAD 1106Rk AHEAD sdgn m installed upstream*nkfe the"ject ImIg. r GENERAL LAYOUT �k GENERAL NOTES: I.Spetial conditions nag be required in ace"dance wifh these ew"amd 7.When Buffer Space carcrat be easirred doe to geametrrc cwrs ojoes,ase TABLE 1 the fallowing sheets. the greatest atfainable levom,mr less there 266'ft. 1.//the Work Mea ereerdwlres an[lee eeeiterhne,use the Latour/fir B.Radlyda'd erdssirosps: DEVICE SPACING Temporary Lane Sluff to Shadder an Shot 2 ardy rf the EzismV Pared a.If an active railroad erd¢sirlg is lwamad onar to Geis Wdree area Hommm.Spsmsdow maaedomm Spacing of Shoulder width is suffieiemt to prarvide for m IF lees between the than tore Weem leeygh&§369 feet,edema tike Buffer Space as Posted of Comes dr Type 7 m Type 11 Between Boater Work Area and file Edge of ExdrddrW Paved Shw,lder.Redoce the potted shvmn on Sheer 2. Tatmdar msrkers B�rir��a/peels!®rarer Speed when appropriate. b.If the queudng of vehicles across an active ratemad crdssire Speed sig- SP-S cammf be avoided,provide a uniformed traffic cameos omfec&r m lhv a 6n a or a on a 3.Temparary Raised Rumble Strips: !/agger at t1W higJwaap-warp grade ermsi w to prevert weft" T Tmdem leT A B C 0 a.Use when both of the following eorrditioas are met cdmeurreraly: from stdpp m wdafun the hiamov_rail grade erossinq,even i/ 26 g6 266 266 266 !06 t5$' i. Ekistimg Palmed Speed is 5o or greater; automatic Irmo warndrrq devices are in peace. id.Work duratdan is meaner than 60 magdles. 3PD 2V so Z9' SB 299'1 269' 269' 169' Z66 to.Uwe a consistent Strip talar througlmh!the Work zone. g.ROAD WOW AHEAD and the HE PREPARED T9 IMP sfgns ore 15 219' -v 26 Me 299'1 269' 266 169 256 C7.Plate each Rade Strip Sat transversely across the lame at dmdffod df all df flee folfmwinq condifians are,neo: 40 � � 2v ,� 166' ZA9' 209 !p6 �Q /ocatims shawn. a.Vrdrk apera ions are 69 lv4mlf"at less. 45 ?g^ 36 26' S6' 336 356 356' o& 366' d.Use option I Of 9ption 2 as shown m Sheet 2.Use an/y and olrlian b.Speed limif is 45"mph at less. thro"A to work 76ne. C•There arcs red sdgld nts§tfuttidns 10 06AWes assroa largt tY:e week �v m 26' 196' 366 SW S6d 236' 423' urea for a ddsfasce elf to the offer Spaco ow"do Table 1. low 26467366 1960' Sob' 4q3' J.Addifional arra-ray control."be.provided 4 Ow faflaw a mads: a.voweles in the wank geed fmva hvgh-tintewsify:ratatiaq,/Yaslrieq�, 69 � g6 9v 196 Zh46 I. 1966' Sri6' 576 a.flog-carrying vehicle: ascdllatimg,of sfro*igphrs opuralfnq. b•official o'chitle; o•valurTe and emomeity of Cha fogdlvay has b w m'sidarad. S6 26 196 2646 I.SB6'1999' 566' 645' C.Pilot vdhdclds: !.If a roilydad crdssdng is pyesdr4,vehw'eles will hat Wreue atcross T9 29 56 26 196 2646 1366 low 560' T36 d.restfir signaY§. raft fracki. When flagg&rs fife the sale ffemmo a/ow-04y cowtrai,the flaggers q.AFAM are fiat id us- musi bo rn oom of cash dth3r or in direct tamwaernieatim at ate times• lo.See Index em toy ganarof icy rmgrriiarr its a:sd addieiamaf ilffdrmatim S.When a side rood intersects the highway within the Ire-~place CONDITIONS TTG 8erieds in secardanca with alher dapeics6fe TCZ Imderes. Il.Aufam mead flatigger A,tvo nee 0aviros WADsI ewe/6w used up g occordame with the efdfe4 ds ShWlq 1. WHERE AN9'VEHICLE,EDUtPplENT, 6.The two efra�lizieg devices diretf/y ife front of Ift work ayea&ay he� WHERE 4 OR THEIR ACTIVITIES ►/ES enacted provided vehfc/es in ltte work arch fe w&krgdr-nrtr'erssity rm lino, flashing,dsti/lating,m.send&&lights sAvokq. ENCROACH THE ANA BETWEEN THE CENTERLINE AND A LINE 2' OUTSIDE THE EDGE Of TRAVEL WAY. l-T DESCI6fPTloN: 2016 INDEX SHEET REvlsrox FD I TW®-II.ANEr ®WAT, xo. No. 07/01/15 �'`a DESIGN STANDARDS W® W L WAY 603 1 of 3 r N o r �t lINL lllK ♦T' feC� '�n'. +.. 4' 3` ' ' ,� _ ,�' ` •7,� ':�` ">!r ' _ R ' a SAlAF`ACE SWAMF&IACEMENT fu's(raCUT#314KT , mh,'a . j l � :'.. `s - a"" ,�.^ ♦� .. __ —_---••_—— i '-- r"d IKlIJIT IASE "'� s l f>+�+ ,.s areHw�oiw SCALE, 1"x40' u1 - colp. „ NW, 107 th STREET Ir vwwcs - , RESFSRAlTI1 N OF WAR, C T --- --�-- - RA I l PROP.RISER WIT Z 6” 3 " PE. SERVICE I BY DIRECTIONAL �I '#6 � MANc&k PAD • BORE WI\� I 1 SOD RESTORATION OLTAIL i I Somk, NOT TO SC1LE i n CENTER LINEr� r ---- ---- - - - - -- rrrr - 'r M MONUMENT LINE '-- rr r LINE -- - -- rr� rrr .. —+ - -r r r R/W RICHT OF WAY ALL EXISTING UTILITIES SHOWN ON ALLEY ��yy P/L PROPERTY LINE THESE PLANS ARE TO BE CONSIDERED APPROXIMATE & '' - R,/W E O,P, EDGE OF PAVEMENT _-— SHOULD BE VERIFIED BY THEY TIE IN SVC TO GAS MAI � A T.T. TAPPING TEE )-EXIST-.2" 0 it� &F.V, EXCESS FLOW VALVE CONTRACTOR PRIOR TO THE EXIST .2" CL WITH T.T./E.F.V. + SVC. SERVICE LINE START OF WORK OPERATIONS. y GAS MAIN •; I I s PE PLASTIC t, "' •' UI W� STM, SEW, STORM SENER 0 3 e,s 15' w PROP.-Y4" PLASTI UA'Tsvc. TO BE 36" MIN. GENERAL NOTES DIRECTIONAL BORfD C 1, REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE 1 THICKNESSOF THE BASE, MIN, 8" AND MAX. 18" 4 2, BASE MATERIAL SHALL BE PLACED IN 6" MAX, (LOOSE MEASUREMENT) I LEXT.2" CI. LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98X OF 1 S�dAIr I 1 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 (1.5" MIN, THICKNESS) _ 5. BASE MATERIAL SHALL HAVE A MIN, LBR, OF 100 AND A MIN. CARBONATE CONTENT OF 70X (6OX FOR LOCAL STREETS) 0 Mo,of SIMM 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES PROFILE CROSSING ON ALLEY SCALE: (V) 1:5' (H) NTS, sHsr tro.: 1 Drawing File: \\browardfs\voll\USERS\PGMXC\Document3\RESIDENTIAL\2015\NW 107 ST. 6, MIAMI SHORES, FL\6 NW 107 ST,MIAMI SHORES, FL.dwg 11/02/2015