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PW-15-2142 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)756-8972 Inspection Number: INSP-241991 Permit Number: PW-9-15-2142 Scheduled Inspection Date: February 23,2016 Permit Type: Public Works Inspector. Hernandez,Rafael Inspection Type: Final Owner: , Work Classification: Public Works Job Address:9540 NE 2 Avenue Miami Shores,FL 33138- Phone Number Parcel Number 1132060132630 Project <NONE> Contractor TECO PEOPLES GAS SYSTEMA Phone: (305)957-3857 Building Department Comments Infracbto Passed comments INSTALL 2" PLASTIC GAS MAIN AND 3/4"GAS SERVICE INSPECTOR COMMENTS False Inspector Comments Passed Failed El V Correction D Needed Re-inspection Fee No Additional Inspeaions can be scheduled until re-inspeaion fee is paid P- V r PEOPLES GAS BY: 5101 NW 21st Avenue,Suite 460 Ft. Lauderdale, FL 33309 (954)453-0811, Fax(954)453-0804 November 19,2015 Miami Shores Village Building Department 10050 N.E.2"d Ave. Miami, Shore 33138 RE: PERMIT EXTENSIO REQUEST PERMIT NO. PW-844-2142 9540 N.E.2ND AVENUE TECO-Peoples Gas respectfully requests a 180 days extension to the referenced permit in order to allow time to secure a Miami-Dade County ROW permit to cross NE 95th St and complete the installation on the gas main and service to for the reference location. Regards, Jesus Vega,Jr. h South Region Manager o N CL z � �oa Cn � Cc: File " q i CC _ jaw' 0. E 'E JU E �� LIZ ````i •• ••• • • • • • •• '4� 1�j� • • •• • • • • • s:` • ••• • ••• ••• ••• • • • • • • 00 • •• • • • •• •• ••• • ••• • • • ••• • • • • ••• • • • •• •• • • • •• •• ••• • • • ••• • • . ... . . . . .. . .. . . . .. ... .. ... ... ... . ... . . . . . . . . ..o . . .. .. .. . . . .. . . . . ... . ... . . ... . . . . ... . . . . . . . . . . .. .. .... ... .. .. . . . . . ... f 42, lot Miami Shores Village 7If� fUO # 10050 N.E.2nd Avenue NE Miami Shores,FL 33138 0000 PBrrrilt 5t6rx 'AI�PRC3�© Phone: (305)795-2204 Iue�i at�:812812i1 Expiration: 11/26/2015 Project Address Parcel Number Applicant 9540 NE 2 Avenue 1132060132630 Miami Shores, FL 33138- Block: Lot: VILLAGE CAFE Owner Information Address Phone Cell VILLAGE CAFE 9540 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 0 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Building I Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PW-8-15-56812 DBPR Fee $2.00 08/21/2015 Check#:5726 $50.00 $66.20 DCA Fee $2.00 Education Surcharge $0.40 08/28/2015 Check#:5729 $66.20 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 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 rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a o ing. F ore,I author' e e above named contractor to do the work stated. August 28, 2015 oriz Sign ture:Owner / Applicant / Contractor / Agent ate Buildin§_p-e0artment Copy August 28,2015 1 t °`� Miami Shores Village g Building Department AUG 2'1 2o15 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 : Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 r�(� FBC 201q BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Alley w/o NE 2nd Ave. from NE 94 St. to NE 96 St. to serve 9540 NE 2nd Ave. 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#: 954-453-0811 Address: 5101 N.W. 21 AVE., SUITE 460 City: FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA, JR. Phone#: 945-453-0811 State Certification or Registration#: E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$2000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL 2" PLASTIC GAS MAIN AND 3/4" GAS SERVICE Specify color of color thru tile: Submittal Fee$ Permit Fee$ Ck-) 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) 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 -3 XI 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 20 by who is personally known to '77 1je ez 4 who is personally known to me or who has produced as me or who has produced ✓L°% as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign Print: Print: =c ""r '•�y Seal: Seal: MAX J CHAMORROs �*� Notary 7amic-State of FkviQa ? • _ My Comm.Expires Oct B,2017 P.a= Commission#FF 2731 v v�o APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) • f• r CTQRuafilying Construction Trades Board BUSINESS CERTIFICATE OF COMPETENCY j .. E1608 'PEOPLES GAS SYSTEM INC D.8A.: VEDA JEW fs certified un+i3lor the Prodiong of Chapter 10 of MIami-Dade County vAu-0—'FOR CONTRACTI"4C� ivltq,;fi3Ogl30is'G.�i5 North Miami Contractor ID Number: 160800000 Town of Bay Harbor Island Contractor ID Number: CONT-061.3-2004-05 QUALIFYING TRADE(S) 0014 FUEL TRANS& DISTRI Cnarlac ganger P E. •�(�, Secretary of the Board vnew,mlamidatte.gwAfuitding p . ACS�f CERTIFICATE OF LIABILITY INSURANCE 07109�1201 3 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 13ETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(las)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 endorsemen s. PRODUCER MCGRIFF,SEIBELS&WILLIAMS,INC NE 0p0.476�291 - -- P.O.Box 10265 N® Birmingham,AL 35202 Di'R - - IQSURE AFFORDING COVERAGE - _--_N-AIC#----- IN$URERA Ourioh American Insurance Company 16635 INSURED - - INSURER 8 ASSOCIated Swat d Cies Ins,Svc, Peoples Gas Syslom TECO Energy,Ineb INSURER C&M Insumnca Corporadon 33600 702 North Franidin Street INSURER D Tampa,FL 33602 — INSURER E t INBUROR Ft COVERAGES CERTIFICATE NUMBER:VZLVMG 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 PALO CLAIMS. TYPE OF INSURANCE ADM MM p Y NOMBER LIMITS GENERAL LIABILITY 12043P EACH OCCURRENCE S 1,000,000 Self Insured Retention DAM=TO RKNM — -- - - X COMMERCIAL GENERAL LIABILITY $1,000,000 -PREMISES tate 3 X I CWMS-MAN ®OCCUR MED Any alis pmaun) S PERSONAL A ADV INJURY S GRALAOGREGATE $ 1,000,000 Gm&AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMPIOP AGO S POLICY LOC S - AUTOMOBILE LIABILITY onounlra COMBINED SINGLE LOTr— olf4neurod Retention 14 t ft'a i 1,000,000 X ANY AUTO $250,000 BODILY INJURY(Per pmw) S �S�SO 804EAUTWLED BODILY INJURY(Per rie�®nt) S - HIRED AUTOS p ED a S S UMBRELLALWB OCCUR 0710112014 07101!2015 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR X CLAIMS-MADE AGGREGATE m Il 11000,000 DED I I RETENTIONS $ A WORKERS COMPENSATION ss Workers' omponsa on: 07/01/2014 07101/2015 X L I' B AND EMPLOYERS'LIABILITY Y 1 N ;Insurance S9318697.03(Statutory Limit Is 1,000,000 ANY PROPRIETOWARTNEWEXECUTiVE mass of$36,000,000 Insured by LM E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED`? O NIA Corporation) (Mandatory In NH) Employer's Liability:XL6129403P E.L.DISEASE-EA EMPLOYEE $ 1,000,000 it derttalba under D IPTION OF OPERATIONS below E.L.DiSEASE-POLICY LIMIT $ 11000,000 s Workers'Compensation 1 - 4 07/01/2014 OTMI 2015 Each Accident or Employee br Disease $ 36,000,000 $ S $ DESCRIPTION OF OPERATIONS I LOCATIONS I VERMLES(Auneh ACORD 101,Additional Roma M Othodulo,it more®prise Is mqulrad) Excess Liability policy provides Insurance In excess of Peoples Gas System's Salf-Insured Retention as stated above. C 'IFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Miami Shares AUTHORISED REPRESENTATIVE 10050 NE 2nd Ave n Miami Shores,FL 33138 Page 1 of 1 01988.2010 ACORD CORPORATION. All rights reserved. Af Aon lift 11fl9f incl Tk.APADn-.arae+Bad 1w^n ► —11—ai Arr%on N A � f wonar IA;o i Kw mam 09 om AMERICAN TRAFFIC SAFETY' _. 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If "7Ai ,. +§, +��,,,�xt. � x• �' 'i� i�• a �A a-+ b� � 4A �}t� 'S.t \�°'aE,rdatTS 4'4 !'*T � QTS • f �i- .r".-� :. - v} 'x x t4 ° ,t _'r' �" >f ».. r ." -� 1�`tt_1T'ty ,, aafi a3't• 4FFs—' y�� -ra � �'i'y t;'�4 a'd $ - xx$+' s � -r a ,�-a FF Ft 714 5 y �4 r;° '� ���' ^.•"#.,r --�,� � ,y,$c'� .*ra u # ,c �i �f '���•e� � �°� i � Y kI f. ��k� iek `§ '�� a� � ..fig a Sri '`h � * �px-� -« t.x •� � ��y � �_ �:. r. t: ; b -:•.�.gyp,�' x+}:: w a+ �1, •�� _ __ .�,� i�'� ,, r a� $+' "� ,-,� • r 'fid-,. PROPOSED 2" PLASTIC GAS MAIN AND PLASTIC GAS SERVICEf rim ALLEY W/O NE 2nd AVE. FROM NE 94th ST. TO NE 96th ST. TO SERVE 9540 NE 2nd AVE. RECEIVED AUG 21.2015 BY: mom Iy . mow 3 My rim11'sm"Waamaua"n%a"Mm aKMONK WL PROJECT MSo�r�m'�O. ,� V,r�„w10'eam ' u' o m,uM, LOCATION "AtaMwTwmaemmrtmasruee rMan C vrus wONra aru K 6MOM WN es MwiaAIM aw wm� L 01412111=6w wvMasAWWPIa0owno"M CONSTRUCTION 1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF CONSTRUCTION. SUNSHINE # 1-800-432-4770 2. RESTORE ALL AREAS TO PRIOR CONDITIONS 3. ALL CONSTRUCTION TO FOLLOW JURISDICTIONAL GOVERNMENT AND TPG STANDARDS. v uIT 3r'■ Miami Shcres Village i APPROVED BY DATE Kww wmftbelovu 7.0NING DEPT Cag befomyou ollg, F=E-IIS i=L-I-- F=' CS dA. BLDG DEPT / OJ ECT: 1�� TECO-PEOPLES GAS W0: 15779 W.DIXIE HIGHWAY N.MIAMI BEACH,FL. SUF-JECT 10 CCMPLLANCE W17N ALL FEDERAL r STaTF ANL) Y r3l;L=S AND REGULATIONS Ir/sr. ",» ... _ 4(SFT DIGS :7 � --.... . REF. A B6//1�T E 3695 T� p PROP FLUSHING CONNECAON l �' f'f —+� 7 ao �/ T2uas ' Ate: t' a"u oau TAT 43+920® E�fS �5.t5-L 1G'.�i awu ®.® a u - mu au wu au eau ��° 3 GATE VALVE /r 2" PL. VLVy eg R l L 1R �� � .: - — — — u aw PROP. 6x2 PL. T/E �! • -rr : 3.ii, i k - - 1i... : rte, c*r=a _.. �, .. _ ..._ 1 .:7.i. 2 1 er.Y i f Ytyl "iT7 �k= 1 Edi . :, 1, — T..._ ,�.y...... ]' 'QV._ -.---PT1�� 1�� i t1Y_ PROP, EASEA/£NT N EXIST. 3 OWJ I \' S PUMPING STATJON P-1 3' REF. AS-BUILT E-4923 0 1'-6" -PROP. 2" LOW PRESSUAF ` TRANSFER 3/4" PE I F ET MAIN A QUEEZE OFF AND C&C FORCEMA/N SDRII HDPE ETIRE 3/4" PE STO M.H. ROP. 2" PE G.M.(DIR. BORE) EX. 6" PE G.M.JA I� ROP. 2 PE G.M. (DIR. BORE) 5 I I � I I `'1— S TORM SEWER A4AA°H0,1—E I I I I TCP R&I ELF 1 = �. I 1 i A/ RLQ L EIV19 F— E-1' 41 4- InIA RAN(G e, PROP 12"RESMAINO ° ROP. 2"PE G.M. 1,0 (DIR. BORE) '� IIS 'EX/ST. 4" ISM __ REF. AS—BUIL T 3 J z O, � � y _. i i T ✓ �� `I � I__..._.- _� -L 4 � —.A/ 2' .\ �\` •.`\ \. \ ,\ \\ 2"x3/4"T/T \. \.., ,, \ `. 1 ,.\ I 11�� `®°`? 15' ALLEY WAY M, �'° ,�®" �Niq� ■ �f \ q I ( \ I \ \ ASPHALT PVMT I WD 7H VARIES PROP. EASEMENT I �? PUMP/NG STATION P-3 5' ^ n _ m ;TLE(— C�(`1� t{ Y6,�t�� � -_`` .7 �`a� ROP. 3/4" PE SVC. f 14 U PR FAB RISER--, dam" I 540 I I X.GRADE 36"MIN. 51 5 \pRnP 9" PF (, M (DIR. BORE) 01 -5 nr4 nNFI,AWN 10Fn; A. t,o('Jty,D14TECO-PROPLS GAS � �' PROPOSED 2" PLASTIC GAS MAIN ' O. FE 15779 W. B HIGHWAY ! AND PLASTIC GAS SERVICES SCALE: 1"=20'(H) " 20 (H) PROPUM -5 GAM N. srAoxH, FL, too a��o SW 27th ST. FROM SW 27th AVE. TO SW 24th AVE. 3 Of 3 1 (V) � �� ,.,,