PW-16-2099 (2) Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)7568972
Inspection Number. INSP-264858 PermitN6mber: PW-7-16-2099
Scheduled Inspection Date: August 08,2016 Permit Type: Public Works
Inspector. Hernandez, Rafael Inspection Type: Final
Owner: JEFFREY KOLOFOFF, EMILY Work Classification: Public Works
Q 1*A r%CI ITC
Job Address:150 NE 108 Street
Miami Shores,FL 33161- Phone N imber
Parcel N imber 1121360100040
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM Phone:(305)957-3857
Building Department Comments
PERMIT AFTER REPLACING AN EXISTING GAS infractio Passed Comments
SERVICE WITH A NEW LINE DURING A GAS LEAK AND INSPECTOR COMMENTS False
BE IN POOR CONDITION,AND TO MALE THE FINAL
RESTORATION AS PER MIAMI SHORES
EXPECTATIONS.
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
Pv
� 0 tai Miami Shores Village PU� �..
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000it
134r �' - t ✓ '..+4i� 4af A �nn `�'
Phone: (305)795 2204
Expiration: 10/21a 1
lssua laa 1812 t �rr
Project Address Parcel Number Applicant
150 NE 108 Street 1121360100040
Miami Shores, FL 33161- Block: Lot: EMILY BRADFUTE JEFFREY KO
Owner Information Address Phone Celt
EMILY BRADFUTE JEFFREY 150 NE 108 Street (786)837-3333
- ----- MIAMI SHORES FL 33161-
150 NE 108 Street
MIAMI SHORES FL 33161-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 0
Scanning:3 Available Inspections:
Inspection Type:
Final
Excavation
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PW-7-16-60750
$2.25 07/26/2016 Check#: 10241 $50.00 $115.10
DCA Fee $2.25
Education Surcharge $0.20 07/28/2016 Check#:10247 $ 115.10 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 properauthorities 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,JROG and SWIMMING POOL work.OWNERS AFFIDAVIT: I certify that all the foregoing information is accurateall work will be done in complance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor work stated.
July 28,2016
Authorized Signature:Owner / Applicant / Contractor Agent D to
Building Department Copy
July 28, 2016 1
Miami Shores Village
BuildingDepartment
UL ���
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Y1-
Tel:(305)795-2204 Fax:(305)756-8972 -r 4
INSPECTION LINE PHONE NUMBER:(305)762-4949 l
FBC 20 ( -4 Cj(�
BUILDING Master PermitNo� ( (o- � l -/
PERMIT APPLICATION Sub Permit No.+
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTEN519N ❑RENEWAL
PLUMBING ❑ MECHANICAL OPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 150 NE 108 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 Phonet.. 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 0 Repair/Replace ❑ Demolition
Description of Work: Permit after replacing an existing gas service with a new line during a gas leak and be in poor condition,and to make the final Restoration
as per Miami Shores Village expectation
Specify color of color thru tile:
Submittal Fee$ Cfi� Permit Fee$ 01 CCF$ n co/ccs
Scanning Fee$ Radon Fee$ C9 Ca� DBPR$ g- Notary$ _
Technology Fee$ il Training/Education Fee$ 0. ;ZD 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 e'.LC1-
F
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this
day of_ 20 by 7—6 day of —20 by
who is personally known to E3ie s who is perso own to
me or who has produced as m4ica
pr duced as
identification and who did take an oath. idn who did take an oath.
NOTARY PUBLIC: N "�#,�`����,, HUB%Ri NUNEosPav ups.;�z ,�: otary Public Stateof Florida• y Comm.ExpiresSep 11,2017Sign: S =;.° "oe� Commission # FF 043679°;;;�' ended Through National Notary Assn.
Print: P
Seal: Seal:
APPROVED BY y �l Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
DATA 4/15/16 : '
Time Reported: TimeArrived:- iIND
teak Not.
10:30 am 11:09 am +" .L" otvitten'
Time DMspatdiad. Time Made Safe: ' ' i s ;`
10:55 am 11:15 am PGS24-GAS LEAK AND REPORT FORM Distribution ❑ Tranamhsten
Geovapldc tomtton CS Date(Office use) Raported By
Address 150 NE 108th ST Premise No: Name:
aty Mimi SHores County Dade tat Phone:7864137-M
Is this focal',on metal lana? D yea ❑No Long: ❑gator ❑ft ❑f ac
0mvioras ❑PGs m oAbw
�-- LE�AAR CPARACTE(i15TIO
Leak Grade BY ®: Grade i I Grade 2 Crede 3 ❑ No Leak E3Mi�0� - re by in
IubHcadn�,orr ad Wjusustin
Lek ROGrede By ReGrede Date:ROM Famt-4MISCrede 1 Grade 2 Grade 3 E3 No Leak [I Not Reportable
DeteWon Method — Pack1 i Fwft Pack r RKD PPM C.We Gas Mtr %Gas
Ell VlsuaWe station I Odor Pressure TePO
Blo mg Gast Oita %
Collecting 0 �.d=
Near Btrlidtn ❑ m Manhole/1larrAvaBable Opea t 1 ❑ ❑ Vent to Atmpa
Other(ghre detaUs
Surface Lawn 7,[7 Asphalt r r c other
06titIPTION Or LEAK %Chis section is completed by first responder
Above Ground Lit(cluedand): 1 FI. Meter Set[ ReptalorStation r Rim Other
Part of System Below Ground Leek Pieckmel: Mein Servke Service Stubi❑ Other
BelvwGr=d Leek
Location of Leat
❑
v&el❑ FMMI❑ Dftl❑ TOP OMOMon ❑ Regabter
❑ alp ❑ t-antroi Mal❑ C.f.Ban a JoIntl❑ C.L Mach Xhul Q Other
detftabontlualc o dmrvAth plo bola 10 below I WC
TIM !
4;e9s Plow Valvas T
Uservlce Eae utas did tt have an enoes ffoW valve? Yes No
U' ,dkldiemueasffovrvahoedosO? [ Yes No
LEak(awes Si Won Ts to b4 competed bV repair ersonnel "Only Check One 8
Fauureto Otbm Irasdeque
erator Emv
I--
O>practice,L�
Dfeo ftaty�
wasmMaterial and Welds FealtyFiddWeld irmhlth(WO aMWOM Deift
qqRsDirsound
Lf -� RR�enicaiMing 3811ke40-ftFWkn
Natural cause UgMsd>ghrg ' Soii Substdernaa Floodhis EnOWIM 1 Tree R Annal
stnMtales _ t
Corrosion pexl C C
Odwoutdderorae Darer Vandansm Veldde r O*Wvawem
DM7Uw F.Dater ❑l3a SarolaaLUa ONMEaDft*WJM ❑Demo
awriallon ❑ camplate Leak and Repair-Dwells SMM nmtd Porro(PGS 24A)
Fa4llity PWs IptT n&Components
MateiMai ❑ Swel Car ❑ mastic ❑ cast MM ❑ Wroaght bon ❑ ❑ 0th
-`l 7rCrS U!tela"ros ®,rWS 11:-214"LPs 2•IPS Frfps
pipe siteF 4r ms F,..i 61 fps C r fps u fps i__ it fps 20°fps
24"DPS r a r fps Other
Ih�re UP IPesopag C HP<lUpda HP>E$pag C HP3-200psig
: racaur<rs�rve ( x-vu[ F� C$W t r7 GOmIzed F sere
E: Fa Good C EVZOM
PtlwCatdidwr r &;dIVD.WWftd HmaWPlft c ueUararauefj%mdns r ComdMtion
MSS 74 mv.10/0304
w �
Q�
0 UL 2 6' 20'16 a.•� t
BY-
zo
_ -- --
Au,
� �-. R • • • • • • • • •
e • ee• •e• ••• • • • • e
•
• •e• • ••e
• • • • • • •
•• • • •• • • • •
.0�C.Lta.F A.�.•.s s s e
• • • • • • • • • •
• •• •• • • • •• ••
••• • • • ••• • •
• �R`' '1
Leak o: Descrtpoon of Include Accurate Measurements in
Give detaffsahwA
boraa nd,w bMap(a"amoa Waft tar
vg
• •
• • o so**
• • •
H e used to tr. s a r r•• •
Cott/DmmR Ipmmn Test Dam. Presmne7est PreasureT Duretlon:
-00-11
RehitatePresawaTast Date Prwmrr� Dmatlon: AssadatadLeak9: •
RgmOW .TbnKnmft Date; •• s • ••
Remaaey •••s • 90-
DM.,
•DM., "/ %Gas %Gas •
Date: %Gas DY: IOU= %Gas • • • • • ••
Sketch Area(Gmw fegketchIs!< • s• •••
• e o • s
:N': •
•s •
TECO
O Inside 0 Outside
MeW No: RH 89669
X=Denotes estimated leak location o=Denotes test locations
i
tternrdsat�: � .
G"MIMMRaPair 0 No ❑ vm A dWhWftsed: CPOsrdC•mAtett:
U9� Dateo40amatnantRapak v�wNo CP my
yes arNo
NIaDPested ev-&bDaPe
Bledm4cal Comector FAM Date
ARed:antml Stab Nin Bated odw os
A' Dari Marta�ewar Pa Number LatMmsbe t
YaazMMmfwtwo* ea but OtherA
Fftft Malarial stave ❑ cwvasb allan @raga Unbaem Other
FRt 9e�vics w bbbtTea Te Tee TrautoTon Fdttkig Riser
tGOOM ordomm Ab=Gm=dwedl=Cmwtd hatdearoubme
M*+do•Maln M&bft4endos & ta9andte mewset
H wLealtowurred Lea&edthrwrgbSeal Levtmdthm Wh2!ft 10 PUBW out
Flaft fta Faf$um Cab
❑ D~AWA ❑ Dr SSW'1
❑ ❑ Pa,4,tm,,W 13 me
4m.
pbftp4marRw
RasitaPl�Spoea o ❑� ❑ D` , 6so8 ❑ 1eMak� ❑
hundacturer Dm°naaM
ubx
❑ D~AWAAAA O ceft ❑ K ❑ u,.,, 13 UT&M
MO
WoThWARM ftbMd tomo s:O11 D8
B
Mee dafbatailaUwtlwwafsov FOmtecOm FWknfn PaFHaaa PAWS Rwtoa
❑ openTrarmh❑ sand❑ Pim❑ Trmmmm❑ m ❑ soD 0 unmown
O Pieria O Lon O f0bg O
an❑ SeWoFasn C3 tbwnPmal tR
13 thdaa KOO)❑ ONO O t ❑ Fl O
O bmartd 13 Raw(ComO ❑ H=FRUdY ❑ Psn❑ Theamt
Load4ta
❑ JwdTrena ❑ Fbw"F8 ❑ eebeasbn $
❑ saddb r Wm❑ ahead
❑ uwwm"❑ oRmr 13 Maim ❑ Cn=Fudm❑ MMBWnEnw
other Previous
Po.424 rev.10(09/14
IN
.iVo
` M,..,w .._�,., is
r y a r r��'�' 'mow• -��'r• i
r��d`t r.r r r..:r.. •r 1..�'r.,•��r SID A
x
VV E - ��
Imo' NE. 108th STREET
SCALE: 1"=40'
a � �
I
S"
_ LW.
PF
FIAT.LANE
SURFACE SAW CUT ASPHALT
SURFACE REPLAtWImtT "�`""- !: it _ - ,.• �—••.'•'rte ` �'� -
prPlcAl) _ ID A , ,, • ..�.-r.. -%.•r r�.�- y�. . 4i v
I Vx�'r i•°eAREPIACEYENBASI
M,
K9 d
(EM MAIERIAQ I"@ ,
Ao
10 DH Sim 16a
O
a.
I`p
r
_ t.
,T
IK
I ". #150tk
RESTORATION OF ROAD CUT 7 —
I _ •� ,
FOR UTILITY CROSSING i - �` ! ° '" I pp • `
-,. -4� '� d,;g`.I r �,. ' h. i� t A f s••••• • i
h
r
" I
7!-
, 4
,� �� _ ,�R. 1, � ,�"' �: i a a. 1 L r `"S�� r '�„�T.a ,� - `�- '� " a,I,.'a - r� - I: la •• ••� • •t•••
EXIST. NEW 3/ate PLASTI �` _ a �° ' +� d ,, a w = � q ••
GAS SERVICE ALREADY coG _ �? . y "" �� ` e•,�.
' �•..•:_
UNDERGROUND a 1 ra 1 , , t# • • ••••
_.
>a` 1';170' " it'dx t ,• _
•
�:.r. rr' .ir' • �ClS �' ��4P.,n,a �' �r °�;.�. w �' '° i' j'is +� � � m,"` •' • � � •
a ' o - a a �' ` ` x� t' • '•
FINAL RESTORATI D °r 1 � }s: ,.' `,..,. a,.F parr a'�k ��{- � ,�g.a ee.- ` '+�i � � >�� • • a•••i• • ••
SHOULD COMPLY BY THET. 2" CS GM � `if _- ' t '" • , • -• o
� a r. x^ " •• • • A ��
z MIAMI SHORES VILLAGE � - _:;; . . • •'.�`•
r
6" STANDARD ,�,< - -_ .: �—•r ,y�, •• 9
f 1�
��— wAl
ids*
40 ' S
p e
Y_ ds, r 4 w
13
<ur <
GAS MAIN �-..�
�wr � rmmm�ie�r i.wu
.•�• i� `. 1 i - .� - a
SOD RESTORATION DETAIL F � ' ,a�
SCALE NOT To SCALE "
ST. 3/a" STL. OLD GAS SERV. 1 r r k
THE NEW GAS SERV. UNE
WAS TIE-IN TO THE EX' RETIRED & WAS CUT & CAP AT GAS '
MAW DUE TO EMERGENCY GAS LEACK
GAS MAIN R PI 4 CF 71 IF
OLD SERVICE IN DUE TO & CORROSION AND REPLACED W1TH A
A GAS LEACK & BAD CONDITION NEW SERVICE BY TECO GAS COMPANY �
X co
8�
F 3s
rng
n Z
20'
GRD.
-------------------- --------
4 NTALLED �-PE: PLAS71C 4
LEGEND GENERAL NOTES
36'M►N, TO BE DIRECTIONAL BORE
19 CENTER UNE 1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE O
Ip MONUMENT UNE THICKNESS OF THE BASE, MIN. 6' AND MAX. 18' "
1 1 ALL EXISTING UTILITIES SHOWN ONR/W RIGHT OF WAY 2. BASE MATERIAL SHALL BE PLACED IN 6' MAX. (LOOSE MEASUREMENT) rj
THESE PLANS ARE TO BE LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 887,OF
CONSIDERED APPROXIMATE & P/L PROPERTY UNE MAX. DENSITY PER AASHTO T-180
3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED
IX 2. CS GAS SHOULD BE VERIFIED BY THE E.O.P. EDGE OF PAVEMENT 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE
CONTRACTOR PRIOR TO THE I. TAPPING TEE MATERIAL(1.5' MIN. THICKNESS)
START OF WORK OPERATIONS. E.F.V. EXCESS FLOW VALVE 5• BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE
SVC SERVICE UNE CONTENT OF 70%(MFOR LOCAL STREETS)
( 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING LIMUMES
NO.OF SHEM
—4 1PROFILE CROSSING AN ALLEY SCALE: H NTS. V 1:5' —4 SHM NO.. 1
Drawing File: G:\Documents\SERVICE REPLACED 2016\NE 108 ST. 150, MIAMI SHORES, FL\150 NE 108 STMIAMI SHORES, FLdwg 07/25/2016
c
N o r<
LL r`
No
SIDEWALK
W rE E '_ - - - - MoD
s
s
NE. 108th STREET _ ---- - 0
CQ
SCALE: 1"=40'
as �
FILL LANE -
SURFACE REPLACEMENT _ w
rzD
SURFACE SAW WT ASPHALT
(TYPICAL) SIDEWALK_ - - -- - -_
---� ¢
- - - - ---- - - - - - - - RIW
ASE
REPLACEMENT
NEW MATERIAL) 1.5' DITCH WIDTH ts' I ,.... - N Pd4' W ZO
I ' darn
I J I
E-
12" w
12" 12' ED
I y W a
150 I "` �3 • o
#
m w �,
o .�L . i .•. w
z �
RESTORATION OF ROAD CUT I — •
FOR UTILITY CROSSING
0_
EXIST. NEW 3/4" PLASTIC\ L1.1 e L o ",' `••'� • •
GAS SERVICE ALREADY I •�
r 1 "••••, '•' '
UNDERGROUND ' �••.,' '�•�• "'••�
I y • le•
FINAL KLSIUKAII( . �•••i• coo 'La'P o•
SHOULD COMPLY BY THE I SEXIST. 2" CS. GM. _ ••• '•; ••.•• a •
z MIAMI SHORES VILLAGE I - --� _ / _ _BI-W- __ - - — _ _ — _ • . qa • rn ,
g" STANDARC
_ «•
u LO
M GAS MAIN — - - — - -— ALLEY WAY _ _ -- ti
SOD RESTORATION DETAIL
-
SCALE: NOT TO SCALE SIL ULU
1
THE NEW GAS SERV. LINE
WAS TIE-IN TO THE EX. RETIRED & WAS CUT & CAP AT GASB` * (� 3
GAS MAIN TO REPLACE THE MAIN DUE TO EMERGENCY GAS LEACK
OLD SERVICE IN DUE TO & CORROSION AND REPLACED WITH A
A GAS LEACK & BAD CONDITION NEW SERVICE BY TECO GAS COMPANY w n
X m
3i Q
rn f
t`
I�Z
20'
GRD.
--------------------LL--------
4 NTA Svr '114" PE. PLASTIC 4 LEGEND GENERAL NOTES
36" MIN. TO BE DIREC77ONAL BORE z
CENTER LINE z
1. REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE 2 q
_ I ALL EX;STING UTILITIES SHOWN ON M MONUMENT LINE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18"
RAW RIGHT OF WAY 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT)
GASTHESE PLANS ARE TO BE LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF
CONSIDERED APPROXIMATE & P/L PROPERTY LINE MAX. DENSITY PER AASHTO T-180
3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED
0 EX.2 CS GAS ANr 0 SHOULD BE VERIFIED BY THE E.O.P. EDGE OF PAVEMENT 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE
CONTRACTOR PRIOR TO THE T.T. TAPPING TEE MATERIAL (1.5- MIN. THICKNESS)
START OF WORK OPERATIONS. E.F.V. EXCESS FLOW VALVE 5. BASE MATERIAL SHALL HAVE A MIN. LBR. OF 100 AND A MIN. CARBONATE
SVC SERVICE LINE CONTENT OF 70% (60% FOR LOCAL STREETS) c
6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES Z
NO. OF SHIMTS:l
-4 1PROFILE CROSSING AN ALLEY SCALE: H NTS. V 1:5' -4 SHEET NO.: 1
Drawing File: G:\Documents\SERVICE REPLACED 2016\NE 108 ST. 150, MIAMI SHORES, FL\150 NE 108 ST.MIAMI SHORES, FL.dwg 07/25/2016