PW-11-1608Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 163970
Scheduled Inspection Date: April 11, 2012
Inspector: Hernandez, Rafael
Owner: POLANCO, DEYSI
Job Address: 1183 NE 91 Terrace
Miami Shores, FL 33138-
0-1 - (73
Permit Number: PW -8 -11 -1608
Project: <NONE>
Contractor: MIAMI DADE WATER & SEWER DEPT
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number
Parcel Number 1132050010200
Phone: (786)256 -5200
Building Department Comments
INSTALL 1 INCH SINGLE WATER SERIVCE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
April 10, 2012
For Inspections please call: (305)762 -4949
Page 7 of 25
1
I
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
Parcel Number
Applicant
1183 NE 91 Terrace
Miami Shores, FL 33138-
1132050010200
Block: Lot:
DEYSI POLANCO
Owner Information
Address
Phone
CeII
DEYSI POLANCO
1183 NE 91 Terrace
MIAMI SHORES FL 33138-
Contractor(s) Phone CeII Phone
MIAMI DADE WATER & SEWER DEPT (786)256 -5200
Valuation:
Total Sq Feet:
$ 1,200.00
18
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.00
$2.00
$0.40
$100.00
$3.00
$1.60
$110.20
Pay Date Pay Ty e Amt Paid Amt Due
Invoice # PW -8 -11 -41901
08/31/2011 Credit Card $ 110.20 $ 0.00
Available Inspections:
Inspection Type:
Final
Excavation
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 accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 31, 2011
Date
August 31, 2011 1
Miami. Shores Viltage
'u�lic Works a
t blic. Work
Pe mit ApOokAtiop
F'BC 2004
Nvetivivx Pomp wane
°tows Name ( `ee T{tetulder}
• s AddieSs
City
To essee 1
t Znd Avenue, Mi i t 8, f1
Tel: posy 7951204 Fax 030 156 ;8972
?DECEIVED
AUG 312011
• r ddr (where work t
City Woe
sus
YES
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• t{tai Fees, ... Feennfeei
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image Leaders Address
City State
pppiioatkd- hetet MadeiO tin al permit to do the wr#ctc: and ihstallatiorttat lotheated, lataglygad tl M
i
cormrlened prier to the issuance of a petit arid that ati wmk lee perforated to meet the stani Ards of alt re teit l in
this luriscllebori. tunde understaritthat a separate_ prima must be secured for ELEC RlC WORK PL INkSIGN WELLS, POOLS,
FURNApf. , BOLLERR, HEATERS, TANKS and AIR CONDITIONERS, ETC .t ;
OWNER mDAVrTYIt:orwthat at the ' felegoing tnfarriratipn. le aevuratd arat tha.aut' ` ;bed i* demPliel***(0114*Ibeble
taws r dad
uwARN0GiO€ws ER Y w FAILURETO RECORD ANO7icE OF commemEENtT wsu i iouRpAY iR
1
FOR iMPRovEm t ra i e3Pt ttal f ,U YOil INTEND TO OBTAIN Oat/w w UL l I THAI ORAN
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;1rf flaaftftm thata copy Other norm oi commencement and combwiloition :�` inectiose to *head fo penal
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alaPeefkal,wflath Odouf Maya afterthattatt.00,00aaff haesuert h, tberibartace Of raerit vested no ar
appnavettiold a reingsedlortfrms will be chatsed
Si$natUre SteritUre
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whOta pejaanally te> i tie me amity has .. _ Who: fsfentonatirknow to me ottas. produced
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NOTARY tom=
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APFIXATtON AFPAtOVED Et .
11t17r
as tdeatiTtatfortand wbo did take meek
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MiaMwaDE)
COUNTY
Water and Sewer
P. 0. Box 330316 a 3575 S. LeJeune Road
Miami, Florida 33233 -0316
T 305 - 665 -7471
miamidade.gov
August 29, 2011
Miami Shores Village
Building Department
c/o Mr. Norman Bruhn
Building Official /Director
10050 NE 2 Avenue
Miami Shores, FL 33138 -2382
Re: Water Service Installation for:
1183 NE 91 TERR
AFA # 231 ER # 16484
Dear Mr. Bruhn:
Transmitted herewith for your approval and permit is one (1) set of the
permit application and two (2) sets of the water service installation
referenced above. Upon approval and issuance of the permit, it is
requested that you return to us one copy of the approved sketch and
the original permit.
If your approval and issuance of the permit has special restoration
requirements, we will need to notify the customer of the additional
charges involved with the installation. Please inform us if there will be
special restoration requirements for this permit request.
Should you have any questions regarding this matter, please advise.
Sincerely,
etamar
Permit Unit Supervisor
New Customer Division
Office: 786- 268 -5259
ARETA01@miamidade.gov
M I A M I•DADE)
r
C&NTY-
Water and Sewer
P. 0. Box 330316 • 3575 S. LeJeune Road
Miami, Florida 33233 -0316
T 305 - 665 -7471
miamidade.gov
August 29, 2011
Miami Shores Village
Building Department
c/o Mr. Norman Bruhn
Building Official /Director
10050 NE 2 Avenue
Miami Shores, FL 33138 -2382
Re: Water Service Installation for:
1183 NE 91 TERR
AFA # 106 ER # 16495
Dear Mr. Bruhn:
Transmitted herewith for your approval and permit is one (1) set of the
permit application and two (2) sets of the water service installation
referenced above. Upon approval and issuance of the permit, it is
requested that you return to us one copy of the approved sketch and
the original permit.
If your approval and issuance of the permit has special restoration
requirements, we will need to notify the customer of the additional
charges involved with the installation. Please inform us if there will be
special restoration requirements for this permit request.
Should you have any questions regarding this matter, please advise.
Sincerely,
Retamar
Permit Unit Supervisor
New Customer Division
Office: 786- 268 -5259
ARETA01@miamidade.gov
VILLAGE OF MIAMI SHORES
MIAMI -DADE COUNTY
SEC. 5 -53-42
25'
80' ±
SCALE: N.T.S.
W
re
BAYSHORE
LU
L- -1
25'
N.E.
91
7.1'
TERRACE
EXISTING 4" C.I.
WATER MAIN
AFA -231 ER -16484
RM/
AFA -106 ER -16495
NEW 1 " SINGLE SERVICE I I RETIRE EXISTING
SET BOX AND SPACER. n 3/4° SERVICE AT
LOCATE AT WEST
PROPERTY LINE
SAME LOCATION
GENERAL NOTES
1.48 HOURS BEFORE DIGGING CALL SUNSHINE
STATE ONE CALL AT 1- 800 - 432 -4770
2. LANE CLOSURES PER F.D.O.T. DESIGN
STANDARD INDEX # 605.
3. PAVEMENT RESTORATION PER M.D.C.P. W.M. R -21.1.
4. SIDEWALK RESTORATION PER M.D.C.P. W.M. R -13.1
5. MAINTAIN MIN. 30" COVER ON ALL SERVICE LINES.
6. DO NOT SET METER(S) AT THIS TIME.
DRAWN: H.B. 1 DATE: 8/16/2011 ICKD :," A. R.
NEW WATER SERVICE AND
EXISTING SERVICE RETIREMENT
AT
1183 N.E. 91 TERRACE
AFA -231 ER -16484
AFA -106 ER -16495
MIAMI - DADE WATER AND SEWER DEPARTMENT
22
23
j
24
/ 1183,-
25
26
4
25'
80' ±
SCALE: N.T.S.
W
re
BAYSHORE
LU
L- -1
25'
N.E.
91
7.1'
TERRACE
EXISTING 4" C.I.
WATER MAIN
AFA -231 ER -16484
RM/
AFA -106 ER -16495
NEW 1 " SINGLE SERVICE I I RETIRE EXISTING
SET BOX AND SPACER. n 3/4° SERVICE AT
LOCATE AT WEST
PROPERTY LINE
SAME LOCATION
GENERAL NOTES
1.48 HOURS BEFORE DIGGING CALL SUNSHINE
STATE ONE CALL AT 1- 800 - 432 -4770
2. LANE CLOSURES PER F.D.O.T. DESIGN
STANDARD INDEX # 605.
3. PAVEMENT RESTORATION PER M.D.C.P. W.M. R -21.1.
4. SIDEWALK RESTORATION PER M.D.C.P. W.M. R -13.1
5. MAINTAIN MIN. 30" COVER ON ALL SERVICE LINES.
6. DO NOT SET METER(S) AT THIS TIME.
DRAWN: H.B. 1 DATE: 8/16/2011 ICKD :," A. R.
NEW WATER SERVICE AND
EXISTING SERVICE RETIREMENT
AT
1183 N.E. 91 TERRACE
AFA -231 ER -16484
AFA -106 ER -16495
MIAMI - DADE WATER AND SEWER DEPARTMENT
PUBLIC WORKS DEPARTMENT
MIAMI -DADE COUNTY
Work Information Form
(To be completed by all agencies planning to perform construction on Miami -Ddade County road rights -of -way).
1. Have the roads, which are impacted by the proposed work recently been paved or surfaced? ❑ Yes LlNo
2. Briefly state type of construction to be performed and the location boundaries of the work:
NEW 1" DOMESTIC SERVICE FOR: 1183 N.E. 91 TERRACE, TO BE INSTALLED AT WEST
PROPERTY LINE.
3. Will this construction affect, in any way, normal traffic flow? 12 Yes —❑ No
4. Will work be started within 15 days of permit issuance? ❑ Yes ES4o
5. If no, state estimated starting date WITHIN 30 DAYS ±
6. Will work continue on a 24 hour basis until normal traffic is resumed? les DNo
7. Please provide an estimate of construction time for which traffic flow will be affected.
(1- WORKING DAY)
8. Provide the number and direction of lanes affected by construction.
North South East West 1
9. Does construction work pass through a signalized intersection or mid -block pedestrian signal?
❑ Yes f2(No (If yes, see Special Provisions below).
10. Does trench or excavation fall within the paved roadway? CS Yes ❑ No
11. Will work damage existing sidewalk, curbs and gutters? 0 Yes E54o
12. Give dimensions (from edge of pavement) showing cut or trenching CUT PAVEMENT
APPROXIMATELY 2 TO 3 FT. FROM EDGE OF PAVEMENT ON WESTBOUND LANE
13. List name and telephone number of person to contact if further information is needed
ALEX RETAMAR PERMIT UNIT SUPERVISOR
786 -268 -5259
14. Please provide e-mail address. aretaOl@rniamidade.gov
SPECIAL PROVISIONS - SIGNALIZATION IN CONSTRUCTION AREA
Any construction work which affects the operation and/or maintenance of a signalization (signalized intersection, mid - block, flashing
signal, flashing sign, etc.), shall require the contractor to accept responsibility for the operation and maintenance of the signalization
from the date and time that work begins until such time as the work is complete, the signalization is returned to normal operation, and
inspectors from the Public Works Department have re- accepted it for operation and maintenance. Between the start and end dates, the
contractor shall employ the services of an officially approved signalization subcontractor who will provide 24 -hour on -call maintenance
on all signalization and signalization related equipment in complete accordance with the current version of the "Miami -Dade County
Special Provis' or Traffic Signal Construction and Maintenance."
MIAMI -DADE WATER & SEWER 786 - 268 -5259
Si.natu
Company Telephone No.
THIS FORM MUST ACCOMPANY PERMIT APPLICATION
.SYMBOLS
Work Area
Sign With 19" x la" fB..)
Orange Flog And Type Light
Manneking gavial! (Sec Index No. &OO)
Work done Sign
Mower
Lane Identrrfcodon +• Drreohon of recent.
GENERAL NOTES
9, The FLAMER legend elgn map be substituted tar the
symbol stone
D. The maslfnum spacing tretwarnn devices shot no
greater than 2H.'
7, For penerelTC2 requirements. end eddltfonalinformaWen,
refer le Was Ha, EOO.
8. The two channetl:fng devfeos dtrectty in front and
dtractfp of the end or the work prey, may be omitted
provided in the de 1'er
r ng fehh7g, oset♦loline, or urea rab 104' pec rnv.
Wart opar'a °ns m7ntt shoflbe coed is one troY.etforte,
1.
!caving the apposing open to traffic.
apposing
Z. When vehicles in er parking 'e-ona block the line of
sight fa rcz stpns or when TC8' sign on a
normofpedestlfan waffneor, the stone shoflbe flasf
mounfad and located n accordance with index ,Ns.. J73 2.
3, Jf worlt area is confined to on outside auxiliary fane,
the world area Ap 11WQAfc ,WEAK aeons. naggers ado n signs
replaced au fr by
raqu+l'eaL
s. naggers shaker In sight or cooed other or In direct
communlcetion of Oe [(tear'
DR THEIR rgld I l el 140.4 eiviwRVre .m Le, ,. e.
PAVSMEMT RE[AfIRJT/o THE CLOTURE 17F ONE
oD � DMAvYn ao 1WNs FN rEtp=CiD
FOR A PERIOD OF MORE THAN DO MINUTES.
CONDITIONS
WHERE ANY VEHICLE, Ef7WPMENT. WORKERS
OR THEIR ACTIVITIES ENCROACH ON THE
PAVEMENT REWOUND THE CLOSURE DF ONE
TRAFFIC LANE, FOR WORK AREAS 20D' DFi
MORE DOWNSTREAM 4
PERIOD THAN M NuTEES
DURATION NOTES
J. R° Ing den AWN:, A1917 may be mnfted ft allot the
of Work operations. ore Oa m111uiar or f►ss.
bJ Sp�eed Is fS mph or lass,
sJ 7Vs+ efghi ebefreallans is Yeteelee approaching the
world erre far a distance of SOO feet.
dJ Vahfflea m the Work ores have high - Intensity,
rotating, Rushing, lt g,e %tracey roadway 6 1 fIng
e) VahJma and opmpfee'fly f 1h
cansfderert.
TWO -LANE 7W0-WAY, WORK-NEAR INTERSECTION
• VILLAGE OF MIAMI SHORES
MIAMI-DADE COUNTY
SEC. 5-53-42
25'
25'
N.E.
.• • . • . • . • . • . • . • .•••.• •
91
-
7.1'
TERRACE
EXISTING 4" C.I.
WATER MAIN
AFA-231 ER-16484
NEW 1" SINGLE SERVICE
SET BOX AND SPACER.
RNV
80'±
AFA-106 ER-16495
LOCATE AT WEST
PROPERTY LINE
RETIRE EXISTING
3/4" SERVICE AT
SAME LOCATION
SCALE: N.T.S.
w
ce
BAYSHORE
(J
GENERAL NOTES
1.48 HOURS BEFORE DIGGING CALL SUNSHINE
STATE ONE CALL AT 1-800-432-4770
2. LANE CLOSURES PER F.D.O.T. DESIGN
STANDARD INDEX # 605.
3. PAVEMENT RESTORATION PER M.D.C.P. W.M. R-21.1.
4. SIDEWALK RESTORATION PER M.D.C.P. W.M. R-13.1
5. MAINTAIN MIN. 30" COVER ON ALL SERVICE LINES.
6. DO NOT SET METER(S) AT THIS TIME.
DRAWN: H.B. DATE: 8/16/2011 CKD:
NEW WATER SERVICE AND
EXISTING SERVICE RETIREMENT
AT
1183 N.E. 91 TERRACE
A. R.
AFA-231 ER-16484
AFA-106 ER-16495
MIAMI - DADE WATER AND SEWER DEPARTMENT
22
23
2
/1183 4
W/A
25
26
4
DAM
25'
25'
N.E.
.• • . • . • . • . • . • . • .•••.• •
91
-
7.1'
TERRACE
EXISTING 4" C.I.
WATER MAIN
AFA-231 ER-16484
NEW 1" SINGLE SERVICE
SET BOX AND SPACER.
RNV
80'±
AFA-106 ER-16495
LOCATE AT WEST
PROPERTY LINE
RETIRE EXISTING
3/4" SERVICE AT
SAME LOCATION
SCALE: N.T.S.
w
ce
BAYSHORE
(J
GENERAL NOTES
1.48 HOURS BEFORE DIGGING CALL SUNSHINE
STATE ONE CALL AT 1-800-432-4770
2. LANE CLOSURES PER F.D.O.T. DESIGN
STANDARD INDEX # 605.
3. PAVEMENT RESTORATION PER M.D.C.P. W.M. R-21.1.
4. SIDEWALK RESTORATION PER M.D.C.P. W.M. R-13.1
5. MAINTAIN MIN. 30" COVER ON ALL SERVICE LINES.
6. DO NOT SET METER(S) AT THIS TIME.
DRAWN: H.B. DATE: 8/16/2011 CKD:
NEW WATER SERVICE AND
EXISTING SERVICE RETIREMENT
AT
1183 N.E. 91 TERRACE
A. R.
AFA-231 ER-16484
AFA-106 ER-16495
MIAMI - DADE WATER AND SEWER DEPARTMENT
PUBLIC WORKS DEPARTMENT
MIAMI -DADE COUNTY
Work Information Form
(To be completed by all agencies planning to perform construction on Miami -Ddade County road rights -of -way).
1. Have the roads, which are impacted by the proposed work recently been paved or surfaced? ❑ Yes l'No
2. Briefly state type of construction to be performed and the location boundaries of the work:
NEW 1" DOMESTIC SERVICE FOR: 1183 N.E. 91 TERRACE, TO BE INSTALLED AT WEST
PROPERTY LINE.
3. Will this construction affect, in any way, normal traffic flow? b(es 0 No
4. Will work be started within 15 days of permit issuance? ❑ Yes C�No
5. If no, state estimated starting date WITHIN 30 DAYS
6. Will work continue on a 24 hour basis until normal traffic is resumed? 'es ❑ No
7. Please provide an estimate of construction time for which traffic flow will be affected.
(1- WORKING DAY)
8. Provide the number and direction of lanes affected by construction.
North South East West 1
9. Does construction work pass through a signalized intersection or mid -block pedestrian signal?
❑ Yes 1/No (If yes, see Special Provisions below).
10. Does trench or excavation fall within the paved roadway? r Yes ❑ No
11. Will work damage existing sidewalk, curbs and gutters? ❑ Yes t 4 o
12. Give dimensions (from edge of pavement) showing cut or trenching CUT PAVEMENT
APPROXIMATELY 2 TO 3 FT. FROM EDGE OF PAVEMENT ON WESTBOUND LANE
13. List name and telephone number of person to contact if further information is needed
ALEX RETAMAR
PERMIT UNIT SUPERVISOR 786 -268 -5259
14. Please provide e-mail address. aretaOl@miamidade.gov
SPECIAL PROVISIONS - SIGNALIZATION IN CONSTRUCTION AREA
Any construction work which affects the operation and/or maintenance of a signalization (signalized intersection, mid - block, flashing
signal, flashing sign, etc.), shall require the contractor to accept responsibility for the operation and maintenance of the signalization
from the date and time that work begins until such time as the work is complete, the signallzation is returned to normal operation, and
inspectors from the Public Works Department have re- accepted it for operation and maintenance. Between the start and end dates, the
contractor shall employ the services of an officially approved signalization subcontractor who will provide 24-hour on -call maintenance
on all signalization and signalization related equipment in complete accordance with the current version of the °Miami -Dade County
Special Provis . or Traffic Signal Construction and Maintenance."
MIAMI -DADE WATER & SEWER 786- 268 -5259
Si•natu
Company Telephone No.
THIS FORM MUST ACCOMPANY PERMIT APPLICATION
rLoso Than
200'
Ind
SYMBOLS
Work Areo
Sign l7 log , And 16Type BJ Light With
Channeliaing Oavfao {sae Index No. sow
Work ions Sign
tJ—_ Flogger
Lone Identfnacffon ''" niroofton or Traftrc
30'
200'
More Thon
200'
GENERAL
1. Work operatlans shoUbv confined to one iraY.011one,
Moving the opposlnp trove None open to trvine.
2. When vehrctes IPi a pork/hp sany block the !ens of
sight to r'7 signs or when MT stens onor000h, on a
nOrinotpedesttian 0 UtT' y, fha stony shaft Oa frost
mounted and loomfad in aernrdanee Oh Index do, J7302.
J, lI work ore° is eonTned to On outside ausUlary tone,
the work araWO gWORN AHEAD signs. Playgoers ore not signs
replaced by
regwfad.
4. Froggors shvUbe in sight of loch other or to direct
communication of oU moos,
NOTES
5, The PLACCER Alpena sign mop be substituted tor the
symbol sign.
6. The mo2HTlum spOOinp trains= devices sheaths no
prattler than 23.`
7, For paneroiTCZ regWFamants and nddttlanotinformaNan,
refer to Index No, Each
e, The two ohannallrtno dovfoos *wetly In front and
dlt'aclfy of this mid of fha work oreo may be omitted
proridad reticles roae ftao r
rotating, floshferer hsoper
Dow
OR THEIR Al+' I f YJ t +o.o efrwr VAVr, f
PAYEMEr1T REOLIIRJND THE OLOSURE DF ONE
00�AN rE 'r2DDm1 $R � AREAS
MR A PERIOD OP MORE THAN so MINUTES.
CtINNITIDNS
WHERE' ANT OR V A'TIYJ7!£S £NCRO CND WORKERS
OR s
PAVEMENT RESUMING THE CLDSURS SF ME
TRAMS LANE FOR WORK ,AREAS 20s' DR
FORDOWNSTREAM
PER>DO MORE WAN T SO MINUTES.
•
•
DURATION NOTES
ROAD WORK MVP are ,i t be omitted ff allot the
Wafting
of Warn oForatlans or BD mfi++'tmo or loos.
bJ Spore /s 45 mph or /ass, p
cJ Norhgoreabforuo ldtsiancevehicles' o 00 approaching
fovi. the
dJ Valifclos In the work oxen hove high— lntenstty,
rblotfl2, RalMng, aselllatvxroa po
tfrg.
aJ Volume and campfOxfly fiih roadway c b
canstdered.
nJa
TWO-LANE TW'O'WAY, WORK NEAR INTERSECTION
st,.sl Se.
est