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PL-12-418Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170945 Permit Number: PL- 3- 12-418 Scheduled Inspection Date: May 04, 2012 Inspector: Hernandez, Rafael Owner: LLC, DEVINELLA Job Address: 9165 PARK Drive Miami Shores, FL Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)785 -8990 Parcel Number 1132060141350 Phone: (305)957 -3857 Building Department Comments INSTALL 220' OF 11/4" PLASTIC NATURAL GAS SERVICE TO SERVE 9165 PARK DRIVE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 04, 2012 For Inspections please call: (305)762-4949 Page 4 of 12 Miami Shores Village Building' Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 7614949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): I' I v : 0e, ZZ C Address: 4, -1 jrra IR0 6Y: o e«< Permit No. p I I .— 41 u Master Permit No. Phone#:( &': %CYO'. Z‘ 5- City: M e, �,, �, �. ,r° k State: Zip: 33/V/ Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: $ S .. County: Miami Dade Zip: ?,- .?./JP Folio/Parcel #: - o/ «- /3 570 Is the Building Historically Designated: Yes City: Miami Shores CONTRACTOR Company Name: Address: /fO ,1 NO -r5co ,4,-) /. Flood Zone: Phone#: 63-0 g577- c 75 V City: .4 J Ae_ J„tie State: Qualifier Name: �,e g Le--Z C e_ State Certification or Registration #: 6-- /C "1.2P Contact Phone#: 1( ) 9',5-3— 5 / Email Address: DESIGNER Architect/Engineer: Zip: . 3C)9 Phone#:( ?C 9 ys" 0/7/ /�) ®Certificate of Competency #: Z Phone#: Square/Linear Footage of Work: lNew URepair/Replace Value of Work for this Permit: $ Type of Work: °Address Description of Work: °Alteration .220 °Demolition ** ******* *aepe *xa ****e** ►s * ***+ * ***awwaF **************************************1P***** Submittal Fee $ Permit Fee $ / Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $� �i' Rending Company's Name (if applicable) Bonding Company's Address City State Z.ip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 VGA .rte J Owner or Agent The foregoing instrument was acknowledged before me this day of _mcbdeL, 20k2_, by - feSu..s VS t+ s wh is perso kno :'.n to me or who has produced As identification and who did take an oath. NOTAR , PU LIC: Print: My Commission Expires: * * ******* r8** ** * ** ** rB* APPROVED BY HUBERTNUNEZ MY COMMISSION # DD 894714 EXPIRES: September 11, 2013 Bonded Thru Notary Public Underwriters Signature Contractor The foregoing instrument was acknowledged before me this -5 day of 'r, 2044 , 20 /e,.by -ES« -s VC- C9 A S wh is personallykno me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print /' - My *** * * ******* Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) rai�t:.pI ,II 1.# 04. .. 0 Commisaton # DD 930875 Expires October 6, 2013 *rA*9rIDrS:B*** Zoning Clerk "41 ,"._BUSIrsiaCs?.. r7FITIF147.". sstire'iPEOPLES GAS ssi ;Zs, ^o^ VEGi-N JEGLIZ' Is certified under the erovizIm3 c! , QUIALiFVING "IT:ADE:CS) 0014 F-tia TRANS DiSTR1 Ac R°® CERTIFICATE OF LIABILITY INSURANCE DATE (M /DO91m 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT E' (NC No. Ext): 800476 -2211 FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Associated Electric & Gas Ins. Svcs. LIABILI Y COMMERCIAL GENERAL LIABILITY INSURED Peoples Gas System TECO Energy, Inc. P.O. Box 111 Tampa, FL 33601 INSURER B :Liberty Insurance Corp. X0521AIA11 Self- Insured Retention $1,000,000 INSURER c Zurich American Insurance Company 16535 INSURER D : $ 1,000,000 INSURER E : $ INSURER F: X I CLAIMS -MADE - OCCUR COVERAGES CERTIFICATE NUMBER:EE74Y5HU 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ASR VFW POLICY NUMBER POLICY EFF @AM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL — LIABILI Y COMMERCIAL GENERAL LIABILITY X0521AIA11 Self- Insured Retention $1,000,000 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ X I CLAIMS -MADE - OCCUR MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: —I POLICY n JECT LOC PRODUCTS - COMP /OP AGG $ $ A AUTOMOBILE — LIABILITY ANY AUTO OWNED � AUTOS — _ SCHEDULED ED AUTOS X0521AIA11 Self- Insured Retention $250,000 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT e 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY GE ( accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X0521AIA11 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED 1 I RETENTION $ $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILTIY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? - (Mandatory in NH) Ryes describe under DESCRIPTION OF OPERATIONS below N / A EWS931859700 X0521 AIA11 07/01/2011 07/01/2012 WC STATU OTH- X I TORY LIMITS 1°N" ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B EXCESS WC Excess Workers' Compensation EW564N004918121 07/01/2011 07/01/2012 Each Accident or Each Employee for Disease $ $ 35,000,000 $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Excess Liability policy provides insurance in excess of Peoples Gas System's Self- Insured Retention as stated above. WC Statutory Limit is excess of $35,000,000 (Insured by Liberty Insurance Corporation) CERTIFICATE HOLDER City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 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. AUTHORIZED REPRESENTATIVE Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD EXIST. 3" CS 13' N OF C/L TIE IN SVC TO GAS MAIN WITH T.T R/W LEGEND: R/W - RIGHT OF WAY P/L - PROPERTY LINE C/L - CENTERLINE E.O.P. - EDGE OF PAVEMENT E.O.B. - EDGE OF BUILDING T.T. - TAPPING TEE E.F.V. - EXCESS FLOW VALVE SVC - SERVICE LINE GENERAL NOTES: R/W 1. REPLACE BASE MATERIAL OVER DITCH SHALE BE TWICE THE THICKNESS OF THE BASE, MIN. 8" AND MAX. 18' 2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF 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 5. BASE MATERIAL SHALL HAVE A MIN. LBR OF 100 AND A MIN. CARBONATE CONTENT OF 70% (60% FOR LOCAL STREETS) ADDITIONAL NOTES: PROP. 220' OF 1 1/4" PLASTIC GAS SVC TO BE DIRECTIONAL BORED PARK DR 0 25 Feet 50 MEMMINIMMEMMEMMEMEMEMMUMO mommammimmumummommEmmamm MINOMMIMMEMBIIMEZMMEMIMMUMM MEMEMINIMEMPENEMMEOMMEEMM • i W ER 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES 7. MAINTAIN A MINIMUM HORIZANTAL SEPARATION OF 5' FROM ANY CITY UTIUTIES 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" OF ANY CITY UTIUTIES SCALE: 1"= 20' HORIZONTAL 1 "= 5' VERTICAL RESTORATION OF ROAD CUT FOR UTIUTY CROSSING I A 1 NW 21t '� FO f LAUDERDALE, "7 —.GL;O FLORIDA 33309 MIMIC OBd- d4H -MOd •=o NS Burner Space See Tate DISTANCE BETWEEN SIGNS Speed Spacing If .) (mph) A B C D 4n or less 270 200 200 100 45 350 350 350 175 50 .500 500 500 250 55 or greater 2640 1040 1000 500 * The ROAD WORK I RILE sign may be used as an alternate to the ROAD WORK AHEAD sign. n 500' beyond the ROAD WORK AHEAD sign or midway between signs whichever is less. BE PREPARED TO STOP sign may be omitted for speeds of 45 NPH Or less. SYMBOLS Wore Area • Sign With LEP a it Mtn.) Orange Flag And Type 0 tight • Channelizing Device (See Index No. 6001 Work Zone Sign Flogger —4 Automated Flapper Assistance Devices (AFADL With Gate ✓ J LOW identification + Direction of Traffic e 250 C 7 Soor ///l / r ■ N Device Spacing - Tangent See Table I Device Spacing -Taper See Table I 41 TABLE I DEVICE SPACING Max. Distance Between Devices Irt.) Speed Cones or Type I or Type II (mph) Markers Barricades or Vertical Pants or Drums Taper Tangent Taper Tangent 25 to 45 20 50 20 50 50 to 70 20 50 20 100 GENERAL NOTES 1. Work operations shall be confined to one traffic lane, leaving the opposite lane open to traffic. 2. Additional one -way control may be effected by the following means: 0. Flap - carrying vehicle; 2. Off iciel vehicle; 3. Pilot vehicles: 4. Traffic signals. When fieggers are the sole means of omrnay control. the fleggers shall be In sight of oath other or in direct communication at all times. 3. The ONE-LANE ROAD signs are to be fully covered and the FLAGGER signs either removed or fully covered when no work is being performed and the highway is open to two -way traffic. 4. When a side road intersects the highway within the TTC cone, additional TTC devices shall he placed in accordance with other applicable TCZ Indexes. S. The two channelizing devices directly in front of the work area and the one clemnelizing device directly at the end of the work area may be omitted provided vehicles in the work area have high - intensity rotating, flashing, oscillating, or strobe lights operating. 6. FN general TCZ requirements end additional information, refer to /tile No. 600. END ROAD WORK DURATION NOTES 1. ROAD WISPS AHEAD and the BE PREPARED TO STOP signs may he omitted if all of the following conditions are snot a. Vlork operations ere 60 mimftes or less. b. Speed limit Is 45 mph or less. c. No sight obstructions to vehicles approaching the work area for a distance equal to the buffer space. 4. Vehicles in the work area have high - intensity, rotating, flashing, oscillating, or strobe lights operating. e. Volume and complexity of the roadway has been considered. BUFFER SPACE Speed (mph) Dist. (ft.) 25 155 30 200 35 250 40 305 45 360 50 425 55 495 60 570 65 645 70 730 When Buffer Space cannot he attained due to geometric constraints. the greatest attainable length shall be used, but not less than 200 ft. CONDITIONS WHERE ANY VEHICLE. EQUIPMENT. WORKERS DR THEIR ACTIVITIES ENCROACH THE AREA BETWEEN THE CENTERLINE AND A LINE 2' OUTSIDE THE EDGE OF TRAVEL WAY. LAST 9EVISION 17/01/09 a DESCRIPTION: FDOT DESIGN STANDARDS FY 2012/2013 TWO - LANE, TWO -WAY, WORK WITHIN THE TRAVEL WAY INDEX NO. 603 . SHEET NO. T