PW-13-208 Miami Shores Village
Public Works Department
10050 N.E.2nd Avenue,Miami Shores,FkwWa 33138
Tel:(305)795.2204 Fax:(305)7563972
Public Works permit No.
Permit Application
FBC 2004
Permit Type: Pubft Works /
Owreefs Name(Fee Simple TiUehokier) Phone
Ow.el.Address e
b
—A4�.., sum t It S State �'L zip �3s3a'
TenarrVLessee Name /lf�.iL Ptmne 8 1#111 .
Job Address(where Owe wont is being done) ss—A AQ.v 1S a p-,L be �/tr. .",!
city Miami Shores vile county Miami!lade Zip 3S'/3s�
Is BuHdkg H Wkaly Designated: YES No ✓
Canirat:Ws Campany Name :: J' Ph..ffi_ eY,W VS-2°0 7 Vt
CantracW&Address S'/b/ /l/ s` ✓s _�/�j�
car A .Csd J,aol , .2, state zip 333g }
Ard*K VEngine&s Nary N appfi-ble) PhOw#-
F Vaiae of Wads For Ods Permta Ibeso®"^ Uraw Footage Of WoW J401
Type of Wank: ❑Addition ❑Att nedon Naw ❑Repaamep— ❑ o—wi.t
Desarbe Wodc —2 e' /
Altr
.........,..+...,.»Fees�....,
SabmNdal Fee s Perm#t Fee t CCF$ CO=
Nary s Teal Fca$ Technology Fee S
Semning S Radar$ Zrmhrg BwW$
Cade F_nfonmnev t$ SlrucWtvl Plant Rertow s
Total Fee Naw Due f 0
(Cmrtinued on opposre side) IV
Bonding Company's Name(if applicable)
Bonding Cc apany's Address WA
City _ _ State Zip
Mortgage Lender's Name(d applicable) NIA
Mortgage Lender's Address
City — State 7ip
Application is hereby made to obtain a permit to do the worts and installations as indicated.I cedffy 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 taws 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 arxwrate 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 conckWo n to this issuance of a Pubkc Works perm wfth an estimated value exceeding$ WOt the applicant must
promise in goad faith that a copy of the notice of comawncernent and cwrsh xfw ken law brodiurre wiffbe dieiivsred to Bee person whose
property is subject to attachment Also,a certified copy of ft rec aided a aft e of cornmencernent must be posted of the joib site iF r ow rust
inspection which occurs seven(7)days after Bme builctng permit is issued In the absence at such posted notice,fire inspection mdiff not be
approved and a reinspecfion fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing Instrument was ad mowledged before me thi& . _--time foregoing instrument was admowledged before me this
day of .20_by day of 20a by J e-3 aS
who is personally known to me or who has produced Who is personally know to me or has produced _.
as Identification and who did take an oath. as kkaMcafion and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sio:
print Print: O'
My Commission Fires:
• ` t1o�dThuTrtyrainbraa� .7019
APPLICATION APPROVED BY: l® r Public Works Director or
his designee.
11/17/2105
Co Tr- iCtEirtg Board
BUSINESS CERTIFICATE OF COMPETENCY
EOPLES GAS SYSTEM INC
VEGA JESUS
F
QUALIFYING TRADE($)
0014 FUEL TRAMS&DISTRI
3eora4piy o4d�•Bamd l 4°-i wutiv,ml�7Fo�$eq�urit�g -�
DATE(MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/29/2012
THIS CERnFICATE 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 BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONTE INSURED,the pollcy(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 I]Gu of such endorsement(s).
PRODUCER CONTACT
MCGRIFF,SEIBELS&WILLIAMS,INC. NAME: I FAX
P.O*Box 10265 T6-2211 (A C,No):
Birmingham,AL 35202 E41AAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:ZurlGh American Insurance mpany 16535
INSURED INSURER B Assoidlated Electric&Gas Ins.Svcs.
Peoples Gas System
TECO Energy,Inc. INSURER C:LM Insurance Corporation 33600
702 North Franklin Street
Tampa,FL 33601 INSURER D:
NSURIERE:
NSURER F: I I
COVERAGES CERTIFICATE NUMBER:YL5N7YFU 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.
ADDLISUBR POLICYEFF POLICY EXP
INSR TYPE OF INSURANCE MBER LlMrrS
LTR INSR WVQ POLICYNU (MMIDDNYYY) (MMIDD/YYYYA
B GENERAL LIABILITY XL5129401P 07/01/2012 07101/2013 EACH OCCURRENCE $ 1,000,000
Self-insured Retention DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY $1,000,000 PREMISES(Ea o=rrence) $ —
-X1 CLAIMS-MADE OCCUR MED EXP(Any one person) _ $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $
—1 POLICYF—]JERCT F-]LOC
B AUTOMOBILE LIABILITY XL5129401P 07/01/2012 07/01/2013 COMBINED SINGLE LIMIT
Self-insured Retention (Ea accident) $ 1,000,000
ANY AUTO $250,000 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON,OWNED PROPEMDAMAGE $
HIRED AUTOS AUTOS (Par., )
1 1 $
B UMBRE LA LIAB OCCUR XL5129401P 07/01/2012 07/01/2013 EACH OCCURRENCE $ 1,000,000
Self-Insured Retention
X EXCESS LIAB Hx CLAIMS-MADE $1,000,000 AGGREGATE $ 1,000,000
DED RETENTION$ $
TATU
LIMIjS I JOTH
A WORKERS COMPENSATION EWS9318593-01* 07/01/2012 07/01/2013 X I 1WRYS ER
B AND EMPLOYERS'LIABILITY YIN XL5129401P
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) NIA E.L.DISEASE-EA EMPLOYEE $ 1,000,000
Ifr nder 1,000,000
Wescribe u
D RIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $
18-122 07101/2012 07/01/2013 Each Accident or Each f—
Excess Workers'Compensation Employee for Disease $ 35,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If 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$35,000,000(insured by Liberty Insurance Corporation)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Miami Shores AUTHORIZED REPRESENTATIVE
10050 NE 2nd Ave
Miami Shores,FL 33138
Page I of 1 @ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
s.
/ BE /0 ROAD
•\ j\�T/�`\"ONE \\�I s"EE°o FA g WORK
..: // exEN�RltEilE AHEAD
AHEAD�!/ PRESENT >
END
ROAD WORk Buffer Space L90' Table 250' C A
Work Area
A g C
� END
ROAD — D Device s acin-Tangent ROAp WORK
WORK %01 '
See Table I
AHEAD / Device Spacing-Taper
t 1NEB ONE LANE — see Table I
■ ERs ROAD BE
AHEAD
PREPARED
TO STOP
DISTANCE BETWEEN SIGNS TABLE I DEVICE SPACING BUFFER SPACE
Speed spacing(ft.) Max.Distance Between Devices(ft.) speed Dist
(mph) A 1 8 1 C 1 D Type I or Type It (mph) (ft.)
40 or less 200 200 200 100 Speed - Cones or Barricades or Vertical 25 155
45 350 350 350 175 (mph) Tubular Markers Petrels or.ems 30 2P0
SO 500 Soo S00 250 Taper Tangent Taper Tangent 35 250
SS or rester 2640 640 1000 Soo
25 Co 45 20 50 20 50 40- 30S
The ROAD WORK 1 MILE sign may be used as 50 to 70 70 50 20 100 45 360
an alternate to the ROAD WORK AHEAD sign. SO 42$
•'SW beyond the ROAD WORK AHEAD sign or GENERAL NOTES DURATION NOTES - 55 405
midway between signs whichever is less. 1.Work operations shelf.be confined to one traffic lone,leaving the opposite lane I.ROAD WORK AHEAD and the BE PREPARED TO STOP signs may 60
570
BE PREPARED TO STOP si n maY be omitted open to traffic. be omitted if all of the following conditions are met: 65 645
0 a.Work operations are 60 minutes or less. 70 730
for speeds of 45 MPH or less. 2.Additional one-way control may be effected by the following means:. b.Speed limit is 45 mph or less..
1.Flag-carrying vehicle; c.No sight obstructions to vehicles approaching the work area When Buffer Space cannot
2.Official vehicle; for a distance equal to the buffer apace. be attained due to geometric
g. A Pilot vehicles; d.Vehicles in the work area have high-intensity,rotating, constraints,the greatest
A£ 4.Traffic signals flashing,oscillating,or strobe lights operating. attainable length shall be
SYMBOLS a.Volume and complexity of the roadway has been considered. used,but not less than 200 ft.
When flegpers are the sale means of one-way control,the flaggors shay be in
Work Area sight of each other or in direct communication at all times.
3.The ONE-LANE ROAD signs are to be fully covered and the FL466ER signs either
%�. Sign With 18'x Is" (Min.) removed or fully covered when no work is being performed and the highway is
Orange Plag And Type B Light open to two-way traffic.
CONDITIONS
■ Channelizing Device(See Index No.600) 4.When a side road intersects the highway within the TTC.zone,additional ITC
Q devices shall be placed in accordance with other applicable TCZ Indexes. WHERE ANY VEHICLE,EQUIPMENT,
Work Zone Sign WORKERS OR THEIR ACTIVITIES
5 S.The two channelizing devices directly in front of the Work area and the one ENCROACH THE AREA BETWEEN
Flagger channalizing device directly at the end of the work area may be omitted provided THE CENTERLINE AND A USE Z
.Automated flapper Assistance Devices vehicles in the work area have high-intensity rotating,flashing,oscillating,or OUTSIDE THE EDGE OF TRAVEL WAY.
'--1 (AFAD),With Gate strobe lights operating.
-Lane Identification+Direction of Traffic 6.For general TCZ requirements and additional information,refer to Index No.600•
iasT $ DescarPTioN: TWO-LANE, TWO-WAY, INDEX srNOEr
REVISION FDOT DESIGN STANaARaS
07101109 FY 201212013 WORK WITHIN THE TRAVEL WAY 603 1
TIE IN SVC TO GAS MAIN
a
J`4 [7 0 is
WITH T.T. / E.F.V. -
0 25 50 (n g
R/W C/L R/W �`r°_e __ ..... LLI a
Feet K • -M..
j r
t tg_�� AT ER r I,
r^ W
f `" )IN..__.�—� �x .. _ Z Vf
77 _C"IZIM4
NG DEPT
_
�. r.. PROP. 30' OF 3/4" PLA _ [)r pT
ALL FEDERAL
GAS SVC TO BE TRENCHE COMPLIANCE WITH
��am):, � M � SUBJECTTn GULAYIC�NS
a COIINN Rl1LES AND RF
{ 3 SPATE AND
A.
i �` N BAYSHOR ` vDR
3% 4
g
J
OU NB U N RT BON
to
�
m EXIST. 2"
PE
'� z -
_ 21' E OF C/L
i
f N
e °s
PE
PRO V4
WA R 2 a
x
St?' 01-29-2013
R/W SCALE: I"= 10' HORIZONTAL
I"= 5' VERTICAL AOV*r-
603
RESTORATION OF ROAD CUT
LEGEND: FOR UTILITY CROSSING /P£V/S/DN.£
nuLm
R/W — RIGHT OF WAY GEENERAL NOTE8s AWMONAL NOTES: SWAM REPLACDMff
P L PROPERTY LINE Std sa )aswT Z•
3
1. REPLACED RASE.MATERIAL OVER DITCH SHALL BE TWICE THE 6. CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION
C/L — CENTERLINE THICKNESS OF THE BASE. MIN. 8" AND MAX. 18" OF EXISTING UTILITIES 2T SCALE
2. BASE MATERIAL SHALL BE PLACED IN 6" MAX. (LOOSE MEASUREMENT) 7. MAINTAIN A MINIMUM HORIZONTAL SEPARATION OF ' "_ j0'
E.O.P. — EDGE OF PAVEMENT LAYER AND EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 98% OF 5' FROM ANY CITY UTILITIES ��'
( ► wiftnai.) i.s' tarcH warm (w) 1.s•
E.O.B. — EDGE OF BUILDING MAX. DENSITY PER AASHTO T-180 8. MAINTAIN A MINIMUM VERTICAL SEPARATION OF 18" •#07
3. ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED FROM ANY CITY UTILITIES
T.T. — TAPPING TEE 4. SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE
E.F.V. — EXCESS FLOW VALVE MATERIAL 1 OF
5. BASE MATERIAL SHALL HAVE A MIN. LBR OF 100 AND A MIN. CARBONATE
SVC — SERVICE LINE CONTENT OF 70% (60% FOR LOCAL STREETS) 12" VAMM 12"