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Home My WebLink AboutHandouts_Regular_Tab 19 and Tab 20_11/14/2013_DDR Architect � y � 4 l�ULE 1488.OD4. F.A.G STATE OF FLORIOA DEPARTNENT OF TRANSPORTATION� 850-040-06 DRAINAGE CONNECTION PERMIT ��AYDESIGN , a+os Page 1 of B To be campleted by DOT Drainage Connectio Permit No. p� �� ' Received By l� " Pr MaiMenance Unit �� State Road No. Work Program Project Np. Sedion No. �� y� Constniction Project No. Milepost �1 • 0 � ' ' ! Station fnstruc#ions for Drain�c e Connection Permit Pursuant to 1486.004(6), F.A.C. "The Drainage Connectlon Permit form serves as the applicatiort. �nce approved by the Department, th� form and supporting documents became the Drainage Connection Permit." The applicant shall submit four completed permit packages with ariginal signatures. Each package shall indude all ° required attachments. All required signed and seaied plans and supporting documentation shatl be submitted on no a larger than {11 ° X 1 T} multipurpose paper, unless larger plar� sheets are requested b�r the reviewer. The package will include the foflowing items. If an item does not appty to your project, indicat� "Not Applicable° or "fWA." Incl�ded Part Title Com leted b. S ial Instructions 1 Permit fnfarmation Sheet A licant 2 Certification by a Licensed �icensed Signed and Sealed Professional Professional 3 Certification licant Si nature 4 Owner's Au#horization of a Owner Signature X Re resentative 5 Affidavit of Ownership o� C3wner Slgnature Controf ar� Statement of Conf uous Interest 6 Permi# General Conditions FDOT 7 Permit S cial Conditions FDOT 8 As-Built CertifiC2tion Licensed Signed and Seated — Submit within 15 Professional working days of cornpletion of construction Attachment L al �escri tion Aitachment Photographs of Existing Conditions Attachment Loc�tion Ma Attachment Gradi Plan Attachment Soil Borin s Licensed Attachment Water Table ! Peroolation Professional Sign�f and Sealed Attachment Caiculations Attachment CD with Electronic Files of all Scanned lmages in pdf format X Submiltal ltems Note: DiFferent Licensed Professior�als may comptete parts of the permit package. For example the Licensed Professional signing and sealing the as-bullt certfficatidn rnay be different from the Licensed Prafessional who signed and sealed the calculations for the permit package. EXCEPTIONS: Activities thaf qualify for an Exception are listed in Rule 14-86, F.A.C. A permit application to the Department is NO7 required. However, ifi you desire verification whether the work qualifies for an excepfion, send a �mpleted copy of this permit package with its requested ir�formation to the applicable FDOT DisVict Office. 13 - �-�q� - oe3 ) -9sa�d ��NI� �� o �,a,0 ha�� J Y • �'�� .�..... I�JLE 14-86.004, FAC. STATE OF FLORIDA DEPARTAENi OF TRANSPORTATION 85604o-06 DRAINAGE CONNECTI�N PERMIT 12 °''°'"a''°�'�" ,o�oe Page 3 M 8 Brief description of facility and proposed connection: Fagade rennova6on. loadina dock e�dension, 0.39' raise of inlet and minpr radin to rneet ADA com lian at handica acss. - �, I'� �fPCJ n ,Yill� xG � Briefly describe why this activity requires a Drainage Connection Permit (Include where ihe starmwater will discharge to FDOT right af �y): This oroiect should be consider+ed as an excention as fhe site drains awav from US 1 The ar000sed imnrovemeMs will not al #►e diredion of stormwater flow. The site ischs�ges to the east awav from U5-1 and w�l coMinue to do so. �� . . ; RULE 1486.004, F.0.C. STATE OF FLpRIDA DEPARTMEN7 OFTRANSPORTAIiON 850-040-06 DRAINAGE CONNEC770P1 PERMtT ROADWAYDESIGN iQWB Page 5 of 8 PART 3- Certlflcatlon by Appllcant 1 hereby certify that the information in submiital is complete and accurate to the best of my knowledge. ApplicanYs Signature: �i1/If �� Date: 10/25/2013 —�-��- Name (Printed): Heidi Belfe He derson P.�. Title and C�mpany: Proiect Manaper with CPH. Inc. � Address:1992 SW 1 Stree# Miami. FL 33135 Phone Number. (305� 274-4805 E-mail address: hhendersan(a�cphoor�.com ___ PART 4- Owner's Authorizatfon of a Represer�tative i(we), the owner, DDR SOUTHEAST TEQUESTA L.L.C. a Delaware {imited li bili cam an , do hereby authorize the following person, or entiiy, as my represenfative: Name (Pri�ed): Heidi B elle Henderson, P.�. Title and Company: Proiec� Manas�er with CPH. Inc. Address: 1992 SW 9 st Street Miami FL 33135 Phane Number: �305) 274-4805 E-mail address: hhendersonCaac�hcorp.00m Part 5- AfFidavit of Property Ownership � Contral and StatemenE of Contiguous Interest I, DDR SOU7WEAST TEQUES7A L L C a DeEaware limited liabilitv comnanvi certify that I own or lawfully control the following described properly_ See leQal descriation on enclosed survev prepared bv CPH, Inc. Does the property owner own or have any in#erests in any adjacent property'? � No ❑ Yes If yes, please describe. Owners Signature requlred far Parts 4 andlor 5 We wilf not begin on the drainage connection until I receive the Permit and f understand all the c�ditions of the Permit. When work begins on the connection, l am accepting all conditions listed in the Permit. Name (Printed); DDR SOUTHEAST TEQUESTA. L.L.C., a Defaware limited liabiiltv companv Address: 3300 Ente�r�se Parkway Beachwood. OH 44922 Phone Num 75 500 Signature: Date: 10/25I2013 $Y Ja s..Fa �.Z, Executive Vice President � . � �,`�-. RULE1486.004,FAC. STATEOFFLOWOAD9�ARIMENTOF'fRANSPORTATION' � 850-0440-06 DRAINAGE CONNECTION PERMIT �"''D�'�"' ,oroa aage 7 or s PART 7— Permit Special Conditions — To be completed by FDOT The above request has been reviewed and has been found to meet the regulations as prescribed in Rule 1486, F.A.C., and is hereby approved, subject to the following special conditions: �� `�T��1T �� i 3 �- �}� b- n03� Department of Transportation: Signature Title Date ��'} �OVPYYi �� .� SPEC/AL PRDV/S/ONS/CONDlT/ONS DRA/NAGE PERM/TS A TTACHMENT �A'� Certified "as-builY' plans must be submitted to FDOT when the jpb is_ completed. � 4 it is the Psrmithee's responsibilityr to obtain ftnal acceptance of permitted work (completed) and the restoration of the Right of Way from the Department prior to usuage. • Pemidtee wili restore the Right of Way as . a minimum, to its original contlition or beEter � in accordartce w/PDOT's Star�dard Specificatians for Road & Bridge Construction or as directed by the R�sidgnt OperatFons Engineer. Permittee shall use the curtrt�ent editions • af the Departrttent's Design Standards, ` 3tandard Speciflcatlons for Road and Bridge Construction and applicable manuals, policies and procedures. ' " All maintenance of VafHc (MOT) wiil be In ' accwdancewith the Departme�s cument edition of the Design Standards, (600 series). 7he Operdtio� Engineer or his designee ressrves the rieM bo drect the removaVrelocationfmodlBcatlon of any traffic device(s} at the Pertn'sttee's sole expense. Restricted hours of opera6on wiil be from 9:00 am to 3:30 Pro, IMonday thru FridaY) unless otherwise appraved by the Operations Engineer, or designee. PERMIT VALI� FOR ONE YEAR FROM DATE OF ISSUE. . " �ermrtree shall coor�iinate aii work with David Moore of Transfield Services a� 954-317-8��44 or emaii: mooreda�transfieldservices.cor� �