1505 8TH PL S.PDF1505 8TH PL S
--:'� WATER-`SEW+EFLDEPA•RTM'ENT
PEfR1VI�IT
Cali:776 2628,• for side, sewer.,,inspecttons, IIFFORE covering any , portions of,. the
'construction:,),
ors'=aftqustOan or'holey inapectiosi�Inspetionr wiii,be ' ' cADDRESS LUCATIQN •OF CONSTRUCT%ON ..... -1-!� : -^j. ........... "�-.......................EA ..::...? ......:�.� .. ......... ...
PROPERTY,.LEGAL.IDESCRYP,.TLON.:,.. ;....,._. ..!..a 5 ��•- ...
OWNER''AN'D/OR BUILDER ...........�..�..... l .1..... a - ...... .................................
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QONTRA&OWS NAIVIE ;& "DRESS''............:....:.: -•-c'" �
;.. Permission, is granted L�t +1 �� for repair and/or connection -of a side sewerto the city sanitary` sewer ,
t. t
s In accordance with City of Edmonds ordinances.
• 1
A�NTION:I$ CALLED TO�•THE FOLLOWING:, 1 -
NOTE No: 1—The owners,'of -the :pi operty- ;may, obtain. a' permit tc -construct', sewer inslde' property line:.,A <Ucensed Side=Sewer Contractor must'be,:employed 10 ,construct, -
'stdc aewer•In,*reet area. Do not cover, any portion, :of. --sewer before'it"has been, Inspected
'NOTE No., 2—All �4ork performed `in'rclty,riglit-of-way-requlres,ian Invasionjrof R.�ght,=of-W.ay`Permit,,otifainable from the City, Engi'neer'sr�office
•NOTE^No': 3=Obtain'fulll',lnformationT regarding,•Ordinance- 11-18'.030 tandl �Regiilationsr !governing,aide•:sewers ,vihen;,you; get .permIC.
NOTE No::4—Top .of aide` sewer muaf 'have at least .30; inches ,coverage ,at<property;; dine% and,'12,1nches. inslde,)property'%line;; minimum..grade' oP :2 / . , No bepds:'im, grade
;sharper than 'A will tbe, permitted'..
NOTE No. 5--,Trenches, in' street mu`sf .be wefer,settled, and surface•:of :street, restoredi..fo;•orlginali�condition. .Contractors 'shall lb 4responsIbI6 for failure due ,toi•improper.
• ," work•'which may develop withimone year of �completlon. ;..
,NOTE No. B=It his uNawfull to alter or -do. any :other .work tnan'ia provided,,for im`•thel•permit,-,or'..to'do-.any work ow'the maln: sewer, or.its:appurtenances except .tooin-:-,
sort` the' pipe intmahewye.. '
DISAPPROVED ;p� atey Date s By, Date By
41� 0
;APPROVED rate...... Cf//....: By ••-,......• ..................... . ..
Remarks.........................................j. . ... . .
BOTH+ Perinit`Coples:MUST-Be ;.Sighed By. Qwnen,ofsFirm' 'Performing Construction PRIOR To R,equ'est For Inspection
I' �• .....:.:. hereby -certify that the side sew.'er Installation constructed un'd'er th>s permit
(O er of Contracting •Firm .erfcrming onatructfonp
installed in' accordance -with a7l,goyerning ordinahces,of',the City, of'Ed'monds.. ;
Datedi'this.......... :::aayF.of ..... ......... ,`.:19i...:...•
Check.BEFORE you dig fora Water • Gas4 Teiephone .`Power Sewer 0 O,ther �r -,1,/
•
a
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT EASEMENT NO. ____........................................
NEW CONSTRUCTION REPAIRS ❑ LID �NO- ---`ECG---ASMT. NO___________________
OWNER .__ PH_11_....... ---------------------------------------- CONTRACTOR --?. -----. M---- C 1J-T iz.-,G.TUI�S PERMIT
JOB ADDRESS _ 1SOS — 8PLL,CE SOUTH LEGAL DESCRIPTION: LOT NO. _______�__ g__________________ BLOCK NO. _.___-_.._._-___.__________._.._.._.
AT A LdC !lC A T1T%TTTf'%WT
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-------------------------------------------------------------------------------------------------------------------
.-oved:
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS 0 --FtASEMFNT No . ..................... ................
OWNER--- Y ...... ........................................... CONTRACTOR ....... 0-t M-1 ................................ ......................... - PERMIT No.
ADDRESS .... ..... .... ................ LEGAL DESCRIPTION: LOT No..- ----•---•----•---•-- ....... BLOCK No - --------------------------------------------
NAME OF ADDITION ----
I
a
MAY
Pubk Works DaX
a
m
0/
Approved:
DATE........... .................................... By — ....................................................
City of Edmonds
Permit No•:2
RIGHT-OF-WAY CONSTRUCTION.. PERMIT Issue Date:11-19-02--
A. Address or Vicinity of Construction: 1505 8 PL S
B. T e of Work (bbe.�pecific)): PERMISSION 1S 'REQUESTED TO INSTALL NEW 2" P.E IP MAIN PROM 15 ST SW
SOUTH TO 100 TO S .5
CONT
C. Contractor:
Mailing Address:
4
State License #:
SUE SIDICK.
Contact:
Phone: 206-418-4239
Liability Insurance: Bond: $ .
R. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision"" ❑ City Project ❑ EUC (PUD, VERIZON, PSE, AT& T, OYV VD)
❑ Multi -Family ❑ ' Single Family ❑ Other
INSPECTOR: -•- .�`•
F. PAVEMENT CUT: YES ❑ NO G. SIZE OF CUT X
CONCRETE CUT: AYES ❑ NO
INDEMNITY: Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from
injuries, damages or,rclaims of any kind or description whatsoever, for or. unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including, defense
costs and attorney fees by reason of granting this permit:
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
�. INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
b _ COMPLETED BY CITY_ FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
= i Traffic contr6F,and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155,-305 and must have certification verifying completion of the
required training in their possession.
♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
♦ Three sets of,construction.drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature: . /�.�-- `� Date: l O —y 1 ` D Z_
3
(Contractor or Agent)
Approved by:
FOR CITY USE ONLY.
�1 )� J W - eG i.0
Right-of-way Fee:
Time Authorized: Void --After
D / 0
/
Disruption Fee/Fund 111:
Special Conditions:
G `
Restoration. Fe'e:
Total Fee: ""'.o `
, tN05,13 ,�tL 1AftA�-'t
�G,t W
_l+l: to:,,•_Receipt
No:.,.1.
Issued by
' t(St21✓ 1�(lttil 10fG2
.n Ct ' iR l�S
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i SC "71 ' C A(G
. ne. �nnnfi�rttdt�S.
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UPON COMPLETION OF PERMITTED WORK, AN. ENGINEERING FINAL,
:. INSPECTION- IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS 1"
COMMUNITY DEVELOPMENT CODE, (Phone 425-771-0220,'Ext. 1326)
FINAL APPROVAL OFPERMITTED WORK: ' I of t- cx DATE: 10L'"a7
,Inspector's Signature c1o1/ii�5
For inspection requirements see Engineering Inspection Information handout.
DAMy Documents\Forms\Engnmg\ROWpermit_ doc
N
TIE—IN SVC TEE
201'ECL, 14'SCL
__'ECL, ___'SCL
15 ST SW
ll° CA 5 LLDW
2" STW IP 14-S (CP)
T-- —6 61Er----
�I
uIt .1
no
u)
b08
PROP 2" PE IP MAIN
20'ECL
_—'ECL
2" PE CAPIE OM —
.t20'ECL, *I 14-SCL
'ECL, 'SCL
50'
R/W
C0
R/W
W
i�-`co
�100
uti e-
808
2" TRANS FITTING
& TEST LEADS
a
20t'ECL, 15'SCL
__'ECL, __'SCL
— PL
0 7
I PL
PL
0
FITTER (CHECK BOX IF COMPLETE)
STANDARD NCC GAS
CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE— CALL" TWO WORKING
DAYS PRIOR TO CONSTRUCTION, 1-800-424-5555.
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AN^ CAS STANDARDS PROCEDURES MANUAL.
3. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE.
4. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE
APPROVED BY PROJECT MANAGER.
5. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE
FACILITIES. CHECK BOX ON REPORT FOR WIRE BOX (TEST LEAD)
INSTALLATION.
6. INSTALL ONE POUND ANODE FOR EVERY 1000' OF LOCATING WIRE. INSTALL
ANODE AND TEST LEAD WIRES PER PSE GAS OPERATING STANDARDS 14.2 AND
14.5.
7. MAINTAIN CATHODIC PROTECTION FOR STEEL MAINS BY THE USE OF
CONTINUITY BONDS OR OTHER MEANS DETERMINED BY THE PSE CORROSION
ENGINEER PER PSE GAS .OPERATING STANDARDS 10.3
8. INSTALL ANODES AND TEST IFAD WIRES AS REQUIRED PER PSE GAS
STANDARDS PROCEDURES P0201 AND P0303 AND PSE GAS OPERATING STANDARD
10.2. TEST IFAD WIRES ARE REQUIRED ON ALL TRANSITION FITTINGS.
9. REFER TO PSE GAS OPERATING STANDARD 6.8 FOR MAIN AND SERVICE COVER
REQUIREMENTS.
10. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS
OPERATING STANDARDS 6.14, 6.17 AND 14.2 AND PSE GAS FIELD PROCEDURE
P0816.
11. CUSTOMER PROVIDED TRENCHES ON PRIVATE PROPERTY SHALL CONFORM TO PSE
STANDARDS.
12. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE
0150.3200 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL AND
ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
13. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEM, NO TWO MAINS
SHALL BE CONNECTED EXCEPT AS SHOWN ON THIS DESIGN UNLESS APPROVED BY
A PSE REPRESENTATIVE.
14. SYSTEM MAOP DENOTED B SYSTEM MAOP =45 PSIG.
15. COORDINATE INSTALLATION WITH CORROSION CONTROL: ED VOOGT 206-396-2799
GAS MAIN INSTALLA710NIRETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
2"
PE
100,
_ _ GAS MAIN PRESSURE 4 TESTING _
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
ISYE
TIME OFF
Design Press 60
MAOP �'S
PROJECT PHASE
NOTIF#
ORDER#
a
O
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
Retirement
X496885421
107014517
I Contractor. CONSTRUCTION COST CODES:
( 021-163-1 I 1 r
_1
REV#
3
2
1
DATE I BY I DESCRIPTION
COUNTY
EMER SECT
Work area left in Clean & Safe condition ❑
SNO
5
Complete all Pipe Tables and Gas PressureStamp ❑
1/4 SEC
OP MAP
Field changes Red —Lined on as —built ❑
SW 25-27-3
164.062
Material verified and Changes noted on paperwork ❑
All Valve & Tie—in Locations noted on cis —built ❑
Note beginning of Main, EOM & Line of Main locations ❑
UTILITIES
CONTACT
Show Rope Locations & Cul—de—sac Radius ❑
Foreman s Signature
PHONE#
', ' PUGET
SOUND I �ti��_.
�`' Fl``
ENERGY
Company Employee ID#
Owner / Developer Contact Info
VIRGINIA HOLLOWAY
15058PLS
EDMONDS, WA 98020
OFFICE 425-775.3992
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
REAL ESTATE/EASEMENT PERMIT
N/A EDMONDS
FUNCTION CONTACT PHONE I DATE
PROJECT MGR DOUG USITALO 206.418-4236 9.30-02
ENGR-GAS
DRAWN BY PEGGY SHULL
CHECKED BY DOUG USITALO
!AS WK CTR APPROVED BY DOUG USITALO
MCNSEG FITTER #1
LAT MAP FITTER #2
165.066 MAPPING
JOINT FACILITIES ARRANGEMENTS
DESIGNED BY PILCHUCK CONTRACTORS INC.
VIRGINIA HOLLOWAY
2" PE IP MAIN EXTN
1505 8 PL S, EDMONDS
206-418-4253 9-30-02
206-418-4236 Na
206-418.4236
P Superior Order:
107014517
SCALE: IPAGE
1" = 50' 1 1/1