211 7TH AVE S.PDF11111111 lill
6964
211 7TH AVE S
APPLICATION
for
The City of Edmonds S11DE SEWER PERMT EASEMENT No . ..........................................
L SEW CONSTRUCTION REPAIRS
E T I
10Q 0 9,�? 5-c
OV,rNER ...... ........................ ................... CONTRACTOR .................................................................................................. PERMIT No . ......................
----------------------------------------------
ADDRESS ....... ... &26.' LEGAL DESCRIPTION: LOT No . ........................................ BLOCK No . ............................................
NAME OF ADDITION
,� #ApprqQ, ed:
v
DATE................................................ By ......................................................................
Permit No:
City of Edmohds
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: Ave_ S
B. T ype of Work (be specific): C--> v-'-,r k, V,� L
0\
M4ole- Z:A- n- ig�a'tk) alt- n� I A vc, S
C> 7 n -,-2Q �S _?ny r- �nlc, V\O!a
C. Contractor: �)Ikcy�ucj)) Contact: tT),,C)4- YA. -1
Mailing Address: 1 2):�)?� 3�oyu_ A V 0 P:hone: cROLo, LAI b-qRY?
State License Liability Insurance: Bond: $
City Business License #:
D. Buil ding Perrmt (if a pplicable): Side Sewer Permit # (if applicable):
E. F� Commercial.
Subdivision City Project EUC (PUD, VERIZON, PSE, COMCAST, 0 VWSD
Multi -Family E] Single Fan -lily Eg-Oiher I
INSPECTOR:
.F. PAVEMENTCUT: RVES nNO G. SIZE OF CUT x
CONCRETE CUT: El YES n NO Z
G. El -Mail A 7ved Permit Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
injuries, �amages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made againsi the City of
Edmondslor any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE.'CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR ' FOLLOWING THE FINAL
INSPECTION A" ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTILTHE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO.THE APPLICANT.
* Traffic control 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) 296-155-365 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�pequired With,the permit application
CALL DIAL -A -DIG (1-800-.424-5555) PRIOR TO BEGINNING WORk,-,.-'
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signaiure: Date: 9'
(Contractor or Agent)
FO
ITYUSE'ONLY,
'g,
Approved,by:
Time Authoriz& Void After. CID
Specifil Conditions: oF<,-rnM 7-5 LM-6- 4 Wnsoec ti 1, dfi,feeL4a&94 ra, 7=41ce I CO
T,f�! 9 F
ftr) J-61lalfeei
70 APPAQV68 724PP/ L ANA. Ree6of'Nai,.
CA[
og,k-/ IV4 t"LS A ;tssued;.by:. -
Z, .7r- L! LIZ /Z-
e. rz A 1:7
&,At. Gs7=Q6rK $�19Q64� .7-V 11,r
f P" Ae dorl %�/r 2
REQUIRED INSPECTIONS: (7), 7-1A Piz i e- (�D tq 77r;' , 0L
J I LiAL- heEe,--m1P_ A 7— / Q"
Call 425- 771-0220, Ext. 1326for a 24-hour voice -recorded inspectioq xif4yest line.
FINAL APPROVAL OF PERMITTED WORK: DATE:
Insvector's Siznature
NO WORK SHALL
BEGIN
PRIOR
TO PERMIT ISSUANCE
CADocurnents and Settings\CtalisNy Documents\Forms\Engnrng\ROWpemit_.doc
Revised 10/01103
Notes:
PlIchuck Contractors, Inc
Job # 107024455
Aug -1
Sheei
4=
N+
a
28" TRAFFIC CONE
WORKAREA
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCA]ION
1. All signs and spacing to conform
to the City of Edmonds Traffic
Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" B/O unless
otherwise specified.
4. Alert affected residents.
5. Work to take place between 9 a.m.
And 4 p.m.
6. Maintain two 111' lanes.
7. Work area will be 216' N of C/L of
Maple St & 22'W of C/L of 7th Ave S.
U)
LU
>
MAINTAIN TWO
11' LANES
.0
ROAD
WORK
AHEAD
7;F
APPROVED AS NOTED
BY ENGINEERING
Date:
MAPLE ST
4=
CE SPACING
IIANGENT
50/70
40
80
35(45
30
60
25130
20
40
CHANNELIZATION DEM
MPH TAPER
DA YTON S T
EOM _6X
Z' MPE CAP R/W
42-N CIL & 22-W CIL
(—')N CIL & (—')YF CIL
652
6 3'
R W
P im
0)
in 04 to
Aix
15' 1p d/swL
�/" -T—
IP "S nw ALLEY
13�4'N
518- 131 'N
r-19-90 -
cli
C14
RV 518" 131'N 709
DETAIL "'A" N, W
Jim 1991
0 60'
R,"W
PLOT PLAN
SCAM. I" - 50' _A01
R/W MAPLE ST
CFIELD TO VERIFY TIE—IN LOCATION
PROPOSED Z' MPE IP MAIN
--------22##r CIL
1) W CIL
TIE- IN, FUSE
Z' MPE IP MAIN
2-N CIL OF ALLEY & 22-W CIL PE IP I S C
(_') N CIL & (_ ") W CIL 9319481
(EOM 0 2-N CIL OF ALLEY & 22-W CIL)
LL :2
C"IC*l
W I
EL1801
46
69 4*
GRAS
SIDEWALK 144"IAU
--'%_.�V T4
V
60'
R/W
7TH AVE S
C/L
I
PROP. 2" MPE IP GAS I
0-1--�2'W' C/t
CROSS—SECTION
N.T.S.
DETAIL "$A"$
SCALE: NONE
N
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe ondition
Complete all Pipe Tables and Gas Pressure Stamp
Field changes Red-Uned on as -built
Material verified and Changes noted on paperwork
All Valve & 1-je-in Locations noted on as -built
Note beginning of Main, EOM & Uine of Main locations
Show Rope Locations & Cul-de-sac Radius
Foreman's Signature
Company PILCHUCK Date
STANDARD GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE —CALL" TWO WORKING DAYS PRIOR TO
TO CONSTRUCTION, IN WESTERN WASHINGTON CALU 1-80G-424-5555. IN KITTITAS COUNTY CALL 1-800-553-4344
2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQUIRMENTS).
3. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADD17IONAL LOCAL JURISDICTION REQUIREMENTS.
5. N07IFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUC71ON ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSl TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
6. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY
THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
7. COMPLETE "PIPE CONDITION REPORT' ON ALL METAUC PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY
THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION IS
NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX.
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
11. SYSTEM MAOP DENOTED BY: ISYSTEM MAOP Jb- PSIG
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERA71NG STANDARDS 2525.3300. AND 2525.1200.
15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION NTH CP TECH.
--------- PHONE ---------
17. NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS —BUILT IN RED. DENOTES
FOOTAGE BETWEEN FITTINGS.
GAS MAIN INSTALLATIONIRETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
I Length
Manufacturer
INSTALL
2N
MPE
as
GAS MAIN PRESSURE & TESTING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
E OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
Design Press 60
SYS MAOP 45
PROJECT
PHASE
NOTIF#
ORIDER0
SAP Superior
Service/Meter
Servicelmoter
Servica/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
Rebrerrierit
X202809097
107024455
X202813720
106157785
Contractor CONSTRUCTION COST CODES:
051-103-1 1 1 1
Project Manager Contact Inforination:
KIM GRAY
CELL* 425-"0-2678
EMAIL kim.GRAY@pse.com
REV# DATE BY DESCRIPTION
3
2
1
Vicinity Map
WORK SITE
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Owner/ Developer Contact Info
GLEN BOUDON
719 NW 116TH ST
SEATTLE, WA 98177
ATTN: GLEN BOUIDON
206-364-6292 office
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
NIA
PERMIT
EDMONDS
FUNCTION 4
CONTACT
PHONE
DATE
PROJECT LfGR-
KIM GRAY
206-418-4233
8116/05
ENGR-GAk
DRAWN BY
AARON HEATH
253-841-6245
8122105
CHECKED BY
&zq&?e_ �
,/�
253-8414271
fJ&11'V
COUNTY EMER SECT GAS WK CTR APPROVED BY <dAA4A
SNOHOMMH 4 MCNSEG CP APPROVAL
1/4 SEC OP MAP PLAT MAP
SW-24-27-03 160.062 163.066 MAPPING
JOINT FACILITIES ARRANGEMENTS
CONTACTI I I
PWME#1
EUGET BOUDON
SOUND 2" MPE IP MAIN EXTENSION
EMGY . 211 7TH AVE S
DESIGNED BY PILCHUCK CONTRACTORS INC. EDMONDS, WA 98177
I
SCALE: PAGE
I . = 50' 1 111