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22130 93RD PL W
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RIGHT-OF-W
't of Edm6ndg Permit No:
CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Constructioll EL W
B. Ty specific \VN�C) m4m 3 ",�>Tu) C@ C� I I RT 6� 93 �O L
.pe.of Work (be
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C. Contractor: 011� Contact: �) L)J
Mailing Address: 135 W �4OPt 0- 4 L) J Phone', c� 0 U
State License LC-4 a) ol M 4 Liability Insurance: Bond:
City Business License #:
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F_� Conu-nercial Subdivision City Project Ej EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
F� Multi -Family Single Fa 'I Other
INSPECTOR: I All--
F. PAVEMENT CUT: X] YES El NO G. SIZE OF CUT x
CONCRETE CUT: El YES El NO
G. F-1 Mail Approved Permit F-1 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, damages or claims of any kind or description whatsoever, foreseen 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 attorneyfies by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK. ESTIMA TED RESTORA TION FEES WILL Bk HELD UNTIL THE FINAL STREET PA TCH IS
COMPLETED B Y-CITY FORCES, A T WHICH TIME A DEBIT OR 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) 296-155-305 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 CitY7
approved material prior to the end o6ifie wor)kLday . N I I
0 EXCEPTIQNS.
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
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
FOR CITY USE ONLY
Approved by: Jaime Hawkins Right-of-way Fee: $160.00 + $15.00
Time Authorized: Void After Febru.Vy / 3rd / 2006 Disruption Fee/Fund 111: $0.0
Special Conditions: Restore ROW to like and/or better condition. InspectionFee: 2@$50.0=$100.0
Maintain 5'Min. setback from all City of Edmonds utilities. Verify Total Fee: $275.00
clear bore crossings. Call for locates of all U/G utilities prior to any Receipt No:
excavation. Alert affected residents and businesses. Confonn to Issued by:
the approved working drawing and Traffic Control plan. Please refer to Edmonds Std. detail E2.3 for utility patch
re storation requirements. P lease call the number below t o sche dule the requ ir ed inspe ction( s).
I REQUIRED INSPECTIONS:
Call 425-771-0220, Ext. 1326for a 24-hour
FINAL APPROVAL OF PERMITTED WORK:
request line.
DATE:
CADocurnents and Settings\CurtisNy Documents\Fomis\Engnmg\ROWpemit_.doc
Rc�ised 10/01/03\
St,4
PlIchuck Contractors ' Inc
Job # 1137026381
Nov 15, 2005
Shoot 1 of I Rob Inglis
NOT
TO
SCALE
24 HR. NOTICE REQ
FOR INSPECTION .�
APPROVED AS NOTED
BY ENGINEERING
Date: Z, 1,7— (/1
WORK AREA Xx 5'
IN PRIVATE DRIVE
CHANNEIRAW)N DEVICE SPACING
MPH
Wpa
VNGENT
W70
40
a
3W45
20
25/30
__160
2.
As,
0 &
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T4GUELAKE
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ARM
IF RM
WORK
MEAD
IF
Notes:
1. All signs and spacing to conform
to the MUICD and City of Edmonds
Traffic Control Manual.
2. Channeilzing d8VlCe3 are 28"
traffic cones.
3. All signs are 48"x 48* 0/0 unless
otherwise specified.
4. Alert affected residents.
5. Work to take place between 9 a.m.
And 4 p.m.
6. One Flogger will control alternating
one lane traffic.
#22130
LEGEND
9 28" TRAFIFIC COME
WORK AREA
WHICROW
WORK VEFUCLE
SIGN LOCATION
220 ST SW
Wce
EOM
2" MPE CAP-
rp
2'N 0 F S PL & 11 5'W CL CJ
(---')N OF S PL & ')W CL A
--- 30'±
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2'
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- - - C14 697'S
IT :J 697'S
Lunkr
`7 LF
Lail
T D
5/8" 722 PS
13
1997
EXCESS FLOW VALVE TIE—IN
(TO BE LEFT IN OPEN —INSTALL 1 1/4" SVC TEE
POSITION) 699'S CL & 21'E CL
(---')S CL & (---')W CL (---')S CL & (---')E CL
R
PROPOSED 130' 1
CL
OF 2" MPE, IP MAIN �� I . .
699'S CL 4)-*
(---')S CL
2" TRANSITION FITTING I
00
(OR 2'N OF S PL 699'S CL & 20'E CIL
(---')S CL & (---')E CL
(n
I
C14
_J
CL
Cq
0 224 AT SW
0�
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe ondition
Complete all Pipe Tables and Gas Pressure Stamp El
CP APPROVAL Field changes Red —Lined on as —built 0
DATE REQUIRED Material verified and Changes oted on paperwork El
All Valve & Tie—in Locations oted on as —built El
Note beginning of Main, EOM & Line of Main locations 0
Show Rope Locations & Cul—de—sac Radius 1:1
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 CALL: 1-800-424-5555. 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 FO.;. TNPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
5. N011FY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION AC11VMES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi 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 REPL11( :,D
PERGAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESP6�SE.
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 METALIC PSE FACILITIES. CHECK BOX ON REPORT FOR MRE
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 Or 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- I SYSTEM MAOP 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 OPERATING 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 WITH CP TECH.
RICK KESSLER PHONE 206-571-7908
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
Length
Manufacturer
INSTALL
21@
MPE
130'
GAS MAIN PRESSURE & 1 EST ING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OF -F
TIME OFF
TYPE TEST+
PRESSURE
TESTED BY
DATE ON
-TIME ON
DATE OFF I
ITIME OFF
Design Press 60
1 SYS MAOP 45
PROJECT
PHASE
NOTIF#
ORDER#
SAP Superior
Servioe/Meter
Service/Meter
Service/Moter
Service/Meter
Ind. Service
Ind. MSA
Die. Reg. / Fr
HIP SvGIMSA
Relocate
Retirement
X212455316
107025381
X212455344
106163986
Contractor CONSTRUCTION COST CODES:
051-103-1 1 1 1
Vicinity Map
WORK SITE
30
220
TH S T �W
P0
CAI
co
228T�
ST SW
Owner I Developer Contact Info
ELIAS OLAFSSON
23934 WEST WOODWAY LANE
OODWAY WA 98020
ATTN: EUAS OLAFSSON 206-533-1661 office
Project Manager Contact Information:
KIM GRAY
CELL: 425-290-2678
EMAIL: kim.GRAY@pse.com
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON 1:0,4 EXACT LOCATION OF FACILITIES
REAL ESTATEIEASEMENT PERMIT
EXISTING CITY OF EDMONDS
REV#
DATE
BY
DESCRIPTION
FUNCTION
CONTACT
PHONE
DATE
3
PROJECT MGR
KIM GRAY
206-418-4233
11106105
2
ENGR-GAS
I
DRAWN BY
JMALM
206-418-4219
11106/05
CHECKED BY
JUSTIN WAHLBURG
425-766-1811
11107105
COUNTY
SNOHOMISH
EMER SECT
5
GAS WK CTR
MCNSEG
APPROVED BY
KIM GRAY
206-418-4233
CP APPROVAL
RICK KESSLER
206-571-7908
1/4 SEC
SE25-27-03
OP MAP
164.062
PLAT MAP
165.067
MAPPING
JOINT FACILITIES ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
SAP Superior Order:
PUGET 107025381
SOUND ELIAS OLAFSSON Dravving Number:
EMGY 2', MPE IP MAIN BRANCH EXTENSION NIA
22130 93RD PL W, EDMONDS WA 98020 SCALE: iPAGE:
DESIGNED BY PILCHUCK CONTRACTORS INC. Its = 50, 1/1
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