23109 94TH AVE W.PDFiiiiiiiiiiii
9204
23109 94TH AVE W
Permit No:
City 'of Edmond,s
4. TION P'EIMIT IssueDate: �0110162_
RIGHT-OF-WAY CONSTRUO
A. Address or Vicinity of Construction: z� i b 4�
B. Type of Work (be specific): �e
0 9 0 a Q LU
C. Contractor: Pi I C-4 L�6 'A
Mailin2Address:
State License #: A k S
D. Building Permit # (if applicable):
Contact:
Phone:, L/
��Uiabiiiiy Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F1 Commercial E] Subdivision 0 City Project EUC (PUD, GTE, PSE, CHAMBERS, OVVvD)
El Multi -Family Single Family F] Other
INSPECTOR-
F. PAVEMENT: YES f-1 NO G. SIZE OF CUT x H. Charge:
CONCRETE CUT: YES E] NO
]DEMNITY.. Applicant understands by hislher sig"n'ature to this application helshe holds the City 6f.Ediiz6fids harm.lessfrom.injuries,
damages'or claims of any kind or description whatsoever, foreseen or unforeseen, that maybe 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 defelise"costs and
attorney'fees by reason ofgranting 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 PATC[i IS
COMPLETED BY CITY FORCES, AT WHICH T1MEA_DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer.. Every
fligger must be trained as required by (WAQ 296-155-305'and must have' certification verifying, completion of the
required training in theirpossession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material priorto the end of the workday — NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS ANDACKNOWLEDGE
THATIMUSTMAKE THEPINKCOPYOF THE PERMITA VAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
UPON COMPLETION OF PERMITTEDVOAk,ANINGINEERING FINAU.-
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK.
INSPECTWS S ATURE DATE: /)J!2:25 119E
Forinspe etion requirements see Engineering'Information Ifindout.
NO WORK SHAIA, BEGIN PRIOR TO PERMIT ISSUANCE
EOM
5'E-WPL, 255W
LOQ—
5W-WPL, 157W--'_______0)_J1 PROP 1- 114 PE 1P MAN
LOC- 5Z-WPL
1 0 4 =120 LOC-
1-114".X 1 " WELD REDUCER 1 —1 !_s- — 9329
1 1 1970
�D 'E- W FLO I awv
LOC-
TIE-RV 1 " SERV
5TWPL, 155W
EX EOM 156W
LOC-
JOB SITE
I
ail 1/?7 86-N
F_ &0--' 1970 9327
CLI
LLJ
co
232_ST I SW
AV
2"STW IP 17-S 20'
T=
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zo 11-100
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:CI-j V_
T_ �io5l V_
9CE6 OM
VICINITY MAP
I
FITTER (CHECK BOX IF COMPLErE)
Work area left in Clean & Safe condition
Complete all Pipe Tables —and Gas Pressure Stomp
Field changes Red —Lined on as —built
Material verified and Changes oted on paperwork
All Volvo & Tie—in Locations oted on as —built
Note beginning of Main, EOM & Line of Main locations
Show Rope Locations & Cul—de—sac Radius
Foreman's Signature
Company Employee ID#
STANDARD NCC CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE— CALL" 48 HOURS
PRIOR TO CONSTRUCTION, 1-800-424-5555.
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AND GAS 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 PSE REPRESENTATIVE.
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 P ROTECTION 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 LEAD WIRES AS REQUIRED PER PSE GAS
STANDARDS PROCEDURES P0201 AND P0303 AND PSE GAS OPERATING STANDARD
10.2. TEST LEAD 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 AND 6.17.
11. COORDINATE INSTALLATION WITH CORROSION CONTROL.
AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
12. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE
0150.3200 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL
GAS MAIN INSTALLATION / RETIREMENT
I R
SIZE
PROP.
LENGTH
I xerm
1'n?E I
MANUFACTUR ER
P,
PROJECT
PHAqF
ORDER # NOTIF #
GAS MAIN
107012218
X942680602
SERVICE
1060766788
GAS MAIN PRESSURE &
TESTING
TYPE TEST.
PRESSURE;
TESTED BY:
DATE ON:
TIME ON:
DATE OFF-
TIME OFF.
DESIGN: 60 PSIG
MAOP 45
CONSTRUCTION
COST CODES
011-103-1
CHAD ROTHSCHILLER
23109 94 AV W
EDMONDS, WA 98020
425-705-3668
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE REUED UPON
FOR EXACT UXATION OF FACILITIES
REAL ESTATE/EASDAENT
FtEO'D
PERMIT
N/A
FUNCTION
CONTACT
PHONE NO
DATE
PROJECT MGR:
DOUG USITALO
(206) 418-4236
12/17/01
ENGR — GAS-
( ) —
/ /
DRAWN BY:
PEGGY SHULL
(206) 418-4253
12/17/01
DATE
Ery
CHECKED ErY:
DOUG USITALO
(206) 418-4236
C"ft
SNO
EMER
5
Work Centw
MCNSEG
APPROVED 13Y'
DOUG UMSFTALO
(206) 418-4236
FOREMEN #I:
NE 36- 27-03
OP MAP
ie*n"
I PIAT Wr
166.067
FORD" #12.
JOINT FAciLM ARRANGEMENTS
UMMEs
I
I
I
CHAD ROTHSCHILLER
1-1/4- PE IP MAIN EXTN
new 23109 94 AV W
)RS, INC. EDMONDS
1070122181
SCAM, I' - 50