23405 78TH AVE W.PDF111111111111
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23405 78TH AVE W
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CWy of Edmonds Permit No,:'
RIGHT-OF-WAYCONSTRUCTION PERMIT Issue Date: 121,110,
A. Address or V icinity of Construction: -7 uo
C)q c - \ noo . 44- 107 01 a- I Lo "t
C. Contractor:
MailingAddress:
State Licen s e #::?I L.,_1 H 0_.:� / c) 1 111 A
D. Building Permit # (if applicable):
Contact: I a S/d IdL 'T'>OL"Cl U S, �&d A
Phon6:Q?0(o-U/q-L
Insurance: Bond:
Side Sewer Permit # (if applicable):
E. Commercial Subdivision CityProject E] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family Other
INSPECTOR-
F. PAVEMENT: E]YES NO .1-G., SIZE OF CUT x H. Chargi� $
CONCRETE CUT: []YES NO
APPLICANTTO READ AND SIGN
IDEMNITY. Applica . nt understands by hislher signature to.this application helshe holds'the City of-Edmonds1harmlessftom inj . uri . es,
-damages or,claims of anj� kind or description whatsoever, A eseen or unforeseen, that may be made against the -City of Ed ' monds or
any of.. its departments or emplo�ees,lincludink but not limited to the defense of any legal proceedings. including defense costs and
attorneyfies by reason ofgranting thi§permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERJALS,,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
COMPLETED BY CITY FORCES, AT WHICHTIMEA DEBIT6,kibRe6I.T'W1LL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
* 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 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.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS! AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
Q-1c Date: I) --r9b - 0 /
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
oabfft W
Approved by Right-of-wayfee:_ �:�7-6'1
me Authorized. 'Void After 11 IS 40?- Disruption Fee/Fund 111:
Special Conditions:_ M 0101ftl d 5-'-fa?QM Restoration Fee:.
at,,L 1A1ATkR_ -51 W-S, Total Fee:;*
WATIIEU a3ffl �,D 0__�IoPNTS )�,P_vjz RecelptNo:'
by-�
.:-,.kg-!n0jZg D15T-V@35Qssued
lj�Ngsc ig-eg, :0�' 'I'l led-' 6?_
I A. �i A10h &.0, A-2 VS, Cwin r- t t2fl- t )r--r-7 /r-n I C-TICLA If\ A-T'!o nC-
UPON COMPLETION OF PERMITTED WORK., AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OFTHE EDMONDS
COMMUNITYPEVELOPME CODE.
FINAL APPROVAL OF PERMITTED, WORK,
INSPECTOrR'S SIG7VA TURE DATE.,
for inspection requirements see Engineering Information Haw
NO NNIORK SHAIA, BEGIN PRIOR TO PERNIIT ISSUANCE
STANDARD NCC GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL NONE- CALLN 48 HOURS
PRIOR TO CONSTRUCTION, 1-800-424-5555.
234 ST SW 2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AND GAS STANDARDS PROCEDURES MANUAL.
60' 3. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE.
R/W 4. ANY CHANGE IN ROUTE9 TIE-IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE
APPROVED BY PSE REPRESENTATIVE.
5. COMPLETE NPIPE 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
60' ANODE AND TEST LEAD WIRES PER PSE GAS OPERATING STANDARDS 14.2 AND
R I/W 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
E.O.M
I VE, 589'N CIL OR. 8. INSTALL ANODES AND TEST LEAD WIRES AS REQUIRED PER PSE GAS
WE - ------ S C/L 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
PROPOSED 2" MPE-IP MAIN REQUIREMENTS.
__�L5/8" 515'N C4
11 'E CIL
10. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS
1982
OPERATING STANDARDS 6.14 AND 6.17.
< 11. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200
2" SHORT STOPPER Do 0.10- 0
r-_ 1 C-4 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL
T/L WIRE & BOX LOCAL JURISDICTION REQUIREMENTS.
518'N, WE C/L
2" TRANSITION FITTING
519'N. WE C/L
VICINITY MAP
NOT TO SCALE
23:6 � ST , SW
- —I- — -
Owner/ Developer Contact Info
BRIAN KING
23405 78 AVE W
EDMONDS, WA 98026
425-778-5512
FITMR (Check Box if Complete)
• WORK AREA LEFT IN CLEANISAFE CONDITION. r_1
• COMPLETE ALL PIPE TABLES AND GAS PRESSURE STAMP R
• FIELD CHANGES RED —LINED ON AS—BUILTS. El
• MATERIAL VERIFIED AND CHANGES NOTED ON PAPERWORK. 1:1
• ALL VALVE AND TIE—IN LOCATIONS NOTED ON AS —BUILT. 0
• NOTE BEGINNING OF MAIN, EOM,& LINE OF MAIN LOCATIONS. 1:1
• SHOW ROPE LOCA77ONS & CUL—DE—SAC RADIUS. 0
Fitter's Signature
Company Employee ID#
ProJect Manager Contact Information: DOUGUSITALO
Ofte Phone 206-418-4236
Cell Phone 425-327-3451
GAS MAIN INSTALLATION RETIREMENT
I / R
SIZE
PROP.FT.
ACTUAL FT.
TYPE
MANUFACTUR
1
2'
70'
W? E
PROJECT PHASE
NOTIF #
ORDER
GAS MAIN
X702031031
107012169
IND MTR
SERVICE
X817298853
106076432
RETIRE
GAS MAIN PRESSURE TESTING
TYPE TEST:
PRESSURE;
TESTED BY:
DATE ON:
TIME ON:
DATE OFF:
TIME OFF:
DESIGN: 60 PSIG
SYS MAOP: 45 PSIG
COST CODES:
.CONSTRUCTION
011-102-1
PROJECT SITE
C\I
T"
0
r*-.
0
T"
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
5
REAL ESTATE/EASEMENT
NOT REQUIRED
PERMIT
EDMONDS
4
3
FUNCTION
CONTACT
PHONE NO
DATE
2
PROJECT MGR:
D. USITALO
(206) 418-4236
1
ENGQ POWER:
REV#
DATE
BY
DESCRIPTION
ENGR GAS:
COUNTY
SNOHOMISH
EMER SEC
5
WorK Center
MCNSEG
DRAWN BY:
PHUONG DAD
(206) 418--4218
11/20/01
CHECKED BY:
C. WOOLERY
(253) 476-6300
114 SEC
NE-31-27-04
OP MAP
1664-0658
PLAT MAP
166-069
APPROVED BY:
D. USITALO
(206) 418-4236
FOREMEN 4*1:
U-MAP#(POWER)
C IR MAP#
CIRCUIT#
FOREMAN #2:
I MAPPING:
JOINT FACILITIES
ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
PUGE MAIN & SERVICE EXTENSION SAP SUPERIOR ORDER# 107012169
SOUND 23405 78 AVE W RETIREMENT#
ENERGY (BRIAN KING) 106076432
DESIGNED BY PILCHUCK CONTRACTORS9 INt- 9 SCALE: iff 50 1