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403 2ND AVE N.PDF111111111111 4793 403 2ND AVE N 0 ' CIT� OF EDMONDS ' PUBLIC WORKS DEPARTMENT, ENGINEONG DIVISION APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION EERMIT THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION'-PURPO SE'S Applicant to Complete Parts A and B A. Permit to be issued, to:— ell! For Work at:(addr*ess or -vicinity) -'/Q 3 Type of Work to be done: e'f AEfa -S (attach drawing when applicable) Time Required -- Start: 0 Finish: I? Owner: FILE, Name Mailing Address -5 7 7? 7 3) City State Zip Telephone Number C o n t r a c t o r: a, "�- '1441el-l'--v Name 'alp 0 )- I / "C� /V Mailing Address '; /�- - ??/ 7 Ci,ty State Zip 64 -,< /-/ � A47,�- - 2- -3 -3 2- State License Number ��-4 Za-A� -3 P / Telephone Number NO WORK'TO BEGIN PRIOR TO PER11IT ISSUANCE ** INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs, court costs, and attorney fees by . reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is subject to inspection.and restoration in accordance with City Code. A 24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220. I understand that this permit must be available at the*job site for inspection purposes at a . 11 times. TO Signature-�,��, Date: Owner or Agent I TO BE COMPLETED BY ISSUING AGENCY:, Date Issued: Permit No.: Fee Security Bond: Time Authorized: 1 0 - 7 7 1 ir ( V � - 4 � ^ I ) APPROVED BY r, -7 0 4 - f - --, - - A N D a t e : '7do Al2 wo L� �row A� APPLICATION for Th 1 9 City of Edmonds SIDE SEWER PERMT EASEMENT No . .......................................... NEW CONSTRUCTION 0 REPAIRS 0 113-01500 OWNER.......... Wm....J.....T.usan -------------------------------------------------------------------- CONTRACTOR .................................................................................................. PERMIT No . ...................... ADDRESS ...... 40-3 ... 2nd..Ave....-Ii . ............................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . .............................. NAMEOF ADDITION ......................................................................................................................................... Dye Tested On Sewer 1972 Approved: DATE................................................ By ...................................................................... City of Edmonds PermitNo: 42003— 0� RIGHT-OF-WAY CONSTRUCTION PERMIT . Issue Date: -4q-3-03 A. Address or Vicinity of Construction: 77 V� 4- B. Type of Work (be specific): �Z,� V�\ k I,-) ( C r,� (A' U e_ kA, �>_ n V I, I 9r- C. Contractor: Mailing Address: 134'-n Statc (01 il Licensel�_:�_, D. Building Permit # (if applicable): E. El Commercial Subdivision Multi -Family g-Single Family INSPECTOR: P oo 7 Contact: ..�UQ_ S de-4, k�J Phone: 4 t Liability Insurance: T 136nd: $ 2> Side Sewer Permit # (if applicable): E] City Project F] EUC (PUD, VERIZON, PSE, AT& T, OVV*rD) Other F. PAVEMENT CUT: EL;VES El NO G. SIZE OF CUT x CONCRETE CUT: YES NO INDEMNITY.' Applicant understands by his/her signature.to thik application helshe holds the Cit�.qf Edmonds "harmless from injuries, damages or claims of any kind or description w hatsoever, foreseen or unforeseen, that may be made against the City 0� Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and attorneyfees by reason ofgrahting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLORING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK , ESTIMA TED RESTORA TION FEES RILL BE HELD UNTIL THE FINAL STREET PA TCH IS COMPLETED BY CITY FORCES, A T WHICH TIME A DEBIT OR CREDITFILL BE PROCESSED FOR ISSUANCE TO THE.APPLIC,4NT. 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. Cl ALL DIAL -A -DIG (1-800424-5555) PRIOR TO 9EGINNING WORK IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUINEMENTS AND ACKNOWLEDGE THA i�WVST MAKE THE PINK' COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS Signature: J.� K_^ 9—U C_ Date: �Iek (Contractor or Agent) UPON COMPLETION OF PERMITTED WORK, AN, ENGINEERING FINAL INSPECTION !$REQUIRED PER CHAPTER 18.00 OF THE EDMONDS OMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326) FINAL APPROVAL OFPERMITTED WORK. DATE: Inspector's Signature For inspection r . e'quirements see Engineering I . nspection Inf(;�ina'tion handout. NO WOIZK SHALL ffl-,GIN 14UMTO 1'1,-1ZM1T ISSUANCE DAMy Documents\Forms\Engnmg\ROWoermit—.doc V !b 2 X 900 MPE ELL AIN 2 0 YN CIL, —'E CIL ---END OF M 333'N CIL,—'E CIL '��w ZI)i I 2" MPE IP MAIN FIELD LOC.—'E CIL '0 USE TIE—IN 2 " X 900 MPE ELL 203'N, 26'E CIL y FIELD TO LOCATE EXISTING MAIN LOCATION —'E CIL PLOT PLAN SCALE. I — 50' FITTER (CHECK BOX IF COMPLETE) Work area left in Clean & Saf�Lsondition Complete all Pipe Tables nd Gas Pressure Stamp Field changes Red —Lined on as —built Material verified and Changes noted on paperwork All Valve & Tie—in Locations ioted on as —built Note beginning of Main, ECIM & Line of Main locations Show Rope Locations & Cul—de—sac Radius Foreman's Signature Company Employee ID# 1 . 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 15. STANDARD GAS CONSTRUCTION NOTES: FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE —CALL" TWO WORKING DAYS PRIOR TO CONSTRUCTION, IN WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344 ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES. 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. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES 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 ISNTALLED OR REPLACED PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY PSE GAS ENGINEERING SERVICES. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE BOX (TEST LEAD) INSTALLATION. ACTIVE SERVICES DENOTED BY: PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2500. 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 REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX, TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS SHOWN ON THIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES. SYSTEM MAOP DENOTED BY: ISYSTEM MAOP = Aq- PSIG] GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR 13ETTER CONDITION. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED. (USE MANOMETER FOR LIP SYSTEMS) RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3400, AND 2525.1200. El 0 11 0 11 El 11 GAS MAIN INSTALLATIONIRETIREMENT Type/Work Pipe Size Type Estimated Length Actual Length Manu%cturer INSTALL MPE 130' GAS MAIN PRESSURE & TESTING llywf—k--�f PRESSURE YEST ED BY --- DATE ON TIME ON DATE OFF TIME OFF TYPE TEST PRESSURE TESTED BY DATE ON TIME ON DATE OFF TIME OFF [6;sign P�ss 60 SYS MAOP 45 PROJECT PHASE NOTIF# ORDER# SAP Superior Service/Meter Service/Meter Servica/Meter Service/Meter Ind. Service Ind. MSA Dis. Reg. / FT HIP SvdMSA Rellomite Retirernent X443936485 107017345 X076696Z70 10611Z182 REV# 2 I I Contractor CONSTRUCTION COST CODES:_ 1021-103-11 1 1 Project Manager Co.. Infonnaflon: DOUG USITALO CNLL: 425-327-3451 OPPICB.* 206-418-4236 DATE I BY DESCRIPTION COUNTY SNOHOMISH 1/4 SEC NE 23-27-3 UTILITIES CONTACT PHONE# EMER SECT 5 OP MAP 160.062 WORK SITE 1`1 %k QD -41 01 Ownerl Developer Contact Info EARLERN BURDE7T 403 2ND AVE N EDMONDS, WA 98020 ATTN: EARLEEN BURDRYT 425-771-7883 office CALL (800) 424-5555 2 BUSINESS DAYS BEFORE YOU DIG THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES ESTATE/EASEMENT PERMIT NIA EDMONDS nON CONTACT PHONE I DATE PROJECT MGR D. USITALO 206-418-423811 -ENGR-GAS DRAWN BY MLOCK CHECKED BY D. USITALO GAS WK CTR APPROVED B? D. USITALO MCNSEG FITTER #1 PLAT MAP FITTER #2 162.065 MAPPING JOINT FACILITIES ARRANGEMENTS PUGET EARLEENBURDETT SOUND ENERGY 2" MPE IP MAIN EXTENSION 403 2ND AVE N EDMONDS, WA 98020 DESIGNED BY PILCHUICK CONTRACTORS INC. 206-418-4217 o7-26—o3l 206-418-4236 206-4f8-4236 SAP Superior Order. 107017345 NIA SCALE: I" — 50'