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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 108601735
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 437 5 ave S
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑iC Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Yes ® No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 67' E c/1 of 5th AVE S On walniut St
5th AVE S on Walnut St
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 10861
PAVEMENT CUT:
CONCRETE CUT:
❑ Yes ❑ No
❑ Yes ❑ No
If yes, indicate size of cut: 3
If yes, indicate size of cut: _
x5
x
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIGN
*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 and Standards. All street -cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
Indemnity: The Applicant has signed an application which states he/she hold 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 defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE
DATE 1 /13/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #: 108601735
Date: 1/2/18
Jurisdiction: Ed tads
Right of Way Permit? YES ❑ NO
Est. Start Date:
Est. Duration:
PRE -INSPECTION REPORT
Address: 437 5th Ave S
City / Zip: Edmonds
Customer:
PM / Insp: CUST PHONE NUMBER
PHONE NUMBER
WORK DESCRIPTION:
Construction Method
Open Trench ❑
4 , L - S , o �j VJ Ara u —,
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Trenchless
PLAT MAP: i1,s .v&D(P
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WA
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LSD
Work Location
Size of Cut
Surface Type
r f CIL t,uAta, dT
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LPN At'i"'
'NSofCL
& 'EWofCL
'N S of CL
'E W of CL
FLAGGERS # MPH
❑ TROLLY LINES ❑ BUS STOP #
❑ METER HOODS #
❑
OFF CERS # SPEED LIMIT
❑ TRAFFIC SIGNAL ❑ ARTERIAL
NO PARKS #
Commercial ❑ Altered Commercial
❑ Leak Repair Service Information
Template Bar
❑❑
Residential ❑ Altered Residential
❑ CP work Diameter
Meter
EFV
Bollards 2.5" #
❑
Mufti -Family❑
❑ Replacement Service ❑ Pothole ❑ 5/8"
❑ 250
❑
1800
❑ Bollards 4" #
❑
New Constr. ❑ Main Maintenance
❑ Extension ❑ 1118"
❑ 425
❑ 2600
❑
Stub ❑ Service Maintenance ❑ 11/4"
❑ 630
❑
10,000 ❑ FUEL LINE PERMIT NEEDED
❑
Extension ❑ We Maintenance
❑ 2"
❑ 1000
Fuel Line Length:
❑
Compete Sery Cut & Cap
Mtr Loc;
Fuel Line Diameter:
LEGEND
®
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
4}O
WARNING FLAG
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WALNUT ST
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UTILIT
WORK
AHEAD
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TO BE PLACED AT 6TH
AVE S
MINIMUM TAPER LENGTH = L (feet)
LANE
POSTED SPEED LIMITS
WIDTHS
20
25
30
35
40
45
10
70
105
150
205
295
475
11
75
115
165
225
295
495
12
80
125
180
245
320
540
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425 p
A�
PUGET
' SOUND
ENERGY
Job#108601735
437 5TH AVE S, EDMONDS, WA
January 9, 2018
Sheet 1 of 1 gregory.harwood@pse.com
(425) 424-6425
Notes:
1. All signs and spacing to conform to the MUTCD and City of EDMONDS
standards.
2. All sidewalks, driveways, exits and egresses shall be completely clear
unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not obstruct pedestrian
access.
5. Crew is required to leave a minimum of 11' for traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be 5' SCL of BECK LN & 67' ECL of 5TH AVE S.
CHANNELIZATION
DEVICE SPACING
TANGENT
TAPER
MPH
80
40
55/70
60
30
35/45
40
20
25/30
SIGN SPACING
"X"
55 +
800
60/65
500'
45/55
350'
35/40
200'
30
100,
25
PLAN PREPARED BY:
TRAFFIC MANAGEMENT, INC.
800.763.3999
www.trafficmanagement.com
Traffic Control Services -Sales &Rentals �TMI
Permits &Consulting -Engineering -Training
C31 # 785804
TMI CONTACT PERSON: Michael Flanagan
TCS CERT #: 301872
PLAN ORDER: 32270 DATE: 11912018- CS
g163066 rhttp://sesoams1/map_file/gis/mapviewer/plat/g163066.tifl Page 1 of 1
PERMIT REQUEST FORM
Date of Request: 01/12/18
Job number
Job address
Project mgr:
PM email:
108601735
437 5 Ave S City: Edmonds Zip:
Gayle Plaisance
gayle.plaisance@pse.com
Estimated job start date:
01 /29/18
Estimated job completion date: 02/09/18
PM contact #: (253) 617-6013
Description of work to be performed:
Retire gas sentice to above address lnnated (@ 67'ecl . Ave S on Walnut St
See attached tcp for specific traffic control
Pavement cut? FlYes ®No
If yes, Dimensions of Cut: Length 3' Width 5'
How many cuts? 1
Surface Type asphalt
Require trenching? r7Yes No
If yes, Dimensions of trench: Length Width
Method of installation:
Traffic impact:
Road closed
aes
®✓ No
Lane closed
Yes
®✓ No How Many?
Shoulder closed
Yes
F No
Sidewalk closed
®Yes
No
Emergency Contact: Mike Blood
Cell Number: (425) 864-6154
Depth
Direction? south