109110220-73 ave w & 212 ST SW.pdf0 \:L L?,11(7.
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109110220
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: 72nd AVE W & 212th ST SW
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) : Retire and relocate the first stage of the natural gas regulating station
approximately 15' to the south of it's current location. Install new equipment in new vault.
Remove old existing vault. Restore concrete sidewalk.. (1) 20x6 concrete sidewalk cut anticipated open cut method of installation.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 1091
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.
Susan-1 1 - Digi�e signed ,d Suse ,1111 /LO/LO
I d I cK DN at=Susan 11 " ,=di,nitlin DepaNnUS ou=Muniapal
SIGNATURE D1b.nn=emn��0121n=50700=e�nm�-Ds DATE
Dena: 2018.06 20 12.E 5 25-0�'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PRE -INSPECTION REPORT
Job #:
109110220
Date:
6/19/18
Address:
Jurisdiction:
Edmonds
City / Zip:
Right of Way Permit?
Il YES ❑ NO
Customer:
Est. Start Date:
09/01/18
PM / Insp:
Est. Duration:
4 weeks
Q� UUt I SOUND ENERGY
SW corner of 72nd Ave W & 212th St SW
Edmonds
System
Shawnte Anderson t'd6PfWIffl
W RK DESCRIPTI N:
e ire an re acate the first stage of the naturalgas regulating station approximately 15' to
the south. Install new equipment in new vault. Remove old existing vault. Restore concrete
PLAT MAP: 261.085
exisitng 6" IP gas main 14'S
rn
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3
PHONENUMBER
Construction Method
Trenchless ❑
Open Trench 121
New Construct ❑
exisitng 16" HP gas main 9'S
212th St SW
Work Location
Size of Cut
Surface Type
11 100'S S of CL
212th St SW
& 26'
'E f CL
72nd Ave W
20 x 6
conc sidewalk
'N of CL
&
'E W of CL
N of CL
&
'E q7y CL
❑
FLAGGERS #
40 MPH
❑
TROLLY LINES
❑
BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑
ARTERIAL
❑ NO PARKS #
❑
Commercial ❑
Altered Commercial
❑
Leak Repair
Service Information
❑ Template Bar
❑
Residential ❑
Altered Residential
❑
CP Work
Diameter
Meter EFV
Pressure ❑ Bollards 2.5" #
❑
Multi -Family ❑
Replacement Service
❑
Pothole
[:1 3/4"
❑
250 ❑ 1800
❑
6" WC
❑
New Constr. ❑
Main Maintenance
El
Extension
❑ 11/8"
E]425
❑ 2600
El2#
El Bollards 4" #
❑
Stub ❑
Service Maintenance
❑ 11/4"
❑
630 ❑ 10,000
❑
>5# ❑ FUEL LINE PERMIT NEEDED
❑
Extension ❑
Valve Maintenance
❑ 2"
❑
1000
Fuel Line Length:
❑
Compete Sery ❑
Cut & Cap Mtr Loc:
Fuel Line Diameter:
- — - — - — - — - — - — - — - — _� t� —••
---------- ---- - -- --- F 277 ��LL
100' � 100' -100---' 100-'- 100' _
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�00-W4-2L
LEGEND
m M6 2
O >> m
"' W20-7A
C)
r
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m
0
W34 RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
®
28" TRAFFIC CONE
O
VALVE LOCATION
TRAFFIC FLOW
41
UNIFORMED
POL
POLICE OFFICER
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
POW POW
CHEVRON
ARROW BOARD
PLACE SIGNS ON
ALL SIDES OF
WORK AREA
• PARKING
o= o
PUGET
SOUND
ENERGY
JOB# 109110220
72nd Ave W & 212th St SW
June 1, 2018
ina.ustemchuk@pse.com
425-398-6063
Sheet 1 of 1
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>IIVM341S • ; Q o 0 212TH ST SW
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----------------------------------------------
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
CLOSED
AHEAD
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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.
Use traffic drums (barrels) with steady burning
Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" 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
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Work area will be 17', 26' WCL of 72nd Ave W & 30', 50',
55', 100' , ' SCL of 212nd St SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
STREET USE PERMIT REQUEST FORM
Date of Request: 06/19/18
Job number:
Job address:
Project mgr:
PM email:
109110220
SW corner of 72nd Ave W & 212th City: Edmonds Zip:
Shawnte Anderson
shawnte.anderson@pse.com
Estimated job start date:
09/01 /18
Estimated job completion date: 10/01/18
PM contact #. (425) 456-2894
Description of work to be performed:
Retire and relocate the first stage of the natural gas regulating station approximately 15' to
the south of it's current location. Install new equipment in new vault. Remove old existing
vault. Restore concrete sidewalk.
Pavement cut? ❑✓ Yes ❑No
If yes, Dimensions of Cut: Length 20 Width 6
How many cuts? 1
Surface Type conc sidewalk
Require trenching? Dyes ❑No
If yes, Dimensions of trench: Length Width Depth
Method of installation: opencut
Traffic impact:
Road closed ❑Yes ❑✓ No
Lane closed [?]Yes ❑ No How Many? 1 Direction? South
Shoulder closed ❑Yes ❑� No
Sidewalk closed Yes ❑ No
Emergency Contact: Joe Graham Print Send
Cell Number: (206) 396-7413
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