109112638-21712 76 Ave w.pdf0 \:L L?,11(7.
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109112638
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: 21712 76th Ave w
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) • Replace 5/8 twin services to 21712 & 21706
with 1 1/8 service @ 248' n C/I of 218th ST SW & 18' E to 16' W c/1 of 76th Ave W- retire gas service to 21710 76th Ave w
1 4x6 paving cut & 1 3x5 paving cut anticipated
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
I d I cK DN at=Susan 11 " o=Pain itlin DepaNnUS ou=Muniapal
SIGNATURE D1b.nn=emn��8111n=�20700=e�nm�-Ds DATE
Dena: 2018.06 OB 11 � 4.12-0�'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PERMIT REQUEST FORM
Date of Request: 06/08/18
Job number:
Job address
Project mgr:
PM email:
109112638
21712 76th Ave W
Gayle Plaisance
gayle.plaisance@pse.com
Estimated job start date:
Estimated job completion date:
07/31 /18
Citv: Edmonds ZiD: 98026
PM contact #: (253) 617-6013
Description of work to be performed:
replace -518" PF twin gas services to 91712 & 21706 NA/ith complete 1-11,9" PE host and buin
@248' NCL 218th St SW, retire gas service to 21710, please see pre -inspect for details
Pavement cut? ',/ Yes F-]No
If yes, Dimensions of Cut: Length see pre-insp Width
How many cuts? 2
Surface Type asphalt
Require trenching? es F,/]No
If yes, Dimensions of trench: Length_
Method of installation:
Traffic impact:
Road closed ElYes
F✓ No
Lane closed
M✓ Yes
F]
No
Shoulder closed 171yes
F No
Sidewalk closed
Elyes
F1
No
Emergency Contact:
Cell Number:
Width
Depth
How Many? see tcpDirection? North
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No electric grid information available
Scale 1:1800
S 164068, Q 164069
03-15-2018
Lat\Long=47.8024,-122.3379
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The Information on the attached maps is subject to change without notice. Puget Sountl Energy makes no worronty espressed or implied, concerning
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fha Intormallon on the attached mops is subject to ch-ge Mhoul notice. Puget Sound Energy m 1.+. ho warranly. expressed or implied...... rning
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11/4" PE -A IP
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Job #:
109112638
Date: C}S_,?—y -- �
Jurisdiction: gdmonds
Right of Way Permit? YES ❑ No
Est. Start Date:
Est. Duration:
PRE -INSPECTION REPORT
Address: 21712 76th Ave W
City / Zip: Edmonds
Customer:
PM / Insp: GUST PHONE NUMBER
PHONE NUMBER
WORK DESCRIPTION:
- w i r 1 _,s,,e- 9, tA_ 7-0 Zl - -t 7_
Construction Method
Open Trench
2-t C9Lo t-j� r.J ..lJ t ��-6 PS S 4- A,- C) �'�..� �4
Trenchless ❑
PLAT MAP: UOL4
-4-0 Co
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Work Location
Size of Cut
Surface T e
r ' N of CL .�
& of CL -F� �_ w,
}C
of GL t S�
&_1 1 'Eft f CL .2 1
X
1. in L
'NSofCL
& 'EWofCL
E�'FLAGGERS # CL S MPH ❑
TROLLY LINES ❑ BUS STOP # ❑ METER HOODS #
❑ OFFICERS # SPEED LIMIT ❑
TRAFFIC SIGNAL ARTERIAL ❑ NO PARKS #
❑ rcial ❑ Altered Commercial ❑
Residential
Leak Repair Service Information ❑ Template Bar
Diameter Meter EFV
E1,0ft6red Residential ❑
CP Work Ilards 2.5" #
❑ MLJM-Famih/ Replacement Service ❑
❑ New Constr. ❑ Main Maintenance ❑
Pothole. ❑ 5/8" El250 El1800
Extension ❑ 11/8" ❑ 425 ❑ 2600 ❑ Bollards 4" #
❑ Stub ❑ Service Maintenances
❑ 11/4" ❑ 630 ❑ 10,000 FUEL LINE PERMIT NEEDED
❑ Extension ❑ Valve Maintenance
❑ compete Sery
❑ 2" 1o0o Fuel Line Length:
(T"
L-.�& Cap
Mtr Loc: + Fuel Line Diameter: � t
LEGEND
® 21F TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
FLAGGER
WORKVFHICLE
SIGN LOCATION
WARNING FLAG
PUGET
' SOUND
ENERGY
Job#109112638
21712 76th Ave W, Edmonds, WA
June 7, 2018
0V3t1V I Sheet 2 of 2 gregory.harwood@pse.com
N NaOM i ! I ! (425) 424-6425
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I-BUSINESS(S) WILL BE
INFORMED OF POSSIBLE
TEMPORARY DRIVEWAY
-• ' CLOSURE
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11:11I11:11 ' oYo¢
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0. 220' 40'1
218TH ST SW i -- --- Puget Sound Energy
r Traffic Control Supervisor.
O a O Gregory Harwood
Card No. 008997
_ O Card Exp. 08/132019
n':Z'
gregory.harwood@pse.com 218TH ST SW (425)424E42�100,Notes:
1. All signs and spacing to conform to the MUTCD
I i and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
11 .11 11. 11 i N
W20-1 shall be completely clear unless otherwise indicated.
=
. � 14 . 4 RIGHitANE � 3. Channelizing devices are 28" traffic cones.
W
CLOSED oUse traffic d urns (barrels) with steady burning
AHEAD N Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36' x 36" and shall
ROAD . not obstruct pedestrian access.
r I r WORK CD 5. Crew is required to leave a minimum of 11' for
AHEAD
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 18' ECL of 76th Ave W 8 248'
NCL of 218TH ST SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
MINIMUM TAPER LENGTH = L (feet)
LANE
POSTED SPEED LIMITS
IMDTHS
20
25L
35
40
45
10
70
105
205
295
475
11
75
115
225
295
495
12
80
125
2451
320
540
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.
763.999
www.trafficmanagement.com
ww.trafficmanagement.camT.flfl
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Rentals
Conlral Seq.Egtrl
Perrtits&CansJ6np�Enpinearinp -Trmrvnp
P.H it
�iw•'
C31 # 785804
TAII CONTACT PERSON: A4cha0lanagan
TCS CERT #: 301872
PLAN ORDER: 37959
DATE: 61708
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fd11110
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CD
0
RESIDENT(S) WILL BE
INFORMED OF POSSIBLE
TEMPORARY DRIVEWAY
CLOSURE
SIGN SPACING
55 +
800 60/65
5W 45/55
359 35/40
2W 30
1W 25
CHANNELIZATION
DEVICE SPACING
TANGENT
TAPER
MPH
80
40
55170
60
30
35/45
40
20
25130
MINIMUM TAPER LENGTH = L (feet)
LANE
POSTED SPEED LIMITS
WIDTHS
20
25
30
35
40
1 45
10
70
105
150
205
295
475
11
75
115
165
225
295
495
12
80
125
180
245
320
540
LEGEND
® 28'TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
FLAGGER
WORX—ICLE
SIGN LOCATION
WARNING FLAG
218TH ST SW J
-------
100'
W20-1
Q;m11.11I11.11 '
FZ-i V:�IQ:Q
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PRIVATE ROAD
PUGET
SOUND
ENERGY
Job#109112638
21712 76th Ave W, Edmonds, WA
June 7, 2018
Sheet 1 of 2 gregory.harwood@pse.com
(425) 424-6425
0' 20' 40'
Puget Sound Energy
Traffic Control Supervisor.
Gregory Harwood
Card No. 008997
Card Exp. 08I13Y2019
g rsgory.harvrood@pse.com
(42255)4224--,6425
(4 / 0 A--'?"
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 16' WCL of 76th Ave W 8 248'
NCL of 218TH ST SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
6-OZM
100'
218TH ST SW
CD
N
PLAN PREPARED BY:
TRAFFIC MANAGEMENT, INC.
800.763.3999
ww.trafficmanagement.c9m
w
TralficC Sale,&RcTT
Serg
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C -E
Perrtiis&ConsJAnA�FnAineerinA-TreirinA
�TM'
C31 # 785804
TMICOIITACT PERSON: Mhaelrlanayan
TCS CERT #: 301872
PLAN ORDER: 37959
DATE: 617118
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