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ENG20130341.PDFCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20130341
RIGHT OF WAY PERMIT (7-EUC Standard)
Permit Number: ENG20130341 Expiration Date: 08/22/2014
Job Address: 15631 75TH PL W, EDMONDS Location:
APPLICANT CONTRACTOR
FRONTIER INC Pacific Cable
P.O. BOX 1003 11321 Hwy 99, Suite #10
EVERETT, WA 98206-
(425)346-2083
LICENSE H: EXP:
Bore service drop from pole to home. Bore in shoulder along 75th PI W. from pole to property line.
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: (OXO)
PARKING: (OXO ) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: (OXO ) DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY. • The Applicant has .signed an application which .states he%she holds 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 but not limited to the defense of any legal proceedings including defense costs and
attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK.
• 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
possesion.
• 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.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
ED
Printed:
DATE
21.2014
E COPY INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG2O.13O341
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Alert affected residents and/or businesses prior to work start.
• Conform to approved working drawings and Traffic Control plan.
• Public utilities maintain 5' separation from City Utilities.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7am-6pm and Saturdays 1 Oam-6pm. No work on Sundays or Federal Holidays.
• Call for required inspections as noted.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction'sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:OOam to 6:OOpm on weekdays and 10:00am and 6:OOpm on Saturdays,
excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must
comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance fa this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any
ordinance provision.
• E-Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
Chapter 2
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Work Zone Traffic Control Guidelines M 54-".01
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Page 2-T
Iwo # , . Job k Batch a
24961 Job Information 3344
Customer Name: DAVID SPIRO 5/22/13
Customer Address 15631 75TH PL W EDM,WA Dispatch Date 05/22/2013 05:31:
Contact name: Commitment: 01-3-05-29
city: EDMONDS state WA Zip 98026 Job Status:
Contact #. 4257419212 BTN: 4253441165 CO:
_ .. -----..._---. -- - - --- - � Circuit ID•
Work Center Fibe
Wire Center #:
i Wire Center Code ON NW.031131889
PACCAB M my 20S -
CUSTADDR: 16631 75TH PL W110AERIAL: COMMIT 5/29/13F)SO OD 5/30/13 APPT. 0800.1700nuAERIAL PER DPI. IF BURIED DROP IS
1 II NEEDED AND THERE IS NOT ENOUGH TIME TO CALL FOR LOCATES, PLEASE PLACE A TEMP AND NOTIFY BSW DISPATCH (� R `I WESTBSWDISPATCHQFTR.COM OR CALL 8884839666 OPTA THANK YOU. u u I
i
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Drop Terminal Inform ion
Drop Term Addres 15701 75TH PL W EDM,WA • Drop Term Name C6FTP/FT-7
Related Term 7 A,
Address:
FDT Type MFG:
Drop Term Port # 0
Splitter hub Name C6FTP/H402
Dist Fiber Strand 0
Drop Type: mmw Ruky
FDT Type # of
Ports
P59A P43D --- _ - P57A — L50A —_—_ L50B
P36A P71A _ - S14A -- - L40A L40B
P93E P93H P36B E20A , ;E30A
1 No of Sores j —� _ Bore Lengths - _ — j - --- - Drop Length
---
Aerial _ Name: Tax Code 3131 Fiber Length: Hours
— — —
TG: T R S Time In
Date: -- I
loured cross street: Time Out —_
'Name: 60/40 _I
1- — Permit # 65/35 _
,Date: Locate#: Due Date: ether
RIGHT OF WAY CONSTRUCTION PERMIT ROUTING FORM
PERMIT #: ElUvat 2013 034 I RECEIVED:
WORK ADDRESS: I.S1o31 — 7 0 PL W
CONTRACTOR: M
-�- - ` (_THIS PERMIT IS TRACKED BY PERMIT TRAX
Please remember the following:
► "Sign off" on permit under your specific review and Check Complete Box.
► OR Attach Review Corrections in Permit Trax.
• Corrections will be sent to the applicant by Engineering Reviewer.
• Note "Corrections attached" under your specific review.
• Re -assign your review to the Engineering Reviewer.
► Track Review Time under your specific review.
► Add Conditions that need to show on the permit document.
► Add a Message if you need to flag other reviewers of a specific project issue/concern.
�PMUBLIC WORKS REVIEW: DATE RECEIVED:
❑ STREET DIVISION--------------------- Date Review Complete: 4�
❑ --------------------------
STORM DIVISION Date Review Complete:
❑"WATER DIVISION -------------------- ------ Date Review Complete: -,i
-SEWER DIVISION -------------------------- Date Review Complete:,g /I /3
❑ PW DIRECTOR -----------------------------Date Review Complete:
(❑ 15LANNING: REVIEW REQUIRES) ONALL WIRELESS FACILITIES I
(cell antennas, unicell,.etc.)
Date Received: Date Review Complete:
ENGINEERING REVIEWER: JENNIFER LAMBERT
1► // ►► RETURN TO ENGINEERING REVIEWER M Ii 11
Comments made on the attached documents need to be done with a RED PEN and on ALL 3 COPIES.
_ Date and initial all changes or comments.
❑ FRANCHISE FEES REQUIRED: $ (COLLECT PRIOR TO ISSUANCE.)
❑ COPY OF PERMIT TO SANDY CHASE, CITY CLERK
C:Wy Documents\Spellman\Forms\Jana's ROW Routing 3-07.doc Revised 5-11-10
City of Edmonds Permit Not__.._.
RIGHT—OF-WAY CONSTRUCTION PERMIT Issue Date:
A, Address or Vicinity of Construction: 15631 75TH PL W, EDMONDS
B, Type of Work (be specific): BORE SERVICE DROP FROM POLE TO HOME, BORE IN SHOULDER ALONG 75TH PL J1,
' FROM POLE TO PROPERTY LINE, 'WO#5103898-47
C,"Contractor; PACIFIC CABLE
,Mailing Address: 11331. HWY 996#10
State License #: 600-587-702
City Business License M.
D, Building Permit # (if applicable):
E, ❑ Commercial ❑ Subdivision
Multi -Family ( Single Family
INSPECTOR:
F. PAVEMENT CUT: ❑ YES
CONCRETE CUT: CJ YES
(33, ❑ Mail Approved Permit
Contact: Ar'iLIK)ny Khan
Phone: a25-316-2083
Liability Insurance: Bond; $
Side Sewer Permit # (if applicable);
City Project ® EUC (PUD, VERIZ�O' N�•;P,S,E; COMCAST, OVWSD)
❑'Other
© N00 G. SIZE OF CUT X t ?019
tS'JN
❑ Call for Pickup �f �JSfON
INDEMNITY,• Applicant understands by hislher signature to this application helshe holds 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 but not limited to the defense of any legal proceedings including. defense
costs and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWINQ THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK, - ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICHITIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
i Traffic control and public safety *shall be in accordance with City regulations as required by the City Engineer, Every
fligger 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.
CALL DIAL>A,DIG (L 800-424.5555) PRIOR TO BEGINNING WORK
I HAVE RgfW TI,I,E ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDG4
THAT I MUST XE TH PINK COPY F THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature, . Date;
{Cohtraetor or Agent)
?� t, '. _ 4� FORzCITY [JSE ONLY r s"
v
ApPCoved;by, r
- : RI 6t ofwa
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T zed., Vold-, i
/• Disruption4fe'fFundiilis
�peFial Ctanditions
Insp�ehon Fees
„s....._ , .:..
Total Fee
tT
£4
REQUIRED INSPECTIONS:
Call 42$R771-0220, Ext, 13M6 for a 244our voice -recorded inspection request line.'
FI'N L APPROVAL OF PERMITTED WORK: DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE