ENG20150418.PDFor En,y
CITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20150418
RIGHT OF WAY PERMIT (6-EUC) I
Permit Number: ENG20150418 Expiration Date: 04/18/2016
Job Address: 19228 OLYMPIC VIEW DR, EDMONDS Location: 19228 Olympic View Dr
PSE/Infrasource
PSE/Infrasource
C/O Susan att: Sidick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
.(425)457-6353
LICENSE #: infrasl871c2 EXP: 02/22/2017
Installation of new gas service @ approx 525' S centerline of Cherry street & 10' W of Olympic View Dr. Alternating closure of North
and South lanes for traffic. Pavement cut: 2: 3X5 paving cuts anticipated in gravel and black top.
DISRUPTION INFORNIATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
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
INDEAfATTY.• The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that maybe made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONE VEAR 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 DIALrA-DIG (1-800424-5555) BEFORE ANY IXCAVA770N
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO TIC E REQ UIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOT PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday, October 16, 2015
FILE COPY INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED ENG20150418
• 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.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep streetclean.
• Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• 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 fromtemporary construction sites as a result ofconstruction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm 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 fromthe issuance of this pen -nit. 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.
INSPECHONS
• E•Traffic Control
• EEngineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
e)
j C. 7.:3`� q
RECEIVED
OCT 0 9 2015
DEVROPIMENT SENCES
PROJECT INAI!' E: 106302490
--- ..............._.........._..........._..........._._
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane Burlington Wa
--_----_._........._......_._.._..._.._......... -----............._............__..........._.....................
State Ucense 4: INFRASL871C2
City BMill Ueell IC it: NR-019840
1,10 V av k.'.I r .Ir t'✓A 6'll. 1\I0.
15= l i
II_ifiOE IDKIT;:
EX)NTACI` Susan Sidick
Plione #: 425-457-6353
Fax 11:
—-...._...__._... .... _.................... ......._ ._._.._....
lsin��t tt' susan.sidick@pse.com
- =— --- _....._---_ ..--- -- - --
`J I.,iability hi stir <ance C l Ponded
ADDRESS OR INTERSECTION OF COrJS'll'PLYJC"9'ION: 19228 Olympic View Dr
ROW WORK ASSOCIIATI IED WI['I IR THE J'OIC LOWING TYPE, Q: I .>i➢ROJ + CT --I
❑ Commercial ❑ Subdivision EJ City Project ❑ Traffic Con(rol (Only)
❑ RZulti-Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, HE,,
CONICAsr, ®VWSD):
Is this permit part of a blanket permit? (_� files ❑ No
_------- _._..._...
ANY ASSOCIATED PERMITS?__--
ID.E,SCItIP riON OF PROPOSED WORK (Ile Specific): —
Permission to_install new gas service .��?_approximately 525' S cen_terWjQCm)LSL&_-
10'W of Olympic View Dr. Alternating North -_and South lanes for traffic.__._ __.._—_.._.___._...-.......__._--
Pavement cut: 2: 3x5 paving cuts anticipated in gravel and black top. - --_ —
-- --- -_.._._
W.AS STREET OVERI.,AVE D WITHIN'1HE ILAST FIVE 5 )LE Ams? 'N's NO ❑ Xear:
PAVEMENT CUT: F lies El No Ifyes, indicate size of cut: 3
CONCRETE CUT: ❑ Yes L] No li'yes, indicate sire of ent: --_-_x
RIGHT-OF-WAY
• AREA
TOTAL
S YF+LL DURATION
CLOSURE
(NUMBER OF MONTHS)
Sidewalk 48 ffi s +
LF LF
SF
Alley 72 Hrs +
LF
X
I LF
SF
Parking 72 Hrs +
LF
X
I LI
SF
APPLICANT TO REAL AND SIGN
*Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. l;very flagger must be trained as required by (WAC) 2.96-155-305 and must have certification
verifying completion of the required training in their possession. I
';Restoration is tp 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 hind 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 flees 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.
SIGNATUI2IJ t ,l`1 t �':' DATE 10/08/15
�
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
00
tt 00) a ppE
I, O� N� N U N
O O � rrC�L,N
� 0 E TN
0 '6
3
j
a�
5
U
(6
E
w
® O
N
00
O
N
N
r-
U)
as MejA ogdujAjo
Z
LU
2 a
0 Z
;g O 3 0 3 m
®� 4 ®sue
O
U v o
ELU
�
m w
�r
Q12
1 u
Q
— }}�� "•
E
2 'o
z
UH F"
a°
c cd o r o
p
>Z�
C CO to N E 'E
CU -,,
Z
c� v YTS d E >
O c
cca o Y o
W y
U)
Za
5n
3;�;��cn a)a�E'
C Q
�oo�
'g
F
a o� = O'm cv
m nod 0
-�
LU
12
oEyy`mrnc
C Y d � •p3 •
vn—CCc
Y49
rcC)
LU
iq
o a.y
Lm5D.�� CULC�y
p
c'
�at++•
Z Q$c
am UW —a(an0�
a .E.U..�
�CN
m O o LO
..-..-.9
.
W
o
Z w (V 8 M •a• O vi
6 h 06 ad 6
MA
ti-OzM
----------
----- -----
100�100.
-------- ------------------------------- --------------------------__._-
�aas-N,7s aaaa--------- --
�p Merl ord�.u�f�p - -
�o�
€
U
� � m �. �.
W20-1 m W20-7A
W20-4=.
Z
I
w
3
C3-�
v oEi 7
ZO coow4
OZ
0
F—D
w w M N
MZ U
= LLLLLL>lll
-
UOxotn0
A M N
O (��Q' ? O O N
N U
•Np I.
\J�Q° °OVA
EO1Trri
020
N
�72
U co
EL o
E w
® =- N
O c
N00 0
N
Z
$ 3 `o
t U � W O Z
a
F°
N m
®®4 ° ®A-44
L
Q) C
c0 L a
rn U 3 >
•o v
IV— w
= N ca
o''a
m E v E o r- o
p fn y G _C 7 __ 1
c � N E E v c U ��
° c T p m 'C to
33 �
mc�v as •-
�a
m � •c c .5 � c
°- c •p 5 °� n m� 1° ° m
ai o ` �' CL= s Z
D E ui m cmr '9 d'
C -0 .Y a) c Q .x .}+ .•.+
O
m w 13 N m v i cog Q4
m p '�C7 Z C� Kw
` m m° N
a� 3�! ��) 3-.
yin c
_ U— at.rn 2 Cu 3 a) o o L 3 a)
v-a..E..U..cq. u ...C) _(..a-3-3:-,ii..� .._....
'
. _. __...... ...._ ... _ ...
_._
Z<- NCV .p Md' 0u-; aCO r-�.6.0 Qj O
. 3 -OZM
N
b'L-OZM
�
6-OZM
. .y
ap MejA oldwI�p
,00 of oo
�
- _
100' 100' 100'
.rQ Mein oldw�fjp
g
N
W20-1 m W420-7A
W20-4 T
z
� °�
0�
z
U la
a
w N w
g7ZW�vMN
S � F
Vp=oao
v
b M N
Job #: 1,043 042 41 0
Date:
Jurisdiction:
Right of Way Permit? YES ❑ NO
Est. Start.Date:
Est. Duration`
PRE -INSPECTION REPORT
Address:
City]zip:,
Customer:
PM / Insp: CUST PHONE NUMBER
PHONE NUMBER
WORK' Construction
Mothod
�Q.. - j.� Q t [ Dl�o,i �!)E �G
Open Trench ❑
-
b gr —
Trenchiess R
PLAT MAP:
—
—
-
-
t
r7-
r.
a
FT
Work Location
Size of Cut
Surface
Two
'N S f CL S & 'E f CL..K')(
3Y5
6 (eNvc
, 'N(pof CL .;-. & ►i W of CL , evJ a
t �
'N S of CL & 'E W of CL
FLAGGERS # :?- ' aS MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS #
❑ OFFICERS # SPEED LIMIT ❑ TRAFFIC SIGNAL ❑: ARTERIAL ❑ NO PARKS #
8 Commerd I Altered Commercial. Leak Repair Service Information ❑Template Bar
Residenlla� 8 A�tered Residential B CP Work Diameter Meter EFV
[IMulti-Family ❑ Replacement Service ❑ Pothole ❑ 5/8" ❑ 250 ❑ 1800 ❑ Bollards 2.5" #
New Constr. ❑ Main Maintenance ❑ Extension ❑ 11/8" ❑ 425 ❑ 2600 ❑ Bollards 0 #
❑ Stub ❑ Service Maintenance ❑ 11/4'. ❑ 630 ❑ 10,000 ❑ FUEL LINE PERMIT NEEDED
❑ Extension ValIvMaintenance 2- ❑ 1000 Fuel LIne,Length:
Compete.Sery 8 Cut e a Cap
Mir Loc: Fuel Line blameter:
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
PERMIT .REQUEST FORM
10/07/15
106302490
19228 OLYMPIC-VIEW DR City:EDMONDS Zip: 98020
NCIOLE MCDANIEL
nicole.mcdaniel@pse.com
Estimated job start date:
Estimated job completiori date:
Description of work to be performed:
PM contact #: (206) 716-2753
Pavement cut? FYes 0No
If yes, Dimensions of Cut: Length 3 1/Vldth 5
How many cuts? 02
Surface Type laa c k 4p
Require trenching? E]Yes ®No
If yes, Dimensions of trench: Length Width � Depth •�
Method of installation: hole -hog
Traffic impact:
Road closed Yes []No
Lane closed [Dyes rNo How Many? 1 Direction?
Shoulder closed Oyes ® No
Sidewalk closed ®Yes ® No
Emergency Contact:
Ce// Number: .
uj
LO
Cp
rn
CN
in
L L
O
1ti9
CM
LU
to
.... ...............
cr)
13 1
Wlt di 3d.V
Na M31A OldAAlO
co
Jo main D!dwAlo
JO A%OIA oldwAlo
CL
UP
a)
LO
LO
4e�
A
......... ... .. .............
/ ... .... ..... ...