ENG20150452.PDFDAf
OF EY o�u,
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
,no I g90 PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20150452
RIGHT OF WAY 13ERM IT (6-EUC)
Permit Number: ENG20150452 Expiration Date: 03/10/2017
Job Address: 23207 75TH PL W, EDMONDS
Location:
APPLIC.ANT CONTRACTOR
PSE/Infrasource PSE/Infrasource
C/O Susan att: Sidick C/O Susan att: Sidick
1660Park Lane 1660 Park Lane
Burlington, WA 98233 Burlington, WA 98233
(425) 457-6353
LICENSE #: infrasl871cz EXP:
11 DESCRIPTION
Permission requested to install new 1 1/8" PE gas service at appro)rimate 220' N of c/o of 74th PL W and 16' W of c/I or 7th PL W.
Occupying the south bound late oftravel.
WO# 106303639
One 2 x 4 paving cut anticipate
DISRUPTION 1 RJMATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 }
PARKING: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: ( OX0) DURATION 1N 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 ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCEOFTHEWORK.
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 DIAIrA-DIG (1-800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
RELEASED BY
Printed: Monday, May 09, 2016
DATE
P9 FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
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STATUS: ISSUED ENG20150452
• 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 street clean.
• 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 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 6:00pm 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 from the issuance of 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.
INSPECTIONS
• &Engineering Final
PARTIAL INSPECTION DATE: IMTIAL: NOTES:
PARTIAL INSPECTION DATE: ITIITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: TMTIAL:
OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSION i-O ITROr , AND DRAINAGE
I Applicant shall rep,Air/replace all damage to
i u:,I.ItI4.. or ;mprovements in City ,
right-of-w&y par C ;y :standards that is cau::ed yly
I or occur,- clutiing tlia permitted project. t
1-1
J
Notes:
1. All signs and spacing to conform to the MUTCD
and Snohomish County 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 1 V 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 220' NCL of 74th PI W
& 16', 6' WCL of 75th PI W.
CHANNELIZATION ,..::: _.
bEVICE SPACING ..:._
MPH
TAPER
TANGENT
55RO
40
35/45
30
" 60
25130
= 20 ''
` 40
I�
PUGET
SOUND
ENERGY
Job#106303639
23207 75th PI W, Edmonds, WA
October 31, 2015
Sheet 1 of 1 Eduard.Volianskiy@pse.com
(425) 4246428
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PRE -INSPECTION REPORT
Job 6:
Date: /,�q - 2 -7 - Address:- N,
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ctlon: :city /zP:-
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PHOWNUMBER
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.. .O.RK . . DESCRIPTION: .
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Const . ructi6hWe'thod
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PLAT MAP: .
Applicant shall repair/replace all damage to.
1 j utiRkes or frontage in -iprqvemen
ts i City
'right -of
-oay per Ci�y standards that is caurei
or occurs, during:ft'permitted pro) 37'ct.
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OWNER/CONTRACTOR IS RESPONSIBLE
0OSION ONTRO!W'GE-RER,
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Work Location Size of Cut
-Surface Type!
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of o� L L .!I. P
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FLAGGERS MPH.
.[- �[j METEk.Hobb5:#
_J, TROLLY LINES. ❑ BUS.STOP #
OFFICERS-# SPEED LIMIT
[]: TRAFFIC SIGNAL ED ARTERIAL 1E] NO PAIRKS 4
Comriiercial E] Altered 6mmerdal
Leak Repair Service information n Template Bar
ff-Residential D Altered Residential.
E r 6k.aetdr Meter EFV
CP W6 k Ej 8ofims'25' #
❑Multi-FamiY
. Fj Replacement
❑ Pothble 5/8'❑ 250 0 1800
❑ Bollards 4"
New C(instr. fl Main Maintenance
Stub
11/8" %425
tkentlon A 2600
-630
D SOrvlee Malfif6hance
11/4' ❑ 10,000 (] RJEL:LINE PERMIT NEEDED
Extphqlnn Valve Maintehance
Ej 2" ❑ 1000, Fuel Llne.Ungth:
'Compete'Sery cot &-Cap.
M - Ir Lot:' Fuel Line Diameter:
i
PERMIT REQUEST FORM
Date of Request: 11/02/15
Job number: 106303639
Job address: 232007 75th PI W City: Edmonds Zip: 98026 I�
fi
Project mgr: Teresa Bradford PM contact #: (425) 457-9386
PM email: teresa.bradford@pse.com
Estimated job start date:
12/28/15
Estimated job completion date:
12/31/15
Description of work to be performed:
Install gag service t6 9391717 t6p-io on xuPqtqiriP nf Z.1ith RI W soft sbai ildpr winrinvy over
Water.
Pavement cut? ✓;Yes
E]No
If yes, Dimensions of Cut:
Length 2' Width 4'
How many cuts? 1
Surface Type asphalt
Yp
�.
Require trenchirig? iYes
El 1.
If yes, Dimensions of trench:
Length Width Depth
Method of installation: hogging
Traffic impact:
Road closed E]Yes
-[DNo I
Lane closed Oyes
No How Many? 1 Direction? south
Shoulder closed ✓j es
No
El
Sidewalk closed �'es
✓� No
Emergency Contact: Mike Blood
Cell Number: (425) 864-6154
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ROW PERMIT NO.: EVG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106303639
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: iNFRASL871C2
City Business License #: NR-019840
CONTACT: Sue Sidick
RECEIVED
NOV 0 3 1015
ENGINEE,gING DIVISION
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23207 75th PL W
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSI,,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes R No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Permission requested to install new 1-1/8" PE
gas service at approximately 220 ' N c/I of 74th PL W & 16'Wc/1 of 75th. PL W.
Occupying the slouth bound lane of travel. 1 2x4 paving cut anticipated.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year,1
PAVEMENT CUT: N Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No I.f yes, indicate size of cut: x_
RIGHT-OF-WAY
AREA
CLOSURE
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-I55-305 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&LQZ A , � 0. DATE 1 1/02/15
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE.