ENG20160185.pdfYV2O1
CHANNELIZATION
DEVICE SPACING
MPH
TAPER TANGENT
55/70
40 80
BORE PIT
=�
TRAFFIC FLOW
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ENGINEMINQ WA
Notes:
|eignmandopodnOtoounformto the MUTCD
L,63AndCity o/Edmonds standards.
2.All sidewalks, driveways, exits and egresses
shall becompletely clear unless otherwise indicated.
3.Chonne/izinydevices are 28''traffic cones.
4.Sign size can beuminimum of48,x48"and
shall not obstruct pedestrian access.
5.Crew \nrequired toleave aminimum of11'for
traveling lane width.
G.Alert affected residents and businesses.
7.Work hotake place between 8om.and 4pm.
8. Work area will be440'NufC/Lof241o\STSVV
&14'EofC/Lof?4thAve VV.
�"y;�l�l��!����p����������
LEGEND
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28" TRAFFIC CONE
M
BORE PIT
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TRAFFIC FLOW
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WORK VEHICLE
SIGN LOCATION
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WARNING FLAG
PUGET
SOUND
ENERGY
Job#106310803
W, Edmonds WA
May 13th, 2016
)neysett@pse.corn
(425) 424-6425
to the MUTCD
A egresses
ierwise indicated.
ffic cones.
.8" x 48" and
S.
num of 1 Vfor
nesses.
m. and 4 p.m.
)f 241st ST SW
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
II"
Job#107052567
23917 74th Ave W, Edmonds WA
July 28, 2016
Sheet 1 of 1 ryan.honeysett@pse.com
(425) 398-6066
pacing to conform to the MUTCD
mds standards.
driveways, exits and egresses shall be
unless otherwise indicated.
levices are 28" traffic cones.
be a minimum of 48" x 48" and shall not
an access.
A 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.
8. Work area will be from 410' to 440'N of C/L of 241st ST
SW & 15'W of C/L of 74th Ave W.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
LEGEND
®
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
pacing to conform to the MUTCD
mds standards.
driveways, exits and egresses shall be
unless otherwise indicated.
levices are 28" traffic cones.
be a minimum of 48" x 48" and shall not
an access.
A 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.
8. Work area will be from 410' to 440'N of C/L of 241st ST
SW & 15'W of C/L of 74th Ave W.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
PERMIT REQUEST FORM
08/01/16
107052567
23917 - 74th Ave W
Lisa Griffith
lisa.griffith@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
09/13/16
09/15/16
Citv: Edmonds Zip: 98026
PM contact #: (425) 406-0121
Pi-rmos.genn requested to tie into existing 2" PF IP gas main located at 1,15W of C-11 of 74tb
Ave W and 444' N of C/L of 241st St SW to extend 2" PE IP north 84' to tie into existing 2"
PE IP main located at 18'W of C/L of 74th Ave W & 381'S of C/L of McAleer Way & to
extend 1 118" service to "239'17". Four TX5'soft surface cuts anticipated. One 2'X2'
o e t h o le -eves' -water -a R t+e+oa to d.
Pavement cut? ETYes No
If yes, Dimensions of Cut: Length 5' Width 2'
How many cuts? 1
Surface Type Asphalt H2O
Require trenching? ®✓ Yes Li
No
If yes, Dimensions of trench: Length 5' Width 3'
Method of installation
Traffic impact:
Road closed
Lane closed
Shoulder closed
Sidewalk closed
Open trench/hole hog
Yes
No
®✓ Yes
No How Many? 1
F-71Yes
No
Yes
No
Emergency Contact: Dean Latimer
Cell Number: (253) 350-6687
Depth 3'
Direction? North
Job #: 106310803
Date: 5/10/16
Jurisdiction:
Right of Way Permit? R YES ONO
Est. Start Date:
- - - - - --- - - --- - --
PRE -INSPECTION REPORT
Address: 23917 74TH AVE W
City / Zip: Et)MONI)5
Customer: RYAN GPEENWAY 206-290-5153
PM I Insp: MARK BOWLING 72 F SUMN4
PHONE NUMBER
Est. Duravon: V r 1t�
Construction Method
VVORK DESCRIPTION:
open Trench El
L1sSCAT SVC 60'1118PEW142TMTR 1\JFWC01\15RUCTT0A'
Trenchless
PLAT MAP:
N
F+4.3
IL, _t,6c,
'THr
Size of cut Surface Type
Work Lacafion
& 4_ &i: 6 L .4-
46 of CL_ .._244 T__S_T_SW-- _j_
-----_S
3X5 GRAVEL
*NSofCL1 'E W of CL -
,R 6 '241ST ST SW AVF W
2X5 ASPHALT H2O
440 of CL,
FLAGGERS 4 2 25 MPH [:)TROLLY LINES
Li BUS
STOP #
F-IMETER HOODS 4
-SPEED LIMIT ❑ TRAFFIC SIGNAL
El OFFICERS #
R ARTERIAL
El NO PARKS
Q commercial F] Altered Commercial Leak Repair
Serviceinformation
EFV Q Template Bar
Residential F-1 Altered Residential F-1 CP Work
Diamcfer
El 5/8"
Meter
0250
EjBollards 2,5"#
01800
I hilt-Farnify Replacement Service D Pothole
❑D Extensi an
P] 11/8"
B 425
❑ Bollards I" #
[2] 2600
R[21 ew constr, Q Main Maintenan ce
0 11/4"
El 630
Fl10,000 []FUEL LINE PEPMITNEEDED
tub 0 service maintenance
0 2"
R 1000
Fuel Line Length: —
0 Extension 0 Valve Maintenance
P/1 Compete Sery El Cut & Cap
Mtr Loc:
— O/L
Fuel Line Diameter: _NLA_
V�5,wetn&)
Main- ioqo6260
Job #:
-106310803
Date: 5/10/16
Jurisdiction:
Right of Way Permit? [A YES FINO
Est. Start Date:
Est. Duration:
Address: 23917 74TH AVE W
City / Zip: EMONDS
Customer: RYAN GREENWAY 206-280-5153
PIVI / Insp: MARK B0W1-INGjj_6j-(fflfl) 2 f CA IN
WORK DESCRIPTION:
ji6fiLl I 9411-21C TIP W60 and,
1/5 564 r 5 K 60'-1118 PE W1429M D? — NE W CONSR UC T
PLAT MAP:
�V &AU- X69- 1-0(-A'[V�.
Construction Method
Open Trench n
Trenchless
o0t N
Ord
440a N
ll IN
IN
Work
of CIL
of CL-
of CIL 24i$TSTSW
of CL--,-----74MAYJE W---,--.
W f CL
NWof CL 74TH AVEW
ajZe of Cut Surface Type
39 5 GRAVEL
PHALT H2O
2X--6 &S=
FLAGGERS #
2 26 MPH
Q TROLLY LINES
❑ BUS STOP #
El METER HOODS #
OFFICERS #
SPEED LIMIT
❑ TRAFFIC SIGNAL
E] ARTERIAL
XNO PARKS #
El commercial
F] Altered Commercial
❑ Leak Repair
Service Information
E] Template Bar
PI Residential
0 Altered Residential
Q CP Work
Diameter meter
EFV n Bollards 2.5" #
El Multi -Family
0 Replacement Service
[j Pothole
1:15/8" [--1?5o
01800 0 Bollards 4" #
F/I New Constr.
0 Plain Maintenance
❑ Extension
Q 11/8" Q 425
fal 26300
Q Stub
El Service Maintenance
❑ 11/v El 630
010,000 E] FUEL LINE PERMIT NEEDED
0 Extension
n Valve Maintenance
❑ 2" F] I=
Fuel Line Length:
0 Compete Sery
E] Cut & Cap
Mtr Loc: - - - OIL
Fuel Line Diameter: W
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•
ROW PERMIT NO.:
ISSUE DATE:
PROJECT NAME: 107052567/ ENG20160185 CONTACT: Sue SidiM
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: NR -0 19840
Phone #: 425-457-6353
Fax #:
Email 11: Susan. Sidick@pse.com
n Liability Insurance n Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23917 74 AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F1 Commercial Subdivision El City Project 1] -Traffic Control (Only)
F] Multi -Family nX Single Family
n EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
F1 Other
El Yes FAI No
I ANY ASSOCIAIIII TED PERMITS? I BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): Permission requested to tie into existing 2" PE IP gas main located at
15'W of CA- of 74th Ave Wand 444'N of CA- of 241st St SW to extend 2" PE IP north 84' to tie into existing Textend 2" PE IP north 84' to tie into existing 2"
main located at 18'W of C/L of 74th Ave W & 381'S of C/L of McAleer Way & to extend 1 1/8" service to "23917".
Four 3'X5' soft surface cuts anticipated. One 2X2° pothole over water anticipated. This is for extended work under permit # ENG20160185
I I DV,F$M 9, N DI fWiV 111111106 FIT 0 ikvwnmmm■ r■�
PAVE MENT CUT: M Yes F] V
CONCRE TE CUT: El Yes F1 rl
If yes, indicate size of cut: 3
x5
If yes, indicate size of cut: X.
RIGHT-OF-WAY
AREA TOTAL
CLOSURE
Sidewalk 48 Hrs + I LF I X LF1 SF
Alley 72 Hrs + LF X I LF I SF
A
Parking 72 Hrs + LF X LF SF
[Qua Ina -Xsj 02��
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.
ts or employees, inc U I
any oFFMa FePp a r I Rme n i
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow allrequirements in aider faa° the pe mit to be d -
SIGNAT DATE 08/03/2016
U �
.-I 0CLIA'I(a'.
RECEIVED
MAY 17 201
UL-'VELGP,kIENT SERVICES ROW PERMIT NO,: ENS y O. J- 01
�
ISSUE DATE:
!X
FOXIM 1 1111A.
PROJECT NAME: 106310803
CONTRACTOR. PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License g: INFRASI-871C2
City Business License 14-* RIR-019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax 4:
Email Susan.Sidick@pse.com
[-ILiability Insurance 0 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 2391774 AVEW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
R Commercial Lj Subdivision ❑ City Project ❑ Traffic Control (0111y)
n Multi-Fainily FX -1 Single Family E] Other
0 EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD):
fs this permit part of a blanket permit? ❑ Yes *No
[ANY�ASS�0C,IA�TEI)�PE�l�-M�ITS?� ENGH
DESCRIPTION OF PROPOSED WORK (Be Specific) : Permission requested to install new 1-1/8" PE
gas service at approximately 440'n c/l of 241st ST SW & 14'w c/I of 74th Ave W.
1 3x5 cut in gravel & 1 25x window over water. Tie in is on the west side of 74th AVE W.
-.1-1 . .........
T14IN THE LAST FIVE (5)'YEARS? YESE] NOF-1 Year: 106b
PAVEMENT CUT: Z Yes [j No if yes, indicate size of cut' 3 x 5
CONCRETE C'UT: El Yes E] No if yes, indicate size of Olt: — x—
APPLICANT TO READ AND SIGN
`Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flaggcr 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 stales 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.
1. have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in older for the permit to be valid.
SIGNATURE 1,4r r� r, ..�� DATE 05/17/2016
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE