ENG20160491.pdf" EUS
CITYOFEDMONDS
1215TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220- FAX: (425) 771-0221
*PE MUST BE POSTED ON JOBSIT*
STATUS: ISSUED ENG20160491
Permit Number: ENG20160491 Expiration Date: 07/03/2017
Job Address: 707 MAIN ST, EDMONDS Location: 707 Main St
Psinnfras Ource P SE/Infrasource
GO Susan att: Sidick C/O Susan att: Sidick
1660 Park Lane 1660 Park Lane
Burlington, WA 98233 Burlington; WA 98233
(425)457-6353
LICENSE 4: infrasl871c2: EXP: 02/22/2017
Work area is approx 19'N GL of Main St &`485'W c/I of 8th Ave N. '1 3X5 paving cut anticipated to install gas service line
tlSSE,88K) VALUE-, $0,00, PROPERTY AREA;`, 0
,SIDEWALK: (.OXO) DURATION IN MONTHS:0 FEE: $0,00' STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
PARKING: ( 0X0) DURATION IN MONTHS: 0 FEE: $0„00 YEAR OF OVERLAY: 0 FEE $0;;00
AIJX'i ' ( 0X0) 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 ofany kind or description whatsoever, foreseen or unforeseen, that maybe made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofanylegal 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 FOLLOWING THE FINAL
INSPECTION AND AC C EPTANC E O F,THEW O RK.
• 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 ofthe required training in their
possesion.
• Restoration is to be in accordance with City codes. All street -cut trench work shall bepatched `with asphalt or City approved
material prior to the end ofthe workday -NO EXCEPTIONS.
• Three sets ofconstruction drawings ofproposed work are required with the permit application.
CALL DLAL A-DIG(1'-800-424-5555)' BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE RF. UIRM FOR ALL INSPECTION REQUESTS
FEES
SPACE PROVIDED,,
Printed:
DATE
FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
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 fromtemporary construction sites` as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 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 fordamages 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.
• 11Traffic Control
• E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION'' DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
RTCEIVED
2016
r '�- Jaw..,.ai' a ;l`T SERV ROW PERMIT NO.: ENC��,-k ��� �", �� �
ISSUE DATE:
PROJECT' NAME: 106315512
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: NR -01984
0
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:._r
Susan, Sidick@pse.com
il� , Insurance,ET-
ADDRESS
EJ Liab' 'ty E Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 707 Main ST
ROW WORD ASSOCIATED WITH TIJF FOLLOWING TYPE OF PROJECT:
Coni ---- ,�.. Ci Project - - ..� ._».....
�.._.�... mercia
"Subdivision � �� ty j Traffic Control (Only)
❑ Multi -Family ® Single Funnily ❑ Other
❑ EUC. (PUD, VERILON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanl<et permit? ❑ Yes ®No
SSO( IAIE
v PEizNIl 1 s l3r.r)# 1JNc�#
DES CRIPr1'IOI� Oh PROPOSED WORK (Be Specific) : Work a pp C/L of Main St &
ON � � ...............rea is a rox 9� .._ ----------
485'W
485'W c/1 of 8th AVE N 1 3x5 paving cut anticipated. To install gas service at above location,
WAS
SIRw,II OV.E..R...rL.,.AYSD WI1IIN TI�E LAST FIVE (5) YEA%
R.S�. . .Y..e.. ...
-....
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut:. ...... u ..... ..... ...1111.1— x
APPLICANT TO READ AND SIGN
tla.•.iw,..awfiMiw��i�Md�w4Wiwu'�'WAFn.4 drvd�Wli1 JL56'dtlMp�IWWVI WLMPorvW.'MV561�IR"�Lf(��Rii'�mfd�iF.iSi� Mw��..(XI�....Gr wCn •" •»•"d�Jl:4.lGLw1�.1/J]II'oYiYdiW'Jbil..dw��'YbWYWW'.NSW'�T"YY(�M'MF6YAYWNNNI�IA'M'N,WWIWI NdGJN.BB"�M+'�N�YYJ�IONIGpIti�IN'P �.wP.�MDI%WI'e.I�O.WM1'Ii�WWMN0.
*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 Sidick 12/02/2016
SIGNATURE WOVOW0 DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Job #:
106315512
Date:
11/1/16
Jurisdiction:
EDMONDS
Right of Way Permit?
F] YES ❑ NO
Est. Start Date:
12/19/16
Est. Duration:
I DAY
PRE -INSPECTION REPORT
MPITI���
Address: 707 MAIN ST
City / Zip: Edmonds 98020
Customer: RICHARD WURDEMAN 206-940-3864
S6PNE NUMBE
2 )6
PM / Insp: Kiara Hays T - T 13-920
PHONE NUMBER
WORK OQKHIPTM
INSTALL 10'OFI-118" PE SCA TSTUB AND 50'0F1-118"PESCA TEXT SET A425MSA
01R/F.
PLAT MAP:Power Pole �A&W '[At,V A lvkouiM,)�,A Of-, s'
Rood Sign ()A 0-NIYA,"A; P"P&I Z,V'r"f v"T'it-i rg
A =Sculpture
=Handicap Parking,*
1Z
Fire Hydrant (86' from tie in)
&M, LDi'l
0 IF_.WArN4
tA1to;00't`t LIF- PL—S� 'LPAPA" ;yv1%)
707 Rockery with
PL—N, PL
SIDEWALK SIDEWALK
G 803078 G
s— — — — — — — — — — — — — — — — — — — — — — — — — — — — — S
SIDEWALK
PL PL
of CIL _._ffHAVX_N_.
of CL
ofCL, . . ...................... . ...... ... ...... . . ....... .... ..... ... . ...... ..
Construction Method
Open Trench ❑
Trenchless
Size of Cut I Surface Type
❑ BUS STOP #
..........
. ....
ARTERIAL
._=4%=gM__'!1!CL_MAIN_ST
'N S of CIL
Service Information
& 'E V
Diameter
'N S of CIL
EFV
E] Bollards 2.5" #
& 'E V
❑
FLAGGERS #
1800
MPH
E]
TROLLY LINES
❑
OFFICERS #
630
SPEED LIMIT
[:)
TRAFFIC SIGNAL
E] Commercial
E] Altered Commercial
F]
Leak Repair
C]
Residential
E]
Altered Residential
❑
CP Work
C]
Mufti -Family
E]
Replacement Service
❑
Pothole
New Constr.
[:]
Main Maintenance
❑
Extension
Stub
F1
service maintenance
Extension
F1
Valve Maintenance
❑
Compete Sery
E]
Cut & Cap
of CIL _._ffHAVX_N_.
of CL
ofCL, . . ...................... . ...... ... ...... . . ....... .... ..... ... . ...... ..
Construction Method
Open Trench ❑
Trenchless
Size of Cut I Surface Type
❑ BUS STOP #
❑ METER HOODS #
ARTERIAL
❑ NO PARKS #
Service Information
❑ Template Bar
Diameter
Meter
EFV
E] Bollards 2.5" #
❑ 5/8"
E] 250
E]
1800
❑ 11/8"
❑ 425
❑
2600 [j Bollards 4" #
E] 11/4"*
630
10,000 [:] FUEL LINE PERMIT NEEDED
] 2"
El 1000
Fuel Line Length:
Mtr Loc.
____QLP_VE_
Fuel Line Diameter:
PRM
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