ENG20170024.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH-'EDMONDS, WA 98020
to" PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS TE*
Job Address: 711 MAIN ST, EDMONDS!
PSF/Infrasource
GO Susan att: Sidick
r Jb/1!111 dJU W GC
C/O Susan att: Sidick
1660 Park Lane 1660 Park Lane
Burlington, WA 98233, Burlington, WA 98233
(425)457-6353,
LICENSE #.,infras]871 c2 . EXP: 02/22/2017
Work area is approx 19'N c/1 of Main St & 230' E c/1'of 7th Ave N to install gas service. 13x5 cut in paving anticipated.
DIS RUPTION IN FORMATION
ASSESSED 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
ALLEY: l OX0 1 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 ofany legal proceedings including defense costs and
attorney fees by reason ofgranling this permit:
THE CONTRACTOR IS RESPONSIBLEFOR'WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONEYEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OFTHEWORK
• 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 NO TIC R RFX")UIRED F'OR ALL •INSPECTION RfDUESTS
Location: 711 MAIN `& 7TH AVE N
THIS APPLICATION IS` NOTAPERMITUNTIL SIGNED BY THE CITY ENGINEER ORHISMERDEPUTY: AND FEES
SPACE PROVIDED„
RELEASED BY
❑ FILE COPY ❑ INSPECTOR COPY
JD, AND RECEIPT IS ACKN O W LEDGEI
917120,17
TE
APPLICANT COPY
STATUS: ISSUED ENG2O17OO24
Restore ROW to City standards
0 Restore Landscape to like or better conditions.
0 Callfor locates of underground utilities prior to any excavation,..
0 Alert affected residents and/or businesses prior to work start.
0s' Conform to approved working drawings and Traffic Control plan.
• Verify clear bore crossings
Utility patchrestoration 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.
0 Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm 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.
r; 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 ofthis 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.
&Traffic Control
0 E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
_( of EDA4 �
;ti Qm:� , r: "!Geii''ER' V9c1 s u
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106320014
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
....... ......... ._...................
Fax #:
Email #: Susan.Sidick@pse.com
Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 711 Main St & 7th Ave N
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, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑* No
ANY ASSOCIATED PERNHTS. BLD# ENG# �mm
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 19'N c/I of Main St
& 230' E c/I of 7th AVE N to install gas service 1 3x5 cut in paving anticipated.
........__
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES NO Year:106a
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
CLOSURE AREA TOTAL(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
Parking 72 Drs 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) 296-155-305 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"�� 01/20/2017
MN Mu$r.WM�.S: Wwupxa wb @iu�rNBr: yu.6twtUu
SIGNATURE P�`"� DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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PLAT MAP:
A425 MSA
10
" U,
50' 1-1/8" PE
SCAT
EXTENSION
PE SCAT
STUB
Maintain 3' separation
between sewer, storrn &
miater on 1prhi,ate property
PRE -INSPECTION REPORT 1111)(,t
I '700b,'0 L Y
Job #;
106320014
Date:
1/13/17 Address: 711 Main ST
of C L
Jurisdiction:
EDMONDS City / Zip: Edmonds 98020
3x6 Asphalt
Right of Way Permit?
❑ YES ❑ NO Customer: Lief 425-770-1970
&_
Est, Start Date:
PM / Insp: A, Saunsgard
. ........ . . .
Est. Duration:
...... ......
PHONE NUMBER
WORK DESCRIPTION:
&
'E W of CL_
CQpLtruc1jgp Met
Install a 11' 1-1/8 Scat Stub and a 50' 1-1/8 Scat Extension. Set a 425 meter. We need to
New Construct
FLAGGERS # 2 25 MPH
❑ TROLLY LINES
---
BUS STOP #
ExIstin
�
❑ METER HOODS #
❑
_qtgi,.Akj_priva t e p.roperty.-
of _�Lepplrationo r,q_M s�&er,qqn_4 IN
❑ TRAFFIC SIGNAL
OpelI tench
ARTERIAL
❑ NO PARKS#
❑
Trenchless
Manifold
PLAT MAP:
A425 MSA
10
" U,
50' 1-1/8" PE
SCAT
EXTENSION
PE SCAT
STUB
Maintain 3' separation
between sewer, storrn &
miater on 1prhi,ate property
Work Location
Size of Cut Surface Type
of C L
3x6 Asphalt
'N S of CL
&_
'EWo 6L
.
. ........ . . .
...... ......
'N S of CL
&
'E W of CL_
FLAGGERS # 2 25 MPH
❑ TROLLY LINES
❑
BUS STOP #
❑ METER HOODS #
❑
OFFICERS # SPEED LIMIT
❑ TRAFFIC SIGNAL
❑
ARTERIAL
❑ NO PARKS#
❑
commercial ❑ Altered commercial ❑
Manifold
eryice Information
E] Template Bar
❑
Residential ❑ Altered Residential ❑
Main Extension
Diameter
Meter EFV
Pressure ❑ Bollards 2,5" #
Multi -Family ❑ Replacement Service F]
Pothole
❑ 5/8"
[j
250 [:]
775
[:] 6"wc ❑
Bollards 4" #
Ej
New Constr. E] Main Maintenance. ❑
Bollards
11/81,
E]
425 E:]1800
E]2#
E)
Stub F-1 service maintenance
❑ 11/4"
❑
630 Q
2600
5# ❑ FUEL LINE PERMIT NEED
Ej
Extension ❑ Valve Maintenance
❑ 2"
❑
1000 ❑
10,000
Fuel Line Length:
E)
Compete Sery E) Cut& Cap Mtr Loc:
4"
E]
IMO ❑
NA
Fuel Line Diameter: