ENG20170040 (2).pdf1 e11
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121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS E*
STATUS: ISSUED ENG20170040
RIGHT OF WAY PERMIT (6-EIJC)
Permit Number: ENG20170040 Expiration Date: 08/10/2017
Job Address: 7600 212TH ST SW, EDMONDS Location: 7600 212 ST SW
APPLICANT
PSIAnfras ource
CONTRACTOR
P SE/I nfrasource
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 #`: infras1871 c2 EXP: 02/22/2017
Pennission is requested to tie into e)asting 6's c/1 of 212th st sw &''18' W c/1 of 78th Ave W to extend 58'-2" pe ip'gas main north. Ret
e)dsting bare steel main. One I6x5 asphalt cut for tie in anticipated. 2 3x5 potholes over water & fiber, anticipated. 1 5x10 soft surface
cut for tie in on 78th Ave W & replacement of mounted pedestrian flashers and sidewalk stripping will be required located in front of
Edmonds/Woodway High School
-Project not to start until City 'ofEdmonds has installed Rectangular Rapid Flashing Beacons at the crosswalk (212th St SW & 78th Ave
W). City project appro)amate completion, March 9th 2017. Confinnation of city's project completion required prior to PSE job start.
ASSESSED VALUE: $0.00 PROPERTY AREA;; 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE $0;00 STREET DISRUPTION TRENCH CUT: ( 16 X 5 )
PARKING' ( OX0) DURATION IN MONTHS: 0 FEE. $0,00 YEAR OF OVERLAY: 0 FEE: $0,;00
ALLEY: ( 0X0) DURATION IN MONTHS: 0 FEE: $0,00
INDEMNITY The Applicant has signed an application lvhich'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 PERIOD OF ONEYEAR FOLLOWING THEFINAL
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 ofthe 'required training in their
posseson.
•, 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 (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO TIC E REQ UIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL
sAPPLICATION IS NOT APERMIT UNTIL SIGNED BY THE CITY EN GINEER OR H ISMER DEPUTY: AND FEES ARE PAID AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED,
Printed; Frida l^ebwa 10 201
D FILE COPY ❑ INSPECTOR COPY F APPLICANT COPY
2-//0//7
,ATE
STATUS: ISSUEDENG20170040
RIGHT OF WAY PERM IT (6-EUC)
CONDITIONS
• 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.
• Confonnto 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.
• Project not to start until City ofEdmonds 'has installed Rectangular Rapid Flashing Beacons at the crosswalk (212th St SW &'
78th Ave W). City project appro)amate completion, March 9th 2017. Confirmation of city's project completion required prior to
PSE job start.
• Applicant shall repair/replace all damage to utilities or fiontage 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 thenoiselimits
of ECC Chapter 5.30 only during the hours of 700amto 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.
0 Applicant, on behalf ofhis or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmles's the City of Edmonds, Washington, its officials, employees, and agents fiom any and all claims for damages of
whatever nature, arising directly or indirectly fromthe 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
• E Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
OV EDA449
m)'C 1,4 1,4 E 1)
RECEIVED FEB 9110111
i. 01 201
�7
BUILDING ROW PERMIT NO.: ENG C�lo 0� 1
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109102248
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 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 700 212th ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
.......- _.
❑ Commercial Subdivision City Project Traftic Control (Only)
❑ Multi -Family 0 Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
Other
❑ Yes 0 No
ANY ASSOCIATED PERMITS? BLD#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Permission is requested to tie into existing
6's c/1 of 212th st sw & 18'W c/1 of 78th Ave W to extend 58'- 2" pe ip gas main north Retire existing bare steel
main. One 16x5' asphalt cut for tie in anticipated. 2 3x5 potholes over water & fiber anticipated . 1 5x10' soft surface
cut for tie In on 78th AVE W & replacement of mounted pedesirlan flashers and sidewalk stripping will be required located in frnt of Edmonds / Woodway High School
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NQTI Year:1096
PAVEMENT CUT: N Yes ❑ No If yes, indicate size of cut: 16x5 x 3x5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
MENNEINNNOW
RIGHT-OF-WAY DURATION
CLOSURE AREA TOTAL (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
.�..................—� ._..........._w__...................
Alley72 Hrs + LF X LF SF
Parking 72 Hrs + LF X LF SF
APPLICANT TO READ AND SIGN
MM
*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.
�„=trs.,,
. "°
Susan SIdick
P s s-sm°°'°°
02/01/2017
bale dU10AYJ 30095'/30 -0%W'
SIGNATURE
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
01 /31 /17
109102248
7800 - 212th St SW
Lisa Griffith
lisa.griffith@pse.com
Estimated job start date:.
Estimated job completion dater
Description of work to be performed:
04/03/17
04/14/17
Citv: Edmonds Zip: 98026
PM contact #: (425) 406-0121
equested to io�stio "
212th St SW and 18'W of C/L of 78th Ave W to extend 58'- 2" PE IP gas main north.
Retire existing bare steel main. One 16X5' asphalt cut for tie in anticipated. Two 3X5'
Q walk
Pavement cut? F'e'es ®No
If yes, Dimensions of Cut: Length 16' Width 5'
How many cuts? 1+2-3X5's
Surface Type Asphalt
Require trenching? FlYes FNo
If yes, Dimensions of trench: Length 16' Width 5'
Method of installation
Traffic impact:
Road closed
Lane closed
Shoulder closed
Sidewalk closed
Open trench/hole hog
Des
✓
No
-✓
yes
No How Many? 1
✓ es
No
"Yes
No
Emergency Contact: Dean Latimer
Cell Number.' (253) 350-6687
Depth 3'
Direction? East
SAP# 109102248
23
BYPASS MATERIALS
45
44
43
42
2
TEE SERVICE PUNCH 1/2" X 5/8" PE OUTLET
7800575
41
10'
CP WIRE #10 TEST LEAD
8500930
40
1
1
1
1
HDPE FUSION TAPPING TEE 1-1/4" X 5/8" (GAUGE TEE)
REDUCER 2"X 1-1/4" MPE
BOX COMPLETE 1" THRU 4" POLYVALVES
BOX SUPPORT 2" POLYVALVE
7800776
7200399
9996260
9996257
23
22
21
20
19
18
17
2
TEE SERVICE PUNCH 1/2" X 5/8" PE OUTLET
7800575
16
10'
CP WIRE #10 TEST LEAD
8500930
15
14
13
12
1
1
1
1
HDPE FUSION TAPPING TEE 1-1/4" X 5/8" (GAUGE TEE)
REDUCER 2"X 1-1/4" MPE
BOX COMPLETE 1" THRU 4" POLYVALVES
BOX SUPPORT 2" POLYVALVE
7800776
7200399
9996260
9996257
11
1
VALVE 2" MPE
5600259
10
1
TRANSITION FITTING 2"
7800809
9
1
CP TEST LEAD BOX COMPLETE
5000307
8
7
6
5
1
1
1
1
TEE 2" SERVICE H-17501
BOLT KIT, 8" 15FVX, (UNINSULATED)
FLANGE, WELD NECK, 6" CLASS 150
STOPPER 6" X 150 STD SHORT STOPPER H-17275 T/W
7800711
5000097
6400440
7600782
4
58'
WIRE #14 TRACING
8500940
3
10'
PIPE 2" MPE STRAIGHT
7000263
2
58'
PIPE 2" MPE COIL
7000261
1
ITEM
12'
QTY
PIPE 6" X.280" STW (FBE, X42)
DESCRIPTION
9995862
PART NO.
BILL OF MATERIAL
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