ENG20170080.pdfcl Ott
CITY OF EDiMONDS
121 5TH AVENUE NORTH'- EDMONDS, WA 98020
„e I 1 PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170080
Permit Number: ENG20170080 Expiration Date: 09/18/20,17
Job Address: 21608 81 ST AVE W, EDMONDS Location: 21608 81 ST AVE W
APPLICANT
*. .,
PSE/lnfras ource
P SE/I nfraso urce
C/O Susan att: Sid ick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Btu ington, WA 98233
(425):457-6353
LICENSE 4: infras187Ic2 EXP: 02/22/2017
area
SIDEWALK: (OXO)
PARKING: '(OXO)
DURATION IN MONTHS: 0
DURATION IN MONTHS: 0
DURATION IN MONTHS: 0
lst Ave W 15x5 pa
FEE $0,00 STREET DISRUPTION TRENCH CUT: (5 X 5 )
FEE $0,00 YEAR OF OVERLAY: 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 he made against the City of Edmonds or
any of ils departments or employees,including but not limited to the defense,ofany legal: proceedings including defense costs and
attorney fees by reason ofgranting this permit,
THECONIRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONEYEARFOLLOWING 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 musthave certification verifying completion of the required' training in their
posses on.
• Restoration is to be inaccordance 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 (1-500-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO TIC E REQ UIRED FOR ALL INSPECTION REQUESTS
CITY
SPACE PROVIDED,
IS ACKNOWLEDGED IN
Printed: Friday, March 1
7
FILE COPY. F INS PECTOR COPY EjAPPLICANT COPY
0e 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.
• 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. Referto City of Edmonds traffic control requirements.
0 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 aresult of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:OOpm on weekdays and 10:OOam and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originatingfrom 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
liam>less 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 ofthis 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
E -Engineering Final
PARTIAL INSPECTION' DATE: INITIAL: NOTES:
PARTIAL' INSPECTION' DATE: INITIAL:- NOTES:`
FINAL INSPECTION APPROVED DATE: INITIAL:
RIG:T-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 892044640 CONTACT: Sue Sidick
CONTRACTOR: PSE/Infrasource
Phone #: 425-457-6353
Mailing Address: 1660 Park Lane, Burlington, WA 98233 Fax #:
State License #: INFRASL871 C2 Email #: Susan.Sidick@pse.com
City Business License #: NR -019840 Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 21608 81 st Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision ❑ City Project F1 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 PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 100' S C/I of 216th ST SW &
12'W c/I of 81 st AVE W 1 5x5 paving cut anticipated
To investigate and repair leak
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES D NO 0 Year: 8926
PAVEMENT CUT: ® Yes ❑ No
CONCRETE CUT: ❑ Yes ❑ No
If yes, indicate size of cut: 5
If yes, indicate size of cut: —
x5
x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LFI SF
.. ,. _ _... -
Alley 72 Hrs + LF X JLLF
SF
Parking 72 Hrs + LF X 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.
SIGNATURE Susan Sidick',"°s's °° DATE
3/2/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Job #: Noo�2cqq
Date: 2-8–IC
Jurisdiction: mo,
Right of Way Permit? N YCS El No
Est. Start Date:
Est. Duration:
WORK DESCRIPTION:
PLAT MAP:
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PRE -INSPECTION REPORT
Address; 7,1�0.k ;gl-ST C,,,Vc_ L-,/
City/Zip:
Customer:
PM / Insp: CUS1 PHO M N rrdeR
PHONE NUMBER
Cons Vuctlon ge—thod
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❑
FLAGGERS # MPH
❑ TROLLY LINES ❑ BUS STOP #
❑ METER HOODS #
❑
OFFICERS # SPEED LIMIT
❑ TRAFFIC SIGNAL C3 ARTERIAL
❑ NO PARKS #
❑
commercial E) Altered Commercial
E] Leak Repair Service Information
E] Template Bar -
❑
Residential [:] Altered Residential
El CP Work Diarnotor Motor
EFV El Bollards 2.5" #
❑
Multi -Family E] Replacement Service
El Pothole E]5/8" [j250
L) 1801)
[j Bollards
❑
New Constr. ❑ Main Maintenanre
❑ Extension ❑ 11/8" E] 42S
E] 2600 4" # -
❑
Stub ❑ Service Maintenance
❑ 11/4" [:] 630
❑ 10,000 ❑ FUEL LINE PERMIT NEEDED
E]
Extension F] valve maintenance
E] 2" El 1000
Fuel Line Length:
E]
Compete Sery E] Cut & Cap
Mtr Loc:
Fuel Line Diameter:
STREET USE PERMIT REQUEST FORM
Date of Request: 03/01/17
Job number: 892044640
Job address: 21608 81st Ave W City: Edmonds zip. 98026
Project mgr: Veronica Paulson
PM email: veronica.paulson@pse.com
Estimated job start date: 04/05/17
Estimated job completion date: 04/05/17
Description of work to be performed:
Pavement cut? o"es ®No
If yes, Dimensions of Cut: Length 5 Width 5
How many cuts? one
Surface Type asphalt
PM contact #: (253) 617-6023
Require trenching? [:]Yes F71No
If yes, Dimensions of trench: Length Width Depth
Method of installation:
Traffic impact:
Road closed
Lane closed
Shoulder closed
Sidewalk closed
LJYes 171 No
Fyes F� No
"es No
"yes ✓ No
Emergency Contact:Blood
Number- 864-6154
How Many? one Direction? south
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