ENG20170091.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020`
/6(% l %r)0 PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERM,IT UST BE POSTED ON JOBS:I'TE*
STATUS: ISSUED ENG20170091'
RIGHT OF WAY PERMIT (6-EUQ
Permit Number: ENG20170091 Expiration Date: 09/25/2017
Job Address: 1137 6TH 'AVE "S, EDMONDS Location: ,1137 6TH AVE S
JAPPLICANT CONTRACTOR
PSF/Infras ource P SE/I nfraso urce
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 #: infrasl871 c2' EXP: 02/22/2019
JOB DESCRIPTION
Work area is approx 125'N c/1 of Elm St & 17W c/1 of 6th Ave S to install gas service . 1 3x5 paving cut anticipated.
DISRUPTION'
ASSESSED VALUE: $0,00 PROPERTY AREA:0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0,00 STREET DISRUPTION TRENCH CUT: (3 X 5 )
PARKING: ( OXO) 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 which states he/she holds the City ofEdrnonds 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 of its departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees'by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD 0F.ONE YEAR FOLLOWING THE FINAL
INSPECTION AND AC C EPTANC E 0 F THE W 0 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 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.
0 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 HO URNOTICEREQ UIRED"FOR ALL INSPECTION REQUESTS
APPLICATIONAPPROVAL
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER' DEPUTY: AND FEES ARE PAID, AND RECEIPTTS ACKNOWLEDGED IN
SPACE PROVIDED
Printed: Friday, March 24 2017
RELEASED BY DATE'
0 FILE COPY ❑ "INSPECTOR COPY D',APPLICANT COPY
G2O17OO91
• 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
•s 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 fiomtemporary construction sites as aresult of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of7:00amto 6:OOpmon weekdays and 10:00amand 6:OOpmon 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 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.
INSPECTIONS
• E-Fngineering'Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
,IA'"c. 0
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106321430
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: I N FRASL871 C2
City N R ..019 _...�.
Business License #: 840
CONTACT: Sue Sidick
Phone #: 425-457-6353
.................�
Fax #:
Entail M Susan.Sidick@pse.com
Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 1137 6 AVE S
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 pant of a blanket permit? ❑ Yes W No
I ANY ASSOCIATED PERMITS I BLD# _ ENG#m
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 125' N C/I of Elm St
& 1T W C/I of 6th AVE S to install gas service 1 3x5 paving cut anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year:106
PAVEMENT CUT: N 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
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 mHrs + LF X LF SF
Parking72Hrsmm+^m m 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.
SIGNATURESusan Sldlck DATE
3/13/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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PRE-INSPECTION REPORT „ �auP ���,
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Job #: 106321430
Date: 2/25/17
Address: 1137 6th Ave 5
Jurisdiction: Edmonds
City/Zip: Edmonds 98020
Right of Way Permit? ❑ YES ❑
NO Customer: Gory 206-730-0670
Est. Start Date:
PM / Insp: A.Baunsgard 425-495-4465
Est. Duration:
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
-ITITITITmmITIT�
Open Trench ❑
Install47'scat 1-1/8 stub and 60' Scat 1-1/8 Extension. Set a 425 meter. Trenchless Q
PLAT MAP:
,twd G� oot_xvv x jiJi'li4w 1 I�H2 LSF A- a
��.....
N
CApp" ",p zi0A)
N I
n
3 ,5?
1137
a
jj
N
i
A425 MSA
60' scat extension 1-1/8" PE
47' of Scat
1-1 '8" PE
(< r f1,.. LOCA—~- �W
C' i'j.. 1 .
Elm Way
/ .A- O-Ais0j�AJ(A Qu
Work Location Size of Cut Surface Type
of CL W f CL Asphaalt
'N S of CL .. ......
,,. & 'E W of CL
'NSofCL
& EWofCL�
❑✓ FLAGGERS # 2 26 MPH
❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS #
❑ OFFICERS # SPEED LIMIT
❑ TRAFFIC SIGNAL ❑ ARTERIAL ❑ NO PARKS #
❑ Commercial ❑ Altered Commercial
❑ Leak Repair Service Information ❑ Template Bar
❑ Residential ❑ Altered Residential
❑ CP Work Diameter Meter EFV ❑ Bollards 2.5" #
❑ Multi-Family ❑ Replacement Service
❑ Pothole ❑ 5/8" ❑ 250 ❑ 1800 ❑ Bollards 4" #
❑ New Constr. ❑ Main Maintenance
❑ Extension Q 11/8" 425 ❑r 2600
❑l Stub ❑ Service Maintenance
❑ 11/4" ❑ 630 ❑ 10,000 ❑ FUEL LINE PERMIT NEEDED
❑l Extension ❑ Valve Maintenance
❑ 2" ❑ 1000 Fuel Line Length:
❑ Compete Sery ❑ Cut & Cap
Mtr Loc: Fuel Line Diameter: