ENG20170091-Application.pdf()V EDA40
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ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106321430
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email : Susan.Sidick@pse.com
F-1 Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 1137 6 AVE S
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial 0 Subdivision Ll City Project [_1 Traffic Control (Only)
F1 Multi -Family [M Single Family F1 Other
F1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes W No
� ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK. (Be Specific): Work area is approx 125' N C/1 of Elm St
& 17'W C/1 of 6th AVE S to install gas service 1 3x5 paving cut anticipated
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 1062i
PAVEMENT CUT: X Yes F] No If yes, indicate size of cut: -3 x 5
CONCRETE CUT: E] Yes F1 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 Hrs + LF X LF SF
Parking 72 Hrs + 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 �° �g'�_
U5-54�`°�
3/13/2017
SIGNATURE 6a',e: M 609,300]5730-0T '
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #: 106321430
Date: 2/25/17 Address:
Jurisdiction: Edmonds City /Zip:
Right ofWay Permit? E] ns [] NO Customer:
Est. Start Date: PyN/ |nup:
11,111M. I
Gary 206-730-0670
CUST PHONE NUMBER
-A.Baunsgard 425-495-4465
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
Open Trench F-1
Install 47'scat 1-118 stub and 60'Scot 1-118 Extension, Set a 425 meter.
Trenchless F,1
PLAT MAP:
Ln
LD
Cq
LM
1137
A425 IVISA
60'scat extension 1-1/8" PE
47' of Scat
Elm Way
Work Location
Size
of Cut
Surface jype
FLAGGERS # 2
25 MPH
TROLLY LINES BUS STOP #
F-1 METER HOODS #
OFFICERS #
SPEED LIMIT
F]
TRAFFIC SIGNAL ARTERIAL
NO PARKS #
commercial
Altered Commercial
Leak Repair Service Information
Template Bar
Residential
Altered Residential
CP Work Diameter Meter
EFV
E] Bollards 2.5" #
Multi -Family
Replacement Service
E]
Pothole E] 5/8" E] 250
0
1800
E] Bollards 4" #
New Constr.
Main Maintenance
Extension 11/8" 425
2600
Stub E]
Service Maintenance
11/4" 630
10,000
[:] FUEL LINE PERMIT NEEDED
Extension [:]
valve maintenance
0 2" E) 1000
Fuel Line Length:
f I
Compete Sery Ej
Cut & Cap
Mtr Loc:
Fuel Line Diameter:
PUGETmmA I Puget Sound Energy
_ Ta(fic Control Supervisor: 5y SOUND
-, /^1 / n �'^�
o Gregory Hal""d SOUND
Card No. 008997
�n3 i Card Exp, 081132019 ENERGY
e.com
ro gregory.ha—od@ps
(425)424-6425 �p Job#106321430
LEGEND n o i w i.�tawyfo4 1137 6TH AVE S EDMONDS, WA
MARCH 7, 2017
® 2s^ TRAFFIC corse I = Sheet l of 2 sally.bergman@pse.com
GORE alr 1b 1 (425) 398-6003
rte' TRAFFIC FLOW
"- FLAGGER
-�--_-_�' NlORK4EHICLE
Notes:
\ SIGN LOCATION I 1. All signs and spacing to conform to the MUTCD
\ RESIDENT(S) WILL BE INFORMED
arx WARPUINC FLAG OF POSSIBLE TEMPORARYand City of Edmonds standards.
"\ DRIVEWAY CLOSURE 1137 2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
) 3, Channelizing devices are 28" traffic cones.
i 4. Sign size can be a minimum of 48" x 48" and shall not
obstructobsct pedestrian access.
I 11 i 5. Crew is required to leave a minimum of 11' for traveling
Zane width.
i6. Alert affected residents and businesses.
7. Work area will be 17' WCL of 6TH AVE S &
Work to take place between 9 a. m. and 4 p.m,
8.
3 approximately 125' NCL of ELM WAY.
ELM WAY 9. If used, place NO -PARK signs 72 hours in advance
p Ing p Ing p Ing I of the day that the work is to be done.
-------G=am ------- /``, d
CHANNELIZATION
DEVICE SPACING
MPH ITAPERITANGENT
55/70 40 1 80
35!4530 60
25!30 20 40
J l ELM ST
a
° � I Puget Sound Energy !" UGE T
Traffic Control Supervisor. /ry n (''y
o GregoryHarxrood D M SOUND
Car E, 08997 ENrRGY
Card Exp. 08/13/2019
gregory.harvrood@pse.
(425)42a-6425 Job#106321430
LEGEND > cn 1137 6TH AVE S EDMONDS, WA
® > �1� MARCH 7,Co
2017
28-TRAFFICCUiE I ¢ Sheet 2 of 2 salt ber man se.m
s Y 9 @P
VFJ BORE PIT 6 I (425) 398-6003
- b TRAFFIC FLON
'-- FLAGGER
WORK VEHICLE
Notes:
SIGU LOCATION I 1. All signs and spading to conform to the MUTCD
<�a 11-111G FLAG I and City of Edmonds standards.
\ 1137 2. All sidewalks, driveways, exits and egresses shall be
I completely clear unless otherwise indicated.
') 3. Channelizing devices are 28' traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
i , 1 RESIDENT(S) WILL BE INFORMED obstruct pedestrian access.
'1 OF POSSIBLE TEMPORARY 5. Crew is required to leave a minimum of 11' for traveling
f. DRNEWAYCLOSURE lane width.
6. Alert affected residents and businesses.
7. Work to take place belw/een 9 a.m. and 4 p.m.
"\ 8. Work area will be 17' ECL of STH AVE S 8
approximately 125' NCL of ELM WAY.
-------- ELM WAY 9. If used, place NO -PARK signs 72 hours in advance
p Ing p n g Ping I of the day that the work is to be done.
pking kin kind_ o vau N
100' � T t ,
�Ex I
2�
W20-1
CHANNELIZATION \ vy
DEVICE SPACING
MPH TAPER TANGENT
55!70 40 80 ELM ST
35/45 30 60 ~'
25/30 20 40 �'—'----------=
bo
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