ENG20170092-Application.pdfof EVA,10
ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 109103368
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: 1NFRASL871C2
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: 24025 74th AVE W
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 PERMITS? BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 125' N C/l of 241 st
st sw & 12'W c/l of 74th AVE W to install gas service 1 2x5 paving cut anticipated
I WAS STREET OVERLAYED WITHIN THE LAST FIVE, (5) YEARS? YES ❑ NOE] Year: 10918
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: -2 x 5.
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: X_
RIGHT-OF-WAY DURATION
AREA TOTqSF
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF
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.
SIGNATURE Susan Sidick 9==5°� HATE
oa n%,MW0,57�-0r 3/14/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #: 109103368
Date: 2/25/17
Jurisdiction: Edmonds/ SDCo.
Right of Way Permit? E YES F] NO
Est. Start Date:
Est. Duration:
Address: 24O2574fhAve VV
City / Zip: Edmonds 98026
Customer: Alex 206-778-8714
PK8/|nop: ABou ord425-495-4465
* PL)c11`1
Construction Method
WORK DESCRIPTION:
Open Trench
Install 42'scat 1-118 stub and 60' Scat 1-118
Extension. 5et an A 6301neter.
Trenchless
PLAT MAP:
W
Ln
00
24025
60' scat extension 1-1/8" PE
42' of Scat
241st ST SW
Work Location
Size of Cut
Surface_Type
)of
AMLiaalt
2x5
F/I
FLAGGERS # 2
25 MPH
F-1
TROLLY LINES [j BUS STOP #
METER HOODS #
F]
OFFICERS #
SPEED LIMIT
F]
TRAFFIC SIGNAL [_1 ARTERIAL
E] NO PARKS #
n
commercial E]
Altered Commercial
0
Leak Repair Service Information
E] Template Bar
E]
Residential F]
Altered Residential
E]
CP Work Diameter Meter
EFV
[:] Bollards 2.5" #
Multi -Family [:]
Replacement Service
E],
Pothole S/8" 250
1800 E] Bollards 4" #
New Constr. Ej
Main Maintenance
El
Extension 11/8" 425
2600
Stub
service maintenance
11/4" E) 630
10,000 Ej FUEL LINE PERMIT NEEDED
Extension
valve maintenance
2" 1000
Fuel Line Length:
compete Sery
Cut & Cap
Mtr Loc:
Fuel Line Diameter:
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
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
obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be 12' WCL of 74th Ave W & 125' NCL of
241st St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
UE
ENERGYSOUND
Job#109103368
24025 74th Ave W Edmonds, WA
March 11th, 2017
Sheet 1 of 2 mitchell.peterson@pse.com
425-398-6071
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241st St SW 11'
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28" TRAFFIC CONE
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TRAFFIC FLOW
W20-4
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24025
LEGEND
28" TRAFFIC CONE
®
BORE PIT
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TRAFFIC FLOW
FLAGGER
WORK VEHICLE
1+
SIGN LOCATION
WARNING FLAG
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
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
obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be 12' ECL of 74th Ave W & 125' NCL of
241st St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
N
b
:zl'
of
SOUND!
ENERGY
Job#109103368
24025 74th Ave W Edmonds, WA
March 11th, 2017
Sheet 2 of 2 mitchell.peterson@pse.com
425-398-6071
o Ob3M
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1
241st St SW '
.�3- N
_____________—N ___
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
24025
ropy-`qti r`" C
100'
100'
100'
MOO
O T•�
BORE PIT
TRAFFIC FLOW
=Am
FLAGGER
WORK VEHICLE
W20-1
W20 -7A
W20-4
24025
ropy-`qti r`" C
LEGEND
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
PERMIT REQUEST FORM
03/13/17
109103368
24025 74th Ave W
Andrew Baunsgard
andrew.baunsgard@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
1 -.1; SPrvice 1-2x-5 roars cust
04/03/17
04/28/17
Pavement cut? FYes ®No
: Edmonds Zip: 98026
PM contact #: (425) 495-4465
If yes, Dimensions of Cut: Length 5 Width 2
How many cuts? 1
Surface Type asphalt
Require trenching? Mes F�No
If yes, Dimensions of trench: Length 5 Width 2
Method of installation: Hole Hog
Traffic impact:
Road closed Yes ✓® No
Lane closed Eyes FNO How Many? alt
Shoulder closed ®J Yes ®No
Sidewalk closed ®Yes F No
Emergency Contact: Andrew Baunsgard
Cell Number." (425) 495-4465
Depth 36
Direction? south