ENG20170095-Application.pdfk)f EL)tqo
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ROW PERMIT NO.: ENG,
ISSUE DATE:
PROJECT NAME: 106322188 CONTACT: Sue Sidick
CONTRACTOR: PSE/Infrasource Phone #: 425-457-6353
Mailing Address: 1660 Park Lane, Burlington, WA 98233 Fax #:
State License #: INFRASL871C2
City Business License #: N R-023614
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 406 2nd AVE N & Edmonds St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ 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 425'N c/l of Edmonds St
And 17'W c/l of 2nd AVE N 1 3x5 concrete cut anticipated. To install gas service
I WAS STREET OVERLAYED WITHIN THE LAST FIVE, (5) YEARS? YES ❑ NO ❑ Year: 106jj
PAVEMENT CUT: X1 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 TOTAJSF CLOSURE MBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF Alley 72 Hrs + LF X LF Parking 72 Hrs + LF X LF
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 oma.9g 5=SusanSm 3/17/2017
Mm &u Sid ,o Puget Soivh Energy, a Str Use
SIGNATURE W16," 075n=.. ".`=°5 DATE
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Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
3/887
Jurisdiction: Edmonds
Right of Way Permit? 2] YES NO
Est. Start Date:
Est. Duration: 1doy
Address: 406 2nd Ave N
City /Zip: E6mon6m98020
Customer: John 206-235-5056
PM/|nop: A 8ou d4Zb-495-4465 CUST PHONE NUMBER
Construction Method.
WORK DESCRIPTION:
Open Trench
Install 5'scof 1-118 stub and 60' Scat 1-118 Extension, Set a 250 meter.
Trenchless
PLAT MAP:
W
-�T
00
5' of Scat
A250 IVISA 406
LU
60'scat extension 1-1/8"
PE
Edmonds St
Work Location
Size of Cut
Surface Type
—0f au
Concrete
-2x5
FLAGGERS # 1
25 MPH
TROLLY LINES F-1 BUS STOP #
El METER HOODS #
OFFICERS #
SPEED LIMIT
F]
TRAFFIC SIGNAL [:1 ARTERIAL
[-] NO PARKS #
F] Commercial E]
Altered Commercial
Ej
Leak Repair Service Information
El Template Bar
Residential
Altered Residential
CP Work Diameter Meter
EFV
[:] Bollards 2.5" #
Multi -Family
Replacement Service
Pothole E] 5/8" E] 250
D
1800 [j Bollards 4" #
New Constr.
Main Maintenance
Ej
Extension
Stub F]
service maintenance
11/4" E] 630
F-1
10,000 [:] FUEL LINE PERMIT NEEDED
Extension
valve maintenance
2" 1000
Fuel Line Length:
compete sery
Cut & Cap
Mtr Loc:
Fuel Line Diameter:
701
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#406
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Notes;
1. All signs and
406 2nd Ave N, Edmonds, WA
March 16, 2017
Sheet 1 of 1 gregory.harwood@pse.com
(425) 424-6425
spacing to conform to the MUTCD
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
LEGEND
28° TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
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
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obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
Z-
osF FR
7. Work to take place between 9 a.m. and 4 p.m.
Roy ti�
8. 17' ECL of 2nd Ave at 425' NCL of Edmonds St.
411, �`V
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9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
LEGEND
28° TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
Date of Request: 03/17/17
Job number:
Job address:
Project mgr:
PM email:
106322188
406 2nd Ave N City: Edmonds Zip: 98020
Andrew Baunsgard
andrew.baunsgard@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
S -S -service with ane concrete cut
04/17/17
04/28/17
Pavement cut? Yes FNo
If yes, Dimensions of Cut: Length 3 Width 5
How many cuts? 1
Surface Type concrete
PM contact #: (425) 495-4465
Require trenching? 7Yes FNo
If yes, Dimensions of trench: Length 3 Width 5
Method of installation:
Hole hog
Traffic impact:
Road closed
es
✓ No
Lane closed
Z✓ Yes
No How Many? alt
Shoulder closed
Yes
No
Sidewalk closed
les
®No
Emergency Contact. Andrew Baunsgard
Cell Number.' (425) 495-4465
Depth 36
Direction? North