ENG20170120-APPROVED PERMIT.pdfCITY EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PEIMIT MUST BE POSTED ON JOBSITE*
Job Address: 24014 79TH PL W, EDMONDS Location: 24014 79TH PL W
Burlington, WA 98233
Bwlington, WA 198233
(425)457-6353'
T 1('FN1,F.$-'i.f—IR71 r7 FXP n,)/77/?nI
Work area is approx 163'S c/1 of 240th St SW and ISE & T W c/I of 79th PL W to install gas service. 1 3x5 concrete cut anticipated
and 12x4 paving cut anticipated,
DISRIJPTION INFORMATION
ASSESSED VALUE. $0,00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 ):
PARKING:` ( OX0) DURATION IN MONTHS: 0 FEE $0,00 YEAR OF OVERLAY: 0, FEE $0,00
ALLEY ( OXO ',) DURATION IN MONTHS: 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 of anykind or description whatsoever, foreseen or unforeseen, that may be 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.
THE CONTRACTOR IS RESPO NSIBLE FO R WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND AC CEPTANCE 0 F THEW ORK
• 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.
r' 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 HOUR NOTICEREQUIRFD FOR ALL INSPECTION REQUESTS
APPROVALAPPLICATION �
A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR'HIS/HERDEPUTYi'AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED' IN
SPACE PROVIDED,,
Printed: Tuesda , MaX 09,201
RELEASED BY' DATE
❑ FILE COPY ❑ INS PECTOR'COPY
❑ APPLICANT COPY
TATUS: ISSUED
ENG20170120
• 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
• 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 from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on 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 avariance 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.
INSPECITIOMS
• E -Engineering Final
PARTIAL INSPECTIONDATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
Wil' RIGHT-OF-WAY CONSTRUCTION
''C, 1390 PERMIT APPLICATION
PROJECT NAME: 106322787 CONTACT: Sue Sidick
CONTRACTOR: PSE/Infrasource
_.................. ..... .....
Mailing Address: 660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: N R-023614
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance 0 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 24014 79 PL W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision L7City 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?
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 163' S C/I of 240th ST SW
and WE & TW C/I of 79th PL W to install gas service 1 3x5 concrete cut anticipated and 1 2x4 paving cut anticipated,.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO 0_ Year: 106b
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 2 x 4
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: 3 x 5
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
.. - Alley .7.2
Hrs + LF X LF SF
-1.1---11"............ �_........ — �� ._ _....
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 SidickU'U�'v�vadmd "� 4"1
04/11/2017
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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 15'E & 7' WCL of 79th PI W
& approximately 163' SCL of 240th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
240TH ST SW
a
� 11 11
W3.4
eI
•� s
dry., ®•T
" „„
i
F51/7
ANNELIZATION
VICE SPACING
TAPER TANGENT
40 80
30 60
20 40
PUGET
SOUND
ENERGY
trEM
U
LEGEND
28" TRAFFIC CONE
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
V
r �
FIRE HYDRANT 122 FROM TIE IN
PRE -INSPECTION REPORT
�'iiG.�7 SCiLf, ,1�
Job #:
106322787
Size of Cut
I
Date:
3/27/17
Address: 24014 79TH PL W
Jurisdiction:
Edmonds
City / Zip: EDMONDS 98026
Right of Way Permit?
0 YES ❑ No
Customer: Steve Misczuk
704-615-9339
Est. Start Date:
05/29/17
PM / Insp: Kiora Hays
42 -213-920
Est. Duration:
8 Hours
'N S of CL
PHONE NUMBER
PL
r
b0
Construction Method
WORK DESCRIPTION:
FLAGGERS #
MPH
♦�,,C 0
INSTALL 40'OF1-1/8"PESCA TSTUB AND 35'OF1-1/8"PESCA TEXT SETA425MSA
❑ BUS STOP #
Open Trench ❑
♦ "s`PL
❑
OFFICERS #
Trenchless 0
O/R.
TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
PLAT MAP:
Commercial
411
Altered Commercial
40TH ST SW
/ ♦ r'
A+
0
r �
FIRE HYDRANT 122 FROM TIE IN
CL
1
= STORM DRAIN
Size of Cut
I
=SMALL SHRUB GARDEN
f CL
&�5_
CL .ZIt.T-kl..i?.
3X5
CONCRETE
= CONCRETE PATCH
163 S f CL
. 4.DT+ S.T:..Si ,_
I
A IL o(k f °_
i2X4
ASPHALT
_
W
'N S of CL
PL
r
b0
/ ♦S
FLAGGERS #
MPH
♦�,,C 0
O� t 1`Iti�r�fa9l�rl �®
❑ BUS STOP #
♦ "s`PL
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
PL
Commercial
411
Altered Commercial
❑
/ ♦ r'
A+
0
"
0
Residential
❑
W CL
♦
CP Work
'WAAR
Work Location
Size of Cut
Surface Type
f CL
&�5_
CL .ZIt.T-kl..i?.
3X5
CONCRETE
163 S f CL
. 4.DT+ S.T:..Si ,_
W'�EjW__o
� ._„
& _ ._CL 7gT.H_PL W
i2X4
ASPHALT
_
'N S of CL
_
& 'E W of CIL .....,.,�
❑
FLAGGERS #
MPH
❑
TROLLY LINES
❑ BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
❑
Commercial
❑
Altered Commercial
❑
Leak Repair
Service Informations
Template Bar
❑ p
0
Residential
❑
Altered Residential
❑
CP Work
Diameter Meter
EFV
❑ Bollards 2.5" #
❑
Multi -Family
❑
Replacement Service
❑
Pothole
a 5/8" ❑ 250
1800 E] Bollards 4" #
❑
New Constr.
❑
Main Maintenance
E]
Extension Extension
11/8" 425
[❑
r
2600
❑,
Stub
❑
Service Maintenance
❑ 11/4" ❑ 630
10,000 ❑ FUEL LINE PERMIT NEEDED
❑✓
Extension
❑
valve Maintenance
❑ 2" ❑ 1000
Fuel Line Length:
❑
Compete Sery
❑
Cut & Cap
Mtr Loc: 0111 -
Fuel Line Diameter:
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