ENG20170164-APPROVED PERMIT.pdft r�
4
I OF EDMONDS
.
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED
ENG201701
Permit Numbers ENG20170164 Expiration Date: 12/01/2017
Job Address: 17707 TALBOT RD, EDMONDS Location:17707 TALBOT RD
APPLICANT CONTRACTOR
PSF/Infras o urce PSE/In frasource
CIO Susan att::Sidick C/O Susan att: Sidick
1660 Park Lane 1660 Park Lane
Burlington, WA 98233 Bwlington, WA 98233
(425)457-6353
LICENSE#: infrasl871c2 EXP: 02/22/2019
Work area is approx 190'N c/1 of 178th St SW & 18'E c/l of Talbot Rd to install gas, service. l 3x5 cut in gravel
Storm main line to be inspected prior to backfill.
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: (TOXO ) DURATION IN MONTHS: 0 FEE. $0 00
INDEMATTY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description it,hatsoever, foreseen'or unforeseen, that may made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
allorney fees by reason ofgranling This permit.
THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE 'O F THE W ORK
61 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.
• 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 NO TIC E REQUIRED FOR ALL INSPECTION REQUESTS
APPROVAL
UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT Is ACKNOWLEDGED IN
SPACE PROVIDED
Printed: Wednesday, Mav 31' 2017
RELEASED BY 01
❑ FILE COPY ❑ INSPECTOR COPY
,513/120/7
DATE
❑ APPLICANT COPY
• 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.
0 Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• Storm main line to be inspected prior to backfill.
• 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 7:00amto 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, arisingdirectly or indirectly fiomthe 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.
• E -STORM MAIN INSPECTION
• E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL' INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL;
FROOffift'01,
SC A N N E D
A1111 21 20V
APR 21 2017 ROW PERMIT NO.: ENGZ�)01_) ICON
ISSUE DATE:
1-
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106323705
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 17707 Talbot Rd
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
D 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 AI No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 190' N C/I of
178th ST SW & 18'E c/I of Talbot Rd. To install gas service 1 3x5 cut in gravel anticipated,
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year: 106:b
PAVEMENT CUT: ® Yes ® No If yes, indicate size of cut: 3 x 5 gravel
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: x
NNUMMMMMM
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF]
Alley 72 Hrs + LF X LF SF
... ..._ ._ _ _ ..—w ... .
Parking 72 Hrs + LF X LF SF
APPLICANT TO READ AND SIGN
«muuu�uru... uauauu�wuuwwwww
*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.
n7gN H/ �M+d IIJ SWick
Susan Sidick
4/21/2017
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PUGET
SOUND
ENERGY
Job#106323705
17707 Talbot Rd, Edmonds WA
April 20, 2017
Sheet 1 of 1 ryan.honeysett@pse.com
(425) 457-5381
Ak
AS 1"
I
T
All
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
4 lane width.
/ 0 6. Alert affected residents and businesses.
V 7. Work to take place between 9 a.m. and 4 p.m.
' 8. Work area will be 18' ECL, of Talbot Rd & 190' NCL of
N 178th ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
N
�. „ a-
ILEGEND
RESIDENT(S) WILL BE INFORMED
28' TRAFFIC CONE
OF POSSIBLE TEMPORARY
rM BORE PIT
DRIVEWAY CLOSURE
TRAFFIC FLOW
t
FLAGGER
�.. ION
CHANNELIZAT
DEVICE SPACING
� � Q
WORK VEHICLE
_MPH TAPER TANGENT
I I► SIGN LOCATION
55/70 40 80
35/45 30 60pP1
C:)
WARNING FLAG
25/30 20 40
AHCAs
O
o
A
ROAi
O
WORK
178TH ST SW
AHEAD �
PRE -INSPECTION REPORT
Job #:
106323705
+
Date:
3/29/17
Address:
Jurisdiction:
Edmonds
City / Zip:
Right of Way Permit?
El YES Ej NO
Customer:
Est. Start Date:
06/19/17
PM / Insp:
Est. Duration:
8 Hours
& 'E W of CIL
17707 TALBOT RD
Edmonds98026
Adriano Clampitt 425-275-6592
m11E8_
Kiora Hays 42 - 1 "- 0
PHONE NUMBER
Constructiorl MethodWORK DESCRIPTION:
IA15TALL 50'OFI-118"PESCA TSTUgAND 210'OFI-118"PE5CA TEXT SETA425M5A Open Trench
❑
O/R. D0A10TCLJTPAVEMt5A1TIA1,Q0W I Trenchless
PL "'MAF":
178TH ST SW W CIL
II
MANHOLE COVER
IEM =Water Meter box
I
PL
:I1,197 l 01 "1 W
I@ =STORM DRAIN
0 = FIRE HYDRANT (84' from tie in)
Surface Type
tU , -81,
-jaAML N S of CL ---=B 9Y�t_
CL
+
CIL IALBOI-RD-
3X5
W
'N S of CIL
qL
LL
& 'E W
of CIL
4
S of CIL
0
& 'E W of CIL
Q
0
.5 z 5
Fl FLAGGERS #
MPH
❑
178TH ST SW W CIL
II
MANHOLE COVER
IEM =Water Meter box
I
PL
:I1,197 l 01 "1 W
I@ =STORM DRAIN
0 = FIRE HYDRANT (84' from tie in)
Surface Type
tU , -81,
-jaAML N S of CL ---=B 9Y�t_
&=4A=_�Mof
CIL IALBOI-RD-
3X5
GRAVEL
'N S of CIL
& 'E W
of CIL
S of CIL
& 'E W of CIL
Fl FLAGGERS #
MPH
❑
TROLLY LINES
El BUS STOP #
El METER HOODS #
R OFFICERS #
SPEED LIMIT
Ej
TRAFFIC SIGNAL
F-1 ARTERIAL
❑ NO PARKS#
R commercial ❑
Altered Commercial
R
Leak Repair
Service Information
❑ Template Bar
Residential []
Altered Residential
R
CP Work
Diameter Meter
EFV
El Bollards 2.5" #
❑ Multi -Family E]
Replacement Service
R
Pothole
0 5/8'. El 250
Q
1800 E] Bollards 4" #
F1 New ❑Constr. [:)
Maintenance
Extension
❑Main 11/8" 425
❑
2600
P/1 Stub ❑
service maintenance
❑ 11/4" ❑ 630
❑
10,000 [:] FUEL LINE PERMIT NEEDED
❑ Extension ❑
Valve Maintenance
❑ 2" ❑ 1000
Fuel Line Length:
E] compete sery ❑
Cut & Cap
Mtr Loc: OIR
Fuel Line Diameter:
■1, _.. '� wr,: � .. • 'ice... ... ,:
Date of Request: 04/20/17
Job number: 106323705
Job address: 17707 TALBOT RD City: Edmonds Zip: 98026
Project mgr: Kiara Hays
PM email: kiara.hays@pse.com
Estimated job start date: 06/12/17
Estimated job completion date: 06/16/17
PM contact #: (425) 213-9205
Description of work to be performed:
INICTAI I rm, (1F 1_1/R" DD Q( -AT CTI IR AKIrl')1 ' Q _1/8" RE SCAT DYT SET A425
MSA O/R. DO NOT CUT PAVEMENT IN ROW.
Pavement cut?Yes ONo
If yes, Dimensions of Cut: Length Width
How many cuts?
Surface Type
Require trenching? Des No
If yes, Dimensions of trench: Length Width
Method of installation: Hole hog
Traffic impact:
Road closed []Yes
O✓ No
Lane closed ✓ yes
No
Shoulder closed es
No
Sidewalk closed DYes
No
Emergency Contact: Dean Latimer
Cell Number.' (253) 350-6687
Depth
How Many? 2 alt. Direction? North