ENG20170205-APPROVED PERMIT.pdfO 't� t
EDMONDS,
121 5TH AVENUE NORTH - EDMONDS, WA 98020
t1)e 89 PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG2017020
Permit Number: ENG20170205 Expiration Date: 11 /27/2017
Job Address: 8802 217TH ST SW, EDMONDS Location`: 8802 217th ST SW
APPLICANT CONTRACTOR
PSE/Infrasource PSE/Infrasource
C/O Susan aft: Sidick C/O Susan att: Sidick
1660 Park Lane 1660 ParkLane
Burlington, WA' 98233 Burlington, WA '98233
(425)457-6353
LICENSE #-infras187Ic2, EXP: 02/22/2019;
Work area is approx 20''N & "13'S c/I of 217th St SW
anticipated. To install gas service.
ASKISS1:O VALUE:
$0,00 PROPERTY A
SIDEWALK.
(OXO)
DURATION IN MONTHS: 0
LARKING:
( 0X0 )
DURATION IN MONTHS: 0
ALLEY„
4 OXO I
DURATION IN MONTHS: 0
of 88th Ave W. 1 3x5 soft surface cut and 1 2x4 paving cut
FEE $0,00 STREET DISRUPTION TRENCH CUT: ( 2. X 4 )
FEE $0,00 YEAR OF OVERLAY: 0 FEE: $0,,00
r•r:rr �t^nnn..
INDEMNITY 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 na,halsoever, foreseen or unforeseen, that may be made against the City ofEdmonds'or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permil.
THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD O'FONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE OFTHEWORK
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
posseson.
• 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.
wi 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 NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SI(
RELEASED BY
❑ FILE COPY
BY THE CITY ENGINEER OR HIS/HER
SPACE PROVIDED,
❑ INSPECTOR COPY
ES ARE PAID, AND RECEIPTIS ACKNOWLEDGE
Printed: Fridav,'May 26,201
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,
• 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 fi•ontage'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 kites as a result of constructionactivity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:OOpm on weekdays and 10:00amand 6:OOpm 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 a variance 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.
•`. E Engineering'Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
ITITIT
FINAL INSPECTION APPROVED DATE _ INITIAL:
FR4111MI'Mmow—
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RECEIVED
MAY 2 3 2011 �OI�
ROW PERMIT NO.: ENG
BUILDING ISSUE DATE:
:GHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106323153
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
.......................
State License #: INFRASL871 C2
_...�
City License #:
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 8802 217th ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
.._ ......_-
Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family ❑X Single Family [—I Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit pant of a blanket permit? ❑ Yes ❑* No
ANY ASSOCIATED PERMITS? BLD#_ ......... ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 20'N & 13'S c/I of
217th ST SW & 133' W c/I of 88th AVE W 1 3x5 soft surface cut and 1 2x4 paving cut anticipated
to install gas service
[.WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YNO El Year: 106b
PAVEMENT CUT: ® Yes 0 No If yes, indicate size of cut: 2 � 4
CONCRETE CUT: ❑ Yes No If yes, indicate size of cut: x_
RIGHT-OF-WAY 7 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.
SIGNATURE Susan Sidick '4' . pus -fi°�°� DATE
Oak 2fiIfiD3300]6]]OdT10 04/ 18/2017
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 Ip® for traveling
lane width.
6. Alert affected residents and businesses. Nvwd'"
7. Work to take place between -1 a.m. and Qpp.m. o N80M
vo I
8. Work area will be 133' WCL of 88th Av W
& approximately 20' NCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
0
�p
Use maximum
i space available
for sign
217TH ST SW
C2
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80 mm IT
35/45 30 60
25/30 20 40
Z0884
5-1 Z,M 3
a �
it ¢
0
N
LEGEND
28' TRAFFIC CONE
BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
�p
Use maximum
i space available
for sign
217TH ST SW
C2
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80 mm IT
35/45 30 60
25/30 20 40
Z0884
5-1 Z,M 3
a �
it ¢
0
N
W20-1
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 I ty' or traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place betweenj a.m. and p.m.
8. Work area will be 133' WCL of 88th AV W
& approximately 13' NCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
LEGEND
28- TRAFFIC CONE
BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
217TH ST SW
0
W21-5
a351453O
ELIZATION
SPACING
ER 'TANGENT
0 _ 80 - .
60
0 40
Z088#
r
Use maximum
space available
for sign
M
17 O 17
�n4
JOB #: 106323153 PRE -INSPECTION REPOR T r%V kV ,'q'
DATE: 4/6/17 ADDRESS: 8802 217th St Sw
JURISDICTION: Edmonds CITY/ZIP: iEdmonds 98026
ROW PERMIT: E) YES ❑ NO CUSTOMER: Eric Whitehead 206-930-7831
START DATE: PM' Jordan McLean 425 563-37 37
03
DURATION: 1 day
WORK DESCRIPTION: INSTALL METHOD
Ienc a css
From main, install approx. 75' of 1-118" PE scat svc., and set an A250 meter. IVill need two residential Open Trench D
bollards. New Construct 0
Existing
PLAT MAP: 164.068
..................,................., ...
ti 9 A 1,
n i q
e » 8802 2 Res. Bollards
r 9 A250 MSA
1 v �
h NOTE:
r I r•
•t � � Stub: 42'
p ( q Ext: 33'
I x Power, CTV, Fiber,
b
04 PO P 61��
i 1 � all OH.
pAABIS I l an �F � Curb/gutter
W No sidewalk
at1 ROW = 60' Wide
PAV = 32' Wide
` r r', Int} I bel"T I Po Hydrant H13 -10A is
380' from tie-in.
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q— --.--.-- —.—— -- — —.— - —.—. ,,,„. „„„.---.—...—— —. —. .— -- — — ---.— —-.— ——— —.— — --.
2" STW IP 20'N 8815-1966
L � q
M
WORK LOCATION Size of Cut
S of CL _-. ...__2j_7,�t-,SL'5w_ — & 133 'E W of CL 88th Ave W 3x5
$Rth Ave W 2x4
_- 'N S of CL_
& 'E W of CL
.....
❑ FLAGGERS #
MPH
❑
TROLLY LINES
❑
BUS STOP #
❑ OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑
ARTERIAL
❑ Commercial
❑
Altered Commercial
❑
Leak Repair Service Information
Q Residential
❑
Altered Residential
❑
CP Work Diameter
Meter EFV
Pressure
❑ Multi -Family
❑
Replacement Service
❑
Pothole ❑ 5/8"
E]
250 ❑ 1800
6" WC
New Constr.
❑
Main Maintenance
❑
Extension ❑ 1-1/8"
L]
425
2600
❑ 2#
Stub
❑
Service Maintenance
❑ 1-1/4""
630 El
10,000
❑ >S#
Extension
❑
Valve Maintenance
❑ 2"
1000 ❑ 775
4 complete Sery
P
❑
Cut & Ca P Meter Loc:
OR 08
D3000
Surface Ty
Soft
Asphalt
❑ METER HOODS #
❑ NO PARKS #
❑ Template Bar
❑ Bollards 2.5" #
❑ Bollards 4" #
❑ FUEL LINE PERMIT NEEDED
Fuel Line Length:
Fuel Line Diameter: