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ENG20170221-APPLICATION.pdft PROJECT NAME: 106322189 CONTRACTOR: PSE/Infrasource Mailing Address: 1660 Park Lane, Burlington, WA 98233 State License #: INFRASL871C2 City Business License #: N R-023614 OWN MINA11111" CONTACT: Sue Sidick Phone #: 425-457-6353 Fax #: Email #: Susan.Sidick@pse.com F-1 Liability Insurance El Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 7524 180th ST SW ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: F Commercial El Subdivision El City Project F1 Traffic Control (Only) F1 Multi -Family FRI Single Family F] Other F-1 EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? El Yes F*_1 No � ANY ASSOCIATED PERMITS? BLD# ENG4 DESCRIPTION OF PROPOSED WORK (Be Specific): From main, install approx. 78' of 1-1/8" PE scat/plat svc. Gas main in soft shoulder, will need to cut a small portion of asphalt for hog. Work area is approx 13' N & 12' S C11 of 180th ST SW & 159'W c/l of 75th PL W 1 3x5 asphalt & soft surface cut and 1 2x5 soft surface cut anticipated I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year: 106211 PAVEMENT CUT: X Yes F-1 No If Yes, indicate size of cut: -3 x 5 CONCRETE CUT: [J Yes R No If yes, indicate size of cut: X_ RIGHT-OF-WAY DURATION AREA TOTAL (NUMBER MBER OF MONTHS) Sidewalk 48 Hrs + LF X LF SF Alley 72 Hrs + LF X LFSF Parking 72 Hrs + LF X LF E 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 SidickpaeaS,sUa`p� DATE 6/5/2017 te:2015 03300757:30 -07'W' Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE JOB #: DATE: JURISDICTION: ROW PERMIT: START DATE: DURATION: 106322189 5/9/17 Edmonds Q YES ❑ NO Michael Rowan 1 day PRE -INSPECTION REPORT'S ADDRESS: 7524 180th St SW CITY/ZIP: Edt fonds 98026 CUSTOMER: PM: Michael Rowan 425-232-2Q91 Jordan McLean PM PHONE NUMBER 425-563-3703 WORK DESCRIPTION: ( INSTALL METHOD Trenc ess 'Q ❑ Fr•orrr nrcairr, iiisicr/7 appi°ox. 78' of f-118" PE sccarpiol svc and ,.ret circ X1425 melee. Crrsiornei•lri°ovirled crorrclaOpen Trenchil. New Construct ❑ PLAT MAP: 1 160. 070 4"STW IP13'N3704-1962___ CIE__-- ._ .---------------------_._-_-.__-._-._--...-----------------------C/E- .. ....... .......... ...... .......................................................................................................................................................5\NR.................. ... ......................................:........:................. _.: _... H2O 6" CI -Edmonds 1-1/8" PE A425 MSA 7524 ".`Rl7VV- ou VVIUC:: PAV 22'Wide' **Hydrant H3-37 is 155' from tie-in** WORK LOCATION Size of Cut Surface Type ,J,3_ S of CL _ _�8 th�r1_r� _ & 159 'E W of CL 75A1LPLW 3x5 Asphalt/Soft 12 S �f & 159 ' UAV of CL . ._.Z;fla PJM __._m�._....._m _ 2x5 Soft _......_.._w IN S of CL _ _w &__ _ 'E W of CL ❑✓ FLAGGERS # 1 30 MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS # ❑ OFFICERS # SPEED UMlT TRAFFIC SIGNAL ❑ ARTERIAL ❑ NO PARKS # ❑ Commercial ❑ Altered Commercial ❑ Leak Repair Service Information ❑ Template Bar ❑ Residential ❑ Altered Residential ❑ CP Work Diameter Meter EFV Pressure ❑ Bollards 2.5" # ❑ MUlti-Family ❑ Replacement Service ❑ Pothole ❑ 5/8" ❑ 250 ❑ 1800 ❑ 6" WC ❑ Bollards 4" # � ❑ New Constr. ❑ Main Maintenance ❑ Extension n 1-1/8" ❑✓ 425 ❑ 2600 ❑ 2# ❑ Stub ❑ Service Maintenance ❑ 1-1/4" ❑ 630 ❑ 10,000 ❑ >5# ❑ FUEL LINE PERMrf NEEDED ❑ Extension ❑ Valve Maintenance ❑ 2"❑ 1000 ❑ 775 Fuel Line Length: ❑ Complete SVC p ❑ Cut & Cap Meter Loc: OL 03 D3000 Fuel Line Diameter: #7524 18011 ST SW 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 dear 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 159' WCL of 75th PI W 813' NCL of 180th St SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. mllull ° PUGET .SOUND ENERGY Job#106322189 7524 180th St SW, Edmonds WA June 2, 2017 Sheet 1 of 2 ryan.honeysett@pse.com (425) 457-5381 LEGEND ® 25'TWAC CONE 1 Bou Pn TRAFFIC FLOW FL-- WORK VEHICLE F► SIGN LOCATION > WARNING FAG #7524 18011ST SW 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 dear 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 159' WCL of 75th PI W & 12' SCL of 180th St SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. PUGET SOUND ENERGY Job#106322189 524 1801h St SW, Edmonds WA June 2, 2017 2 of 2 ryan.honeysett@pse.com (425) 457-5381 LEGEND ® 2b TRAFFICCONE BORE PIT TRAFFIC FLOW FLAGGER WORKYEHICLE SIGH LOCATION WAR.NIHGFLAG Date of Request: 06/02/17 Job number: Job address; Project mgr: PM email: 106322189 7524 180th St Sw Jordan McLean jordan.mclean@pse.com Estimated job start date: Estimated job completion date: 07/03/17 City: Edmonds Zip: 98026 PM contact #: (425) 563-3703 Description of work to be performed: Eram main, install approx 718' of 1 -118" PE scat/plat s\/r. Gas main in s0ft shni ildPr, will need to cut a small portion of asphalt for hog. Pavement cut? ®✓ Yes FNo If yes, Dimensions of Cut: Length 5 Width 3 How many cuts? 1 Surface Type Asphalt size of cut 3x5 3x5 3x5 Require trenching? [R�l'es FI/ No If yes, Dimensions of trench: Length Width Method of installation: HOG Traffic impact: Road closed l'es F/ No Lane closed Eyes FNO How Many? Shoulder closed FlYes FNo Sidewalk closed FYes F No Emergency Contact: Jordan McLean Cell Number.' (425) 563-3703 Depth Direction? East