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ENG20170324-APPROVED PERMIT.pdf(ITY OFEDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020' PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERM;rr'MUST 'BE POSTED ON JOBSIT * Job Address: 16404 75TH PL W, EDMONDS Location: 16404 75TH PL W APPLICANT CONTRACTOR PSE/Infrasource PSE/Infrasource C/O Susan att: Sidick C/O Susan att: Sidick 1660 Park Lane 1660 Park Lane Burlington, WA98233 Burlington, WA'98233 (425)457-6353' LICENSE #. mfrasl871 c2 EXP 02/22/2019JOB DESCRIPTION Work area is approx 689' S c/1 of private Dr and 12' W c/I of 75th PI W to install gas service. l 3x5 paving cut' anticipated. - NO ASPHALT CUTS PERMITTED ASSESSED VALUE: $0 00 PROPERTY AREA: 0 SIDEWALK: (OXO) DURATION IN MONTHS: 0FEE $0,00' STREET' DISRUPTION TRENCH CUT: ( 0 X 0 ) PARKING: ( OX0) DURATION IN MONTHS: 0 FEE: $0 00 YEAR OF OVERLAY: 0 FEE $0,00; ALLEY ( OX0 ) DURATION IN MONTHS: 0 FEE: $0,00_ INDEMNITY The, Applicant has signed an application which states he/she holds the City ofEdmonds harmless from injuries, damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be 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 attorney fees by reason ofgranting,this permit. THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEFINAL INSPECTION AND ACCEPTANCE O F THE W 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 priorto 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 FORINSPECTION (425) 771-0220 EXT1326 24 H01 R N0rFTCF.RFnITIRFI)'FOR ALI.`INSPECTION 'RFOIJESTS THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER SPACE PROVIDED„ �iLua�.,ruL '.RFI F6 CFr1 RV DATE FILE COPY INSPECTOR COPY APPLICANT COPY EDGED IN • Restore ROW to City standards Restore! Landscape to like or better conditions. Call for locates of undergroundutilities prior to any excavation':' +� Alert affected residents and/or businesses` prior to work start. •. Confornto approved working' drawings and Traffic Control plan. • Verify clear bore crossings • 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. • The permit is issued based on an agreement that the road will not be cut into. If the road needs to be cut into, PSE is to stop work immediately and contact the City for review and approval. • 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 fromtemporary construction sites as 'a result ofconstruction activity are exempt fromthe 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 530.120 • Applicant, on behalf ofhis 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 fromthe issuance ofthis permit. Issuance ofthis 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. INSPLCITIONS Trench Location -No Asphalt cuts &Engineering Final PARTIAL INSPECTION DATE: INITIAL: NOTES:. PARTIAL INSPECTION DATE:d_� INITIAL:, NOTES; FINAL INSPECTION APPROVED DATE: INITIAL: cnmt"'J) SCANNED 54posifflurfflow '` . 1 s 0 00I-7 03 D LI ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: 109106388 CONTRACTOR: PSE/Infrasource __ r ._...... ....... 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 El Liability Insurance 0 Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 16404 75th PL W ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: ------------- Commercial Subdivision City Project Traffic Control (Only) ❑ Multi -Family ❑X Single Family ❑ 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 689' S c/I of private dr and 12' W c/I of 75th PL W to install gas service 1 3x5 dirt and paving cut anticipated. WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO n Year:109� PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 55 CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x RIGHT-OF-WAY DURATION CLOSURE AREA TOTAL UMBER 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 AM WIWVIIVNNW@. *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 8/10/2017SIGNATUREx DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE % RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE Lcot, 0 10 213'TRAFFIC CONE MM BORE PR TRAFFIC FLOW FNGGER M"ZATION ANNELI� EVICE SPACING WORKVENICLE SIGN LOCATIONWARNING L2513 FLAG 20 40 PUGET SOUND ire : FniFarv jP Job#109106388 16404 75th PI W, Edmonds, WA August 91h, 2017 Sheet 1 of 1 brent.pogson@pse.com (425) 462-3030 H', u 1 H: od��"u i II I Notes: I. All signs and spacing to conform to the MUTCD and City of Edmonds standards. 2. All sidewalks, driveways, ex is 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. 6, Work area will be 12' WCL of 75th PI W & approximately 689' SCL of 162nd St. 9. If used, place NO -PARK signs 72 hours in advance of the day Thal the work is to be done. Pueet Sound EnerRv Gas Pre -inspect Form Job #: 109106388 Date: 8/8/17 Address: 16404 75TH PIL W Jurisdiction: Edmonds City/ Zip: Edmonds, 98026 ROW Permit: Yes Customer: Shawn Pringle 425-286.7774 Est. Start Date: 11/13117 PM / inspector: Jordan Cooper Est. Duration: 1- 112 Days Job"BeseRption / Scope of Work ............ At 2" PE IP 2'W Edge Of Paving (902675) C&C 5/8 Service (Prevous C&C in Property) Then New Construction: Install 1/8 Alt Residental PE SCAT Service 130'( 12'Stub & 118'EXT) And Set A630 OL PLAT Map: 157.07 16404 75th PI SW 109106388 A630 MSA 1-1/8" PE Construction Method All Scat / Tre 7chless EXISTING Power OVER HMID 1-t EXISTING Sewer Private DR c 3 � l P/L EXISTING Water 518"PEStub C&C @ Main PIL 689' S of CL Private Drive of CL Work Location & 12' W I of CL & I of CL 175th PI W I Size of Cut Surface Type 3x5 D/Z of CL a -------------- —T of I Service Information Street Information Job Type Diameter: 1-1/'8" PE Flaggers U: Y Arterial: N Altered Residential Svc EFV: 1-1/8" - 2600 - 9999144 Police #: N TCP: y Meter: A630 I I Speed Limit: 25 No Parks #: y Meter Loc: 02 - OFL Trolley Lines: N Mtr Hoods ft: N 500NO OVERGY Del Press: 61, W.C. Traffic Signa I: N Bus Stop: N Bollards: 1 2.5" # 4" # ADA,Ramps #: N Route #'s: I N PERMIT REQUEST FORM Date of RPnuest- R/9/9017 Job Number: 109106388 Job Address: 16404 75TH PL W City: Edmonds Zip: 98026 Project Manager; Jordan Cooper PM Contact #: PM Email Jordan.Cooper@pse.com Esitmated Job Start Date: 11/13/2017 Estimated Job Completion Date: 11/17/2017 Description of work to be performed: At 2" PE IP 2'W Edge Of Paving (902675) C&C 5/8 Service (Prevous C&C in Property) Then Install 1 1/8 Alt Residental PE SCAT Service 130' 12' Stub & 118' EXT And Set A630 OL Pavement Cut: Dyes If yes, Dimensions of Cut: How many cuts Surface Type 1 soft/road E]No -- NOT WOMV4E70,Cu" Length width5" 0" Trenching Required Dyes 7No If yes, Dimensions of Trench Method of installation: Traffic impact: Road Closed Lane Closed Shoulder Closed Sidewalk Closed Emergency Contact: Cell Number: Length Width Depth Hole Hog Yes No How Many Lanes 1 Yes No Direction: S Yes No Yes No Jordan Cooper 425-6235302