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ENG20170400-APPROVED PERMIT.pdf04 I:D4J CITY OF EDMONDS v G 121 5TH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERMIT MUST BE POSTED ON JOBSITE* STATUS: ISSUED ENG20170400 I RIGHT OF WAY PERMIT (6-EtIC) 0 Permit Number: ENG20170400 Expiration Date: 04/10/2018 Job Address: 22001 HIGHWAY 99, EDMONDS Location: 220TH ST SW & HIGHWAY 99 , APPLICANT PSF/Infrasource PSE/Infrasource GO Susan att: Sidick C/O Susan att: Sidick 1660Park Lane 1660 Park Lane Burlington, WA 98233 Burlington, WA 98233 (425) 457-63 53 LICENSE #: infrasl871 c2 EXP: 02/22/2019 Work area is approx 26' S c/I of220th St SW & 57 E c/I of Hwy 99 to perform yearly inspection G1-1785514 at the test lead wire box please rush. DISRUPTION INFORMATION ASSESSIA) VALUE: $0.00 PROPERTY AREA: 0 SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0 00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 ) PARKING: ( OXO ) 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 ofany kind or description it,halsoever, foreseen or unforeseen, that may be made against the City of Edmonds 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 permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF 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 prior to the end of the workday -NO EXCEPTIONS. • Three sets of construction drawings of proposed work are required with the pen -nit 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 SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN SPACE PROVIDED /o1/o1Zo/7 RELEASED BY Printed: Tuesday. October 10. 201 DATE 0 FILE COPY ❑ INS PECTOR COPY ❑ APPLICANT COPY STATUS: ISSUED ENG201704OO • Restore ROW to City standards • Alert affected residents and/or businesses priorto work start. • Conform to approved working drawings and Traffic Control plan. • 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. • Maintain 10' separation between the sanitary side sewer and the water service line. • 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 fromthe noise limits ofECC Chapter 5.30 only during the hours of 9:OOam to 3:OOpm on weekdays and 10:00am and 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 hanriless 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 of this pemut. 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.Traffic Control • E Engineering Final PARTIAL INSPECTION DATE: INITIAL: NOTES: PARTIAL INSPECTION DATE: INITIAL: NOTES: FINAL INSPECTION APPROVED DATE: INITIAL: t tit: t_(.>hfU ,(Nci. -a`)° ROW PERM1'I' NO.: EN(XV1w' O? - 0goc) ISSUE DATE: _-- RIGHT-OF-WAY IGH'I['-OF-WAY (C0N8T1'1:.l(J(CTI0N PERMIT T APP LI((CATIOINI PROJECT NAME: 887033545 CONTRACTOR: PSE/Infrasource Mauling Address:1660 Park Lane Burlington Wa 98233 State License #: INFRASL871C2 City Business License #: NR-023614 CONTACT: Susan Sidick Phone#: 425-457-6353 Fax— Eanall #: susan.sidick@pse.com []Liability Insua•ance Lj Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 220th ST SW & HWY-99 �?ao®1 ROW WORK ASSOCUTE D WITH THE FOLLOWING TYPE Ulf FXUJI;a; f: Commercial El Subdivision 0 City Project Lj Traffic Control (Only) ❑ Multi -family ❑ Single Family ❑ Other ❑ EUC (PUD, VERIZON, PSIE, COMCAST, OVWSD): Is this permit part of a bianlcet permit? ❑ Yes ❑ No ANY ASSOCIATED PERMITS? 1 BLD# (DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 26' S c/1 of 220th ST SW & 57' E c/1 of HWY 99 to perform yearly inspection G1-1785514 at the test leadwire lbox. ease rush — WAS STRT;%T OVERLAVED WITHIN THE LAST FIVE (5) YEARS? YES NO PAVEMENT CUT: ❑ Yes © No If yes, indicate size of cut; x.__ CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x NIGHT -OF -WAY DURATION AREA TOTAL CLOSURE (NUMBER OF MONTHS) Sidewalk 48 Hrs + LF X LF SF Alley 72 Hrs + LF X LF SF µv Parking 72 Hrs + LF X LF SF APPI.,ICANT 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. Indemnify: The Applicant has signed an application which states helshe hold the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may he 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 1 must follow all requirements in order for the permit to be valid. SIGNATURE ._ShJ01 cSlG(Ck DATE 10 0 2017 _ Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE, Date of Request: Job number: Job address: Project mgr: PM email: PERMIT REQUEST FORM 10/03/17 887033545 220th St SW & Hwy-99 Betty Frank betty.frank@pse.com Estimated job start date: Estimated job completion date: 11/03/17 11 /03/17 Edmonds Ziq: PM contact #: (206) 716-2641 Description of work to be performed: Perform_y_earlyinspection GI-17855)14 at test lead \tiire box lnratwrl at 2F' �rl of 22fl St 5;W & 57' Ecl hwv99 Pavement cut? Yes nNo If yes, Dimensions of Cut: Length Width How many cuts? Surface Type n/a Require trenching? Yes nNo If yes, Dimensions of trench: Length Width Method of installation: Traffic impact: Road closed ❑Yes No Lane closed Eyes ❑ No How Many? 1 Shoulder closed Dyes No Sidewalk closed nYes No Emergency Contact: Ce// Number: Depth Direction? West PUGET SOUND ENERGY F—LEGENDS PROJECT LOCATED AT 26' SCI 220th ST SW & 57' Ecl Hwy 99 Mountlake Terrace, WA 98026 DURATION OF WORK APPROXIMATELY 15 MINUTES HOURS OF OPERATION M-F, 9AM-4PM SITE PLAN #1587799 BETTY FRANK Engineering Assistant Puget Sound Energy Corrosion Protection Dept. Cell # 206-396-9244 Email. bettvfrank(7a ose.com s r 220TH ST SW App&mtshd repakhop!aw a!l damepeto (►tipbn*r*wA knpraa-.rentsinGlY ATTACH SIG right -of -my per City staN ndardsVWIsea d SEQUENCE or occurs during Ma p Prep SIGN SEQUENCEA OWNER110W A-70A IS FMOSKE FOR I. R I EROSION COhF n AND DRAINAGE x x X ROAD WORK Ai1Fi�D W20-1 LOSEEDD W4-2L AHEAD W20-5R TRAFFIC DIRECTION TEM .TRAFFIC DIRECTION DDDD CHANNELIZING DEVICE ADVANCE WARNING w SIGN LOCATION T-19L 28" TRAFFIC �■ CONES J � I— �m 165, 100, TAPER TANGENT SPACING TABLE CIIAM FLIZINC DEVICESBPACIN6 (FEET) MPH I TAPER TANGENT / 20130 20 40 / / NOTES: 1. MAINTAIN A MINIMUM OF ONE ACCESS POINT FOR EACH BUSINESS WITHIN WORKAREA LIMITS. 2. ALERT METRO TRANSIT PRIOR START OF WORK. NOT TO SCALE TRAFFIC CONTROL PLAN #1 OF 1 WORK IN INTERSECTION REASON, PREFORM YEARLY READ ATTEST LEAD WIRE BOX 01 G7,o-2 f'h-Gza-2 ACTIVITY AREA 100' TANGENT CpWs�Ru��FoN liOVRS L qAM rGD TO -r0-V.WptA WeEKgAVS 165' T-19L TAPER / / / / �fp • SoA�1, �ea�,�+Go APPROVED AS NOTED ATTACH SIGN BY Nrsr«�ING TSEQUENCE (A) �r TRAFFIC CONTROL SERVICES �J FELIPE 1 MACIAS, TCS#002889 Data: _ /C�� / OFFICE # 5) 8.324658.3656 NOVEM BERER TS-034202 —street view showing location of wire box at 220 St SW & Hwy-99 Test Lead wire box location: 26' Scl 220 St SW & ST Ecl