ROW PERMIT APPLICATION.pdf
ROW PERMIT NO. : ENG___________
ISSUE DATE: ________________
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: CONTACT:
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218166:14
CONTRACTOR:Phone #:
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536.568.7464
Mailing Address: Fax #:
2771QbslMbof-Cvsmjohupo-XB:9344
Email #:
State License #:
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JOGSBTM982D3
City Business License #: Liability Insurance Bonded
OS.134725
ADDRESS OR INTERSECTION OF CONSTRUCTION:
:118PmznqjdWjfxEs
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision City Project Traffic Control (Only)
Multi-Family Single Family Other
EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? Yes I No
BLD#____________ ENG#____________
ANY ASSOCIATED PERMITS?
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DESCRIPTION OF PROPOSED WORK (Be Specific) :
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_________________________________________________________________________
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year:
218166:14
PAVEMENT CUT: Yes NoIf yes, indicate size of cut: _________x_________
46
CONCRETE CUT: Yes NoIf yes, indicate size of cut: _________x_________
RIGHT-OF-WAYDURATION
AREATOTAL
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 anykind 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.
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SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy Gas Pre-Inspect Form
Job #:107055903
Date:6/26/18 Address:9007 OLYMPIC VIEW DR
Jurisdiction:Edmonds City / Zip:EDMONDS, 98026
ROW Permit:Yes Customer:STEVE KISSINGER206-245-4863
Est. Start Date:9/3/18 PM / Inspector:Jordan Cooper425-623-5302
Est. Duration:5 Days
Job Description / Scope of Work
New Construction:
From 2" MPEI IP 28' E Main (107007981-2001) Run Scat 300' PE 2" Main and Run Scat New 1 1/8
PE Service 200' ( 15' Stub & 185' Ext) Set A425 OL. 60' ROW.
Construction Method
All Scat / Trenchless
PLAT Map:160068
9007
N
A425 MSA
1-1/8" PE
greenhouse
P/L
P/L
PROPOSED 2" GAS MAIN
Olympic View Dr
See Attached GIS
Map For Utilities
2" EXISTING GAS MAIN TIE IN
28' E C/l
Work LocationSize of CutSurface Type
EN
28'of CL Olympic View Dr&41'of CL Vista Del Mar Dr3x5C
EN
28'of CL Olympic View Dr&225'of CL Vista Del Mar Dr3x5C
EW
28'of CL Olympic View Dr&540'of CL Talbot Rd3x5C
Service InformationStreet InformationJob Type
YYNew Residential Main & Svc
Diameter:1-1/8" PE Flaggers #:Arterial:
NY
EFV:1-1/8" - 775 - 9995252 Police #:TCP:
25Y
Meter:A425 Speed Limit:No Parks #:
NN
Meter Loc:Trolley Lines:Mtr Hoods #:
NN
Del Press:6" W.C.Traffic Signal:Bus Stop:
Bollards:2.5" #4" #ADA Ramps #:N Route #'s:N
Job#107055903
9007 Olympic View Dr, EdmondsWA
June 30, 2018
Sheet 1 of 2 Yuriy.Bashtovoy@pse.com
(425) 424-6603
SIGN SPACING
CHANNELIZATION
POSTED SPEED LIMITS
LANE
55 +
"X"
DEVICE SPACING
WIDTHS
60/65202530354045
800
MPH
TAPERTANGENT
45/55
500'
10
55/704080
35/40
350'
11
35/453060
30
200'
25/302040
12
25
100'
Job#107055903
9007 Olympic View Dr, EdmondsWA
June 30, 2018
Sheet 2 of 2 Yuriy.Bashtovoy@pse.com
(425) 424-6603
SIGN SPACING
CHANNELIZATION
POSTED SPEED LIMITS
LANE
55 +
"X"
DEVICE SPACING
WIDTHS
60/65202530354045
800
MPH
TAPERTANGENT
45/55
500'
10
55/704080
35/40
350'
11
35/453060
30
200'
25/302040
12
25
100'
107055903
.....
1/3
DATE
7/19/187/20/18
PAGE
N
N/AN/AN/A
office
EDMONDS.
107055903
1"=20'
Drawing Number
SAP Sup Order Nbr
PHONE NO
206-517-3466425-424-6426425-424-6549206-517-3466
PERMITSCALE
206-245-4863
.
D.DAO
CONTACT
J.COOPERJ.COOPER
G.VUKOSAV
N/AN/AN/A
N/A
WORK
SITE
STEVE KISSINGER
N/ASTEVE KISSINGER9007 OLYMPIC VIEW DREDMONDS, WA 98026ATTN:
Vicinity Map Owner / Developer Contact Info
APPROVED BY
REAL ESTATE/EASEMENT FUNCTION PROJECT MGRENGR - GASDRAWN BYCHECKED BYCP APPROVALPC APPROVALMAPPING
CALL 811 AT LEAST 2 BUSINESS DAYS BEFORE YOU DIG
For contacts below dial 1-888-CALL PSE (225-5773)THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF EXISTING FACILITIES
N/AN/AN/A
WATERWATER
TESTED BYTESTED BY
Manufacturer
45
160.068
107055903106338349
Order #
CSPBTGPM
FF
JOINT FACILITIES ARRANGEMENTS
STEVE KISSINGER 2" MPE IP MAIN EXTENSION
Act Lgth
---------
GAS WK CTR
PPPLAT MAP
NITROGENNITROGEN
IP 025-45
9007 OLYMPIC VIEW DR, EDMONDS, WA 98026
225'
Est Length
AIRAIR
N/AN/AN/A
DESCRIPTION
4
160.068
SYS MAOP
START TIMESTOP TIMETEST RESULTSSTART TIMESTOP TIMETEST RESULTS
MPE
Type
BY
500308779505790954
Notification #
Emer SectOP MAP
Yes NoYes No
---------
SOAPSOAP
60
GAS MAIN PRESSURE & TESTING
STANDARD GAS CONSTRUCTION NOTES:
2"
/ / / / / / / /
NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQUIREMENTS).ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.EXCESS FLOW VALVE
TO BE INSTALLED ON ALL NEW RESIDENTIAL SERVICES PER GOS 2500.2200. (RECORD ALLINFORMATION ON D-4 CARD)
FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE-CALL" TWO WORKING DAYS PRIOR TOTO CONSTRUCTION, IN WESTERN WASHINGTON CALL: 1-800-424-5555. OR CALL NATIONWIDE: 811 EROSION
AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARYEROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.NOTIFY PROPERTY
OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYSPRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HANDDELIVER
FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACEDPER
GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE-IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED
BYTHE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.COMPLETE "PIPE CONDITION REPORT" ON ALL METALLIC PSE FACILITIES. CHECK BOX ON REPORT FOR WIREBOX (TEST LEAD) INSTALLATION.PIPELINE
MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GASOPERATING STANDARD 2525.2500.INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS
SHALL BE INSTALLED AND RECORDED BYTHE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION ISNOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTENT
SNOWFALL MAY OBSCURE THE VALVE BOX.SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.RESTORE
ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200.MAINS AND SERVICES
SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS-BUILT IN RED. ( ') DENOTESFOOTAGE
BETWEEN FITTINGS.
TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT ASSYSTEM MAOP DENOTED BY: SYSTEM MAOP = ___ PSIG
GAS MAIN INSTALLATION/RETIREMENT
PSE
DATE
Pipe Size
PHONE#
GOS 2525.3300 sec. 5, Table 5-1 and sec. 5.5
UTILITIES
CONTACT
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION WITH CP TECH. ___________________________, PHONE______________.
1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.17.18.
JORDAN COOPER425-623-5302jordan.cooper@pse.com
Verify Testing Requirements, Chart vs Gauge
Service/Meter
SAP SuperiorService/MeterService/MeterService/MeterInd. ServiceInd. MSADis. Reg. / FTHP Svc/MSARelocateRetirement
21
3
NW 18-27-04
SNOHOMISH
TESTED BY PSE PRESSURE CONTROL, SEE FORM 1928
REV#
INSTALL
Type/Work
DESIGNED BY
TYPE TESTDATE ONDATE OFFTYPE TESTDATE ONDATE OFFPRESSUREDESIGN PRESS2023 02/18
GASProject Manager Contact Information:COUNTY
PRESSURE PROJECT PHASE 1/4 SEC
Manager:E-Mail:
Cell Phone:"Locates Required""Flagging Required"
DATE
LENGTH
NAME
FOREMAN'S
GASSED UP PIPELINE
DEPTH
PIPE
SEGMENT
LOCATION
HOLE HOG TABLE
ENDENDENDENDENDENDENDENDENDEND
STARTSTARTSTARTSTARTSTARTSTARTSTARTSTARTSTARTSTART
BP1BP2BP3BP4BP5BP6BP7BP8BP9
BP10BP11BP12BP13BP14BP15BP16BP17BP18BP19BP20
CALLOUT
(CHECK BOX TO CONFIRM COMPLETION)
Inspected Steel and PE pipe per GOS 2450.1400 and 2450.1500Reviewed and complied with all construction notes.Recorded all required information on the as-built per GOS 2500.1700.Completed
post installation inspection per GOS 2525.1200 and 2525.2700.Left the work area in a clean and safe condition.
Company: __________________________ Date ______________
FITTER'S CHECKLIST Foreman's Signature________________________________________Foreman's Name (printed) ___________________________________
4680 06/11
.....
2/3
DATE
7/19/187/20/18
PAGE
N/AN/AN/A
EDMONDS.
107055903
Scale: NONE 1"=20'
Drawing Number
SAP Sup Order Nbr
PHONE NO
206-517-3466425-424-6426425-424-6549206-517-3466
PERMITSCALE
.
D.DAO
CONTACT
J.COOPERJ.COOPER
G.VUKOSAV
N/AN/AN/A
Scale: NONE
(CHECK BOX TO CONFIRM COMPLETION)
N/A
1' MIN.
CLEARANCE
APPROVED BY
REAL ESTATE/EASEMENT FUNCTION PROJECT MGRENGR - GASDRAWN BYCHECKED BYCP APPROVALPC APPROVALMAPPING
CALL 811 AT LEAST 2 BUSINESS DAYS BEFORE YOU DIG
For contacts below dial 1-888-CALL PSE (225-5773)THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF EXISTING FACILITIES
Inspected Steel and PE pipe per GOS 2450.1400 and 2450.1500Reviewed and complied with all construction notes.Recorded all required information on the as-built per GOS 2500.1700.Completed
post installation inspection per GOS 2525.1200 and 2525.2700.Left the work area in a clean and safe condition.
N/AN/AN/A
TYP. UTIL. CROSSING SECTION
FITTER'S CHECKLIST Foreman's Name (printed) ___________________________________ Company: __________________________ Date ______________
Foreman's Signature________________________________________
4680 06/11
160.068
-CSPBTGPM
JOINT FACILITIES ARRANGEMENTS
ROADWAY CROSS SECTION STEVE KISSINGER 2" MPE IP MAIN EXTENSION
GAS WK CTRPLAT MAP
9007 OLYMPIC VIEW DR, EDMONDS, WA 98026
A
N/AN/AN/A
DESCRIPTION
4
160.068
BY
Emer SectOP MAP
Yes NoYes No
VERTICAL: 1'
MINIMUM CLEARANCEFROM OTHER UTILITIES:HORIZONTAL: 5'PSE
DATE
PHONE#
UTILITIES
CONTACT
JORDAN COOPER425-623-5302jordan.cooper@pse.com
1
32
NW 18-27-04
SNOHOMISH
REV#
DESIGNED BY
Project Manager Contact Information:COUNTY
1/4 SEC
Manager:E-Mail:
Cell Phone:"Locates Required""Flagging Required"
KEY FOR PITS
PLOT PLAN SCALE: 1" = 20'-0"
-
A
R
D
W
E
I
V
C
I
P
M
Y
L
O
D
R
R
A
M
L
E
D
A
T
S
I
V
.....
3/3
DATE
7/19/187/20/18
PAGE
N/AN/AN/A
EDMONDS.
107055903
1"=20'
Drawing Number
SAP Sup Order Nbr
PHONE NO
206-517-3466425-424-6426425-424-6549206-517-3466
PERMITSCALE
.
D.DAO
CONTACT
J.COOPERJ.COOPER
G.VUKOSAV
N/AN/AN/A
N/A
APPROVED BY
REAL ESTATE/EASEMENT FUNCTION PROJECT MGRENGR - GASDRAWN BYCHECKED BYCP APPROVALPC APPROVALMAPPING
CALL 811 AT LEAST 2 BUSINESS DAYS BEFORE YOU DIG
For contacts below dial 1-888-CALL PSE (225-5773)THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF EXISTING FACILITIES
N/AN/AN/A
160.068
CSPBTGPM
JOINT FACILITIES ARRANGEMENTS
STEVE KISSINGER 2" MPE IP MAIN EXTENSION
GAS WK CTRPLAT MAP
9007 OLYMPIC VIEW DR, EDMONDS, WA 98026
N/AN/AN/A
DESCRIPTION
4
160.068
BY
Emer SectOP MAP
Yes NoYes No
PSE
DATE
PHONE#
UTILITIES
CONTACT
JORDAN COOPER425-623-5302jordan.cooper@pse.com
1
32
NW 18-27-04
SNOHOMISH
REV#
DESIGNED BY
Project Manager Contact Information:COUNTY
1/4 SEC
Manager:E-Mail:
Cell Phone:"Locates Required""Flagging Required"