ENG2020-0132OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
AveRIGHT
9:01 1 1
www.cityofedmonds.gov
Description: PSE-CUT AND CAP GAS SERVICE ISSUED: 03/26/2020
Address: 23325 75TH AVE W EDMONDS WA 98026-8519
EXPIRES: 09/28/2020
rmit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00488800300301
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
OWNER OTA MARK L & LEIGH K 23325 75TH AVE W, EDMONDS WA 98026-8519
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $0.00
ENGINEERING INSPECTION FEE $110.00 $0.00
RIGHT OF WAY MINOR - EUC PERMIT FEE $110.00 $0.00
•
REQUIREMENT TYPE NOTES
TRAFFIC CONTROL 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 posession.
RESTORATION 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
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following
the final inspection and acceptance of the work.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she holds 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 but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of
granting this permit.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
3/26/20
DATE
Printed: Thursday, March 26, 2020 11:04:27 AM 1 of 2
-1RRRTF WAY EUC PERMIT
City of • • •
•:• •ENG2020-013
.,
CONDITIONS
CONDITION TYPE
Easement and/or permission from adjacent property owner is required prior to entry or work within
ADJACENT PROPERTY
an adjacent property.
Contractor/Owner shall be responsible for repair/replacement of all damage to utilities and/or
DAMAGE TO FRONTAGE
frontage improvements in city right of way per city standards that is caused by or occurs during the
IMPROVEMENTS
permitted project.
Alert affected residents and/or businesses prior to work start.
Verify clear bore crossings.
ENGINEERING OTHER
Restore landscape to like or better conditions.
Call for required inspections as noted.
ESC REQUIRED
Maintain erosion & sediment control per city standards.
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
HOLD HARMLESS
any and all claims for damages of whatever nature, arising directly or indirectly from the issuance of
this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements
of any City ordinance nor limit in any way the City's ability to enforce any ordinance provision.
Sound/Noise originating from temporary construction sites as a result of construction activity are
exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:OOam to 6:OOpm on
SOUND OR NOISE
weekdays and 10:OOam to 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.
UNDERGROUND UTILITY
Call for locates of underground utilities prior to any excavation.
LOCATES
• ��
INSPECTION TYPE DATE RESULT NOTES
lip
COMPLETE
X-2 ENGINEERING FINAL**
E-7 RESTOR LIMITS
Printed: Thursday, March 26, 2020 11:04:27 AM 2 of 2
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PROJECT NAME:
CONTRACTOR:
RECEIVED 3/24/20
ROW PERMIT NO.: ENG 2020-0132
ISSUE DATE: 3/26/20
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
108621463 CONTACT: Susan Sidick
PSE/Infrasource Phone #: 425-457-6353
Mailing Address:1660 Park Lane Burlington Wa 998233ax #:
State License #: INFRASL871C2 Email #: susan.sidick@pse.com
City Business License #: ❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23325 75 ave w
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑x Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Other
❑ Yes ❑ No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : To cut and cap gas service at approx
12' W c/1 of 75th AVE W & 731' N c/1 of 236th ST SW (1) 3x4 paving cut anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑c Yes ❑ No If yes, indicate size of cut: 3 x 4
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(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 6X\DQ61C FN DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
108621463
3/16/20
Edmonds
Yes
5/18/20
112 Day (4 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
23325 75TH AVE W
EDMONDS, 98026
MARK OTA
Kevin Williams 425-691-7573
Job Description / Scope of Work
At 2" PE main C&C 5/8 PE service to 23325 and remove meter.
New Construction:
0
Cut & Cap only NO BORING taking place
Construction Method
PLAT Map:
164.068
17'Y�
5/8"
PE 1 1 5 'S
City utilities within ROW on 75th Ave W:
00�1
40' ROW
(1) water main
(1) sewer main
518" /V
(1) storm main
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2W7-E
Cl)
O 3
O
V
LU
3 a
N
a
5/8" I,nPE
�
�
a
�,
I1999
N
U
s78„ PE
2000
23326
71 1'N
5/8" PE
1992
23405
236th ST SW
Work
Location
Size of Cut
Surface Type
12'
W
of CL
75th AVE W
&
731'
N
of CL
236th ST SW
3X4
Asphalt
of CL
&
of CL
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
0
Flaggers #:
Arterial:
Cut & Cap
EFV:
0
Police #:
TCP:
Yes
Tie -In Fitting
Meter:
Speed Limit:
No Parks #:
Meter Loc:
0
Trolley Lines:
Mtr Hoods #:
Del Press:
I Traffic Signal:
Bus Stop:
Bollards:
2.5" #
4" #
I
I ADA Ramps #:
Route #'s:
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425
TEMPORARY TRAFFIC CONTROL PLAN
75TH pL W
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RESIDENT(S) WILL BE INFORMED • I
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
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END ROAD WORK
1
236THST SW
LEGEND
■
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
SIGN SPACING
MPH
"X.,
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
END ROAD WORK
PUGET
• SOUND
ENERGY
JOB#108621436
23325 75TH AVE W, EDMONDS, WA 98026
03/23/20
JOHN.CROFOOT@PSE.COM
425-424-6658
SHEET 1 of 1
PLACE SIGNS ALONG
WORK AREA
23325
Q
1
O
- W3-4
'NE LANE
ROAD o
AHEAD
'UAU -
WORK Co
AHEAD
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
Applicant shall repair/replace all
damage to utilities or frontage
improvements to City right-of-way per
city standards that is caused or
occurs during the permitted project.
Owner/contractor is responsible for
erosion control and drainage.
ENGINEERING DIVISION
APPROVED AS NOTED:
NGRIGGS Date:3/25/2020
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.
Use traffic drums (barrels) with steady burning
Type C lights on all State State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" 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
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m.
8. Work area will be 12' WCL of 75th Ave W and 731'
NCL fo 236th St NW.