ENG2020-0161RIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
_7 121 5th Ave N, Edmonds WA ..01 1 1
www.cityofedmonds.gov
Description: PSE-INSTALL GAS SERVICE ISSUED: 05/05/2020
Address: 422 2ND AVE N EDMONDS WA 98020-3105
EXPIRES: 11/05/2020
rmit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00592200001000
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 HOLMBERG JOHN JR 422 2ND AVENUE N, EDMONDS WA98020
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.
:»•>/F9:1H ]1
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
DATE
Printed: Tuesday, May 05, 2020 8:19:43 AM 1 of 2
-1RRRTF WAY EUC PERMIT
City of • • •
•:• •ENG2020-01611
www.cityofedmonds.gov• •
CONDITIONS
CONDITION TYPE
Easement and/or permission from adjacent property owner is required prior to entry or work within
ADJACENT PROPERTY
an adjacent property.
Work approved under this permit may or may not qualify as an essential or allowed activity per the
Governors Stay Home, Stay Healthy Order. Refer to the Order and the Citys website for up-to-date
information related to development activities during COVID-19. Issuance of this permit does not
COVID-19 NOTICE
certify that construction is allowed to immediately occur, and inspections may or may not be granted
accordingly. Construction activities and all required inspections will resume when the Order has been
lifted.
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.
ENGINEERING OTHER
VERIFY CLEAR BORE CROSSINGS.
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
'ENGINEERING
•
INSPECTION TYPE DATE
RESULT
NOTES
COMPLETE
X-2 FINAL"
E-7 RESTOR LIMITS
Printed: Tuesday, May 05, 2020 8:19:43 AM 2 of 2
0 \:L L?,11(7.
RECEIVED 4/27/20
ROW PERMIT NO.: ENG 2020-0161
ISSUE DATE: 5/5/2020
RIGHT-OF-WAY CONSTRUCTION
"VC. I3'�J PERMIT APPLICATION
PROJECT NAME: 106366634 CONTACT: Susan Sidick
CONTRACTOR: Phone #: 425-457-6353
PSE/Infrasource
Mailing Address: Fax #:
1660 Park Lane Burlington Wa 98233
State License #: INFRASL871C2 Email #: susan.sidick@pse.com
City Business License #: ❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 422 2nd Ave N
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ 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 install gas service at a.nnrox 9' W to
8' E to 20' E c/1 of 2nd AVE N to 665' N c/1 of Edmonds St (2) 3x5 paving cuts & (1)
3x5 concrete soft surface cut anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑x Yes ❑ No If yes, indicate size of cut: 3 x 5
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 6XD)61GFN
Contractor or Agent
DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425 -
Applicant shall repair/replace all
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or
occurs during the permitted project.
TEMPORARY TRAFFIC CONTROL PLAN
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
ENGINEERING DIVISION
APPROVED AS NOTED
NGriggs 05/04/2020
PUGET
SOUND
ENERGY
JOB# 106366634
422 2ND AVE N, EDMONDS, WA 98020
4/22/2020
W3-4
IV ;
/ ; ,OW34
'O
O
qy °v
O'
ssT
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500,
35/40
350'
30
025
100'
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
jason.bisenius@pse.com
425-424-7316
SHEET 1 of 2
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 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 9' WCL of 2nd Ave N & 665' NCL
Edmonds St, F ECL of 2nd Ave N & 665' NCL Edmonds St,
20' ECL of 2nd Ave N & 665' NCL Edmonds.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
N
29
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425 -
F'Y�
Ir
TEMPORARY TRAFFIC CONTROL PLAN
PUGET
SOUND
ENERGY
JOB# 106366634
422 2ND AVE N, EDMONDS, WA 98020
4/22/2020
jason.bisenius@pse.com
425-424-7316
SHEET 2 of 2
F/V
THE CREW SHALL CEASE
WORK FOR A FLAGGER/SPOTTER
r TO ESCORT PEDESTRIANS
AROUND THE WORK AREA
422
V "T
W34
o, /
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
If-/o S
O
ST
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
D"40
ayFgo �
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500,
35/40
350'
30
200'
25
100'
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
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 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 9' WCL of 2nd Ave N & 665' NCL
Edmonds St, F ECL of 2nd Ave N & 665' NCL Edmonds St,
20' ECL of 2nd Ave N & 665' NCL Edmonds.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
106366634
4/20/20
Edmonds
Yes
6/26/20
1 Day (8 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address: 422 2nd Ave N
City / Zip: Edmonds, 98020
Customer: John Holmberg (425) 418-8748
PM / Inspector: Noah Fowler (425) 375-3242
Job Description / Scope of Work
Install a 34' 1-1/8" PE SCAT stub and a 45'
1-1/8" PE SCAT extension from a 2" MPE IP main on 2nd
New Construction:
o
Ave N. Set an A250 meter at inches, located
O/F/R of the home.
Construction Method
All Scat / Trenchless
PLAT Map: 162.065
/ 8-49B
-7 2 /
47
��-
`'�
8-141
r
Tie In /
i
Service STUB must maintain at
Sp.
least 5 ft of seperation from /
1-1/8" PE
other utilities in ROW /
/
A250
! /
Qom/
%a
�
s
St
Work
Location
Size of Cut
Surface Type
9'
West
of CL
2nd Ave N
&
665'
North
of CL
Edmonds St
3' x 5'
Asphalt
8'
East
of CL
2nd Ave N
&
665'
North
of CL
Edmonds St
3' x 3'
Asphalt
20'
East
of CL
2nd Ave N
&
665'
North
of CL
Edmonds St
3' x 5'
Concrete/Soft
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
Arterial:
No
Residential Conversion SVC
EFV:
1-1/8" - 2600 - 9999144
Police #:
TCP:
Yes
Tie -In Fitting
Meter:
A250
Speed Limit:
25
No Parks #:
MDPE - 2" IPS - (DIA) 1"CTS
Meter Loc:
01 - OFR
Trolley Lines:
No
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
No
Bus Stop:
No
®,�,�,,
Bollards:
2.5" #
4" #
ADA Ramps #:
Route #'s: