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ENG2021-0208 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds -0208 www.cityofedmonds.gov Description: PSE-ANNUAL VALVE MAINTENANCE INSPECTION ISSUED: 06/17/2021 Address: 7212 220TH ST SW EDMONDS WA 98026-8014 EXPIRES: 12/14/2021 rmit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 27042900301800 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 AMON-EDMONDS INVESTMENT LLC 1000 2ND AVE STE 3230, SEATTLE WA 98104 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. J RELEASED V THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW 6/17/2021 DATE Printed: Thursday, June 17, 2021 9:59:07 AM 1 of 2 -KRWOF WAY EUC PERMIT City of • • • •:• • 1 02 1: 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. It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in DAMAGE TO FRONTAGE City right of Ways or Easements to City Standards caused by or occurring during the permitted IMPROVEMENTS 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 REQ Maintain erosion and sedimentation control per City and SWMMW standard requirements. 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 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. TRAFFIC CONTROL Traffic Control per approved plan and MUTCD. All Flaggers shall be certified. All utilities shall be located prior to any excavation. New locates shall be called for if at time of UTILITY LOCATES excavation, original locates are no longer identifiable. INSPECTIONS INSPECTION TYPE DATE RESULT COMPLETE A-1 JOB START X-2 ENGINEERING FINAL" E-7 TRAFFIC CTRL Printed: Thursday, June 17, 2021 9:59:07 AM 2 of 2 PUGET SOUND ENERGY LEGENDS RECEIVED }N Jun 08 202'I PROJECT LOCATED AT _�+_- -- --_ s t = e �� e o-_ - CITY OF EDMONDS 26 Scl 220th ST SW & 57' Ed H =_ cr a cce DEVELOPMENT SERVICES 99 C DEPARTMENT NOT TO SCALE Mountlake Terrace, WA 98026 P DIRECTION TRAFFIC CONTROL DURATION OF WORK TEM .TRAFFIC PLAN #1 OF 1 APPROXIMATELY 15 MINUTES DIRECTION HOURS OF OPERATION WORK IN INTERSECTION M-F, 9AM-4PM _ _ g- CHANNE_ LIZING _ - _ R€ASO-N-, PR€fO-RM-YEARLY- _ - -- SlTaPLAN. DEVICE READ AT TEST LEAD WIRE BOX BETTY FRANK N ADVANCE WARNING Engineering Assistant SIGN LOCATION Puget Sound Energy Corrosion Protection Dept. T 19L 28" TRAFFIC Cell # 206-396-9244 CONES Email: b frank@pse.com TS-034202 LL 220TH ST SW G ACTIVITY ATTACH SIGN 165' 100, / / / AREA SEQUENCE (A) TAPER TANGENT 100' SIGN SEQUENCE A SPACING TABLE / / 3 /fJ TANGENT w I. N X 200'+/- X X X ROAD WORK AHEAD 165' T-19L TAPER RIGHT LANE W20-1 CLOSED W4-2L AHEAD / ATTACH SIGN W20-5R SEQUENCE (A) NOTES: TRAFFIC CONTROL SERVICES 1. MAINTAIN A MINIMUM OF ONE ACCESS POINT FOR R p 1 1 FELIPEJ.MACIAS, TCS#002689 EACH BUSINESS WITHIN WORK AREA LIMITS. IRU 1 OFFIRtra ccont�658. carnet I OFFICE # (425) 658.3656 2. ALERT METRO TRANSIT PRIOR START OF WORK, NOVEMSER24,2014 10 3 P� �E��RVS 14 R� 10 6 PM CHANN✓;LIZING DEVICES SPACING ( FEET ) MPH I TAPER TANGENT 20/301 20 1 40 OFF DUTY DETAIL INFORMATION SHEET EDMONDS POLICE OFFICERS ASSOCIATION 250 5T" AVE N, EDMONDS, WA 98020 The purpose of this sheet is to provide information regarding the requesting of; cost of; and procedures for scheduling Police Officers for'off-duty' details within the City of Edmonds. Point of Contact: • Officer Jason Shier, EPOA Vice President: o Email: vicepresident.epoa@gmai1.com. o Cellular phone: 206-353-2987 Requesting an officer: (Please request an officer with as much advance notice as possible!) • To schedule an officer, please email Officer Jason Shier at vicepresident.epoa@gmail.com. Please include your company name, Point of Contact (name, phone number, and email), location of the detail, date(s) and time(s) of detail, and a brief description of what officer will be doing (i.e. directing traffic, closing a traffic lane, providing security, etc). • Additionally, if your Point of Contact is NOT the same person to whom the invoice is to be sent, please include the 'Finance Person's': name, email address, and phone number. NOTE: Oficer Shier works a rotating schedule, so to insure that your detail request is received and reviewed in a timely manner, it is recommended that you call his cell phone in addition to sendina the email. Rate of Pay: (NOTE: Minimum of 4 hours will be paid to the officer) • Requests made 7 or more days in advance: The rate of pay for an officer working an off - duty detail will be $75 per hour. • Requests made less than 7 days in advance: The rate of pay for an officer working and off -duty detail will be $80 per hour. 1 Effective: May 24, 2018 OFF DUTY DETAIL INFORMATION SHEET • Details that fall on a holiday will be paid at an additional $30 per hour ($105 per hour with 7 or more days notice/$110 per hour if less than 7 days notice). List of Holidays: New Year's Day (January 1) Washington's Birthday (Third Monday of February) Independence Day (July 4) Veteran's Day (November 11) Friday following Thanksgiving Day Martin Luther King Day (Third Monday of January) Memorial Day (Last Monday of May) Labor Day (First Monday of September) Thanksgiving Day (Fourth Thursday of November) Christmas Eve (December 24) Christmas Day (December 25) New Year's Eve (December 31) Cancellations: (Note: date and time of cancellation will be based on the date and time of the phone call, not email.) • To cancel an officer, you MUST call Officer Shier at 206-353-2987. Additionally, please follow up the phone call with an email to vicepresident.epoa@gmaii.com requesting the cancellation If you cancel an officer more than 24 hours before the start of the detail, you will not be charged for the cancelled detail. • If you cancel an officer less than 12 hours prior to the start of the detail, you will be charged for the '4 hour minimum'. • Administrative fees will still be charged for all details, regardless of when they are cancelled. Payment Deadlines: • If you do not require an invoice, officers are to be paid via check or cash at the start of the event. (check made payable directly to the individual officer(s). • If you require an invoice, officers should be paid within two weeks of invoice being emailed to your Point of Contact (or Finance if provided). • Delays in paying officers may result in difficulty obtaining officers for future details. 2 Effective: May 24, 2018 of eoMotio� ENG2021-0208 RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION RECEIVED Complete and submit this Application in accordance with the Submittal Jun 08 2021 L Za CITY OF EDMONDS C Requirements outlined in Right -of -Way permit Handout E6�. DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A' instead of leaving blank. All fields required. Incomplete Applications will be denied. SECTION A General • Project Name 8987033545 - valve inspection Site Address or if no site address use Property Address at NW corner of project area: WK6W6: Associated Permits: BLD PLN ENG X Owner and Entity Holding Franchise (if applicable) Name of Company PSE/Infrasource Franchise Ordinance No: Point of Contact Susan Sid ick Title SR Permit Specialist Address 1660 Park lane city Burlington State WA Zip 98233 Phone 425-457-6353 Email susan.sidickapse.com Contractor and Authorized Agent of Owner Name of Company (see note below) Contractor Contacts During Construction Primary Name PSE/Infrasource Susan Sidick Agent Name PSE/Infrasource Title SR Permit Specialist Title SR Permit Specialist Mobile 425-457-6353 Address 1660 Park lane Email susan.sidick@pse.com City Burlington State WA Zip 98233 Secondary Name Phone 425-457-6353 Title SR Permit Specialist Email susan.sidick@pse.com Mobile City of Edmonds Business License No: Email State License No: INFRASL871 C2 [N Contractor verifies it is currently bonded E* Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o. o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ Multifamily residential ❑ Commercial ❑ City project ❑ Single family residential subdivision ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? i3xOther, please specify: yearly valve inspection ❑ Utility Franchise Work associated with development (check one of the above boxes as welt ❑ Traffic Control Only (no associated development) ❑ Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Include an overall narrative description of the proposed work. Be specific and detailed: Describe infrastructure to be impacted, such as, poles, wires, conduit, utility mains, etc. Include whether this is construction, maintenance, or repair. Include description of proposed construction methods, (e.g., bores, trenches, overhead wires proposed, depth for underground utilities, etc.) Perform yearly inspection for TS-034202 at test lead wire box located at 26' Scl of 220 St SW & 57' Ecl hwy99 —No paving cuts anticipated RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION Number of Months Sidewalk 72 hours + LF I x LF SF Alley 72 hours + LF Ix I LF SF Parking 72 hours + LF I x I LF SF is minutes per location SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power Exgas ❑ water ❑ sewer ❑ storm Details of Work to be Completed 1. Does the utility owner have existing overhead infrastructure in the area of work? Yes No x 2. Will any equipment be added underground or above ground (e.. pedestals, vaults, etc.)? x If yes, describe: 3. Does the proposed work connect a lot or commercial development with utilities that serve more than one lot or commercial development? x 4. Does the work involve rebuilding or relocating an existing aboveground utility system which connects a lot or commercial development to an existingunderground common utilitystem? x 5. Does the work involve proposed additions to an aboveground utility stem? If es: x Are the additions for the purpose of serving new commercial development? x Are the additions for the purpose of serving a single-family residential subdivision? x Details of Work to be Completed Yes No 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? If yes, answer the following questions related to project area, i.e. the actual area in which the x project is proposed: 6a. Does your project involve wires/cables/lines? If yes: x How many are existing? How many are to be added? City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. Does your project involve poles? If yes: x How many poles are existing in the project area? What is the height of the existing poles? How many poles are to be removed? Are additional poles to be laced? How many? I I What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: x How many? I I What is the height of the poles after? Describe the modification rebuild: SECTION C Traffic Control and Public Safety. 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. Restoration shall 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. Insurance. The City may require the owner or contractor to provide proof of insurance acceptable to the City prior to any permit approval. Indemnification. The Applicant agrees to defend, indemnify, and hold harmless the City of Edmonds, its officials, officers, employees, and agents against any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, including defense costs and attorney fees, resulting directly or indirectly from any act or omission of the Applicant, its subcontractors, anyone directly or indirectly employed by them, and anyone for whose acts or omissions they may be liable, arising out of, related to, or by reason of the granting of this permit; and specifically including but not limited to all loss by the failure of the Applicant to fully or adequately perform, in any respect, all authorizations or obligations under the permit. These indemnification requirements shall survive the expiration, revocation, or termination of any resulting permit approval. Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and requirements set forth in this Application and agrees they apply to any resulting permit and shall comply with them to the satisfaction of the City Engineer. Applicant further agrees to comply with the conditions listed on the Submittal Requirements; with all applicable city ordinances, including but not limited to ECDC Title 18; and with all applicable requirements of state and federal law. Statement of Applicant. I declare under penalty of perjury under the laws of the State of Washington that: I am a licensed and bonded contractor; the information provided herein is correct and complete; and I am authorized by owner to act on its behalf and have authority to bind the owner to this application. Fees. The Applicant is responsible for all permit fees. APPLICANT SIGNATURE: Susan Sidick APPLICANT PRINTED NAME: Susan Sidick APPLICANT TITLE: SR Permit Specialist NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 2021 Date of Request: Job number: Job address: Project mgr: PM email: PERMIT REQUEST FORM 06/04/21 887033545 7212 220th St SW Betty Frank betty.frank@pse.com Estimated job start date: 08/04/21 Estimated job completion date: 08/04/21 RECEIVED Jun 08 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT City: Edmonds Zip. PM contact #. (206) 716-2641 Description of work to be performed: Perform yearly inspection for TS-034202 at test lead wire box located at 26' Scl of 220 St SW & 57' Ecl hwy99 Pavement cut? ❑Yes ❑✓ No If yes, Dimensions of Cut: Length_ How many cuts? Surface Type n/a Require trenching? Dyes ❑No If yes, Dimensions of trench: Length_ Width Width Depth Method of installation: Traffic impact: Road closed ❑Yes ❑ No Lane closed [?]Yes ❑ No How Many? 1 Direction? East Shoulder closed Eyes ❑ No Sidewalk closed ❑Yes ❑ No Emergency Contact: John Rockford Print Send Cell Number: (206) 255-2704 Reset 220 St SW & Hwy99 Job# 887033545 TS-034202 RECEIVED Jun 08 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT TS-034202 —street view showing location of wire box at 220 St SW & Hwy-99 7i85 I?,th S! SW !IpR4ka Tenaca. W&Wgon. Urcted Starts J Test Lead wire box location: 26' Scl 220 St SW & 57' Ecl Hwy-99 "m RECEIVED Jun 08 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT 220 St SW & Hwy-99 Job# 887033545 / TS-034202 F S Location: 2611 Scl 220 St SW & 5711 Ecl Hwy-99 Work Description: Perform yearly maintenance and get read • test lead wire box t ` Excavation : No digging or cutting Lane Closure: 1 Eastbound lane of 220 St SW 4 Duration: 15 mins ��. *-T I'almunds _ate OWL_ SOUTH !ite ofi�lountlake Terrace � � � �j E A S T RECEIVED Jun 08 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT