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ENG2021-0303 ROW PERMITRIGHT OF WAY EUC PERMIT PERMITNUMBER, City of Edmonds • ••� 1 1 111 www.cityofedmonds.gov Description: PSE-REPLACE GAS SERVICE ISSUED: 08/25/2021 Address: 19622 82ND PL W EDMONDS WA 98026-6412 EXPIRES: 02/25/2022 it Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00595000002700 W I 11-14111 a 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 TOWNSEND LORENZO L 17551 WALLINGFOR AVE N, SHORELINE WA 98133 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $0.00 RIGHT OF WAY MINOR - EUC PERMIT FEE $110.00 $0.00 REQUIREMENTS 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. THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW Q W, �el_ � 08/25/2021 RELEASED BY DATE Printed: Wednesday, August 25, 2021 9:20:12 AM 1 of 2 -KRWOF WAY EUC PERMIT PERMIT NUMBER City of • • • Ave•:• • 1 1 1 www.cityofedmonds. ov/425.771.0220 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 RESULT INSPECTION MEN A-1 JOB START X-2 ENGINEERING FINAL" Printed: Wednesday, August 25, 2021 9:20:12 AM 2 of 2 of pMO4O� ENG2021-0303 E RIGHT OF WAY CONSTRUCTION RECEIVED PERMIT APPLICATION Aug 04 2021 Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS DEVELOPMENT SERVICES /'V . i s')3 Requirements outlined in Right-of-Wgy permit Handout E6�. 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 109138309 Site Address or if no site address use Property Address at NW corner of project area: 19622 82nd PL W 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 d( 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 ixSingle family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ 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.) To replace 3/4 gas service at approx 276' S c/I of 196th ST SW & 20' W c/I of 82nd PL W (1) 4x6 grass 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 Ix I LF SF 1-2 days SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power r* gas ❑ 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 existing underground common utility stem? 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 project is proposed: x 6a. Does your project involve wires/cables/lines? If yes: x How many are existing? I I 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 DATE: 08/04/2021 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 Job #: 109138309 Proj Rcvd Date: 07/20/21 Jurisdiction: Edmonds Right of Way Permit? 711 YES ❑ NO First Poss Start: 15D First Poss Comp: 15D PRE -INSPECTION REPORT R..�gE.tVED Aug 04 2021 Address: 19622 82nd PI W CITY OF EDMONDS City / Zip: Edmonds 98026 DEPARTMENT HVICES Customer: Liana Widjaja Cust. Email: PM / Insp: Tanya Martinson 206-928-1547 425-417-0639 Job Description / Scope of Work: iService Replacement 1 Est. Job Duration: 8-16hrs NEW CONST.- Replace 3/4" STW service with 1-1/8" PE or 5/8" PE. Possible CP short; if not, may be able to ❑ YES 0 NO insert 5/8" PE into 3/4" STW. IFS / PSE Dig Call John Rockford (206) 255-2704 when complete. Service Work - Yes Stub Ftg: 10 Ext Ftg: 78 Tot Svc Ftg: 88' Main Ext Work - No PLAT MAP# 162 069 FIELD INSPECT-M.I.W.ON: 07/22/21 BY: Dave Nichols 360-913-3739 NOT TO SCAL 196TH ST SWOWNER/CONTRACTOR RESPONSIBLE FOR LOCATING C/L — — ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY - • -- N UTILITIES MAY REQUIRE A SEPERATE PERMIT. OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE N�rn I Na NV 00 / ooQoASPHpwAV �0000 / 1 78, o00000 : 0 5 Applicant shall repair/replac damage to utilities or front 7O, improvements in City right-o /U SCHEDULE ALL INSPECTIONS THROUGH P/L 1 per city standards that is cau, �� occurs during the permitted p MYBUILDINGPERMIT.COM 1 82ND PL W WAS OVERLAYED IN 2019. IF wl a ® I ENGINEERING DIVISIO PAVEMENT CUTS ARE NEEDED CUT FEES AND wl I APPROVED AS NOTE[ RESTORATION SHALL BE REQUIRED. CIO Q i ^jell W441M+04z 08/24i RESTORATION LIMITS TO BE DETERMINED BY VV CITY ENGINEERING INSPECTOR , 0 60' ROW Work Location Size of Cut I Surface Type_ 276' S of CL 196th St SW & 20' W of CL 82nd PI W 4x6 Grass of CL & of CL of CL & of CL ❑✓ FLAGGERS #: 2 25 MPH ❑ TROLLEY LINES ❑ BUS STOP #: ❑ METER HOODS #: ❑OFFICERS M SPEED LIMIT ❑ TRAFFIC ❑ ARTERIAL ❑ NO PARKS #: WORK TYPES Pipe Size EFV Meter (Q, tY. Pressure Misc Meter Stuff ❑ COMMERCIAL [—]STUB ❑POTHOLE ❑ 1/2" ❑ 775 ❑ EXTENSION ❑ MAIN MAINT. ❑✓ RESIDENTIAL ❑ 5/8 ❑ 1800 ❑ 3/4" ❑ 250 ❑ 6"wc ❑ Tempi Bar Size: ❑ COMPLETE SVC MAINT. ❑ MULTI -FAMILY ❑TWIN ❑ ❑ 2600 ❑ 11/8� 42 ❑ 5 ❑ 2# ❑ Bollards 2.5" M ❑ 11/4" ❑ 10,000 ❑ NEW CONST. ❑ ALTER COMM SVC ❑ VALVE MAINT. ❑ 2" ❑ N/A ❑ 630 ❑ 5# ❑Bollards 4" #: ❑ ALTER RESID. SVC LEAK REPAIR ❑ ❑ 4 ❑ 6 ❑ 1000 Li Fuel Line Permit Fuel Line Length: ❑ CUT & CAP ❑ SERVICE REPL. ❑ CP WORK ❑ 8" I Mtr Loc: 03 Fuel Line Diameter: all Ige -way ,ed or -oject. 1 2021 TEMPORARY TRAFFIC CONTROL PLAN 19622 82nd PI W Edmonds WA 98026 USA RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE 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 for 19622 82ND PL W, will be at 276' South of centerline of 196TH ST SW, and at 20' West of centerline of 82ND PL W. W3-4 — "V3HV O I O O ad3H`d � ad08 3Nt/13NO � I 0 13 O I o �V • 0 sss e Orb aN e��, b OM01 o • • 0 0 Q O N o I O 0 O 13 'NE LANE p ROAD c� AHEAD WORK AHEAD SIGN SPACING MPH "X" 60/65 1000, 45/55 500, 35/40 350' 30 200' 25 100' O N E RECEIVED Aug 04 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 LEGEND ® 28" TRAFFIC CONE ® WORK PIT TRAFFIC FLOW FLAGGER WORK VEHICLE/ II FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY NOW Puget Sound Energy REV PUGET Designer: Traffic Control SupeMsor: Gregory Harwood 08/03/2021 0 SOUND MATLOCK HIGHBARGER Card No.012238 ENERGY 808-375-4152 Card ry.hamood@ps Job # g regory. ha rwood@pse. com MATLOCK.HIGHBARGER@PSE.COM (425)424-642 � 109138309 Project Address: 19622 82ND PL W, EDMONDS, WA Page 1 OF 1 8224 1 3/4" STW-U 1963 19628 8220 2�Os 3/4" ST 1963 3/4" STW 1963 33jS No electric grid information available S 160068, 07-20-2021 The information on the attachetl maps is subject to change without notice. Puget Sound Energy makes no warranty. expressed or implied concerning the sui}ability of this infonnafion for any purpose. Recipien}agrees to not disclose this confide%Information to any o}her person orentity. unless authorized in writing by Puget Sound Energy. This map is not to be used for tletermining the actual location of any PSE facilities (call 811)." 24,s 19601 19621 3/4" STW-U 1963 3/4" STW-U 1963 19627 Scale 1:450 Lat\Long=47.8209,-122.3445 OD 1962 1960 3/4" ST 1962 1961 1962 3/4" ST 1962 3/4" ST L7\` 1962 1962 Aug 04 2021 DEVELOPMENT SERVICES DEPARTMENT QPUGET SOUND ENERGY