ENG2021-0442 ROW PERMIT APPLICATIONEN G2021-0442
of EpM04O�
RIGHT OF WAY CONSTRUCTION RECEIVED
PERMIT APPLICATION Nov 16 2021
CITY OF EDMONDS
Complete and submit this Application in accordance with the Submittal DEVELOPMENT SERVICES
/'Vc. i sa° Requirements outlined in Right -of -Way 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
Site Address or if no site address use Property Address at NW corner of project area: 7627 195TH St SW
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 d6ingle 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.)
install gas service at
approx
o
o c o
c of
16th
(1) 3x5 paving cut
(1) 3x4 pavin g
cut &
(1) 3x7 paving
and soft surface cut 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
Ix
I LF
SF
1-2 da s
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 ❑ 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
2. Will any equipment be added underground or above ground (e.. pedestals, vaults, etc.)?
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
x
project is proposed:
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: 10/11/2021
APPLICANT PRINTED NAME: busan 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 #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
106379285
7/9/21
City of Edmonds
Yes
9/6/21
1 Day (8 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
7627 195TH ST SW
RECEIVED
Nov 16 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Edmonds, 98206
MICHAEL LASSEN 206-999-3691
Loaan Ghirinahelli 1 (804) 401-6809
Job Description ROW Scope of Work
Project Scope: From 1-1/4" MPE main (109007374-2000) on 195th St SW - install approx 61' (39' Stub with 2600 EFV & 22' extension)
New Construction:
No
of 1-1/8" PE scat svc ext and set an A425 meter at
inches, OL. ROW 50'.
Construction Method
All Scat / Trenchless
PLAT Map: 161.069
N
'7705
7619
5/8" MPE
7627
2000
a425
5/8" M P E
2008-E
W
a
eo
— —
Stormwater
— — —7'
— — — — — — — — — — — —
Water Main— — —
—� — — — — — —
— — — — — — —
— — — — — —— —
— — — — — — — — — — —
— — _ — — _ — — — �.
Sewer
— — —
— — 1 1 - 1, * SW -------
JULq
3
= c
to
3'
1 1 /4" NVEl !P
U11
20'S
—` — ----------
— — —r
——— — — — — ——
-1 a`f007�4 2000
� I
_Stormwater
00
+7708
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Work
Location
Size of Cut
Surface Type
14'
South
of CL
195th St SW
&
319'
West
of CL
76th Ave W
3 x 5
Soft Surface
2'
North
of CL
195th St SW
&
319'
West
of CL
76th Ave W
3 x 4
Asphalt
5'
North
of CL
195th St SW
&
319'
West
of CL
76th Ave W
3 x 7
Asphalt/ soft
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
Arterial:
No
New Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
TCP:
Yes
Tie -In Fitting
Meter:
A425
Speed Limit:
No Parks #:
MDPE - 1 - 1/4" IPS - (DIA) 1"CTS
9999546
Meter Loc:
03 - OL
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
SNO YRD - Snohomish .' :.
Bollards:
2.5" #
4" #
ADA Ramps #:
Route #'s:
TEMPORARY TRAFFIC CONTROL PLAN
41-
0 od�� o
A 39 --A
-T-
v 12 7627
195TH ST SW
_a co
CO
W20-7A
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 14' SCL of 195th ST SW & 319'
WCL of 76th Ave W.
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
PLACE SIGNS
BOTH SIDES OF
WORK AREA
SIGN SPACING
MPH
"XI.
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
1 100'
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195TH ST SW
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RESIDENT(S) WILL BE INFORMED '
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
CHANNELIZATION Sa
DEVICE SPACING �Z
MPH
55/70
TAPER
40
TA E T
/45
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196TH ST SW
Designer:
Puget Sound Energy
PUGET
Traffic Control Supervisor:
SOUND
Jason Bisenius
Gregory Hawood
Card No. 012238
ENERGY
425-424-7316
Card Exp.09/ od@p3
gregory. harwood@pse.com
jason.bisenius@pse.com
425)424-6425
Project Address:
7627 195TH ST SW, EDMONDS, WA 98206.
REV
08/09/2021 0
Job #
106379285
1 OF 2
TEMPORARY TRAFFIC CONTROL PLAN
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wo�V4 g
o 12� 12 3
195TH ST SW
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W20-7A
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 2' and 5' NCL of 195th ST SW &
319' WCL of 76th Ave W.
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
11 7627
PLACE SIGNS
BOTH SIDES OF
WORK AREA
SIGN SPACING
MPH
"XI.
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
. • •
VL-2M
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-- - - - � - -
195TH ST SW
CREW SHALL POTHOLE
FOR WATER MAIN DEPTH L
I
PRIOR TO PROJECT START
CHANNELIZATION
DEVICE SPACING S3
MPH
TAPER
TANGENT
55/70
40
8
35/45
30
6
25/30
20
40
1Ndw12i
Ina3S 1N wdo� �o Designer:
30NOWO3 o PUGET
rOZ 9 SOUND Jason Bisenius
^ ENERGY 425-424-7316
WAN N jason.bisenius@pse.com
Project Address:
7627 195TH ST SW, EDMONDS, WA 98206.
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44111-6�4
196TH ST SW
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory. harwood@pse.com
REV
08/09/2021 0
Job #
106379285
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1994
RECEIVED
Nov 16 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
19425
19505
5/8"
1996
PE
7707
3
a
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7531
7731
5/8"MPE
6
1996
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33
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No electric grid information available
Scale 1:1012
S 160068, Q 161069
08-04-2021
Lat\Long=47.8222,-122.3369
OD
0 PUGET SOUND ENERGY
,M x�vr �`M•'
The information on the attachetl maps is subject to change without notice. Puget Sound Energy makes no warranty. expressed or implied concerning
the suitability of this information for any purpose. Recipient agrees to not disclose this confidential information to any o}her person or entity.
unless authorized in writing by Puget Sound Energy. This map is not to be used for determining the actual location of any PSE facilities (call 811)."