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ENG2022-0041 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds Er", -0041 www.cityofedmonds.gov Description: PSE REPAIR GAS LEAK IN PAVEMENT ISSUED: 02/14/2022 Address: 7403 228TH ST SW EDMONDS WA 98026-8473 EXPIRES: 08/13/2022 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 27042900307700 iiii I 11-14111 a NAME TYPE NAME ADDRESS PHONE APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTACT PUGET SOUND ENERGY- CORROSION 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 DEPARTMENT CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 OWNER BRIAN & REBECCA WILLIS 7403 228TH ST SW, EDMONDS WA 98026 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $110.00 $110.00 RIGHT OF WAY STANDARD - EUC PERMIT FEE $330.00 $330.00 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 02/14/2022 RELEASED BY DATE Printed: Monday, February 14, 2022 8:29:40 AM 1 of 2 WAY EUC PERMIT PERMITNUMBER, City of Edmonds Ave-KRWOF •:• •ENG2022-001411 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. 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 any and all claims for damages of whatever nature, arising directly or indirectly from the HOLD HARMLESS issuance for 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 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 E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL" E-7 RESTOR LIMITS Printed: Monday, February 14, 2022 8:29:40 AM 2 of 2 ofEOMoz RECEIVED RIGHT OF WAY CONSTRUCTION FEB 04 2022 PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS p pp DEVELOPMENT 'Vci s')3 Requirements outlined in Right -of -Way permit Handout E6�. 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 892061172 Site Address or if no site address use Property Address at NW corner of project area: 7403 228 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 ❑Xommercial ❑ City project ❑ Single family residential subdivision ❑ Single 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.) Repair gas leak at approx 15' N c/1 of 228th ST SW & 161' E c/1 of 74th PL W (1) 4x5 paving _cut anticipated RIGHT-OF-WAY AREA TOTAL DURATION CLOSURE (Number of Months) 72 hours + LF x LF SF —Sidewalk Alley 72 hours + LF x LF SF Parking 72 hours + LF x LF SF - 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 degas ❑ 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 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? Are the additions for the purpose of serving a single-family residential subdivision? 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: 02/03/22 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 #: 892061172 PRE -INSPECTION REPORT 1111, Date Received: 12/09/2021 Jurisdiction: Edmonds Right of Way Permit? 21 YES ❑ NO First Poss Start: 15D First Poss Comp: 151) Address: 7403 228th St SW City / Zip: Edmonds, 98026 Cust Name: Customer Email: PM / Insp: Jennifer Bergman Job Description / Scope of Work: ILeak Repair Est. Job Duration: 8 hrs NEW CONST: ❑ YES 0 NO Repair leak @ tie-in to 7403. Possible old stub. IFS / PSE Dig LEAK #N0130312 Service Work — No Stub Ftg: Ext Ftg: Tot Svc Ftg: 0' Main Ext Work — No PLAT MAP# 165 070 FIELD INSPECT-M.I.W.ON: BY: t 11 II N SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COA RECEIVED FEB 04 2022 Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way a 7403 11TO per city standards that is caused or d occurs during the permitted project. S CITY OF EDMONDS $ DEVELOPMENT M ti6" SERVICES DEPARTMENT p existinq 5/8" MPEI service CUTS 0 o IN ROADWAY AND/OR ENGINEERING DIVISION u SIDEWALK SHALL REQUIRE APPROVED AS NOTED o ADDITIONAL INSPECTIONS o AND FEES ^lQ/I (,�l�.iX,u...,,4p 02/10/2022 � p VV area of leak reoair 2" STW IP cias main - 15' N C/L - 109036132-2007 0 0 0 0 0 0 0 0 0 0 0 t0 0 0 0 0 0 0 0 0 0 ----------axistirw_water_-0JN-Cl--------- ----------------- - - - - -- existing sewer - 4' S C/L -------------------------------------------- 228th St SW -------------------------------------------- existina storm drain - 7' S C/L Work Location Size of Cut Surface Type 15' N of CL 228th St SW & 161' E of CL 74th PI W 4 x 5 asphalt 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 M 5 WORK TYPES P i P e S i z e EFV'S Meters Qty. Pressure Misc Meter Stuff ❑ ❑ ❑ COMMERCIAL ❑STUB ❑POTHOLE 1/2" ❑ 775 5/8 250 ❑ 6"wc ❑ Templ Bar Size: ❑ EXTENSION ❑MAIN MAINT. ❑✓ RESIDENTIAL ❑ COMPLETE ❑ ❑✓ ❑ 1800 3/4" 11/8" ❑ 2600 _ ❑ 425 ❑ 2# ❑ Bollards 2.5" M ❑ MULTI -FAMILY ❑SERV MAINT. ❑ TWIN ❑ 11/4" 10,000 _ ❑ 630 ❑ � 5q ❑Bollards 4" #: ALTER COMM SVC ❑VALVE MAINT. ❑NEW CONST. ❑ ❑ ❑ 2" 4�� ❑ N/A _ - Fuel Line Permit ❑ ❑ ALTER RESID. SVC ❑✓ LEAK REPAIR ❑ 6„ ❑ 1000 Fuel Line Length: ❑ CUT & CAP ❑ SERVICE REPL. ❑CP WORK ❑ 8" Mtr Loc: 8 Fuel Line Diameter: OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. V0Il03dSNI HIV 3�nI03HOS � 4H3HV v o �aoM avow 13,13 ----------------------- TEMPORARY TRAFFIC CONTROL PLAN J CL #7403 ----------------- -- - _ -200' 200' - --- _ — _ r b � r �-200t1 200 i W20-1 Notes: 1. All signs and spacing to conform to the MUTCD and City of Edmond 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 15' NCL of 228th St SW & 161' ECL of 74th PI W 7A 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 SIGN SPACING MPH "XI. 60/65 1000, 45/55 500' 35/40 350' 30 200, 25 1 on, W3-4 b-OZM b L'OZM 0V3HV p NaOM 4 i CL ¢¢¢ 6'OZM avow I p Z o Y o 19,19 o o w ------------------------ k --- 4-- --------------------- 228TH ST SW Y��,E PLACE SIGNS BOTH SIDES OF WORK AREA CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 1 20 1 40 ZZOZ/o 4/ZO 4310N SV G3IAOcJdd!V RECEIVED FEB 04 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Puget Sound Energy REV .S g Traffic Control Supervisor: PUGET Gregory Harwood 01 /05/2022 0 SOUND Kali-Jamal Collins Card No.012238 ENERGY 425-424-6425 Card Ex .pham od@p3 Job # gregory.phamood@pse.com Kali-Jamal.Collins@pse.com (425)424-6425 892061172 Project Address: I 7403 228th St SW, Edmonds, WA Page 1 OF 1 RECEIVED FEB 04 2022 CITY OF EDMONDS M BuildingPermit.com CITY OF EDMONDS Right -of -Way Application #1086769 - 892061172-7403 228 ST SW SERVI ESLOPMENT DEPARTMENT Applicant First Name Last Name Company Name Susan Sidick Puget Sound Energy- Corrosion Department Number Street Apartment or Suite Number E-mail Address 1660 Park Lane susan.sidick@pse.com City State Zip Phone Number Extension Burlington WA 98233 4254576353 Contractor Company Name PUGET SOUND ENERGY INC Number Street Apartment or Suite Number 1660 Park Lane City State Zip Phone Number Extension Burlington WA 98233 (206) 716-2641 State License Number License Expiration Date UBI # E-mail Address PUGETSE033DD 3/28/2023 17gD1nns i susan.sidick@pse.com Project Location Number Street Floor Number Suite or Room Number 7403 228TH ST SW City Zip Code County Parcel Number EDMONDS 98026 27042900307700 Associated Building Permit Number Tenant Name 892061172 Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Brian & Rebecca Willis Number Street Apartment or Suite Number 7403 228TH ST SW City State Zip EDMONDS WA 98026 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 2/3/2022 Submitted By: Susan Sidick Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1086769 - 892061172-7403 228 ST SW Project Contact Company Name: Puget Sound Energy- Corrosion Department Name: Susan Sidick Email: susan.sidick@pse.com Address: 1660 Park Lane Phone #: 4254576353 Burlington WA 98233 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project Name: 892061172-7403 228 ST SW Description of Work: Repair gas leak at approx 15' N c/I of 228th ST SW & 161' E c/I of 74th PL W (1) 4x5 paving cut anticipated Project Details Project Information Job Number 892061172 Page 2 of 2