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ENG2022-0135 ROW PERMITOF WAY EUC PERMIT PERMIT NUMBER City of Edmonds EdmondsRIGHT 98020 1 1 www.cityofedmonds.gov Description: PSE - CUT AND CAP GAS SERVICE W/ CONCRETE CUT ISSUED: 04/18/2022 Address: 24310 76TH AVE W EDMONDS WA 98026-9106 EXPIRES: 10/18/2022 rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00491100001010 i 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 RAYKA I & STEFAN I KRUMOVA 23122 84TH AVE W, EDMONDS WA 98026-8601 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $220.00 $220.00 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 04/18/2022 RELEASED BY DATE Printed: Monday, April 18, 2022 2:38:56 PM 1 of 2 -KRWOF WAY EUC PERMIT City of Edmonds •:• •ENG2022-01351 . -. ov/425.771.0220 CONDITIONS CONDITION TYPE ALERT RESIDENTS ALERT AFFECTED RESIDENTS AND OR BUSINESSES PRIOR TO WORK START. 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. MAINTAIN EROSION AND SEDIMENTATION CONTROL PER CITY AND SWMMW STANDARD ESC REQUIREMENTS 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. SCHEDULE REQUIRED INSPECTIONS AS NOTED THROUGH MY BUILDING PERMIT. INSPECTIONS www.mybuildingpermit.com POTHOLING VERIFY CLEAR BORE CROSSINGS. RESTORE LANDSCAPE Restore landscape to like or better conditions Sound or 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 AND 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 and activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. 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 E-7 CONCRETE SIDEWALK E-7 RESTOR LIMITS Printed: Monday, April 18, 2022 2:38:56 PM 2 of 2 of EpM04O� /'V.isa° SECTION A RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal Requirements outlined in Right-of-Wgy permit Handout E6�. RECEIVED AFTi ]IWZ•y�% CITY OF EDMONDS 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. General • Project Name 1o8634392 Site Address or if no site address use Property Address at NW corner of project area: 24310 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 ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ExOther, please specify: Cut and cap ❑ 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.) Cut and cap gas service at apprOX 285' N c/1 of 244th ST SE & 33' E c/l of 76th Ave W (1) 3x5 concrete cut anticipate 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-day 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 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? 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? X If yes, answer the following questions related to project area, i.e. the actual area in which the 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: 1 22 APPLICANT PRINTED NAME: APPLICANT TITLE: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 PRE -INSPECTION REPORT Job #: 108634392 Date Received: 03/04/22 Jurisdiction: Edmonds Right of Way Permit? ❑� YES First Poss Start: First Poss Comp: ❑ NO 15D 15D Address: 24310 76th Ave W Q PUGET SOUND ENERGY City / Zip: Edmonds 98026 %W " W �" Cust Name: Mar 31 2022 Customer Email: CITY OF EDMONDS DEVELOPMENT SERVICES PM / Insp: Tanya Martinson DEPARTMENT Job Description / Scope of Work: Cut & Cap Est. Job Duration: 4 hrs NEW CONST. ❑ YES Q NO ***IDLE RISER PROGRAM*** RETIRE 1-1/8" PE IDLE GAS SERVICE AT MAIN @285' NCL 244TH ST SW IFS / PSE Dig ARCH PLAT HAS ADP 24300, NO 04 FOR 24310 SEE D4'5 FOR 24300 Service Work -- No Stub Ftg: Ext Ftg: Tot Svc Ftg: Main Ext Work -- No PLAT MAP# 167 069 FIELD INSPECT—M.I.W.ON: 03/10/22 BY: Dave Nichols ENGINEERING DIVISION ...,7TED 14/13/2022 �JI m ' I I � a� / _01a� 1 11 _ _ T° , existing Fiber - 30' E c/I APPROVAL FOR CUT & CAP ONLY. ANY NEW SERVICE SHALL REQUIRE REVISION TO PERMIT. a I� I E E 1� N 1,a I d N I I I. 1 , y Mn I Q 24310 I 0 work zone I MA I I oC&C ®000°ooeooee o o ,°°�°°o�P0000°000 o r 1 I existing 1 1/8" MPE IDLE gas Svc 1 , I I I a Utility patches shall be combined and full width or half 1 I width overlay will be required depending on the extent I N of disturbance. Where utility patches fall entirely within I , I Q I I a i14 one travel lane, the overlay shall extend to the , rn centerline of roadway. Where utility patches extend into both travel lanes then a full width overlay is required. I 1 i LA i I 171 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM 1 OWNER/CONTRACTOR IS RESPONSIBLE FOR — 244th St SE Applicant shall repair/replace all damage to utilities or frontage EROSION CONTROL AND DRAINAGE _ improvements in City right-of-way per city standards that is caused or OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING occurs during the permitted project. ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. Work Location Size of Cut Surface Type 285' N of CL 244th St SE & 33' E of CL 76th Ave W 3 x 5 concrete of CL & of CL of CL & of CL ❑✓ FLAGGERS #: 2 35 MPH ❑ TROLLEY LINES ❑ BUS STOP #: ❑ METER HOODS #: ❑ OFFICERS M SPEED LIMIT ❑ TRAFFIC ❑✓ ARTERIAL ❑ NO PARKS M WORK TYPES Pipe Size EFV'S Meters Qtv. Pressure Misc Meter Stuff ❑POTHOLE � COMMERCIAL ❑STUB ❑ ❑ 1/2" ❑ 5/8 E]775 ❑ 250 [:]Tempi Bar Size: ❑ RESIDENTIAL ❑ EXTENSION [:]MAIN MAINT. ❑ 3/4 ❑ 1800 _ ❑ 6"wc ❑Bollards 2.5" #: ❑ COMPLETE �ERV MAINT. ❑� 11/8" ❑ 2600 ❑ 425 _ ❑ 2# ❑ MULTI -FAMILY ❑ TWIN ❑ 11/4" ❑ 10,000 ❑ 630 ❑ 5# ❑ Bollards 4" #: El NEW CONST. � ALTER COMM SVC []VALVE MAINT. ❑ 2" N/A ❑4 ❑ _ Fuel Line Permit ❑ ❑ ALTER RESID. SVC ❑LEAK REPAIR ❑ 6„ ❑ 1000 Fuel Line Length: ❑CUT & CAP ❑ SERVICE REPL. CP WORK ❑ 8" Mtr Loc: Fuel Line Diameter: SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM - TEMPORARY TRAFFIC CONTROL PLAN-- ----- ----- -- I e- - -- LO I e I o ---------- ------------------ 12.5 112.5 ; ' 242ND T S I I I I I N END ROAD WORK 0V3HV o A2yJoMI 1 0 V 021 u01 W 0IdVd 38 �C v D Utility patches shall be combined and full width or half width overlay will be required depending on the extent of disturbance. Where utility patches fall entirely within one travel lane, the overlay shall extend to the centerline of roadway. Where utility patches extend into both travel lanes then a full width overlay is required. #24310 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. 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. 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 T C I' ht II St t t I 4 � I I 23 IIIIII II II I I I I I 4— N00 2 1=2 � Q N END ' ROAD WORK -R-- -- ----------- u� � 00� 0�� 0 00 � � - YFU V sons ae ouesa 2MT--H ST 4. Sign size can be a minimum of 3 x 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... o • 7. Work to take place beUween,9 a.m. and 4 p.m unless otherwise specified. All work'forarterials . SIGN SPACING MPH "X" 60/65 1000' 45/55 500, 35/40 350' 30 200' 25 100, and major roadways wil a.m. to 3 p.m _ 8. Work area will be Work ar PUGET Designer: St SE & 33' ECL 76th Ave W. ' SOUND Prachl Joshi ENERGY 425-354-8457 9. If used, place NO -PARK signs 72 hours in prachi.joshi@pse.com advance of the day that the work is to be done. Project Address: 24310 76TH Ave W Edmonds CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 Puget Sound Energy Traffic Control Supervisor: Gregory Harwood Card No. 012238 Card Exp. 09/30/2023 PROVIDE PEDESTRIAN DETOURS TO NEAREST DESIGNATED CROSSWALKS IF SIDEWALK IS CLOSED. JS STOP 150' SOUTH r\11'4U UUUNTY METRO WILL BE CONTACTED AT 206-477-1150 FIVE DAYS IN ADVANCE OF SCHEDULED DATE. CONTACT COMMUNITY TRANSIT FOR BUS STOP RELOCATION AS NEEDED • � o N RECEIVED BE � PREPARED Mar 31 2022 TO i STOP CITY OF EDMONDS DEVELOPMENT SERVICES ROAD WORK � N AHEAD DEPARTMENT LEGEND ® 28" TRAFFIC CONE ® WORK PIT =:> TRAFFIC FLOW FLAGGER WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY ROW Liov 03/24/2022 Job # 108634392 1 OF 1