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ENG2022-0180 ROW PERMIT (2)RIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds -0180 www.cityofedmonds.gov Description: PSE-INSTALL NEW GAS SERVICE CUT AND CAP OLD ISSUED: 05/16/2022 Address: 23406 HUMBER LN EDMONDS WA 98020-6158 EXPIRES: 11/12/2022 rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00571300101300 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 GREGORY C\SUSIE L WRIGHT 11010 ALGONQUIN RD, WOODWAY WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 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 ENGINEERING DIVISION "DTED RELEASED / I eK>,,,,, 15/16/2022 DATE Printed: Monday, May 16, 2022 8:36:46 AM 1 of 2 -KRWOF WAY EUC PERMIT City of • • • •:• • 1 01 :1 . -. 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** Printed: Monday, May 16, 2022 8:36:46 AM 2 of 2 ofEOMoti RECEIVED �`� RIGHT OF WAY CONSTRUCTION APR 26 2022 PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS z�'1'�. is') Requirements outlined in Right -of -Way permit Handout E6�. DEVELOPMENT q � X-p 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 109142742 Site Address or if no site address use Property Address at NW corner of project area: 234o6 Humber Ln 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? ❑ 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 new and cut and cap old gas service at approx 11'[ W c/l of Humber Ln & 116' N c/l of Nottingham Rd (1) 5x5 paving 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 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 ❑xgas ❑ 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.g. 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 project is proposed: x 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. Susan Sidick 04/25/22 APPLICANT SIGNATURE: DATE: APPLICANT PRINTED NAME: Susan Sidick APPLICANT TITLE: Sr Permit Snecilaist NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 RECEIVED Job #: Date: Jurisdiction: ROW Permit: Est. Start Date: Est. Duration: 109142742 4/8/22 EDMONDS Yes 5/16/22 1 Day (8 Hours) Puget Sound Energy Gas Pre -Inspect Form Address: City / Zip: Customer: PM / Inspector: 23406 HUMBER LN EDMONDS, 98020 GREG WRIGHT 425-422-2121 Nayeli Torres -Garcia 206-556-5066 Job Description Project Scope: DISCONNECT 5/8" PE TWIN SVC AT P/L FROM HOST AT 23330. FROM 2" PE MAIN ON HUMBER LN, INSTALL NEW 82' New Construction: OF 1-1/8" PE SCAT SVC (19' STUB/63' EXT) AND SET A425 MSA O/R. No HUMBER LANE ON 2022 OVERLAY SCHEDULE: ALL WORK TO BE COMPLETED BY JUNE 1ST. Construction Method ONLY T-CUT RESTORATION REQUIRED. All Scat / Trenchless PLAT Map: 166.066 APPROX 800 SQ FT WORK ZONE I N NO CUTS IN NEW ROAD PERMITTED ROW60 FT II 1 I I I I °; II I I D II 1 0 I I I I II I cD z II I I a II I I 23330 11 1 1 II 1 I II II 1 I II I I II 1991 I 1 I MAINTAIN 5 FT * I HORIZONTAL I I I I SEPARATION FROM 1-118"PE i i STORM CATCH BASIN I� I II 1 II Z I I II 1 23406 1 W ENGINEERING DIVISION .'7TED I I 1 m I 15/16/2022 1 II I II 1 I = III 1 Applicant shall repair/replace all 01 1 1 damage to utilities or frontage I I 1 improvements in City right-of-way 2" PE IP 11'W per city standards that is caused or M w occurs during the permitted project. 912342 Q Ln NOTTINGHAM RD OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE Work Location Size of Cut Surface Type 11' West of CL HUMBER LN & 116' North of CL NOTTINGHAM RD 5 X 5 X 2 A of CL & of CL of CL & of CL of CL & of CL of CL & of CL Service Information Street Information Job Type Diameter: 1-1/8" PE Flaggers #: 0 Arterial: Yes Altered Residential Svc EFV: 1-1/8" - 2600 - 9999144 Police #: 0 TCP: Yes Tie -In Fitting Meter: A425 Speed Limit: 0 No Parks #: 0 HDPE - 2" IPS - (DIA) 1"CTS 9999564 Meter Loc: 08 - OR Trolley Lines: No Mtr Hoods #: 0 Del Press: 6" W.C. Traffic Signal: Bus Stop: No SNO YRD -Snohomish Bollards: 2.5" # 4" # ADA Ramps #: 0 Route #'s: APR 26 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT NO CUTS IN NEW ROAD PERMITTED 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 11' WCL of Humber Ln & 116' NCL of Nottingham Rd NJ NJ 0 V W3-4 0 D LEGEND ® 28" TRAFFIC CONE ® WORK PIT TRAFFIC FLOW FLAGGER WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY ROW TEMPORARY TRAFFIC CONTROL PLAN N?JOM SIGN SPACING MPH "XI. 60/65 1000, 45/55 500' 35/40 350' 30 200' 25 100' HUMBER LANE ON 2022 OVERLAY SCHEDULE: ALL WORK TO BE COMPLETED BY JUNE 1ST. ONLY T-CUT RESTORATION REQUIRED. RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE YQ�,I PLACE SIGNS ALONG WORK AREA �ZOZ/9 4/SI W3NPISIAIG DNRi33NION3 • /-00ZM bL-OZM , ■ 1 � 100' 100, I -OZM Y O i)'361 pall iLad ay; buunp sin000 pas —rye s'ley; spiepue;s Apo aad ?M-1Q::P46=( I0 ul s;uauaanoidual !llll;n o; abewep eoeldaippdai Ileys lueollddV 4AM RD 30bNI"(] GNV-10iJ1N00 NOISOiJ3 2i0=1 3181SNOdS32i SI 2]=V'diN002i3NMO CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 PUGET Designer: SOUND Kali-Jamal Collins ENERGY 425-424-6425 Kali-Jamal.Collins@pse.com Project Address: 23406 Humber Ln, Edmonds, WA RECEIVED APR 26 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Puget Sound Energy REV Traffic Control Supervisor Gregory Harwood 04/25/2022 0 Card No. 012238 Card Exp.0113112123 Job # gregory. harwood@pse.com 42el424-6'Z 0 109142742 1 OF 1