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ENG2023-0184 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds 98020 NG2023-0184 www.edmondswa.gov i IL Description: PSE - EMERGENCY REPAIR ON 2" GAS MAIN WITH PAVEMENT CUTS ISSUED: 04/25/2023 Address: 8523 215TH ST SW EDMONDS WA 98026-7319 EXPIRES: 10/25/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00555400000800 NAME TYPE NAME ADDRESS PHONE APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTACT PUGET SOUND ENERGY 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)516-4388 OWNER ROBERTJ & ROBERTA H MCBRIDE 8523 215TH STSW, EDMONDS WA 98026-7319 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS $252.00 $252.00 RIGHT-OF-WAY PERMIT - STANDARD $378.00 $378.00 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 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. RELEASED BY: MAJ DATE: 04/25/2023 Printed: Tuesday, April 25, 2023 1:08:38 PM 1 of 2 RIGHT OF WAY EUC PERMIT PERMIT NUMIBE City of Edmonds ... - •:� 1 1 :� www.edmondswa.gov • • 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 RESTOR LIMITS Printed: Tuesday, April 25, 2023 1:08:38 PM 2 of 2 RECEIVED of EpM04O� 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�. Apr 10 2023 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 887o3$203 Site Address or if no site address use Property Address at NW corner of project area: 8523 215 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 ix 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.) Emergency follow up request for Job Description Dug up 2" STW main due to possible short in gas main. Found 3/4" STW no record idle stub at —559' W C/L 84th Ave W & W S C/L. Retir ed 3/4" idle stub (i) 8x5 paving cut work completed req nest is for restoration 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 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 3xgas ❑ 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? 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: 04/04/23 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 RECEIVED PUGET Apr 10 2023 PAVING CITY OFM E SOUND � DEVELOPMENTT SERVICES REQUEST ENERGYDEPARTMENT RESTORATION LIMITS TO BE DETERMINED BY CITY ENGINEERING INSPECTOR ADDRESS: Z,,5- TICKET: 5117978 PERMIT: rno✓t,ey� L°� SHEET: OF % CHECK: CITY: REQUESTED BY: P3 INSIDE ❑ OUTSIDE )U r,/Y)n vX 1-5 ❑ POTELCO ff INFRASOURCE ❑ PSE DRAW LOCATION OF CUT AND NUMBER IT ACCORDINGLY: MATCH # FROM DRAWING ABOVE (SEE KEY BELOW) (CALLED OUT) DEPTH IN INCHES LOCATION SIZE (ACTUAL INSTALLED) Example 1 A 2 X 8 8" 25' N CIL Test St AA to complete -wet, ENGINEERING DIVISION r7TED _ p(� 14/21 /2023 SAP ORDER NUMBER: A R77 n 3 B 2- D 3 SAP NOTIFICATION NUMBER: PM/PERSON RESPONSIBLE: //��/ I ,✓i "r, � n S 0� FORM FILLED OUT BY: pd J /,'I s LOCATE NUMBER: 1.'50 U� 3 / Z DATE HOLE CLOSED: �J ' Z4 -2-31 DATE AA RECEIVED: AA LOCATE NUMBER: YES NO KEY TRAFFIC CONTROL ❑ C = > CONCRETE 1N STREET OR ALLEY ONCLUDING CURB AND GLITTER) POLICE OFFICER ❑ C/WC = CONCRETE WHEEL CHAIR RAMP PLATE OVER HOLE ❑ C/SW = CONCRETE SIDEWALK, DRIVEWAY APPROACH NO PARKS ❑ (INCLUDING CURB AND GUTTER) SHALLOW UTILITIES (LESS THAN18") ❑ C/G = CONCRETE CURB OR GUTTER IN RIGHT OF WAY ❑ A = ASPHALT PRIVATE PROPERTY ❑ A/C = ASPHALT OVER CONCRETE UNDER TROLLEY LINES ❑ G/O = > ASPHALT GRIND AND OVERLAY FINAL TICKET FOR THIS JOB ,j ;' ❑ V = VALVE (RAISE VALVE AND REPAVE) EXTRAORDINARY NCC (OFFICE USE) ❑ ❑ B = BRICK (COBBLESTONE) M = M ISC (STRIPE, GRADING, ETC,) Applicant shall repair/replace all damage to utilities or frontage OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING improvements in City right-of-way OWNER/CONTRACTOR IS RESPONSIBLE FOR ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY 4/3/23 Per city standardsthat iscaused or occurs during the permitted project. EROSION CONTROL AND DRAINAGE UTILITIES MAY REQUIRE A SEPERATE PERMIT. 1967 02/14 8523 NO PARKING SIGNS SHALL BE PLACED A MINIMUM OF 72 HOURS BEFORE THE PROPOSED WORK DATE. 8516 RESIDENT(S) WILL BE INFORMED OF TEMPORARY DRIVEWAY CLOSURE TEMPORARY TRAFFIC CONTROL PLAN 9_2m �-OZM W ?AOlO�]IdS 3Nl L A9 GANIMIA-LAC A0 O I� NO 1S32i J 100' 100, a ----------------- b w 215TH ST SW Notes: 1. All signs and spacing to conform to the .;oaroid pa; pied ay; suunp sin000 ao pasneo si;ey; spiepue;s Alp aad MUTCD and City of Edmonds standards. Aem-;o-;yBu A;!o w s;uau,anojdun 2. All sidewalks, driveways, exits and egresses y g wep a eoeld}�o sai;ili;n o;lu e!ldd Ile aoelda�/�ieda� pays;ueoilddy shall be completely clear unless otherwise indicated. 1 3. Channelizing devices are 28" traffic cones. Use traffic drums (barrels) with stead"IMMY0 dNV-10211NOO NOIS0213 Type C lights on all State State00dtdsl9 aA��J SI 2J010b2J1NO0RJ3NM0 4. Sign size can be a minimum of 36" x 36" and shall not obstruct pedestrian access. �eceN° 5. Crew is required to leave a minimum of 10' for ® 28°TRAFFIC CONE traveling lane width. lIN J3d 31b2J3d3S v 32JIf10321 AVN WR401T `d And IIVOO132J 'S311111f1 1 6. Alert affected re SNOdS32J 2JOlO`d 1� 7. Work to take place be ween 9 a.4 p.m WORKVEHICLE/ unless otherwise specified. All work for arterials a FLASHING LIGHTS and major roadways will be from 9 a.m. to 3 p.m. I-► SIGN LOCATION 8. Work area will be 560' WCL of 84th Ave W & 16' RIGHT OF WAY SCL of 215th St SW. Row SIGN SPACING MPH .'x" 60/65 1000, 45/55 500, 35/40 350' 30 200' 25 100' CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 1 20 1 40 L Q 215TH ST SW aco -------------------- b 8 �ZOZ/2/tl am _5)�r� 431G,.... — NOISIAIG ONI2J33NION3 I o , o I I i <<[�000000��0000�� 20111 I 1N Y Energy REV PUGET Designer: S30IAN3 nis°r. SOUND Jason Bisenius saN IN 04/04/2023 0 Card Exp.09(/�y.0/2023 Job # ENERGY 425-424-7316 £ZO P4 ) 464tl 5 pse.com 11911724 Project Address: jason.bisenius@pse.com Q 3A 8523 215TH ST SW, EDMONDS, WA 98026 Page 1 OF 1