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ENG2023-0393 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NU BE City of Edmonds - N, Edmonds WA 9:01 1 931 www.edmondswa.govi Description: PUD - EMERGENCY REPAIR TO DAMAGED CONDUIT ISSUED: 08/15/2023 Address: 310 6TH AVE N EDMONDS WA 98020-3089 EXPIRES: 02/11/2024 Permit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00434210000000 NAME TYPE NAME ADDRESS PHONE APPLICANT MOE MATTHEWS PO BOX 1107, EVERETT WA 98206 (425)783-5681 CONTACT SNOHOMISH COUNTY PUD PO BOX 1107, EVERETT WA 98206 (425)238-7372 CONTRACTOR SNOHOMISH COUNTY PUD PO BOX 1107, EVERETT WA 98206 (425)783-4353 OWNER CITY OF EDMONDS 700 MAIN ST, EDMONDS WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 RIGHT-OF-WAY PERMIT - MINOR $126.00 $126.00 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: WHJ DATE: 08/15/2023 Printed: Tuesday, August 15, 2023 3:58:52 PM 1 of 2 RIGHT OF WAY EUC PERMIT PERMIT NUMBE City of Edmonds 121 5th Ave N, Edmonds WA 98020 ENG2023-0393 1 www.edmondswa.gov / 425.771.0220 ■ CONDITIONS INSPECTIONS INSPECTION • DATECOMPLETE®- 1 .; START X-2 ENGINEERING FINAL" Printed: Tuesday, August 15, 2023 3:58:52 PM 2 of 2 �� of EOA.tO41 � cGI�IT OF STAY CONSTRUCTION PERMIT APPLICATION Compete and submit this Application in accordance with1�Submittal z 301 1N3 W dM3n30 INC. 139 0 Requirements outlined in Right-of-Wgy permit Han o � do A1l0 If any field is not applicable to your project, write "N/ instead of leaving blank. All fields required. Incomplete ApplicationA�J�11 SECTION A General• Project Name PRI CONDUIT REPAIR - 310 6TH AVE N Site Address or if no site address use Property Address at NW corner of project area: 310 6TH AVE N, EDMONDS WA 98020 Associated Permits: BLD PLN ENG owner and Entity Holdingapplicable) Name of Company SNOHOMISH COUNTY PUD NO.1 FranchiseOrdinance No: Point of Contact KARL HAACK Title ASSISTANT DESIGNER Address21014 63RD AVE W City LYNN WOOD State WA Zip 98036 Phone425-238-7372 Email KJHAACKQa SNOPUD.COM Contractor and Authorized Agent of Owner Name of Company SAME AS ABOVE (see note below) Contractor Contacts During Construction Primary Name SAME AS ABOVE Agent Name Title Title Mobile Address Email City State Zip Secondary Name Phone Title Email Mobile City of Edmonds Business License No: Email State License No: 313-005-741 ® Contractor verifies it is currently bonded ® 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 well ❑ Traffic Control Only (no associated development) e Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Project Description 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 (1) EXISTING PRIMARY RISER CONDUIT ON EXISTING POLE ON EAST SIDE OF 6TH AVE N, IN FRONT OF BOYS & GIRLS CLUB. WORK TO BE DONE AS EMERGENCY MAINTENANCE. NO TREE TRIMMING REQUIRED, NO PAVEMENT CUT, NO GRADE PENETRATION. NO INSTALLATION OF NEW FACILITIES. PARTIAL SIDEWALK CLOSURE ON EAST SIDE OF 6TH AVE N BETWEEN BELL ST AND SPRAGUE ST. ALL WORK TO BE DONE BETWEEN THE HOURS OF 8:OOAM TO 4:OOPM. NO TRAFFIC CONTROL NEEDED. WORK TO TAKE APPROX 30 MINUTES. -NOTE THAT WORK WAS DONE AS EMERGENCY** RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF N/A Alley 72 hours + LF x LF SF N/A Parking 72 hours + LF x LF SF N/A SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC. Type of Utility Facilities 1. The work in the right of way is on or for the following type of facilities:: ❑ telecommunications ❑ cable e power ❑ gas ❑ water ❑ sewer ❑ storm Details of • be CompletedNo 1. Does the utility owner have existing overhead infrastructure in the area of work? YES 2. 1 Will any equipment be added underground or above ground (e.g. pedestals, vaults, etc.)? NO 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? NO 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. YES 5. Does the work involve proposed additions to an aboveground utility system? If es: NO 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 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: Yes No NO 6. 6a. Does your project involve wires/cables/lines? If yes: YES How many are existing? 13 How many are to be added? 1 0 City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. I Does your project involve poles? If yes: YES How many poles are existing in the project area? 3 What is the height of the existing poles? so, How many poles are to be removed? o Are additional poles to be laced? No How many? I I What is the height of the additional poles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: N O How many? 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 �forall permit fees. APPLICANT SIGNATURE: i6!'( al�i DATE: 7/31/23 APPLICANT PRINTED NAME: KARL HACK APPLICANT TITLE: ASSISTANT DESIGNER NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 unp sin- els Alp a wanoadt 95ewep jueoilddt MS"11"0111S"TY'll U. 1 CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST TO FROM DATE LYNNWOOD CONSTRUCTION K HAACK 7/31/23 ADDRESS/LOCATION/POLE NUMBER 310 6TH AVE N, EDMONDS WA 98020 MAP NO. ORDER NO. OPERATION NO. 454-F5 900705 ACTION• O REPAIR UG 30 PRI CONDUIT ON POLE PLI 276618. USE (2) 3" SPLIT SLEEVE COUPLINGS (F0373) W/ BLACK ACETAL CABLE TIES (R1040). SPRAGUE ST o z d IJ..I I I > I < ~ -r 310 I I OSL-131619-H 150-463913 PL1 276618 A-55905 IU I I I I I I I I I LAYOUT For de -energizing customer service for Customer work G1 IS TIAIER CREW HOURS CZOZ/51/90 VW I e e d, can the PUD of 425-783-1000 Customer Signoture Dote 09"IldZW 0 ch 0) os NOISlnl4 RjA!MpM&qro ACTION TAKEN OR OTHER ACTION• • APPROVED,BY COMPLETED BY DATE 1N3W12iVd30 S30Inii3S 1N3WdM3n30 Distribution: While -Deportment Responsible For Work -Return To Ofiginolor When ComO&S" ' �IIue GIS, 03, After Work Completion Conory-Deportment Responsible For Work -File Copy CZOZ �Dft%riginotor a3AI333U EMERGENCY REPAIR - No traffic control/lane closure required. There may have just been a brief sidewalk closure but there was no need to set up in the road at all. Location: SPRAGUE ST z w > , , co SL-131619-H PL1 276618 „ 3 F- , „ LAYOUT ..I 1" = 60' APPROVED OTIROVEDAS DNEERING N RECEIVED J�tV1,xJyi,4 08/15/2023 Aug 01 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT RECEIVED Aug 01 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1355729 - 900705 - 310 6TH AVE N - PRI CONDUIT REPAI Applicant First Name Last Name Company Name Moe Matthews Snohomish County PUD Number Street Apartment or Suite Number E-mail Address PO Box 1107 permits@snopud.com City State Zip Phone Number Extension Everett WA 98206 (425) 783-5681 Contractor Company Name Owner Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 310 6TH AVE N City Zip Code County Parcel Number EDMONDS 98020 00434210000000 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name CITY OF EDMONDS Number Street Apartment or Suite Number 700 MAIN ST City State Zip EDMONDS WA 98020 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: 7/31/2023 Submitted By: Moe Matthews Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1355729 - 900705 - 310 6TH AVE N - PRI CONDUIT REPAI Project Contact Company Name: Snohomish County PUD Name: Karl Haack Email: permits@snopud.com Address: PO Box 1107 Phone #: (425) 238-7372 Everett WA 98206 Project Type Activity Type Scope of Work Utility Purveyor Utility Work No Disturbance of Surface Project 900705 - 310 6TH AVE N - PRI CONDUIT REPAIR Name: **THIS WORK WAS ALREADY COMPLETED AS AN EMERGENCY REPAIR ** PUD to repair 1 existing primary riser conduit on an existing pole on east side of 6th Ave N, in front of Boys & Girls Club. Broken conduit hit by car was reported by City of Edmonds Engineering Permit Description Department as an urgent potential hazard. Work to be done as emergency maintenance due to of Work: exposed secondaries and conductors in a highly public area determined to be a possible public danger. No tree trimming required. No pavement cuts, no grade penetration. No installation of new facilities. Partial sidewalk closure on East side of 6th Ave N between Bell St and Sprague St. No traffic control needed. Work to take approximately 30 minutes. Project Details Project Information Job Number 900705 310 6TH AVE N Page 2 of 2