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ENG20170079.pdfCITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERMIT MUST BE POSTED ON JOBSITE* STATUS: ISSUED ENG20170079 Job Address: 17003 TALBOT RD, EDMONDS Location: 17003 TALBOT RD CONTRACTORAPPLICANT PSE/Infrasource PSE/Infrasource C/O Susan att: Sidick C/O Susan'att: Sidick 1660 Park Lane 1660 Park Lane Burlington, WA 98233 Burlington; WA 98233 (425)457-6353 LICENSE #`: infras1871 c2 EXP: 02/22/2017 rk area is approx I FN c/1 of 171 st St SW & 9'E c/I of Talbot Rd 1 3x5 paving cut anticipated. To investigate and repair leak. SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 ) PARKING: ( OXO ) DURATION IN MONTHS 0 FEE: $0„00, YEAR OF OVERLAY: 0 FEE $0„00 ALLEY ( OXO I DURATION IN MONTHS: 0FEE: $0.00' INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims ofany kind or description ivhatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and attorney fees by reason ofgranting this permit, THECONTRACTOR IS,RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR,FOLLOWING THEFINAL INSPECTION AND ACCEPTANCE OFTHEWORK. •; 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 possesion. • 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. • Three sets of construction drawings of proposed work are required with the permit application. CALL DIA1,A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220 EXT. 1326 24 HOUR NOTICEREA)UIRED FOR ALL INSPECTION RFQUESTS IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND, RECEIPT IS SPACE PROVIDED, �%I�LGdtI.�ZCL RELEASED BY Printed: brit , March' DATE ❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY ENG20170079 Restore ROW to City standards • Restore Landscape to like or better conditions. • Call for locates of underground utilities prior to any excavation. • Alert affected residents and/or businesses prior to work start., • Conform to approved working drawings and Traffic Control plan. • Utility patch restoration to be in accordance with Edmonds Standard detail E2.3. Additional fees will be applied for cuts into surfaces paved within the last 5 years. • Maintain erosion & sedimentation control. Keep street clean. • Call for required inspections as noted. • Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements. • Applicant shall repan•/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that is caused, by or occurs during the pemvttedproject. • 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 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all othertimes 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. • 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 issuance of this permit. Issuance of this pennit shall not be deemed to modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance provision. • E Engineering Final PARTIAL INSPECTION DATE: INITIAL: NOTES: PARTIAL INSPECTION DATE: INITIAL: NOTES: FINAL INSPECTION APPROVED DATE: INITIAL: � RIG: T -OF -WAY CONSTRUCTION 4141C. 1u oo PERMIT APPLICATION PROJECT NAME: 887033706 CONTACT: Sue Sidick CONTRACTOR: PSE/Infrasource Mailing Address: 1660 Park Lane, Burlington, WA 98233 State License..#.........�..............................�.. �w.................,............................................ INFRASL871 C2 City Business License #: NR -019840 Phone #: 425-457-6353 Fax�m.m.._.. Email M Susan.Sidick@pse.com ❑ LiabilityInsurance Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 17003 Talbot Rd ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: ❑ Commercial _m Subdivision......................_.........City Project �_W� µµµTraffic Control (Only) ❑ Multi -Family ❑X Single Family ❑ Other ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? ❑ Yes ❑* No ANY ASSOCIATED PERMITS? BLD#ry . ENG# DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 11' N C/I of 171st ST SW & 9' E c/I of Talbot Rd 1 3x5 paving cut anticipated To investigate and repair leak WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NOE] Year: 887 PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5 CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x - ------- --- RIGHT-OF-WAY DURATION CLOSURE AREJAI OTAL (NUMBER OF MONTHS) Sidewalk 48 Hrs + LF XSF Alle 72 Hrs + LF X SF Parking72Hrs+LFX SF APPLICANT TO READ AND SIGN *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 is to 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. Indemnity: The Applicant has signed an application which states he/she hold 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 defense costs and attorney fees by reason of granting this permit. I have read the above statements and understand the permit requirements and acknowledge that I must follow all requirements in order for the permit to be valid. Susan Sidick 3/2/2017SIGNATURE A%M DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE d 4, r 0 a J o w Q Q m O w _� O 3: K00 d 03 \ � � � cmwnx xm is uiQ v o �Q o� m Q�� oZ v iogio� o >• o Faxz w �o I Z F F B d O NUw� �FwN p O= ZJm K ¢ �> o zxzN rx�oow a3 �w d N U ri Z Iw/10�w�jO WN��OZ KOO r\ CL U^ w �20Z �ON N�zrz1ao Cl e� > > o a a � z �zoWQz. uJmwYQpizO� Gm zti�c� how z5 sx Asa aV w w y Y16 m�acYiz ��U �Fz<� <N�rccwi3 mmvi �a�¢�� o>�wm cu k y m� wZ O O > ta/1UD�d>W ANO YdJ ?UQmO LLol�awz w=~w dao Ja ''� V 1 R Un w owui�(n �w0 "h ZZ41 OJm NWS' KJ \�x¢.Z� KH c�ogazz �rc u�? o�n0 na�n via W, _ ® K �0• J� o zd¢z��UFz�zrc� wxxx ��oua000 ozgowo� OOSEOZ5ow , ,. urn m tu z a� 'h oaaam�n z� cl vi a vi n io m d 4, lO J 3: K00 00 ~ O U 0 0 tl 00 m Q�� V v iogio� � W I B d d I � .............. . .. . . . . . . .......... . Sill: .. CL as ,A 6 Cl e� Slm a- i o.r if cu k y l I W V R Un w 1033_70�0 PRE -INSPECTION REPORT Job #:� , l�0_[13s3_9 Date: — Address: 170(93 TA (.BDT iZ o Jurisdiction: City/Zip: monc%s y8C726 Right of Way Permit? 5U YES ❑ No Customer: Est. Start Date: PM / Insp: PRUN9 NUMBER Est. Duration: PHONE NUMBER WORK DESCRIPTION: Construction Method Open Trench ❑ Trenchless 0 PLAT MAP: I wa Cb Q 0 kir r adv r o'e, bog �oG / L✓ tE. xc Work Location Size of Cut p Surface Type --- 'N S of CL [Q� FLAGGERS # 7,6 MPH ❑ OFFICERS # SPEED LIMIT ❑ Commercial ❑ Altered Commercial ❑ Residential ❑ Altered Residential ❑ Multi -Family ❑ Replacement Service ❑ New Constr. ®_Main Maintenance ❑ Stub ❑ Service Maintenance ❑ Extension ❑ valve Maintenance ❑ Compete Sery ❑ Cut & Cap E W raf CL, 7"�Jbo Y & .E W of CL - ----- — ❑ METER HOODS # ❑ TROLLY LINES ❑ BUS STOP # ❑ TRAFFIC SIGNAL ❑ ARTERIAL Leak RepaireryicIre In formatipr ❑ CP Work Dfemefor Motor ❑ Pothole ❑ 5/8" ❑ 250 ❑ Extension ❑ 11/8" ❑ 425 ❑ 11/4" ❑ 630 ❑ 2" ❑ 1000 ❑ METER HOODS # NO PARKS It (p ❑ Template Bar EFV ❑ Bollards 2,5" # ❑ 1800 ❑ 2600 ❑ Bollards 4" # ❑ 10,000 ❑ FUEL LINE PERMIT NEEDED Fuel Line Length: Fuel Line Diameter. STREET: USE PERMIT REQUEST FOR Date of Request: 03/01/17 Job number: Job address: Project mgr: PM email: 887033706 17003 Talbot Rd Veronica Paulson veronica.paulson@pse.com Estimated job start date: 04/05/17 Estimated job completion date: 04/05/17 Description of work to be performed: Talbot Rd. Pavement cut? M"yes No If yes, Dimensions of Cut: Length 3 Width 5 How many cuts? one Surface Type asphalt :Edmonds Zip: 98026 PM contact #: (253) 617-6023 Require trenching? ®Yes' No If yes, Dimensions of trench: Length Width Method of installation: Traffic impact: Road closed `des ✓ No Lane closed ✓ yes rNo Shoulder closed Dyes ✓ No Sidewalk closed F]Yes F,( No Emergency Contact: Mike Blood Cell Number: (425) 864-6154 Depth How Many? one Direction? West LJI C4 (L �" a W! p p� NN \ w. U C) d z: `a X " N — — 3,Oi dl ddW „Z a 441 X ie00 g d) r0 cq 7 1u •� °J LO o / In— C) / SIM I p t"' a p ' p/ r 00 � W W W 3.lZdl / IgO r - el / / Lu / o o y Al RD /"° / o' / W O �d �s,o[i•3,61 ccs N u O v ab n, tl "c e'S �'o� 73 "4'?'Z2N iss