ENG20170103-Application.pdfof EV%,
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ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 109102178
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: 1NFRASL871C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email": Susan.Sidick@pse.com
R Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 9803 Edmonds Way
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial F] Subdivision El City Project El Traffic Control (Only)
Fj Multi -Family X Single Family F] Other
R EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes W No
� ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
Permission requested to tie into existing 4" MPE IP gas main located at 25'W of C/L of 100th Ave W and 440' N of C/L of
Edmonds Way to extend 2" PE IP replacement service to PCC. Service to be hole hogged with one open cut 3'X5' in asphalt
one 3'X5' asphalt cut to pothole over water main and one exit pit in 5X5 concrete sidewalk.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [:] NOE] Year: 1091h I
PAVEMENT CUT: Xj Yes D No If yes, indicate size of cut: 3 X5 & 5x5
CONCRETE CUT: F-1 Yes F1 No If yes, indicate size of cut: — x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF X LF SF
*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.
SIGNATURE Susan Sidick mm�@� --us DATE 3/27/2017
Date: 2016 09 W 0:67J0 -0M'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request: 03/23/17
Job number
Job address
Project mgr:
PM email:
109102178
9803 Edmonds Way City: Edmonds Zip: 98020
Lisa Griffith
lisa.griffith@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
05/10/17
05/12/17
PM contact #: (425) 406-0121
Pt-rmoSsq4on rpqi lested tn tip into existing 4" MPE 112 gas main Inrated at 95' NIV of ('11 of
100th Ave W and 440'N of C/L of Edmonds Way to extend 2" PE IP replacement service to
PCC. Service to be hole hogged with one open cut 3'X5' in asphalt for tie in, one 3'X5'
asphalt cut to pothole over water main and one exit pit in 5X5 concrete sidewalk.
Pavement cut? F✓ Yes ®No
If yes, Dimensions of Cut: Length 5' Width 3'
How many cuts? 3
Surface Type Asphalt/Sidewalk
Require trenching? FlYes r7No
If yes, Dimensions of trench: Length 5' Width 3' Depth 3'
Method of installation: Open trench/hole hog
Traffic impact:
Road closed Yes F✓ No
Lane closed Wes No How Many? 1 Direction? south
Shoulder closed F-7 es ® No
Sidewalk closed F]Yes ® No
Emergency Contact: Dean Latimer
Cell Number (253) 350-6687
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PRINT ON
11X17" SHEETS ONLY
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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.
4. Sign size can be a minimum of 48" x 48" 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.
8. Work area will be 435' NCL of Edmonds Way & 25' WCL
of 1001h Ave W.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
9803
LEGEND
28' TRAFFIC CONE
® BORE PIT
c* TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
Sr }' ARROW BOARD
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/7040 80
35/45 30 60
25/30 20 40
PRINT ON
11X17" SHEETS ONLY
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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.
IIN
1
3. Channelizing devices are 28" traffic cones.
TLOO'd
4. Sign size can be a minimum of 48" x 48" 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.
8. Work area will be 435' NCL of Edmonds Way & _'ECL
of 100th Ave W.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
9803
LEGEND
28" TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
: ;}::• ARROW BOARD
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35145 30 60
25/30 20 40
..... ................................................................ ...........
--� ----- --- ----
- — — _ — C -CURB _ — — — _ L. — — — — — —
.,, .•.....'.................................................... .... ..................
- -
EDMONDS WAY (SR 104)
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ROAD
WORK
AHEAD
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9803
LEGEND
28" TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
: ;}::• ARROW BOARD
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35145 30 60
25/30 20 40
..... ................................................................ ...........
--� ----- --- ----
- — — _ — C -CURB _ — — — _ L. — — — — — —
.,, .•.....'.................................................... .... ..................
- -
EDMONDS WAY (SR 104)
PRINT ON
11X17" SHEETS ONLY
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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.
4. Sign size can be a minimum of 48" x 48" 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.
8. Work area will be 435' NCL of Edmonds Way & 33' ECL
of 100th Ave W.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
CREW WILL USE ADA COMPLIANT
RAMPS FOR PEDESTRIAN
DIVERSION
(SEE ATTACHED SHEET FOR DETAILS)
9803
LEGEND
28° TRAFFIC CONE
® BORE PIT
L;y TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
ARROW BOARD
o----C-CURB �-— — — -----
.......................................
EDMONDS WAY (SR 104)
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
PRINT ON
L
11X17" SHEETS ONLY
TCP - 15 PEDESTRIAN DIVERSION DETAIL
PAGE CAN BE ADDED TO THE BACK OF TRAFFIC PLAN
Crew will create peclestriand
wheelchair 'empliant ramps
and assist pedestrians around
work area.
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Add additional mines
for safety
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