Issued ROW Permit ENG20190253.pdfAl
CITY 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 ENG20190253
R IGHT OF WAY PERM IT (6-EUC)
Permit Number: ENG20190253 Expiration Date: 12/18/2019
Job Address: 22404 92ND AVE W, EDMONDS Location: 22404 92nd Ave W
PSE/Infrasource
P SE/Infrasource
C/O Megan att: Carabba
C/O Megan att: Carabba
1660Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425) 457-6353
LICENSE #: infras1871c2 EXP: 02/22/2021
Emergency follow up- crew was called out 5/ 14/19 for an emergency leak repair/investigate and repair leak on the main at 22404 92nd
Ave W. Work started on 5/14/2019 and ended on 5/14/2019. 1 (4x6) soft surface cut was made. Job #887035541
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 )
PARKING: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: ( OXO) DURATION IN MONTHS: 0 FEE: $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 whatsoever, foreseen or unforeseen, that may he 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 OF ONEYEAR 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 pemrit application.
CALL DIAL -A -DIG (1 -800424-5555) BEFORE ANYEXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NO TIC E REO UIRED FOR ALL INSPECTION RFOUESTS
THIS APPLICATION IS NOT PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
RELEASED
Printed: Tuesday. June 18.2019
C%«
DATE
FILE COPY INSPECTOR COPY APPLICANT COPY
STATUS: ISSUED
ENG2O190253
• 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.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• 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 repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:OOam to 6:OOpm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise lints 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 fromthe issuance of this permit. Issuance of this permit 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:
OF EDA40�O�
ROW PERMIT NO.: ENJG•"t 1 OQ7.53
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 887035541
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 96233
State License #: INFRASL871C2
City Business License #: NR-019840
CONTACT: Megan Carabba
Phone #: 360-333-9461
Fax #:
Email #: megan.carabba@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22404 92nd Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial ❑ Subdivision El City Project El Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes W No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Emergency Follow Up -Crew was called out
on 5/14/2019 for an emergency leak repair/investigate and repair leak on the main at 22404 92nd Ave W.
Work started on 5/14/2019 and ended on 5/14/2019. 1 (4x6) soft surface cut was made.
Job #887035541
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES NO 0 Year: 8871N
PAVEMENT CUT: ® Yes ❑ No
CONCRETE CUT: ❑ Yes ❑ No
If yes, indicate size of cut: 4 x 6
If yes, indicate size of cut: X.
RIGHT-OF-WAY
CLOSURE AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIG
*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 fib the permit to be valid.
SIGNATURE % DATE 6/3/20 1 9
Contrs for or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
October 17, 2017
Job #:
Date:
Jurisdiction:
EMERGENCY PRE -INSPECTION FORM
2 '? '76 � s s`L
5.1
Address: 2ILI 0 (1 Q� M� c, U e W
City/zip: l3d")lds
Customer: MIMMER PHON9 NUMBER
PM / Insp:
Work Description 1
Constructlon Method
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Trenchless ❑
KETCH
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Work Locatloa
Size of Cut
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2003 Edition
Figure 614-6. Shoulder Work with Minor Encroachment (TA-6)
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Typical Application 6
END
ROAD WORK
Note: See Tables 6H-2 and
6H-3 for the meaning
of the symbols and/or
letter codes used in
this figure.
Truck -Mounted
Attenuator
(optional)
Buffer space
(optional)
1 /3 L
A
ROAD',
,i WORK
AHD
Page 6H-17