20190342 ROW Permit IssueCity of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360-458-8406
FAX: 360-458-8417
Permit No.
Application to Perform Work on
Public Right of Way and/or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to: 5�4i (f,,,t re -1e Ln got—
t.,r
Location of work: So q v
1 agree to perfonn the work in strict compliance with Yelm Municipal Code, Chapter , the special
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
applicable topen-nits contained on this form.
The Public Works Department (360-458-8406) must be contacted for inspection 24 hours before work
commences or this ermit will be void.
The Under round Utilities Coordinating Council (1-800-424-5555) must be contacted two (2) working days
! before proceeding with any excavation associated with this permit.
Name:
Address: o o X (( 7 Y G..��, r 9F1S3 Z Phone: 2-5-9- 5-761;
Proposed starting date of installation: 7-1�` y 1 Pugfion: Z -3 j
Date: 7-Z
Signature:
PERMIT REQUIREMENTS
For Official Use Only
Fee $
Issued
_ Digitally si netl b Derek M. MCDo
DN'. C=US, E-tlerekm�yelmwa.gov, '
Application Approval D=Qtyolyaim.DU=DivilR,,iaw
pp pp Derek M. McCoy Engineer, CN=Derek M. M.Coy
Reason: I M1ave reviewetl MIs
Signature:°°`ama°'
Dasa: sms.mas io as:oonroo•
Fee Received $
Receipt Number
To Be Completed By City
_
Permission is hereby granted to perform the above described work subject to the general provisions contained
on this form, and the following special conditions:
A bond in the amount of is required to insure compliance with the above
conditions, refundable upon satisfactory completion of work. _
No work shall be done under this permit until the party or parties to whom it is granted shall have
communicated with and received instructions from:
Remarks:
First Inspection Inspector Final Project Date: i
Date: Completion Approval:
Revised 03/09/2011 �6vrCe\ 'Z2rl t9 2A ()
GENERAL PROVISIONS APPLICABLE TO ALL PERMITS
In accepting this permit, the petitioner, his successor and assigns, agree to protect the CITY OF YELM,
WASHINGTON, and save it harmless from all claims, actions or damages of every kind and description which
may accrue to or be suffered by any person, or persons, corporation or property by reason of the performance of
any such work, character of materials used or manner of installation, maintenance and operation or by the
improper occupancy or rights of way or public structure and in case of any suit or action is brought against said
City for damages arising out of or by reason of any commencement of such action, defend the same at his or
their sole cost and expense and will satisfy any judgment after the said suit or action shall have finally been
determined if adverse to the said City.
If the work done under this permit interferes in any way with the drainage of the area, the grantee shall wholly
and at his own expense make such provisions as the City may direct to correct said drainage problems.
Upon completion of said work herein contemplated, all rubbish and debris shall be immediately removed and
from the roadway and roadside shall be left in a neat and presentable condition that is satisfactory to the City.
The party or parties to whom this permit is issued shall maintain at his or their sole expense the structure or
object for which this permit is granted in a condition satisfactory to the CITY OF YELM.
The CITY OF YELM may revoke, annul, change, amend, amplify, or terminate this permit or any of the
conditions herein enumerated if grantee fails to comply with any or all of its provisions, requirements or
regulations as herein set forth or thru willful or unreasonable neglect, fails to heed or comply with notices given
or if the utility herein granted is not installed, operated, and maintained in conformity herewith or at all or for
any cause or reason whatsoever.
All work areas shall be adequately barricaded according to MUTCD Standards. Barriers shall be properly
lighted at night.
All trenches shall be backfilled with selected backfill materials unless otherwise directed by the Engineer.
PAVEMENT REPLACEMENT: Asphalt pavement shall be replaced to a minimum depth of four (4) inches
thick or match to the existing pavement whichever depth is greater and to the dimensions specified by the
Engineer. In gravel alleys the permittee shall replace base and surface rock.
All work shall be conducted using current WISHA/OSHA regulations. Particular attention shall be paid to the
requirements as they pertain to work in trenches, electrical work, work in high places and to safety apparel such
as, hard hats and safety vests.
All work shall be completed to City Standards as set forth in the City of Yelm Development Guidelines, and
policies.
The PUBLIC WORKS DEPARTMENT office (360-458-8406) must be contacted for insl2ections 24 hours
before work commences.
Revised 03/09/2011
Schedule 40 Fittings Technical
Hot -Tap Saddles Dimensions & Information
�.
Allows Connection to Existing Pipelines. Under Pressure
Specially designed tapping saddle allows pipe branch connection to
pressurized "Hot" lines without system shut -down. Available in PVC
White, Gray or CPVC Gray configurations.
'= Industrial Grade Bolt -on Saddle with EPDM or FKM
O-ring Seals and Choice of Zinc Plated Steel or Type
w 316 Stainless Steel Hardware.
7 �^ Built-in Brass or Stainless Steel Cutter Easily Cuts Hole
in PVC, CPVC, HDPE and PP Pipe. Special Design
Captures and Retains Coupon from Hole.
• Pressure Rated to 235 psi @ 73°F.
• Available to fit IPS Pipe 2" through 8" with Versatile 3/4" Socket - 1" Spigot Combination Branch
Outlet or 1"-1/2" Socket - 2" Spigot Combination Branch Outlet.
TECHNICAL DATA
Maximum Service Temperatures Pressure Rating @ 737
PVC 140°F 2" - 4" 235 psi
CPVC 200°F 6" 200 psi
Note: Elevated service temperatures 8" 150 psi
require system pressure de -rating.
Not for Distribution of Compressed Air or Gas
Some leakage is possible during the tapping process,
therefore "hot -taps" are not recommended for corrosive or
dangerous fluid medium.
Dimensions - Saddle x Socket (Spigot)
Size
G
G1
H
H 1
H2
L
L1
M
2 x 314 (1)
3-9116
1
6-3116
2
1-112
2-7/16
3-1/2
2
2 x 1-112 (2)
4-9/16
1-1/4
8-15/16
2-11116
1-112
2-7/16
3-1/2
2-7/8
2-112 x 314 (1)
3-15/16
1
6-9/16
2
1-3/4
4-1/8
4-118
2
2-1/2 x 1-1/2 (2) 1
4-13/16
1-1/4
9-3/16
2-11/16
1-3/4
4-1/8
4-1/8
2-7/8
3 x 314 (1)
4-1/6
1
6-11/16
2
2
3
4-3/4
2
3 x 1-1/2 (2)
5-1/4
1-1/4
9-518
2-11/16
2
4-118
4-314
2-718
4 x 3/4 (1)
4-11/16
1
7-5/16
2
2-518
3
5-13116
2
4 x 1-1/2 (2)
5-13/16
1-1/4
10-3/16
2-11/16
2-5/8
4-1/8
5-13/16
2-718
6 x 3/4 (1)
6
1
8-518
2
3-718
3
8-1/8
2
6 x 1-112 (2)
7-1/8
1-1/4
11-1/2
2-11/16
3-7/8
4-118
8-118
2-718
8 x 314 (1)
7-1/4 1
1
9-7/8
2 1
4-718
8-1/2
10-1/8 1
2
8 x 1-1/2 (2) 1
8-9/16 1
1-1/4
1 12-9/16 1
2-11/16 1
4-7/8
1 8-1/2
10-1/8 1
2-7/8
PaSe 7 -- `-I I Ye-�M
Made in the u.s A. Suitable for Oil -Free air handling to 25 psi, not for distribution of compressed air or gas
See Spears® Product Sourcebook for product offerings
Page 2
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