2014 ROW Permit 01062014 Incomplete '50 C6 P01-r- I cell
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'06, of Yel"I Permit No.
J'uliuc WOR-KS
901 Rhotmi Rd W; " Application to Perform Wt)i,h on
Yelin,WA 98597 Public Ril-lit of Way and/or Connect
Phone; 360-458-8406 to Utilities
FAX- 360-458-8417
APPLICATION
The undersigned hereby makes application it):
...............................
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n oFv work: K.
...........
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1.__...c agee to perform 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
_2pplica. contained on this form.
The Public Works Department(360-458-8406),ruyst he contacted for iris iiectioi,i, 24#tours.before,Mo
commences or this 1!ermit will be vui&
............
The Underground Utilities Coordinating Council (1-800-424-5555) must be contacted two(2)working days
Names before procee " ivith an excavation associated with this permit.
Phone
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Iting date of instal lation- duration:
Date: n
L
]REMENTS---
For Official Use 0,111y
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Application Approval
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ll.etail:lwlmernbea° Si nature:
Be C_qLnp! ted By Clt
Permission is hereby granted to perform the above described work subject to the general provisions contained
on this form,and the followim, ow
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X-bond in the amount of ....................... is required to insure compliance with the above m.
refundable it atisfactory coo. letion of work,
No work shall be clone under this permit until the party or parties to whom it is granted shall have
communicated with and received instructions from........... .................--............. ...... .mm_................
.... ............. ........... ...........
.......... ..........
In-a frispection Ins'pector jrar l
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Dnie: cc)!n .......
Revised 03/09/2011
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TRANSFORMER R INSTALLTION IRE AMES:
Install at site REPLACE POLE
Grid#
KVA Rating 559800-147833
Foreman to redline the following information
Company ID
Connected to PH Ph
Tested'Sec Voltage FOREMAN(CHECKBOX WHEN MPL E )
PSE Equip.LOCKED/SECURED&work Are left in CLEAN/SAFE condition
Grid,.Cable,and switch numbers INSTALLED&VERIFIED
Field changes RED-LINED on As-built
Material VERIFIED and CHANGES noted on Paperwork
Remove at site Total PRIMARY Cable noted on As-built
Grid# Company I[Ws RECORDED in correct location on As-built
IKVA Rating Indicate correcxt FUSE SIZE on as-builts&VERIFY proper PHASE
Deviations noted on the As-builts and their reason.
Foreman to redline the following information I certify that the work performed meets PSE's standards and procedures
Company ID and that all quality requirements are met.
,Conned to Pd Ph Foreman"s Signature
Tested Sec Voltage Print name —0 a e
CABLE INFORMATION REAL ESTATE/EASEMENT
CABLE# CABLE# CABLE#1 NAME PHONE NO DATE
YEAR YEAR YEAR FUNCTION
TYPE TYPE TYPE PROJECT MGR SUSAN BUCKLE 360-786-5990 12/1712013
ENGR-POWER
POLE INFORMATION ENGR-GAS
POLE CLASS POLE HEIGHT DRAWN BY SUSAN BUCKLE 360-786-5990 12117/2013
CHECKED BY SUSAN 13UCKL 360-786-5990 12117/2013
COUNTY Emer Sect Gas Wk POWER WK CTR APPROVED BY
FOREMAN#1
114 SEC 'OP MAP PLAT MAP FOREMAN#2
MAPPING
U-MAP NO(POWER) OH Ckt Map t1G Ckt Ma CIRCUIT NO
1702EO72 YEL23
Incident# MAOP:
PUGET CREW 3 - REPLACE POLE
SOUND Gas Order Elect Order
ENERGY 9200 WILKENSEN RD
101...086716
SCALE
USE UMAP FROM"MAPVIEWER"ONLY