20160324 ROW Permit 09132016o.
"Ir \5�
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360 - 458 -8406
FAX: 360- 458 -8417
Permit No. Zot(, n i 7-q
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION I '
The undersigned hereby makes application to: Install approx. 300' of 2" PE gas main in Coates Ave NW,
200' of the 2" PE gas main is on property. No asphalt cuts required.
job # 1070.52350
Location of work: 311 Cullens St NW
I agree to perform the work in strict compliance with Yehn Municipal Code, Chapter , the special
conditions enumerated herein and the attached conditions I have read and will adhere to the general provisions
applicable to permits contained on this form.
The Public Works Department (360- 458 -8406) must be contacted for inspection 24 hours before work
commences or this permit will be void.
The Underground Utilities Coordinating Council (1- 800 - 424 -5555) must be contacted two (2) working days
before proceeding with any excavation associated with this permit.
Name: Puget Sound Emergy It InfraSource
Address: 3130 South 38th St Tacoma WA 98409 Phone: 42,;-457-3397
Proposed starting date of installation: 0717116 1 Duration: 3 days
Date:
Signature:
L
A4
PERMU
J&QUIREMENTS I
For Official Use Only ,
Fee $ /as —
Issued
Fee Received $
Application Approval
Signature:
Receipt Number &tV :;t
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
Date:
Inspector Final Project
Com letion A roval:
Date:
Revised 03/09/2011
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360 - 458 -8406
FAX: 360- 458 -8417
Permit No. _%WaC3 %� `-i
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION
The undersigned hereby makes application to: Install approx. 300' of 2" PE gas main in Coates Ave NW,
200' of the 2" PE gas main is on property. No asphalt cuts required.
job # 107052350
Location of work: 311 Cullens St NW
I agree 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
applicable to permits contained on this form.
The Public Works Department (360- 458 -8406) must be contacted for inspection 24 hours before work
commences or this permit will be void.
The Underground Utilities Coordinating Council (1- 800 - 424 -5555) must be contacted two (2) working days
before proceeding with any excavation associated with this permit.
Name: Puget Sound Emergy / InfraSource
Address: 3130 South 38th St Tacoma WA 98409
Phone: 253 -476-603 7 425-457-3397
Proposed starting date of installation: Duration: 3 days
Date:
Signature:
L\k� M n 1
PER QUIREMENTS
For Official Use Only,.
Fee $ has, —
Issued T
Fee Received $ i
Application Approval
Signature:
Receipt Number 00 ��
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
Date:
Inspector Final Project
Completion Approval:
Date:
Revised 03/09/2011
City of Yelm
PUBLIC WORKS
901 Rhoton Rd NW
Yelm, WA 98597
Phone: 360 - 458 -8406
FAX: 360 - 458 -8417
Permit No. _=aC3 Z`'(
Application to Perform Work on
Public Right of Way and /or Connect
to Utilities
APPLICATION I
The undersigned hereby makes application to: Install approx. 300' of 2" PE gas main in Coates Ave NW,
200' of the 2" PE gas main is on property. No asphalt cuts required.
0
Location of work: 311 Cullens St NW
I agree 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
applicable to permits contained on this form.
The Public Works Department (360- 458 -8406) must be contacted for inspection 24 hours before work
commences or this permit will be void.
The Underground Utilities Coordinating Council (1- 800 - 424 -5555) must be contacted two (2) working days
before proceeding with any excavation associated with this permit.
Name: Puget Sound Emergy / InfraSource
Address: 3130 South 38th St Tacoma WA 98409 Phone: 253-476-60_37 42_9-457-3397
Proposed starting date of installation:
Duration: 3 days
Date:
Signature:
PERMUJOEQUIREMENTS
For Official Use Only
Fee $
Issued
Fee Received $
Application Approval
Signature:
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 followingspecial 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
Date:
Inspector Final Project
Completion Approval:
Date:
Revised 03/09/2011
City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: PUGET SOUND ENERGY
Address: 3130 S 38TH ST
TACOMA WA 98409
Property Information:
Site Address: Ill rl 11 I FNC Rll NW
Assessor Parcel No.: 21724140502
Contractor Information:
Name: PUGET SOUND ENERGY
Address:
3130 S 38TH ST
TACOMA WA 98409
Contractor License No.:
Permit No.: 20160324
Issue Date: 9/13/2016
(Work must be completed within 180 days)
Phone
Owner:
Subdivision: N/A
Phone:
Expires: 0 /00 /0000
253 - 476 -6295
Lot: N/A
Project Information:
Project: UTILITY
Description of Work: INSTALL APROX 300 FT OF 2 INCH PE GAS MAIN IN COATES AVE NW, 200 FT OF 2 INCH
PE GAS MAIN IS ON PROPERTY. NO ASPHALT CUTS REQUIRED.
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
RIGHT OF WAY
Contractor
PUGET SOUND ENERGY
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations u ing those governing zoning and land subdivision, and in addition, all covenants,
easeme 'ts restri tions of record. If applying as a contractor, I further certify that I am currently
register i e St a of Washin t n. p
Signatur Date l "
Firm
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
T I of Yell
o 458 -3244
REC #: 00243397
OPER: CO TERM
REF #: 1203816
PAID By:
9/13/2016
001 10:35 AM
IRAN: 33.0000 BUILDING PERMITS
20160324
PUG ET SOUND ENERG.0(CR
ROW 317 CULLENS RD NW
125.0(CR
1ENDERED:
APPLIED: 125.00 CHECK
125.00-
CHANGE: - — - - ---
0.00
Q� E o�o
('o O U
W Z I E
N d
}
��1 O
` y `Yl 04 f/7
L �+l (qa dv m° d v
m mzW"o r ,
/i
j .
U a H w U
r N
' M c Ati
z
ZOZQ °mm °v
ZA, J
W
0' �'�!• U to Q M N
z
P ~
=W
U°a°vM
In fh N
i.
IMP `b
\ 'oo
�Q° EN
N of /.
/
O M O V d J
N
Lu 2. C44
O > Y N M O Y
N
��+ /W ��a �v a��
0 b 0
N y Z W / r
cc
U .c d W U H U W
r N
ui Z
ZGO f
O °O4
`V O Z
P )<
ri
LLI w QV a
vMV
QV>
_O u� )
r.- M N
/ / r
ri.
li r
Oe
r
o
_
y C _ r
d BOA O V O
L N U X
U _ E
3 0 ui E
O M N�
O N O N 7 U N
d = N
O O @ C
>
W
(3 N V
N N
C N V U O 'O O
U @ >
m >. m aD y
a
d M� N, m d
M
a vS a� m = 2
C 4% Y d C V Q
C N U O N O M
y = c 0 .3
�¢L U U) co U
r m N M CM V M O
A
\ 7
3
v
U
O
O
N
r
to
E
v
0)
Y
a
3
N
Q)
to
�3
.f.r
U
N
0
a
C
i
O
3
3
CL
U
E
Q
O
M
I
(D
0
N
N
..__ T
__ -- ------ -- -- ..... . I L L
END OF MAIN
CAP 2" MPE
1O'S C/L & 560'W C/L
S C/L & ___'W C/L
CP WIRE #14 TEST LEAD &
CP TEST LEAD BOX COMPLETE
S. C/L & ___'W C/L
I
I
I
I
I
I
I
I
I
I
I
I
I
I
9523
I
I
PROPOSED
1 O'EASEMIENT
I
BEGIN
CUSTOMER PrOVIDED rTREldCH
I
I
�- POLYVALVE 1 -1/8" MPE (OPEN) PROPOSED PIPE 2" MPE IP MAIN
WITH VALVE BOX & SUPPORT 10 "S C/L ___'S C/L
12'S C/L & 520'W C/L
S C/L & ___'W C/L
PROPOSED
1Y6 "MPE SVC
I
I
I
I �
I Z
I
I ~ 1
I �
-
I �
I Z
W I
I
I J
I U
I
I
I I
I II
I
I
9525 6'N
I
I 86 ,16'E
I
80' R ES
I
I ,14'E K
I
I
-J
--------------- - - - - -- J
_ >+
" 1412L 112 5'N-WALK
N W 107005254 -1999
/
r�
2 "MPE IP 17' -23'E
186550916 -2008
311 / ',4 ��� /
GJ
1 1 4" MPE /
\ 2062 /
\ S
116
\ / 1 1 4"
2062
c
/ 20024" MPE
\ 317
PLOT PLAN
SCALE: 1 " = 50' -0"
N
' ► 25'
14' I 11.5'
ASPHALT PARKKING
WATER - 20'N
ASPHALT
q_
50' R/W
83'S,27'W \
/
/
0
ol 62
1
610
i
i
i
/608 �
� 60\
S
25' -'
11.5' 1 13'
ASPHALT
EXIST. / PROP. 2" MPE IP - 12'N
GRAVEL
a
r
Backfill for Direct Bury - The final backfill may be soil -based select material or native soil, but
free of construction debris and shall not contain rocks larger than 10' " -in. diameter to prevent
impedence of gas system maintenance.
VEHICLE
ACCESS Excavated Dirt Pile
SIDE 12" -18"
Min 24" Min
Final Grade \ \ , f
2° Min. of ���,,�. ,�.,�,. �• /% % .
Acceptable Backfill
36" ' (See Definition Abover)
Cover
NOTE: Install 12" shading
if the backfill contains rocks
-, .,..0 `t,`•� 6" Sand Shading _ greater tthan 6" dia.
4" Sand Bedding
Gas Main Line
TYPICAL GAS MAINLINE TRENCH DETAIL
Not to scale
FITTER'S CHECKLIST (CHECK BOX TO CONFIIRM COMPLETION)
❑ Inspected Steel and PE pipe per GOS 2450.1400 anci 2450.1500
❑ Reviewed and complied with all construction notes.
❑ Recorded all required information on the as -built per (GOS 2500.1700.
❑ Completed post installation inspection per GOS 2525.1200 and 2525.2700.
❑ Left the work area in a clean and safe condition.
Foreman's Signature
Foreman's Name (printed)
Company: InfraSource Construction Date _
4680 06/11
STANDARD GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE- CALL" TWO WORKING DAYS PRIOR TO
TO CONSTRUCTION, IN WESTERN WASHINGTON CALL: 1 -800- 424 -5555. OR CALL NATIONWIDE: 811
2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQUIREMENTS).
3. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION C
5. N TION A TIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
6. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE -IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY
THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
7. COMPLETE "PIPE CONDITION REPORT' ON ALL METALLIC PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY
THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION IS
NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTENT SNOWFALL MAY OBSCURE THE VALVE BOX.
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
11. SYSTEM MAOP DENOTED BY: SYSTEM MAOP = 60 PSIG
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200.
15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION WITH CP TECH.
-- - - - - -- , PHONE --- - - - - --
17. NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS -BUILT IN RED.( ') DENOTES
FOOTAGE BETWEEN FITTINGS.
18. EXCESS FLOW VALVE TO BE INSTALLED ON ALL NEW RESIDENTIAL SERVICES PER GOS 2500.2200. (RECORD ALL
INFORMATION ON D-4 CARD)
12 " -18"
Final Grade
6: 1� •i ~-
_ 4i.
�'. ;55, �
HOLE HOG TABLE
LOCATION DEPTH LENGTH
CALLOUT
.1`f .. ±4,"
BP1
START
BP2
END
BP3
START
BP4
END
BP5
START
BP6
END
BP7
START
BP8
END
BP9
START
BP10
END
BP11
START
BP12
END
BP13
START
BP14
END
BP15
START
BP16
END
BP17
START
BP18
END
BP19
START
BP20
END
FITTER'S CHECKLIST (CHECK BOX TO CONFIIRM COMPLETION)
❑ Inspected Steel and PE pipe per GOS 2450.1400 anci 2450.1500
❑ Reviewed and complied with all construction notes.
❑ Recorded all required information on the as -built per (GOS 2500.1700.
❑ Completed post installation inspection per GOS 2525.1200 and 2525.2700.
❑ Left the work area in a clean and safe condition.
Foreman's Signature
Foreman's Name (printed)
Company: InfraSource Construction Date _
4680 06/11
STANDARD GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE- CALL" TWO WORKING DAYS PRIOR TO
TO CONSTRUCTION, IN WESTERN WASHINGTON CALL: 1 -800- 424 -5555. OR CALL NATIONWIDE: 811
2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQUIREMENTS).
3. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION C
5. N TION A TIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
6. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE -IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY
THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
7. COMPLETE "PIPE CONDITION REPORT' ON ALL METALLIC PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY
THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION IS
NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTENT SNOWFALL MAY OBSCURE THE VALVE BOX.
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
11. SYSTEM MAOP DENOTED BY: SYSTEM MAOP = 60 PSIG
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200.
15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION WITH CP TECH.
-- - - - - -- , PHONE --- - - - - --
17. NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS -BUILT IN RED.( ') DENOTES
FOOTAGE BETWEEN FITTINGS.
18. EXCESS FLOW VALVE TO BE INSTALLED ON ALL NEW RESIDENTIAL SERVICES PER GOS 2500.2200. (RECORD ALL
INFORMATION ON D-4 CARD)
12 " -18"
Final Grade
6: 1� •i ~-
_ 4i.
�'. ;55, �
Type/Work
: ?',; :t. 4 +. •.
.1`f .. ±4,"
Est Length
+..
Manufacturer
INSTALL
2"
PE
260'
N/A
N/A
PLAT
2"
PE
200'
N/A
N/A
N/A
N/A
N/A
N/A
I N/A
Final Backfill
N/A
DRAWN BY
.WALKER-PAU
253 - 625 -0964
7/5116
CHECKED BY
B.TAYLOR
A Depth
COUNTY
THURSTON
Emer Sect
49
GAS WK CTR
CSPPGPM
+ •ti.
i
GAS MAIN
6" Sand Shading ,
.i....4.
TESTING
GAS PIPE DIRECT BURY
CUSTOMER PROVIDED TRENCH
NTS
1. IF THE TRENCH BOTTOM CONTAINS ANY SHARP OR UNUSUALLY
ROUGH SURFACES, A MINIMUM OF 4" OF INITIAL BACKFILL MATERIAL
IS REQUIRED TO BED THE PIPE, UNLESS THE CARRIER PIPE IS
ENCASED OR WRAPPED WITH AN APPROVED ROCK SHIELD MATERIAL.
2. INITIAL BACKFILL SHALL BE SAND, NATIVE SOIL, OR SOIL -BASED SELECT
MATERIAL THAT DOES NOT CONTAIN ANY SHARP ROCKS OR ROCKS
LARGER THAN 1/2" DIAMETER. SEE PSE SPECIFICATION 1275.1380,
"SAND BACKFILL FOR GAS PIPE, ELECTRICAL CONDUIT, AND CABLE.
3. A MINIMUM OF 6" OF INITIAL BACKFILL SHALL BE PLACED OVER THE GAS
PIPE. IF THE NATIVE SOIL CONTAINS ROCKS LARGER THAN 6" DIAMETER,
THEN A TOTAL OF 12" OF INITIAL BACKFILL SHALL BE PLACED OVER
THE GAS PIPE.
4. IF THE CARRIER PIPE IS ENCASED, INITIAL BACKFILL IS NOT REQUIRED.
THE BACKFILL MATERIAL SHALL MEET FINAL BACKFILL MATERIAL
REQUIREMENTS. WHERE THE CARIER PIPE ENTERS AND EXITS THE CASING,
THE INITAL BACKFILL AND BEDDING REQUIREMENTS APPLY.
5. FINAL BACKFILL MAY BE SOIL -BASED SELECT MATERIAL OR NATIVE SOIL,
BUT SHALL BE FREE OF CONSTRUCTION DEBRIS AND SHALL NOT CONTAIN
ROCKS LARGER THAN 10" DIAMETER TO PREVENT IMPEDANCE OF
GAS SYSTEM MAINTENANCE.
GAS MAIN INSTALLATION /RETIREMENT
Notification #
Type/Work
Pipe Size
Type
Est Length
Act Lgth
Manufacturer
INSTALL
2"
PE
260'
N/A
N/A
PLAT
2"
PE
200'
N/A
N/A
N/A
N/A
N/A
N/A
I N/A
N/A
N/A
DRAWN BY
.WALKER-PAU
253 - 625 -0964
7/5116
CHECKED BY
B.TAYLOR
425 - 466 -8377
COUNTY
THURSTON
Emer Sect
49
GAS WK CTR
CSPPGPM
APPROVED BY
GAS MAIN
PRESSURE &
TESTING
CP APPROVAL
TYPE TEST
❑ SOAP
❑ AIR
❑ NITROGEN
❑ WATER
DATE ON
/ /
START TIME
TESTED BY
DATE OFF
/ /
STOP TIME
PRESSURE
UTILITIES
CONTACT
PHONE#
TEST RESULTS
OP ❑ F
TYPE TEST
❑ SOAP
❑ AIR
❑ NITROGEN
❑ WATER
DATE ON
/ /
START TIME
N/A
TESTED BY
DATE OFF
/ /
STOP TIME
SCALE
1 " =50'
PAGE
1OF1
PRESSURE
TEST RESULTS
❑ P [--IF
❑ TESTED BY PSE PRESSURE CONTROL, SEE FORM 1928
DESIGN PRESSI 60 1 SYS MAOP 1 60
2023 03/10
PROJECT PHASE
Notification #
Order #
GAS SAP Superior
Service /Meter
Service /Meter
Service /Meter
Service /Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc /MSA
Relocate
Retirement
501784365
107052350
503542358
106313557
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
I N/A
N/A
Project Manager Contact Information:
Manager: NATE LINVILLE
Cell Phone: 253- 970 -7284
E -Mail: nathaniel.linvilleO-pse.com
Vicinity Map
N/A
Owner/ Developer Contact Info
EAST HAVEN VILLA
PO BOX 386
FOREST GROVE, OR 97116
ATTN: ANDY ROYCE 360 - 239 -2702 office
For contacts below dial 1- 888 -CALL PSE (225 -5773)
CALL 811 AT LEAST 2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF EXISTING FACILITIES
"Locates Required" Yes ❑ No ❑
"Flagging Required" Yes ❑ No ❑
REAL ESTATE /EASEMENT
REQUIRED
PERMIT
YELM
REV#
DATE
BY
DESCRIPTION
FUNCTION
CONTACT
PHONE NO
DATE
PROJECT MGR
N.LINVILLE
253 - 970 -7284
6/30/16
ENGR -GAS
N/A
N/A
N/A
DRAWN BY
.WALKER-PAU
253 - 625 -0964
7/5116
CHECKED BY
B.TAYLOR
425 - 466 -8377
COUNTY
THURSTON
Emer Sect
49
GAS WK CTR
CSPPGPM
APPROVED BY
N.LINVILLE
253 - 970 -7284
CP APPROVAL
1/4 SEC
NE 24 -17 -01 E
OP MAP
280.038
PLAT MAP
282.043
MAPPING
JOINT FACILITIES ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
N/A
N/A
NIA
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
, I��
P lJ EAST HAVEN VILLA MEMORY CARE
SOUND 2" MPE IP COMMERCIAL MAIN
ENERGY 311 CULLENS ST NW YELM 98597
DESIGNED BY PSE
SAP Sup Order Nbr
107052350
Drawing Number
N/A
SCALE
1 " =50'
PAGE
1OF1