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20170180 ROW Permit Pkg 05022017City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360- 458 -8417 Permit No. 2�b 00(W Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION The undersigned hereby makes application to: Crew to investigate and repair a gas main leak with work to be done on 3rd St. 75' South of CL SE Mosman Ave and 16'W of CL 3rd St SE. 4x4 hard surface cut in right of way. (concrete sidewalk). Location of work: 215 SE Mosman Ave Job #887033698 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 Energy/ InfraSource Mary McCorkle mary.mccorkle @pse.com Address: 3130 South 38th St, Tacoma 98409 Phone: 253-476-6037 Proposed starting date of installation: 5/15/17 Duration: 1 Day Date:4 /20/17 Signature: )�� VW L 0 PERMIT REQUIREMENTS I For Official Use Only Fee $ 12C — Issued s Fee Received $ i25_— Application Approval Signature: Receipt Number 6b&-7,,50'1 To Be Cow leted B Ci Permission is hereby granted to perform the above described work subject to the general provisions contained on this form, and the following special conditions: Y 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 By$' VX 2017 c711A, �i ti City of Yelm PUBLIC WORKS 901 Rhoton Rd NW Yelm, WA 98597 Phone: 360- 458 -8406 FAX: 360 - 458 -8417 Permit No. Zb 00 ( W Application to Perform Work on Public Right of Way and /or Connect to Utilities APPLICATION The undersigned hereby makes application to: Crew to investigate and repair a gas main leak with work to be done on 3rd St. 75' South of CL SE Mosman Ave and 16'W of CL 3rd St SE. 4x4 hard surface cut in right of way. (concrete sidewalk). Location of work: 215 SE Mosman Ave Job #887033698 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 Energy/ InfraSource Mary McCorkle mary.mccorkle @pse.com Address: 3130 South 38th St Tacoma 98409 1 Phone: 253-476-6037 Proposed starting date of installation: 5/15/17 Duration: 1 Day Date:4 /20/17 Signature: LL�� 01V4L- PERMIT REQUIREMENTS I For Official Use Only Fee $ 125, _ Issued Fee Received $ 1 Z '— Application Approval Signature: Receipt Number 6b O1 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 Appro yal: Date: Revised 03/09/2011 10 't:/ 4 syl ,rirrras�rr�s��auu t r- 4 IV90 33'17 7 Rev. 1 June 7, 2013` ►,�Q' Job #: Date: 3 2 Jurisdiction: m Est. Start Date: Est. Duration: PRE- INSPECTION FORM Address: a5 SF Aos"11 VG City/ Zip: Yelm Q'969' Customer: CUSTOMEA PHQN NUm8EA P1N1 / Insp. .�N.N Work Descriotion MA,14 e /, 1` (0"e ''c e_ c✓ 111004 Construction Method Open Trench ❑ Trenchless ❑ P_lai_ma it! II iil!! IIIII !!Il Ilf!I +;i I!Illl lit,!!Itii II I I IIIiIfIII tl 111!i11 +11111K I! II! Ilitl'!I I� �I ;;II III!IIIItII� I Illllliill IIII III hill !itl • I l l l i I I I i! I!' I!! I ! c i l i I l l l l l l l i l i l l l i � l l i � � I! I l l , l �' I I I I I I I I 1 1 11 I' ! I I I •I_•I _ I 1 +' I �_�I —'_—_ i � ze i I! I I I! :! •I� ! I I 1 i I I ! IV S I l i l i!! T 1 _ I I t 1!! t l i •_1 _Li I t I I I I( ! 1 T_�....'•. I I I i i T I I l i L! t Y 1 —i I _. 1- —i• _ — i I _ _i ,�.L.. ' i! �, ,`� l it '� Li ! 71I _ L i I I I I! �I. � •I-�i '_' t I ! I T ! ! i _! I I f t I 1 i !—I _ FT -i I I I I .;i�) .7- �' i I i � I I I t IX I F I I I I I I s l!; Y I I Y i'+liilllll!!+! 111!1!11 I IIII''11llillllli!I ! liiilt ' ii!II tilI!111 1!!1!111!1 !IIII It I II Iliil it;!1.111!II �!i '!! Ili!IIIll!III !liilll I lil 1111111f1!III!II;I{II- •it! +illli!I!III I i IIIIII� ! I 1il I I1 111!tlll! !- ! I V I I I I I I I 1 4 i t I N I I I I ; I I 1 11 1 1! +!! 1! i, l l l l l l I!! I i l!! I 1 1 1! 1 ! I I I I I I I I I I l l l i i l l l i l l l l i l i�• ! I I I I I 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 I I I NI I I I 1I I I I i I I I i I I I I I I- ! il!IIII Illillil II111111 III ! lil IIIIIIII111111!7�_ IN ! I I I I I I I I I I I I I I! I I 1 1 1! I i t i l l l l 11 I! I I 1 I I I I I I I ! I I I I!! I r I I I I I I I I I I I I I I! I I I' I! l i i Work Location Size of Cut Surface Tyne 7 S f CL o Aj 1S.A tOR, 1r,_'E&j2f CL r != H x 84 -�u/ 'NSofCL & 'EWofCL 'NSofCL & 'EWofCL Flaggers ❑ # Police Flaggers Trolley Lines ❑ Bus Stop ❑ # Meter Hoods ❑ # Speed Limit m h ❑ # Traffic Signal ❑ Arterial ❑ No Parks ❑ # Commercial [:]Altered Commercial ❑ Leak Repair Residential ❑ Altered Residential ❑ CP Work Multi - Family❑ Replacement Service ❑ Pothole New Service ❑ Main Maintenance ❑ Extension Stub F-1 Service Maintenance❑ Complete Cut & Cap ❑ Valve Maintenance ❑ Service 0 Service Information Bollards ❑ 2.5 " ❑4 "# ❑ Diameter Meter EFV Template Bar ❑ ❑ 5/8" ❑ 250 ❑ 1800 ❑ Fuel Line Permit ❑ ❑ 1 1/8" ❑ 425 ❑ 2600 E1 Fuel Line Length 1 1 /4'x❑ 630 ❑ 10,000❑ Fuel Line Diam. ❑ 1 2" ❑ 1000❑ Meter Location . LLI LY 00 C) 00a ILA 04 14-�Cv W- �14 LLI ti cr) LU Uj OD 6 C114 LU aLyce) ()0 N co 0 N. Ln m Ln LO LO 00 ol Lli V- C) x 0 .-�-q I.,,- .-- Ln T- CN LL, LY CL in CV (L ui k 0 co co C14 F-� W co I 0 D uj LU d, co co C14 F-� W co I e «*Er �§ ®§q) G LLJ CL O Z!—ID ; Lk < <�° ° ) e z & \ LO }k {2 § ) = au L) �Z .2 \ \ .� a �•� -=CZ--+ 2- [\ D ) §i§ { ; n "r t§\ ]§� k \\in 5G«} §k \jk {#) {L>U� /a�,e ;��2� w / \afkGkff§kZ5 £ < <- uw- okk�£o z- :"{.¥{ag6ka% § ■§? EM City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: PUGET SOUND ENERGY INFRASOURCE Address: 3130 S 38TH ST TACOMA WA 98409 Property Information: Site Address: 218; MC')SMAN AVF CF Assessor Parcel No.: Contractor Information: Subdivision: Name: PUGET SOUND ENERGY INFRASOURCE Address: 3130 S 38TH ST TACOMA WA 98409 Contractor License No.: Permit No.: 201 70180 Issue Date: 5/02/2017 (Work must be completed within 180 days) Phone: 253 - 476 -6037 Owner: Lot: Phone: Expires: 0 /00 /0000 Project Information: Project: UTILITY Description of Work: CREW TO INVESTIGATE AND REAPIR A GAS MAIN LEAK WITH WORK TO BE DONE ON 3RD ST. 75 FT S OF CL SE MOSMAN AVE AND 16 FT W OF CL 3RD ST SE. 4X4 HARD SURFACE CUT IN THE ROW. CONCRETE SIDEWALK Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item Contractor RIGHT OF WAY PUGET SOUND ENERGY INFRASOURCE 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 an correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm regulat ns incl n those governing zoning and land subdivision, and in addition, all covenants, easements d strictions f record. If applying as a contractor, I further certify that I am currently registered in he t e of a hington. i Signature Date S"2— 'r7 Firm ivxr� lI 1A ' ,.Vf" Fees $ 125.00 $ 125.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City of Yell (36) 458 -3244 REC4: 00267501 510212017 9 :09 AM OPER: CO TERM: 001 REFS: 845844 PAID BY: TRAN: 33.0000 BUILDING PERMITS 20170179 125.0(CR PUGET SOUND ENERGY 1NFRP- 30URCE 810 YELM AVE W ROW 125.0( CR IRAN: 33.0000 BUILDING P[RMI1,3 20170180 125.O(CR PUGET SOUND ENERGY INFRA30URCE 215 MOSMAN AVE SE ROW 215 TENDERED: 250.00 (HECK APPLIED: 250.00- CHANGE: -� 0,00