HomeMy WebLinkAboutMFP19000854DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Page 1 | Published: 3/30/2017
Planning Division | 1055 South Grady Way, 6th Floor | Renton, WA 98057 | 425-430-7200
Email: franchisepermits@rentonwa.gov Website: rentonwa.gov
FRANCHISE PERMIT APPLICATION
Published: 3/30/2017
TO THE APPLICANT: Submit an electronic copy of the plans with the Franchise Permit Application and the
Traffic Control Application to franchisepermits@rentonwa.gov. Permit cost is $360.50. Inspection fee for
trenching more than 60 lineal feet or installation of 6 or more poles will be billed at $60.00 per hour.
Franchise Agency:
Franchise Job Number: Phone:
Contact Name: Email:
Job Site Address: Project Name:
Description of Work:
Please check all that apply:
☐ New Construction ☐ Repair/Relocate ☐ Underground ☐ Overhead ☐ Sidewalk ☐ Street
☐ Open Trench ☐ Bore # of feet:
Contractor Name: Phone:
State Contractors License #: City of Renton Business License #:
“I certify that I am the owner or applicant’s authorized agent and do hereby agree to abide to the terms and conditions set forth under this permit and shall comply with the City of Renton’s Trench Restoration and Street Overlay Requirements. ”
Signature Date
INSPECTIONS SHALL BE REQUESTED 24 HOURS PRIOR TO COMMENCEMENT OF ALL WORK BY CALLING THE
INSPECTION LINE AT 425-430-7203 OR BY GOING TO MYBUILDINGPERMIT.COM
Jobs are required to be called in for job start, re-inspection and project final. Re-inspection fees are billed at $75/hour.
All Pre-Construction meetings shall be scheduled at a maximum of 14 days prior to the job start date.
Plan Review/Development Engineering Date Approved as submitted
Pre-Construction Meeting required
Site Construction Inspector Date Approved with comments or redlines
Camera inspection of utilities required
Development Engineering Manager Date
CITY OF RENTON
TRAFFIC CONTROL PLAN
PROJECT NAME: PERMIT#
CONSTRUCTION COMPANY: PHONE#:
CONTACT NAME: PHONE#:
ADDRESS: CELL#:
E-MAIL ADDRESS: FAX#:
PROJECT LOCATION: N/E/S/W OF:
WORK TIME: APPROVED BY:
WORK DATE: APPROVAL DATE:
OFFICE COPY T-
CONTRACTOR
DEV. SERVICE, INSPECTION P. MILLER
DEV. SERVICE, PLAN REVIEW B. BANNWARTH
POLICE CHARLES KARLEWICZ
FIRE FIRE MARSHALL FS #13
Permit Holder agrees to all the following:
• Comply with all traffic regulations of the City of Renton and the State of Washington.
• Prepare a traffic control plan and obtain City approval of that plan. That plan shall be implemented for
all street and lane closures, and the plan shall be performed in compliance with the Manual on
Uniform Traffic Control Devices.
• Notify emergency services (253-852-2121) twenty-four (24) hours before any street or lane closures.
• Any lane or street closures not in conformance with the approved traffic control plan and/or without
notification of emergency services may result in receiving a citation for violation of R.C.W. 47.36.200
through 47.36.220, 9A.36.050 Reckless Endangerment, and other applicable State and City codes.
• Indemnify and hold harmless the City of Renton from any and all claims, actions, and judgments,
including all costs of defense and attorney’s fees incurred in defending against same, arising from and
related to implementation of the approved traffic control plans including claims arising from towing of
private vehicles and the acts of the Permit Holder’s agents and employees.
• The City of Renton shall be entitled, in its reasonable discretion, to settle claims prior to suit or
judgment, and in such event shall indemnify and hold harmless the City for any such claims paid,
including the City’s reasonable attorney’s fees and litigation costs incurred resulting from such claim.
• In the event any claim or suit is brought against City within the scope of this Agreement, Permit Holder
will pay for legal counsel chosen by the City to defend against same.
• Flagger and sign placement are subject to revision by the City Inspector on site, if needed to address
traffic or pedestrian safety or travel.
• By my signature herein, I acknowledge all the above requirements.
PRINT NAME: DATE:
SIGNATURE:
Reset FormPrint Form
SKETCH
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NOTES:
• Work Zone Traffic Control shall be in accordance with the Manual on Uniform Traffic Control Devices (MUTCD)
and shown by sketch or reference to WSDOT.
• The plan must be submitted to the City’s PW/Transportation Division for review and/or approval at least three
working days prior to work.
• Approved Temporary Traffic Control Plan must be at the work site during work hours.
• Contractor or entity must call Renton School District (425-204-4455) or any public/private agency to be affected
by a temporary lane or road closure.
• Complete assistance and accommodation shall be provided to all kinds of pedestrian traffic when sidewalk or
walkway is impeded.
• Total road closure lasting more than 24 hours is subject to the approval by the City Council.
• Any vehicle, equipment, barricade, or portable tow-away sign used within the work area must display a
company logo or any legally acceptable sign showing the company name, address, and telephone number at a
conspicuous place on the vehicle or equipment.
In the case of Temporary No Parking Zones, all the following apply in addition to previous:
• Contractor must complete form to show limits of Temporary No Parking Zone identifying barricade locations for
vacate parking or curb lane usage.
• Contractor must post notice of dates and time of Temporary No Parking Zone with at least two signs per block
72 hours in advance of effective date and time.
• The cover sheet of this Traffic Control Plan form must be attached to each Temporary No Parking Sign on the
project site.
• Temporary traffic control devices must be removed immediately when work is done or no construction activities
are going on. If deemed abandoned, City crews will remove and store them at the City’s maintenance shop
(3555 NE 2nd Street).
Est. Start Date:
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Job #:106351342
Date:206-276-2081 Address:10710 SE 192ND ST
Puget Sound Energy Gas Pre-Inspect Form
3/28/19 PM / Inspector:RANDALL DEBOLT 253-395-6329
Est. Duration:1 Day (8 Hours)
Jurisdiction:RENTON City / Zip:RENTON, 98055
ROW Permit:Yes Customer:HUYEN NGUYEN 206-687-0690
PLAT Map:215.082
N
Work Location Size of Cut Surface Type
Job Description / Scope of Work
TIE INTO EXISTING 8" MPE MAIN(109020488) AND INSTALL 100FT 1 1/8" SCAT SERVICE(50FT
SCAT STUB/50FT SCAT EXTN) WITH 2600 EFV AND A250 METER.
New Construction:
No
Construction Method
All Scat / Trenchless
of CL SE 192ND ST 3X5 ASPHALT
of CL
90'East of CL S 108TH AVE SE 9'South
of CL
Service Information Street Information Job Type
of CL
of CL
of CL of CL
New Residential Svc
EFV:1-1/8" - 2600 - 9996743 Police #:TCP:Yes
Diameter:1-1/8" PE Flaggers #:Arterial:No
Trolley Lines:Mtr Hoods #:
Meter:A250 Speed Limit:
Tie-In Fitting
Route #'s:Bollards:2.5" #4" #ADA Ramps #:
Del Press:6" W.C.Traffic Signal:Bus Stop:
No Parks #:
Meter Loc:08 - OR
of CL of CL
10710
Grass DIRT / GRAVEL
Tree
PL
CL
Tree
Tree
S 108TH AVE SEPL
SE 192ND ST108TH AVE SE107101111SHOULDERWORKSHLDR-WKUTILITYWORKAHEADW21-7100'100'UTILITYWORKAHEADW21-7
100'UTILITYWORKAHEADW21-7100'UTILITY
WORK
AHEAD W21-7100'UTILITYWORKAHEADW21-7 100'CHANNELIZATIONDEVICE SPACINGMPH55/7035/4525/30TAPER403020TANGENT806040NPSEPUGETSOUNDENERGYJOB#10635134210710 SE 192nd St, Renton, WAJanuary 23 2019jaber.tofan@pse.com425-424-7808SHEET 1 of 1Puget Sound EnergyTraffic Control Supervisor:Gregory HarwoodCard No. 008997Card Exp. 08/13/2019gregory.harwood@pse.com(425)424-6425TEMPORARY TRAFFIC CONTROL PLANWORK PITLEGEND28" TRAFFIC CONESIGN LOCATIONTRAFFIC FLOWWORK VEHICLE/FLASHING LIGHTSRIGHT OF WAYROWROWSIGN SPACINGMPH60/6545/5535/403025"X"1000'500'350'200'100'Notes:1. All signs and spacing to conform to theMUTCD and City of Renton standards.2. All sidewalks, driveways, exits and egressesshall be completely clear unless otherwise indicated.3. Channelizing devices are 28" traffic cones.Use traffic drums (barrels) with steady burningType C lights on all State State Routes and Hwys.4. Sign size can be a minimum of 36" x 36" andshall not obstruct pedestrian access.5. Crew is required to leave a minimum of 11' fortraveling lane width.6. Alert affected residents and businesses.7. Work to take place between 9 a.m. and 4 p.munless otherwise specified. All work for arterialsand major roadways will be from 9 a.m. to 3 p.m.8. Work area will be 90' WCL of S 108th Ave & 9' SCLof SE 192nd St.