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DOT Form 350-071 Revised 03/2018
Request for Approval of MaterialContract Number FA Number SR Date
Section / Title of Project County
Contractor Subcontractor
This form shall be completed prior to submittal. If this form is not compete at time of submittal it may be returned for information that was omitted.
For WSDOT Use OnlyRAM #
Bid Item No.
Material or Product/Type
Name and Location of Fabricator, Manufacturer or Pit Number
PE/QPL Code Hdqtr./QPL Code
Project Engineer Date State Materials Engineer Date
Acceptance Action Codes for use by Project Engineer and State Materials Laboratory1. Acceptance Criteria: Acceptance based upon “Satisfactory” Test Report for samples of materials to be incorporated into project.2. Acceptance Criteria: Mfg. Cert. of Compliance for ‘Acceptance’ prior to use of material.3. Acceptance Criteria: Catalog Cuts for ‘Acceptance’ prior to use of material. Catalog Cut Approved Yes No4. Acceptance Criteria: Submit Shop Drawings for ‘Approval’ prior to fabrication of material.5. Acceptance Criteria: Only ‘Approved for Shipment’, ‘WSDOT Inspected’ or ‘Fabrication Approved Decal’ material shall be used.6. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action.8. Source Approved:
9. Approval Withheld: Submit samples for preliminary evaluation.10. Approval Withheld:11. Miscellaneous Acceptance Criteria.Remarks:
State Materials Engineer Distribution
Contractor Region Materials General File Signing Inspection
State Materials Lab Other
Fabrication Inspection MS 47365
GD-089 Received3/5/2021
N/A
CITY OF BOTHELL DEPARTMENT OF PUBLIC WORKS
SUBMITTAL REVIEW
SR 522 Stage 3 Improvements
No Exceptions Taken ____ Approved as Noted ____
Amend and Resubmit ____ Rejected ____
Important Notice; This review does not relieve the contractorfrom its liability to comply and conform with the Plans,
Specifications, and Contract Documents.
____________________________ ____________ Signature Date
3/5/21
Kenmore PM
3/8/21
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
Arrow Board
*Not to scale
80TH PLNE
Signs will be placed before 80TH PL NE
RWAW-20-1
RWAW-20-1
RWAW-20-1
Right LaneEnds
Right LaneClosed Ahead
W9-1
Dog Leg Left
W9-2
Work Zone
Begin Work Zone
Enclose west endwith lit chan devices
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
Use warning lightson delineationdevices during nightand periods oflimited visibility
Add chan devicesfor bus exit
Add PCMS boardwith messaging24/7 during closure
PCMS Board
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
RFI 27 Response 7/1/19
Limits to be determinedin field by City Inspector.
Work Zone
*Not to scale
Arrow Board
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale*Not to scale
Arrow Board
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale*Not to scale
Arrow Board
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale
Arrow Board
Work Zone
*Not to scale
Arrow Board
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale
Arrow Board
Work Zone
*Not to scale
Arrow Board
Work Zone
PrivateDrivewayEntrance
End of WorkZone. 4Lanes ofTraffic
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale
Arrow Board
Work Zone
*Not to scale
Arrow Board
Work Zone
End of WorkZone. 4Lanes ofTraffic
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale
Arrow Board
Work Zone
*Not to scale
Arrow Board
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140
City of Bothell
1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com
JURISDICTION:CITY OF BOTHELL
JURISDICTION:CITY OF KENMORE
*Not to scale
Arrow Board
Work Zone
*Not to scale
Arrow Board
RWAW-20-1
Work Zone
REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140