HomeMy WebLinkAbout805 E 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
REQUEST
9 - ;2 ) - 'If
Date
Time
).. : J{) r.M
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Tf)>
c
S-Q.
porc.E
17~ 1-~
Phone No
Permit No
C0
\:)
\h
f1l
~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
Illv' )tv "/
INSPECTION NOTES
Inspected Date ~l-;;.. "} - 9 7
Remarks 15 If he. ~ i!/ /-leI? p
~~E7f
.- .
Time ) tio P n By pi( V If/'
C v}" r p",e,O Sf ..,.. C I Tr 'J 5' c,l( vrcE-
~ESTORA TION REQUIRED YES NO ~-
".... 115' (
'lJ IlJ _____J
~ '"
...J ,
'" ~
;:::. ~
'v
~
~ -- - - -)..{..3 - - '-7 X
()
~>
'-
~ F/\/JI't/CJ5
] ~
~ \.J\
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
[3'COMPLETE
o INCOMPLETE
o Other LAw,.</
ICf6/
,
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: I r , I
Reported: ~/,) >t L Y
Repaired: -1..1;'} 1 q- "7
Condition:
Source:
Repair Location:
Address.
Loc. Description:
Component R~aired:
Main:
Icrew: 1\ IJ;V J PEIV/VI; , ;1>9/11 I ~
r
Emergency V Routine
Citizen Complaint
Leakage Survey _ Other
<joY E >~
i~ (3EHI/IIp MeTe/( AT Cc-lVl((.:cr/~N
Main Line IDD:
Joint Cir Break
Long. Break _ Hole
Other
Service:
Line Valve:
Hydrant:
Other:
Tap _ Corp. Stop _
Flange Nuts, Bolts
Branch Valve
Split Bell_
Clamp _
Pipe t./"'"
Stem
Barrel
Curb Stop _
Bonnet
Repair Type: Clamp _
II S ~ f.. T/vN ()f j?1f't:
)
Site Condition: Surface
Curb
~ Damage:
-.
Dresser
Other <<E I'L 1'1 C e IJ
Gravel Roadway _ Asphalt Street _
Top Soil Area ~ Soil Type _
Sidewalk
Cuts: Street CUt: Ft.
Sidewalk CUt: Ft.
Main Condition:
Curb Cut: Ft.
Diameter- Inches
Material.
Depth of Cover. Ft.
Internal Lining:
Tuberculation: N/ A
External Corrosion. N/ A
Special Conditions. Bedding:
Other Structures:
Samples Taken:
Water Off:
,-
v~...
Joint Type:
External Prot:
Minor
Localized
Severe
Extensive
Pipe Section_
From~/;>'3/77
FromL/W99
Coupon _
To 3.vo AM
To !i~'vU AM
Apparent Cause of Leak: ( I P f: 13 rf( ~ K t. . w tI e ~ E P ~ f? FIT T / /V G H ~ It ler
.
()N Tp TNE Cl/5 T f//11 cft /..> .
5/19/98
Pagel
PW-902.09