HomeMy WebLinkAbout912 S Race St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQU~T ~
Date ':t - :)1--- 0./ Time Received by (phone, person)
Location of Work to be inspected 1 / ~
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
5 f{({(Z-
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11. . ~ Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other C;Jo\:j-e~
INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED
/.
YES [/ NO
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Y ~
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SURFACE RESTORATION
SURFACEtPE D Unimproved DGravel
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D Repaired by City
CJ Repaired by Permittee
o No Damage Found
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
/.
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQU~T' ~
Date r:t- -... ;).~-- 'B Time Received by (phone, person)
Location of Work to be inspected 1 /?--.
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing
~li~c~neNo
Permit No
Final Sewer Excav Other
L;J~
INSPECTION NOTES
Inspected Date
Remarks
Time By
P~c-e lip'
~yu/2-e . u-J / l
kJ J x?-Q "
/ ' 1/
P ~'PF
7;( P 5-erUtC-<2-
,
RESTORATION REQUIRED
,/
YES [/ NO
. I \ c..--y
,
/01'
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SURFACE RESTORATION .~ ~ /'
SURFACE tPE 0 Unimproved DGravel ~phalt " MC ; I 0 Other
C t (t \ '1 0 Repaired by City Work Order # b b 0 3
J 0 ) ~ \ \ Q 0 Repaired by Permittee 0 COMPLETE
I \ 0 No Damage Found I[YfNCOMPLETE
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of .S/;I-e 1~4Jlc
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CIty 01 IJort Angeles
Public \Vorks Departnlent
\" ater Distribution Repair Report
f-}~ w F (0 be -:)
IWork Order No.
DATE REPORTED
b~61
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CONDITION
EMERGENCY D ROUTINE D CITIZEN COMPLAINT V'
LEAKAGE SURVEY D OTHER D
1---16-03 TIME
q I J.- S. (.(4 (~
DA.M. DP.M.
DATE OF REPAIR.
REP AIR LOCA nON
ADDRESS
TYPE OF MAIN
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL, D LONG BREAK 0
HOLE 0 CLAMP 0 OTHER /'
SERVICE. TAP 0 CORP STOP 0 PIPE/CURB STOP 0 FITTING 0
METER SETrER 0 METER 0
Old 5-eYr/I(e /rqJ/{{C-f.
w,+A I'f/,E:-
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR, CLAMPO DRESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP Son.. AREA 0 SOn.. TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I 2. cr P,P,M.
WATER OFF FROM /.L P M. TO .-1.e.. M.
2hDuj-e ()U+-
JhYI
FROM
M,TO
M.
/1+ft