HomeMy WebLinkAbout102 W 2nd St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: 1.1
Date .1 - q-o 1. Time 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):
Sewer Foundation Framing Chimney Plumbing
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L1 t"h tr-O Phone No.
Permit No.
Final Sewer Excav. Other
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INSPECTION NOTES:
Inspected: Date
Remarks:
Time By
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RESTORATION REQUIRED . . . . .. YES L,/ NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel ~sPhalt 0 PCC 0 Other
o Repaired by City Work Order # ) 3 V ')? I DO Y
o Repaired by Permittee 0 COMPLETE
o No Damage Found D INCOMPLETE
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(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: /3 <g.z y.... 66Y' I
ICrew: / I Y
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DATE REPORTED: L
CONDITION: EMERGENCY 0 ROUTINE 0 CITIZEN Co.MPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR: /,-q-o V' TIME:
DA.M. DP.M.
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TYPE OF MAIN:
101-
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SIZE:
REPAIR LOCATION: ADDRESS:
DEPTH OF MAIN:
CLOSEST VALVE DEPTII:
COMPONENT REPAIRED: J../
MAIN: JOINT D CIR. BREAK n SPLIT BELL D LONG BREAK 0
HOLE 0 CLAMP D OTHER
SERV1CE: TAPD CORP. STOP D PIPE D CURB STap D FITIING D
METER SETTER D METER 0
LINE VALVE: FLANGE NUTS/BaLTS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VAL VE D BARREL D
OTHER:
COMPONENTS OF REPAIR: CLAMPO DRESSERD aTHER
SITE CONDITION: GRAVEL 0 ASPHALT~IDEWALK D CURB D
TOP saIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRIVEWAY CUT _FT.
MAIN CaNDITION: INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL caRROSION LOCALIZED 0 EXTENSIVE 0
C1-ll..aRINE RESIDUAL SAMPLE
WATER OFF: FROM II ( }D ft. TO.
P.P.M.
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APPARENT CAUSE aF LEAK
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: y
Date J - q-o
Time
Received by
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
10:2- 60 Q M~(
'-"r" LVI i (oy
I~ t- h t- 0 / Phone No.
Permit No.
(phone, person)
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date
Remarks:
I l. Ic'\. t-e 1/"-
~
,
RESTORATION REQUIRED . . . . .. YES l./ NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel ~sPhalt Dpcc o Other
o Repaired by City Work Order # J 1 V "i? '06 Y , ' .
[] Repaired by Permittee )-if COMPLETE "~~ {'~~\ l---tJd, \0 \t~t
o No Damage Found 0 INCOMPLET(E ~~<'t~A~ ><3-'\ (::.",- (ll~
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(Continue on reverse side if necessary) STREET SUPERINTENDENT (DA TEl