HomeMy WebLinkAbout1417 E 3rd St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUES!j ___ 0 "l
Date b d-..? - D 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):
Ii 17 E- 3r/
'IW ,. I cc:. ~
/1 r-tl.....{- Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
iAJut+er-
'"
INSPECTION NOTES:
Inspected: Date
Remarks:
RESTORATION REQUIRED . . . . .. YES
~~
~
~
~" /fC::--
/lI1'
f(.ef(.1...( 'r
~ lf6 (
~
{3d
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt
o Repaired by City
[] Repaired by Permittee
o No Damage Found
OPCC
o Other
SS" g >
Work Order #
~PLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of l~ort Angeles
Public 'V orks Departnlent ~ {,U p (t csrs D
", ater Distribution Repair Report
CONDITION:
~s- ?s-
6-)<3-0;
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
, - A ') -6 3 TIME: I :L-
Itll?
. ,
ICrew:
;1 (/
,
IWork Order No:
DATE REPORTED:
REPAIR LOCATION: ADDRESS:
DA.M. ~.M.
E:- 'Jye(
DATE OF REPAIR:
TYPE OF MAIN:
SIZE:
DEPTH OF MAIN:
CLOSEST VALVE DEPTH:
COMPONENT REPAIRED:
MAIN: JOINT D CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE 0 CLAMP 0 OTHER .
SERVICE: TAP 0 CORP. STOP 0 PIPE ~URB STOP D FIITING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OTHER:
COMPONENTS OF REPAIR: CLAMPD DRESSERD OTHER
SITE CONDITION: GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA .....-s-OIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRIVEWAY CUT _FT.
MAIN CONDITION: INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF: FROM 52.. P M. TO "3 'pM.
! ht;USe
ou'+-
",0
FROM M. TO
M.
fJHffl-e P E
j//P-k-
APPARENT CAUSE OF LEAK:
......
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
.....
REQUEST
Date 7 - 2 Z - ocf
Time /0 AM
Received by f)~ft&1.r.S L (phone, person)
Location of Work to be inspected leftr E. 5 ,"d ~
Name of person requesting inspection [)e.t-U.-1 ,~ r
Address of person requesting inspection C ~ Y'f 'r~ r-d
Type of Inspection (circle appropriate one)
Chimney Plumbing Final
Phone No
permit~
Sewer Excav Ot er Wa. '7'; )
Sewer Foundation Framing
Time,!! OC: ;L/M t- By /J.e.v...vtl'!:> F..
s.~V-Vt '-< I "w O-e 1-tJe.-<..v\. ~VI ~
RESTORATION REQUIRED
YES
NO X
~ ~ ~ .
'oJ' ~
Or /
\I) J gr( A.<::".
...... 258'
~ i( i'f \..
~ ~
-.......::
E. 3 0 s.:t ~
.
~ -
.
~
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # /{ z 7~ - ?H4-
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No HZ18--CX!4
I Crew '( rs- "f- Ct-~t.J
J
DATE REPORTED
1- f1 rot
CONDITION E:NIERGENCY D ROUTINE D CITIZEN COIvlPLAlNT ~
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. 7 - Z. "L - c) cf TIME -1.: PO DA.M. )(P.M.
REPAIR LOCATION ADDRESS I'{t 7 E. 3 LcR. 51-:
TYPE OF MAIN AL . SIZE ell
DEPTH OF MAIN ~ CLOSEST VALVE DEPTIl .--
COIvlPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK D SPLIT BELL D LONG BREAK D
HOLE D CLAMP 0 OTHER
SER \lICE T..:\P 0 CORP STOP 0 PIPE)( CURB STOP 0 FITTING 0
NIETER SETTER D METER 0
LINE VALVE. FLANGE NUTSIBOL TS D STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
3~,"1
COIvlPONENTS OF REPAIR. CLAMPO DRESSERO OTHER /'-f Ct:)~. V/1fOvl S ~ IE I1fe 3/;/'
SITE CONDITION GRAVEL 0 ASPHAL T 0 SIDEWALK 0 CURB 0
TOP SOIL AREA)( SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT IT
MA1N CONDITION INTERNAL LINING ;0#1 11JBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION ' LOCALIZED 0 EXTENSIVE D
CHLORINE RESIDUAL SAMPLE - P P M.
WATEROFF FROM II 5DIM. TO /2' fJ M.
FROM
\1. TO
M.
APPARENT CAUSE OF LEAK. .~ ;:::'~ty
1::;1 ~
.