HomeMy WebLinkAbout321 E 9th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
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Date
Time
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Received by !l / ( c
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
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Inspected Date
Remarks .>E~ //Ie E L e AK
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RESTORATION REQUIRED
YES c.---. NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
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D COMPLETE
[B-tNCOMPLETE
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
LIty OllJort Angeles
Public 'V orks Departnlent H-~-~ "i.?... y (p
"1 ater Dlstribution Repair Report
IWork Order No' i,v f
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DATE REPORTED
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CONDITION E1vfERGENCY ~OUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REPAIR.
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ADDRESS 3 .?-/
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GA.M. ~M.
REP AIR LOCATION
CI
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SIZE. / CJ /....
TYPEOFMAlN
DEPTH OF MAlN ;;.. ( CLOSEST VALVE DEPTH. ;<,.> I
COMPONENT REPAIRED,
MAlN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER
SERVICE TAP 0 CORP STOP 0 PIPE ~ CURB STOP 0 FITTING 0
.METER SETTER 0 METER 0 C i/ 7 IIY WI Tt( f'elcE CI r
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LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
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HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR, CLAMPO DRESSERO OTIIER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOn.. AREA er-SOn.. TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P,M,
WATER OFF FROM
M.TO
M,
FROM M. TO M.
APP ARENT CAUSE OF LEAK. 8 C f/ -t T C/ .1? ~ f' I f E
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