HomeMy WebLinkAbout2535 W 10th St - Engineering
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CITY OF PO.RT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST-
Date cf'- ~ ".- D (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 Final
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Phone No
Permit No
Sewer Excav Other ~L)l1.f-e//
INSPECTION NOTES:
Inspected Date
Remarks
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Time
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RESTORATION REQUIRED _ _ _ _ _ _ YES
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Y NO
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SURF CE RESTORATION-
SURFACE TYPE 0 Unimproved 0 Gravel Asphalt 0 PCC 0 Other
o Repaired by City (t,-lo-v.J Work Order # ~), If ~
o Repaired by Permittee 1\'/ tr ~ COMPLETE (!-1J-- ?- c~
o No Damage Found 0 INCOMPLETE ~
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STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES ~u.J -2(!O?t, 2-;:> (,y'-
DEPARTMENT OF PUBLIC WORKS
- . . . . . . INSPECTION REPORT . . . . . . . . . . .
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REQUEST
Date J~-L(- 6/-
,
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)
:2 S- '3 S- t.--J /0-/11
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/ 7-ril t-(J Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other {A,..J~~
INSPECTION NOTES
Inspected
Remarks
Date
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/Jlj ..e
Time By
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NO
RESTORATION REQUI ED YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC 0 Other
o Repaired by City Work Order # ;;2 ~ ~
[] Repaired by Permittee ~MPLETE
o No Damage Found 0 INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'Vorks Departnlent Dt.v ::""OD"1- - 2 2.~~'-
Water Distribution Repair Report
'work Order No:
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DATEREPORTED /~_~e1L
CONDITION EMERGENCY D ROUTINE D CITIZEN COMPLAINT ~.
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. 1 9, - L( .~ 'D 1-. TIME. / ./- DA.M. ~.M.
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REPAIR LOCATION
TYPE OF MAIN
ADDRESS
j'~ IK-
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLANW D OTHER
SERVICE TAP D CORP STOP D PIPE ~URB STOP D FIITING D
METER SEITER D METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VALVE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLANWD DRESSERD OTHER
SITE CONDITION GRAVEL D ASPHALT D SIDEWALK D CURB D
TOP SOIL AREA D SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE l31 P.P.M.
WATEROFF FROM J 2. P M. TO 2..~p M.
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APPARENT CAUSE OF LEAK.