HomeMy WebLinkAbout121 E 14th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS /2.:r-4/
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . (
REQUEST 1 . I
Date '9- _~ - () Time Received by (phone, person)
Location of Work to be inspected I :1/ E!! C; fA
Name of person requesting inspection -r LJ :' / C (j y:
Address of person requesting inspection / ! tl? ~ 8 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L0(\~Y
INSPECTION NOTES
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Inspected Date
Remarks.
Time
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RESTORATION REQ UIRED .. . . . YES ( NO L/ )
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SURFACE RESTORATION.
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC 0 Other
o Repaired by City Work Order # f q ~ '
o Repaired by Permittee ~MPLETE - /
o No Damage Found 0 INCOMPLETE
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STREET SUPERINTENDEN.-!.------ (DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST . " /
Date 4 - 1--0 1
Time
Received by
(phone, person)
Location of Work to be inspected /1....{ f-- I rill s'l I
Name of person requesting inspection ry- U-J 11 ce y
Address of person requesting inspection I 7 tit <{;. 13 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (yJ ~L~
INSPECTION NOTES
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Time By
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Inspected
Remarks
Date
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RESTORATION REQUIRED
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YES V NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel D Asphalt
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Dpcc DOther7Z9/7 ,>c); l.-
Work Order # 2(., 7 C( ,
o COMPLETE
o INCOMPLETE
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STREET SUPERINTENDENT
(DATE)
LIty 01 lJort Angeles
Public 'V orks Departnlent Ii-k~ ~c."?>4- - I
\Vater Distribution Repair Report
IWork Order No'
~b 31
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DATE REPORTED
3- 51-0)
CONDITION E1vIERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAlR. ll- 1- 0 j
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REP AIR LOCATION
ADDRESS
IA.( f
:2 if ~ct~v ( SIZE
TYPE OF MAIN
DEPTII OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASP~T 0 SIDEWALK 0 CURB 0
TOP SOn.. AREA $ SOn.. TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEW ALK _FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-1VlINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE i 21 P.P.M.
WATER OFF FROM / (/J jtJ1~. TO / (J t9/~.
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APPARENT CAUSE OF LEAK.
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