HomeMy WebLinkAbout116 - 122 W Park Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
1) W' <...00 "1' 2 t.. 2> 3
REQUEST
Date b~ "J - 6 1-
&),4-'
Time
Received by
(phone, person)
location of Work to be inspected lIb -+ 1/1 - /).. D ~ I A 2- UJ A r'/C
Name of person requesting inspection I W i I (O,fC
Address of person requesting inspection I '1-th. ~ 8 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other Wcc.. ~ J.-
INSPECTION NOTES
Inspected
Remarks
Date
J-...()v..e 5
qncv~
7< Time By
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RESTORATION REQUIRED
/
. YES V NO
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SURFACE RESTORATION '-
SURFACETYPE 0 Unimproved OGravel ~halt OPCC OOther~'p561 L
~~
D Repaired by City Work, Order # -r .
[] Repaired by Permittee [~OMPlETE (f) fA.) - DC> .
[] No Damage Found 0 INCOMPLETE
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(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
CIty of Port .Angeles
Public Works Department J)w '!.oo1-~'33
VVater Distribution Repair Report
'Work Order No: ~ 133
I Crew'
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1
DATE REPORTED S - :J.. q- O;L.
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN CO!v1PLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATEOFREPAlR. b- 3-- 6> 2- TIME. / ~WL DA.M. DP.M.
REPAIR LOCATI0N ADDRESS 1/ b +- //<g - ) -J..D '6-- I'J... 2- uJ Po:...y./(
"'Ze( n/'
TYPE OF MAIN ~ SIZE.
/it'
DEPTH OF MAIN L
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT D CIR. BREAK D SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP D PIPE 0 CURB STOP D FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH D VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER 1<..ep!t.(C e /2-'J/vP:c ~).;u!e~-e
SITE CONDITION GRA VEL 0 ASPHAL T ~IDEW ALK D CURB 0 tu ,-fA AJ-t-'-<.)
TOP SOIL AREA D SOIL TYPE /,1 p~
CUTS ASPHAL T CUT~FT CURB CUT _FT SIDEWALK_FT
DRlVEWAYCUT _FT
MAIN CONDITION INTERNAL LINING TIJBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I)f. P.P.M.
WATER OFF FROM
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