HomeMy WebLinkAbout127 E Park Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . . .
REQUEST
Date If - 2 7 r 0 L{
Time 7, OD II IV{ Received by D~-1./.s E (phone0>erson)
Location of Work to be inspected I 2. 7 ~
Name of person requesting inspection D tv! VI I 5
Address of person requesting inspection C-o (" ()
Type of Inspection (circle appropriate one) {
Po..cK AJe
~
Yo. t7d
Phone No
Permit No ~
Sewer Excav Oth~"'--tt r=- -
Sewer Foundation Framing
Chimney Plumbing Final
INSPECTION NOTES
Inspected Date 4- 2.7 r otf
3.... el
Remarks f!!e;J/Ac....e '">>I- $"erv'Ic.....e...
,
Time
(.~
z ~O PYl By f)b1.VUS E-
-9 yZ::> VV\. M.. &\.. I . r\ To rvt.e...-t e r
RESTORATION REQUIRED
YES
, 21 ~ PA ~lC..
NO
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SURFACE RESTORATION tf'><-C'/
SURFACE TYPE D Unimproved D Gravel ~sPhalt D PCC D Other
D Repaired by City Work Order # 1'I27~-O(9
[] Repaired by Permittee g COMPLETE Af-~ \'-e-~, ~,,~~ \JJH-V\
o No Damage Found D INCOMPLETE 00'\ M r X L.\ -1. ~- 0 (~
1inJ1ff.~; to ;,d-jit J ~1-r (
STREET SUPERINTENDENT
(DA TEl
LIty 01 Yort Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No It/-~I~-D(q
ICrew7 {o Cff-cre..uJ
DATE REPORTED '-I - Z0 -D'f
CONDITION E1v1ERGENCY 0 ROUTINE 0 CITIZEN COtv1PLAINT )&..
LEAKAGE SURVEY 0 01HER 0
D ATE OF REP AIR_ 1 - z. ( - otf
TIME
2->0
DA.M. ~.M.
TYPE OF MAIN
ADDRESS ( Z. '7
Ale-
A IJe...
REF A1R LOCA TIo.N
DEPTH OF MAIN
COrvtPo.NENT REF AIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 o.1HER
SERVICE TAP 0 CORP STo.P D PIPE)t CURB STOP 0 FITTING 0
~TER SETTER 0 ~TER D
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 Bo.NNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
o.THER.
Co.rvtPONENTS OF REPAIR. CLAMPO DRESSERO OTHER{~ (,,~ PE fut:Jl::J 41t Me'+<f 5+op
31t( ~ 9\M4...k
SITE CONDITIo.N GRAVEL 0 ASPHALT 0 SIDEWN--K 0 CURB 0
To.P So.IL AREA):l So.IL TYPE AJA::h~ ~
CUTS ASPHALT CUT ~](. G, FT CURB CUT _FT SIDEWALK_FT
DRlVEW A Y CUT _FT
MAIN CONDITIo.N INTERNAL LINING N;A TUBERCULATIo.N-.MINo.R 0 SEVERE D
EXTERNAL CORRo.SIo.N LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE . 21- P.P M.
WATER OFF FROM g A M. TO 0) 3bA M.
FROM
M. TO.
M.
APPARENT CAUSE OF LEAK. 6rov~ sdtle..