HomeMy WebLinkAbout227 N Baker St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
Location of Work to be inspected d--"d- 7 tV go... Ie e..r- <s f-
Name of person requesting inspection B~ I e
Address of person requesting inspection LDI- p ~a.rd..
Type of Inspection (circle appropriate one)
REQUEST
Date 't - J z.. - 0 t
Sewer Foundation Framing
Time I 00 PM
I
Received by 8€MJ le..--
(phone, person)
Chimney Plumbing Final
Phone No Lf 17 lff if r
Permit No
Sewer Excav Othe~
INSPECTION NOTES
Inspected Date ~ '-/ Time 3. 0"" t 'f;:; By
Remarks ~V\lred feCi\. t Of'\.€- Poo+ )rL Yl t
~-?~kr
RESTORATION REQUIRED
\.,
~
-.':d....
~
\'Q
YES
NO X
~ ,
D rt ve.. UJ'c"-Y .
-t:. If' N"-( +\- b" ? D l e-
Repc.ll A~~,;, ~
d".... _
<
H-cv ~ e.
z. ?-1
i?A.ke.r st-,
DedL
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt D PCC D Other ~
Work Order # I Lf J.-{ 8 -() (Lf
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No Ic..(Z 78' .- Of '-f
, Crew 7 ( fc "i- Gr e t.J
l(
DATE REPORTED L/-.--_ -Ot/-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.
L{--('1.-0'+
TIME ( Z-
DA.M. ~.M.
2..'Z. 7 B~k.e y
Z
REP AIR LOCATION
ADDRESS ~b-3---
2
TYPE OF MAIN
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REF AlRED.
MAIN JOINT D CJR. BREAK 0 SPLIT BELL D LONG BREAK D
HOLE 0 CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE t'( CURB STOP D FIITING D
METER SETTER D METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER P E, 1 Co HA. (). U",- ( a ~ c;
/ I
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRlVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-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.
APPARENT CAUSE OF LEAK. ()(cf) 0Zf--