HomeMy WebLinkAbout1534 W 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . . .
REQUEST
Date /1.- 2- -0 t.(-
Time 8' 20 f/tvt Received by f)et,u" (s C. Jphone, person)
/e 74 .. I . c- i-4.
location of Work to be inspected 2.. J '-'V,JilL
Name of person requesting inspection Oe,^ vq s ~
Address of person requesting inspection ~ r-/J Y~v" J 17 ~ B Phone No if (7- i.f-J: '-f 9
I
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav OtheGJtA+-~~
INSPECTION NOTES
Inspected Date / I - Z - 04
Remarks !2e{)a..lrr 2. ,. c.-I
I
Time I ( L l:i PM By D ~ V\ ..... i. S E
~; V\. br-e.A k .
RESTORATION REQUIRED YES
zit C. 1- ~ $2-{ ~
3{ O~ "fJ
W. 5~ .y-
~D ~~ '7 ~
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
o No Damage Found
D Asphalt D PCC D Other
Work Order # /5828-033
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
'Work Order No 138,28 - 0 s'3 1
JCrew 7' s: ""f>- Cr
]
DATE REPORTED 1(- 2 ---0 '-f
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT Ji...
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR
(I - 2 ~i)<-{ TIME ~ Cj
ADDRESS 15"3i tJ ~-fk
DA.M. ~.M.
REF AIR LOCA TlON
TYPEOFMAlN
L-T. ,
?f
..:::> CLOSEST VALVE DEPTH.
SIZE
Zir
DEPTH OF MAlN
3(
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK K SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PlPE 0 CURB STOP D FITTING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMP)( DRESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING A.J /11 TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE 1A P.P.M. r; X (/ vie
WATER OFF FROM M. TO M.
FROM
M. TO M.
6.,oUVld 5...e.-t+ f~
.tVJPARENT CAUSE OF LEAK.