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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date <)'-/7 - iJ )
Time q, 3 iJ -1/V\ Received by / I 7
----
(phone, ~so_~
Location of Work to be inspected . S-,;? ;<5 (:) A S I
Name of person requesting inspection LJ L..... t ~ r l), (,/
Address of person requesting inspection .1 7c.:>:;. .5 ~ /...'? sr Phone No (117 -ljg'/7
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav 8 (AJ'Cf. Ie /"
INSPECTION NOTES
Inspected Date 5--/ )- uS:-
Remarks
Time ;;. ~ J c../ f-P- By 7 I 7
,;.. '\. f'11 e"'1I#L_ b/ ~ be /."v <'! ~ ~;< Vr.1. /'/ ~ s
"8" \ c.... d7u J" r
,
RESTORA TION REQUIRED . . YES V NO
~ i C ~
-,
UO" ;" c....I V5'7
I<' fI' )/ A~f
"
~9 6'''- ~
~
<X'I
-0-. '1 .\t:J
-- ~
-..,
41-
SURFACE RESTORATION'
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC I;i Othe"{g,fJ SO: /
Work Order # ']O'}y,l. - 037
o COMPLETE
~NCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
.....
REQUEST
Date 2 -'7 - oS-
Time
7 A tlA.
Received by Oi',,1 '" ; ~ E - (phone, person)
Location of Work to be inspected 52 2. ::>0 ';:-1 ~ ;.,..1)
Name of person requesting inspection OCi;l '"'- ~ ') E...
Address of person requesting inspection 4.~;:J Va. rJ le'"'f-- i3 Phone No (-{ / 7 - '-l ?'-?9
II
Type of Inspection (circle appropriate one) Permit No '__H_:~-'-'
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Ot~'--':Uc,+<: 11'''''\
.~ ~
INSPECTION NOTES
Inspected Date Z - '1 - if)
Remarks Ke r I (-l <:. e Z cor 0 ""<;
(.,J ~ + k c,," 4 v e.. ".1 <7 e ,,- Cc"..) f 11"'-5 _
Time t { A t~ By Vt7vt.u.. ~ E
~_....J. 5( P ^-.Thre".J. Cc...;r(l"'-5 c,,-,",-d
re~-Hc,-c..L
RESTORATION REQUIRED .
YES
NO X
Z" c r 31 tJu.f
fi'
-=k..
Repk~t-~J
Z '10 -7T~. (iYJplu'\.")
I - ~If x -
~i' o~ ~.?-r
~
....----..---.----.*"-.-____.___A-*-
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10-
--------/ ()o
I ~ A ~t
-.-~.~__.__.,_._w.__y.~~."."".,~......_.~>__,__
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
D Asphalt 0 PCC D Other
Work Order # SO 5y.Z- - 0 ( '3
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 go~ '-1,- -0 I q
ICrew 7 i ~ "t- &~.t.J
J
DATE REPORTED Z - 4 ~ os
CONDITION E1v1ERGENCY 0 ROUTINE 0 CITIZEN COIvfPLAINT K
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.
-Z -Cj - 0 S TTh1E
REF AIR LOCATION
ADDRESS S- Z. "Z..
So
I ( ~.M. OP.M.
"A " ~.
TYPE OF MAIN
Pt/c
'7 'f
SIZE ~
DEPTH OF MAIN
3'
I I
CLOSEST VALVE DEPTH. Z--z
COIvfPONENT REPAIRED.
MAIN JOINT ~ CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
IvfETER SETTER 0 IvtETER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
tJ ,
COMPONENTS OF REPAIR. CLAMPO DRESSER,$( OTHER t;;Lk 80 - CJo ~ 1- S(~)I... ThJ, ~:oup
,
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ~ SOIL TYPE 6 r~v e.. (
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_IT
DRlVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING 60-0 &... TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORlNE RESIDUAL SAMPLE iJ! A p P.M.
WATER OFF FROM
M.TO - M.
FROM
M. TO M.
A.PPARENT CAUSE OF LEAK. 6rouiA..& ~1fl-e.....