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Job #:
Date:
Jurisdiction:
106321679
3/8/17
Renton
Right of Way Permit? YES
Est, Start Date:
Est. Duration: 1 day
❑ NO
PRE -INSPECTION REPORT
Address: 10733 5E 165TH 5T
City / Zip: RENTON, WA 98108
Contact: BENE PHAM 206-2654131
PM / Insp: Kevin Haibeck) -5
PHONE NUMBER
WORK DESCRIPTION: ,
Install 33 O 41 "PE complete svc 9' scat stub in R/W, 24 p at
extension
o�,Qr_oper�v)�nd_set
A2�0 MSA'
26011 EfV
D New Construction
❑ Existing
-
- -
---
r
4
PLAT 212,082
N
SE 165TH ST
-
- - - -- -
--- -
—CL
WORK
EXISTING
GAS MAIN 2" PE IP 18'S
AREA
892219
W
Q
2
1--
10733 SE 165th St
p
r
Work Location
Size
of Cut
Surface Type
_
18 S if
CL
SE 165TH ST
& 164 W f
CL 108TH AVE SE
3'
X 5'
DIRT/SOFT
N S of
CL
& CL
NSofCIL
& EWofCL
❑
FLAGGERS #
MPH
❑
TROLLY LINES
❑ BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
❑
Commercial
❑
Altered Commercial
❑
Leak Repair
Service Information
❑ Template Bar
i]
Residential
❑
Altered Residential
❑
CP Work
Diameter Meter
EFV
El Bollards #
El
Multi -Family
El
Replacement Service
El
Pothole
❑ 5/8" � 250
El
775
775
❑ Bollards
F1
New Constr.
El
Main Maintenance
El
Extension
El 1-1/8" El 425
El
1800
4" #
❑
Stub
❑
Service Maintenance
❑ 1-1/4" ❑ 630
E
2600
❑ FUEL LINE PERMIT NEEDED
❑
Extension
❑
Valve Maintenance
❑ 2" ❑ 1000
❑
10,000
Fuel Line Length:
F]
Compete Sery
❑
Cut & Cap
Mtr Loc: OL/03
❑
N/A
Fuel Line Diameter: