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Job /0 q /0PREwINSPECTION REPORT f'UGEIISoulsi'£)EAVU: Y
#: '` f `f`
Date: Address: (/0 4_ ? �_ E y: Ave
Jurisdiction:
Right of Way Permit? ® YES ❑ NO
First Poss Start:
First Poss Comp:
City / Zip:
Customer:
INSP PHONE NUMBER
PM / Insp:
Est Duration: Email:
Job Description
/ Scope of Work �P' !� ,- cF,-, ; t.s, < t (
4 ,, �G '
( o (�,
(�
�: r, �, �
New Construction:
�>
->
❑ YES
R NO
CIFS PSE big
Plat Map:
4
-
Erb
a
mm,
r
AL
;j(o`t
LLa� Li1c�A✓e.
i.e
....
i
i
Work Location
Size of Cut
Surface
Type
of
CL
o( -L Ave Sudmmmmmmmmm_
& 7�s"`' Al
of CL (( sw q1
5{.
of
CL
&..
of CL
of
CL
&
of CL
❑IFtAGGERS
#
` MPH
❑ TROLLY LINES
❑- BUS
STOP-#
--❑--METER-HOODS-#
FT OFFICERS it -
- `
SPEED LIMIT
❑ TRAFFIC SIGNAL
❑ ARTERIAL
NO PARKS -#
Commercial
❑
Altered Commercial
❑ Leak Repair S
e ry i c e I n f o r m
a t i o n ❑ Femplate Bar "-
❑
Residential
❑
Altered ResidentialCP
❑ Work Pipe Size
Meter
EFV
❑-._Bol1ards-2,5' #
• - --
❑
Multi -Family
5fl
Replacement Service
❑ Pothole ❑
55/8" [ 11/4"
❑ 250
❑
1800
❑
New Constr.
❑
Main Maintenance
❑ Extension ❑
1/2" ❑ 21'
❑ 425
❑
2600
❑Stub
❑
Service Maintenance
❑
3/4"
❑ 630
10,000 ❑ Fuel Line Permit
Needed
F]
Extension
El
Valve Maintenance
El
11/811
_R � o0
Wo
Fuel Line Length:
69
❑
Compete Sery
�
Cut & Ca
Cap
Mtr Loc:
Fuel Line Diameter:
2