site plan 109131963Rev. iJune 7, 073 - PRE -INSPECTION FORM
Job 142L02J 96,-'�
Date: tcJaii�rr�
Jurisdiction: city/ Zip:`
Est. Start Date:Customer:
Est, Duration:' _ ! %h- d--. cO-COPPNONeNuhIBER �. PM j lnsp: Cnl�� - .
PHONE NUMBER -
Work i7escri tion � � j- - LConstruction Method
Open Trench Ej
Trenchless [�
WorkLacatio size__ of cut SztrFaceTyi?e
r 'N of CL & 'E of CL - /D
of CL & 'E &ofC
—
'NS of CL & 'E WofCL
r
Flaggers ff'# Police Flaggers Trolley Lines ❑ Bus Stop " j] # Meter Hoods[] �#
speed Limit _ mph_ ❑ #! Traffic Signal CI ' - Arterial ❑ No Parrs
Commercial ❑ Altered Commercial E] 1_6k Repair L1 Service Information Bollards ❑2,S"Q4`#
Residential 0" Altered Residentia[ Q W Work ❑ Diameter Meter .EFV Template Bar [
Multi -Family❑ Replacement service Pothole Q 5/8" ❑ 250MDO ❑ Fuel Line Perrnit[]
New Service ❑ Main Mainterlance E] Extension_ El 11/8" �2S -600 uel Line Length f r
Stub CI Service Maintenance[] Complete 1/4" ❑ 68D ❑ 10,0O01J Fuel Line burn.
Cut & Cap ❑ Valve Maintenance [I Service 2" 1711000L] Meter Lacatian