HomeMy WebLinkAbout1212 Emigh St - Special Inspections/Field Verification - 02/02/2017ptjiof Community Development & Nelghborhood Services
1't C ��i115 281 N College Ave; P.O. Box.Sft, Port Collins, GO 00522-0580
Phone: 970 231 6760 FAX: 970 224 6134
Field Verification Form
Job Site (oZ frVN rl �Jt. Permit No. w 6091
Company Name Mr. Rooter lumbing/GDL Industries City of Ft Collins Llo# MP 844
x Replacement of Sewer line approx. �17_ ft (100 it. maximum)
Replace1.fnt of Water line approx. ft. (100 ft. maximum)
Add _ .Replace gas line approx. ft. (50 fL maximum)
Materials used: SDR 40; 3/4-4n. mountain granite; duat-sweep cleanouts
Tested at
Installer Name (print)
Jason Willis
Lbs. for minutes
Installer Signature Data 2 2
Qt
CAW a, CCommunity Development & Neighborhood Services "t 0t�i115 281 N College Ave; P.O. Box 586, Fort Collins, CO 80522-0580
/"•.:. Phone: 970 1216760 FAX: 970 224 6134
Field Verification Form
Job Site
Company Name
Replecernent of Sewer line approx.
RbMaceriient of Water line approx.
-Add. Replace gas line approve
Materials used:
Tested at
Installer Name (print)
Installer Slgnature
Penult No. .
City of Ft Collins Lic#
00 ft. maximum) -
QO ft. maximum)
for minutes
Date